Shin Splints VA Rating and DC 5262 Criteria (Medial Tibial Stress Syndrome)

Complete VA rating table for shin splints and tibia/fibula impairment (DC 5262)

The table below lists every rating percentage and criterion under 38 CFR 4.71a, Diagnostic Code 5262, painful motion (38 CFR 4.59), and compartment syndrome (38 CFR 4.73, DC 5331).

Under the veteran-alone compensation schedule effective 2025-12-01, 10% pays $180.42 per month, 20% pays $356.66, 30% pays $552.47, and 40% pays $795.84.

How the February 7, 2021 musculoskeletal revision changed Diagnostic Code 5262

Before February 7, 2021, 38 CFR 4.71a did not mention “shin splints” or “medial tibial stress syndrome.” Pre-2021 Diagnostic Code 5262 (“Tibia and fibula, impairment of”) listed only nonunion requiring a brace at 40% and malunion at 10% (slight knee or ankle disability), 20% (moderate), or 30% (marked). Adjudicators rated chronic shin splints by analogy under 38 CFR 4.20—typically as analogous to tibia/fibula malunion (5262-5260 or 5262-5271), degenerative arthritis (5003), or tenosynovitis (5024), often assigning a separate 10% rating per leg.

In the November 30, 2020 Final Rule (85 FR 76453, effective February 7, 2021), the VA revised Diagnostic Code 5262 in three ways:

1. Added Medial Tibial Stress Syndrome (MTSS) tiers (0%, 10%, 20%, and 30%): Created dedicated criteria under DC 5262 based on treatment duration (under 12 consecutive months vs. no less than 12 consecutive months), response to conservative care (shoe orthotics or other conservative treatment), and unilateral vs. bilateral surgical failure.
2. Redirected tibia and fibula malunion to knee and ankle codes: Directed adjudicators to evaluate Malunion under the knee pain codes (DCs 5256, 5257, 5260, or 5261) or ankle codes (DCs 5270 or 5271), whichever yields the highest evaluation.
3. Retained nonunion at 40%: Nonunion of the tibia and fibula, with loose motion, requiring a brace remains 40% under DC 5262.

Pre-February 7, 2021 shin splints ratings—such as separate 10% ratings on each leg—remain protected by 38 CFR 3.951(a) unless medical evidence shows sustained material improvement under ordinary conditions of life.

Breaking down the 0%, 10%, 20%, and 30% criteria under DC 5262

Because the MTSS portion of Diagnostic Code 5262 evaluates treatment duration and response rather than goniometer angles, your medical documentation determines which tier applies:

• 0% rating (“Treatment less than 12 consecutive months, one or both lower extremities”): Assigned when service-connected shin splints required fewer than 12 continuous months of treatment, or resolved with care. A 0% rating establishes service connection for VA health care, orthotics, and future claims.
• 10% rating (“Requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities”): Requires continuous treatment or management for at least 12 consecutive months and persistent symptoms despite shoe orthotics or conservative care (physical therapy, NSAIDs, rest, or activity modification). Because the regulation states “one or both lower extremities,” non-surgical shin splints affecting both legs receive a single 10% evaluation under DC 5262.
• 20% rating (One lower extremity) and 30% rating (Both lower extremities): Both tiers require treatment for no less than 12 consecutive months that is unresponsive to surgery and either shoe orthotics or other conservative treatment (20% for one leg; 30% for both legs). Because surgery for isolated MTSS (deep posterior fasciotomy or periosteal stripping) is rare, 10% is the maximum schedular rating under the MTSS criteria of DC 5262 without surgery.

In the Final Rule preamble (85 FR 76453, Section IX), the VA declined to require X-ray or MRI imaging for a compensable shin splints rating under DC 5262, explaining that “shin splints are typically diagnosed—and can be properly assessed—by history and physical examination” (tenderness along the posteromedial tibial border). Plain X-rays are typically normal in MTSS, though bone scans or MRIs remain useful when evaluating tibial stress fractures.

Painful motion (38 CFR 4.59), joint ratings, and compartment syndrome

Veterans diagnosed with shin splints in service may also have adjacent joint pathology, healed tibial stress fractures, or compartment compression:

1. Painful Motion (38 CFR 4.59) and Functional Loss (38 CFR 4.40 and 4.45): Under 38 CFR 4.59, actually painful, unstable, or malaligned major joints—including the knee and ankle under 38 CFR 4.45—warrant at least a 10% rating per affected joint. While the tibial shaft is a bone rather than a joint, if lower-leg pathology causes objective painful motion during active, passive, or weight-bearing movement of the ankle (DC 5271) or knee (DC 5260/5261), 38 CFR 4.59 supports a 10% rating per affected joint even when range of motion exceeds DC 5260 or DC 5271 cutoffs.
2. Separate Ratings vs. Anti-Pyramiding (38 CFR 4.14): Under 38 CFR 4.14, the VA cannot rate the same symptom twice. However, if you have both shin splints (DC 5262) and an ankle (DC 5271) or knee (DC 5260/5261) disability with distinct symptoms, separate ratings are permitted when Section 7B of the DBQ confirms tibial pain with motion in addition to joint pain in Section 3A.
3. Compartment Syndrome (38 CFR 4.73, DC 5331): If exercise-induced lower-leg pain includes chronic exertional compartment syndrome (CECS), Diagnostic Code 5331 rates each affected muscle group separately under DC 5311 (Group XI calf: 0%, 10%, 20%, or 30%) and DC 5312 (Group XII anterior tibial: 0%, 10%, 20%, or 30%).

How the C&P exam and DBQ measure shin splints

During a C&P exam, the clinician completes the Knee and Lower Leg Conditions DBQ or the Ankle Conditions DBQ:

• Section 1B & Section 3 (Diagnoses and Range of Motion): Records “Shin splints/medial tibial stress syndrome - MTSS”, “Stress fracture of tibia”, or “Tibia and/or fibula fracture”, affected side(s), and goniometer measurements for knee or ankle motion (dorsiflexion normal 20°, plantar flexion normal 45°), repetitive-use testing, flare-ups, and painful motion.
• Section 7A & 7B (Tibial or Fibular Impairment and Shin Splints / MTSS): Section 7A records stress fracture of the lower leg, acquired and/or traumatic genu recurvatum, recurrent patellar dislocation, and leg length discrepancy. In Section 7B, for each leg, the examiner records: (1) whether the veteran has or ever had shin splints/MTSS; (2) whether tibial pain with motion exists in addition to joint pain in Section 3A; (3) Length of treatment (No treatment received, Treatment for less than 12 consecutive months [0%], or Requiring treatment for 12 consecutive months or more [10%–30%]); and (4) Response to treatment (Responsive to surgery and/or treatment [0%], Unresponsive to either shoe orthotics or other conservative treatment [10%], or Unresponsive to surgery and either shoe orthotics or other conservative treatment [20% one leg / 30% both legs]).

Bring records showing at least 12 consecutive months of prescribed or recommended shoe orthotics, physical therapy, or continuous conservative care, supported by a lay statement (VA Form 21-4138).

Secondary conditions, combined ratings, and accredited help

Under 38 CFR 3.310(a), a disability proximately caused or aggravated by a service-connected condition may qualify for secondary service connection with a current diagnosis and medical nexus opinion:

• Shin splints secondary to foot, ankle, or knee disabilities: Service-connected flat feet (DC 5276) or plantar fasciitis (DC 5269) cause overpronation and arch collapse, which may strain the inner tibia and cause secondary shin splints. Altered gait from a service-connected ankle or knee pain disability may also overload the tibia.
• Conditions secondary to service-connected shin splints: Chronic tibial stress syndrome may progress into posterior tibial tendinopathy or painful ankle motion (DC 5271), or cause a limp that may aggravate knee pain, hip pathology, or lumbar back pain.

Multiple ratings combine under 38 CFR 4.25, which you can calculate with our VA combined rating calculator. While a standalone 10% rating under DC 5262 covers “one or both lower extremities” once, holding a compensable DC 5262 rating on one leg and a separate compensable rating on the opposite leg triggers the 10% bilateral factor under 38 CFR 4.26.

If your claim was denied or underrated at 0%, Veterans Service Organizations (VSOs) such as the DAV, VFW, and American Legion provide free representation, and VA-accredited claims agents or attorneys assist with appeals. No representative can promise an outcome; verify credentials through the VA Office of General Counsel Accreditation Search.