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VAC PEN 6221: Medical Questionnaire, Knee Conditions

Veterans Affairs Canada uses this two-page questionnaire, one of its medical questionnaires that complement the Table of Disabilities, to document confirmed knee diagnoses and assess the resulting disability for disability benefits. The health professional records the history and treatment of each knee, then examination findings for both knees: leg length, active range of motion, stability, ankylosis and flail joint.

Who completes it

General practitioners, including sport medicine physicians, specialists, nurse practitioners, chiropractors and physician assistants in listed provinces can complete it; physiotherapists may complete it for assessment or reassessment only, not diagnosis. The client is identified by name, date of birth, file and decision numbers.

Submitting and payment

How to submit it
VAC tells clients not to have a medical questionnaire completed until it gives specific instructions about which one is required, and the completed form is returned as VAC instructs.
Who pays
The form asks whether VAC is to be invoiced for its completion.

Good to know

  • Measure active range of motion from the zero starting position with the knee fully extended: flexion against a normal of 130 degrees, extension against 0 degrees, plus any hyperextension or loss of extension.
  • Stability is recorded as clinically stable or not, for example by anterior and posterior drawer tests; note any ankylosis with its position in degrees and any flail joint.
  • For each knee, record pain as none, intermittent with frequency, or daily, with severity, and whether there is current or previous joint effusion.
  • Attach relevant reports such as consultations, hospital discharge summaries and diagnostic imaging, and complete only the sections relevant to the claimed condition.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Questionnaire: Knee Conditions

Questionnaire médical : affections du genou

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Can a physiotherapist complete VAC's knee questionnaire?

Only for an assessment or reassessment of a disability, not for diagnosis. VAC's page on who can complete its medical questionnaires lists general practitioners, specialists, nurse practitioners, physician assistants in listed provinces and chiropractors for PEN 6221, and says other regulated professionals may be considered case by case.

How is leg length measured on PEN 6221?

The form asks for leg length in centimetres for the right and left legs, measured from the anterior superior iliac spine (ASIS) to the medial malleolus, crossing the knee on the medial side. It then asks for examination findings for both knees, even if only one is claimed.

Is PEN 6221 used for first applications and reassessments?

Yes. The form's type of assessment field offers first application, reassessment or assessment, and other. It also records the date of examination and the VAC decision number, and it is published in English as PEN 6221e and in French as Questionnaire médical : affections du genou.