{"page":"https://casescribe.ai/explorer/secondary/knee-impairment-secondary-to-ankle","generated_at":"2026-10-03T18:34:25.726Z","data_as_of":{"decisions":944125,"first_year":2017,"last_year":2026,"latest_decision":"2026-04-30","cfr":"2026-10-01","m21":"2026-09-29"},"about":{"publisher":"CaseScribe AI (VA Law Explorer)","source":"Public Board of Veterans' Appeals decisions (appeals of VA decisions, not VA's first decisions), M21-1 Adjudication Procedures Manual, 38 CFR Parts 3 and 4.","method":"Outcomes are issue-level: each condition the Board decided in a decision counts once. Decision data is extracted by AI and can contain errors. Rates describe past appeals and do not predict any claim.","disclaimer":"For research only. CaseScribe AI is not a law firm and this is not legal advice. Verify figures against the source decisions and regulations.","attribution":"Cite as: VA Law Explorer, CaseScribe AI, with the page URL."},"data":{"claim":"Knee conditions secondary to an ankle condition","secondary_condition":"Knee conditions","service_connected_disability":"an ankle condition","decisions":1754,"years":"2017-2026","granted_pct":18.3,"denied_pct":16.1,"remanded_pct":65.4,"granted_on_merits_pct":53.1,"by_year":[{"year":2017,"issues":155,"granted_pct":9.7,"denied_pct":16.1,"remanded_pct":70.3},{"year":2018,"issues":243,"granted_pct":14.4,"denied_pct":25.1,"remanded_pct":58.8},{"year":2019,"issues":215,"granted_pct":14.9,"denied_pct":16.3,"remanded_pct":67.4},{"year":2020,"issues":264,"granted_pct":12.5,"denied_pct":19.7,"remanded_pct":67},{"year":2021,"issues":273,"granted_pct":10.6,"denied_pct":14.7,"remanded_pct":74.7},{"year":2022,"issues":277,"granted_pct":14.8,"denied_pct":12.6,"remanded_pct":72.6},{"year":2023,"issues":282,"granted_pct":21.3,"denied_pct":14.2,"remanded_pct":63.5},{"year":2024,"issues":248,"granted_pct":26.2,"denied_pct":7.3,"remanded_pct":66.1},{"year":2025,"issues":217,"granted_pct":29.5,"denied_pct":16.6,"remanded_pct":53.5},{"year":2026,"issues":84,"granted_pct":45.2,"denied_pct":7.1,"remanded_pct":47.6}],"benefit_of_doubt_in_grants_pct":80.4,"evidence_on_merits":[{"evidence":"va_exam_favorable","decisions_with":153,"granted_pct_with":73.9,"granted_pct_without":49.4},{"evidence":"va_exam_unfavorable","decisions_with":1464,"granted_pct_with":51.6,"granted_pct_without":67.8},{"evidence":"nexus_positive","decisions_with":392,"granted_pct_with":87.4,"granted_pct_without":24.2},{"evidence":"nexus_negative","decisions_with":1268,"granted_pct_with":51,"granted_pct_without":62.1},{"evidence":"private_opinion","decisions_with":663,"granted_pct_with":72.2,"granted_pct_without":26.3},{"evidence":"treating_physician","decisions_with":99,"granted_pct_with":81.8,"granted_pct_without":49.6},{"evidence":"lay_statement","decisions_with":1467,"granted_pct_with":49.5,"granted_pct_without":79.5},{"evidence":"buddy_statement","decisions_with":54,"granted_pct_with":70,"granted_pct_without":52.6},{"evidence":"combat_service","decisions_with":55,"granted_pct_with":68.2,"granted_pct_without":52.6}],"top_reasons":{"granted":[{"reason":"caused by the service-connected disability","decisions":66},{"reason":"service connection established","decisions":37},{"reason":"current diagnosis established","decisions":27},{"reason":"aggravated by the service-connected disability","decisions":17},{"reason":"secondary service connection granted","decisions":5},{"reason":"va examiner: less likely than not related to service","decisions":4}],"denied":[{"reason":"va examiner: less likely than not related to service","decisions":58},{"reason":"no in-service complaints, treatment or diagnosis","decisions":43},{"reason":"preponderance of the evidence against the claim","decisions":31},{"reason":"service records negative or silent","decisions":29},{"reason":"aggravated by the service-connected disability","decisions":15},{"reason":"no current diagnosis","decisions":12}]},"recent_examples":{"granted":[{"case_id":"A26040930","year":2026,"judge":"MARCUS N. FULTON","rationale":"Service-connected right ankle condition satisfies first two elements of secondary SC.; Conflicting medical opinions regarding nexus between ankle and knee conditions.; Private opinions found more persuasive than VA opinions.; Evidence found to be in equipoise, conferring benefit of doubt."},{"case_id":"A26040413","year":2026,"judge":"MICHAEL A. PAPPAS","rationale":"Conflicting medical opinions on nexus; Benefit of the doubt applied due to equipoise; Later VA exam found at least as likely as not secondary"},{"case_id":"A26036457","year":2026,"judge":"S.C. KREMBS","rationale":"Secondary to service-connected left ankle disability; Pain causes functional impairment of earning capacity; Competent lay testimony regarding symptoms and work impact"}],"denied":[{"case_id":"A26020220","year":2026,"judge":"RAY BARTO SLABBEKORN, JR.","rationale":"Right knee disability not secondary to right ankle disability; Criteria for service connection not met"},{"case_id":"A26010098","year":2026,"judge":"A. JAEGER","rationale":"No service connection for left knee disorder; Claimed as secondary to right ankle disorder; Theory of entitlement raised after initial rating decision"},{"case_id":"A26005377","year":2026,"judge":"MICHAEL LANE","rationale":"Failure to report for VA examination without good cause.; No competent medical evidence of nexus to service.; Evidence persuasively weighs against causation by in-service locking, toxic exposures, or left ankle disability."}]},"how_argued":{"note":"From keyword matches in each issue's AI summary and rationale, not the full decision. Only issues whose text names a medical link are counted under pathways; one issue can name several. A link named in a denial was often the argument the Board rejected.","issues":2258,"aggravation_discussed":{"issues":1034,"granted_pct":9.2},"causation_only":{"issues":1224,"granted_pct":25.9},"issues_naming_a_pathway_pct":26.5,"pathways":[{"pathway":"Altered gait or overuse","issues":480,"granted_pct":37.5,"examples":[{"case_id":"A26011093","year":2026,"outcome":"GRANTED","quote":"The Board found a causal relationship based on private medical opinions and treatment notes attributing the knee condition to the ankle injury and subsequent gait alterations."},{"case_id":"25001667","year":2025,"outcome":"DENIED","quote":"While the veteran is service-connected for the ankle, the most probative VA opinions found the knee disability less likely than not caused by or aggravated by the ankle condition, citing natural aging and lack of gait abnormality."}]},{"pathway":"Weight gain or obesity","issues":70,"granted_pct":21.4,"examples":[{"case_id":"A25048080","year":2025,"outcome":"GRANTED","quote":"Multiple VA opinions inadequate for failing to address obesity as intermediate step or aggravation."},{"case_id":"25014186","year":2025,"outcome":"DENIED","quote":"The Board denied service connection, finding the evidence did not support a link to service, attributing the condition to age-related wear and tear, obesity, and post-service injuries."}]},{"pathway":"Nerve involvement","issues":39,"granted_pct":17.9,"examples":[{"case_id":"A25110554","year":2025,"outcome":"GRANTED","quote":"Service connection for left knee strain was granted as secondary to service-connected residuals of right ankle fracture, loss of use of the left foot, and peripheral neuropathy of the right lower extremity."},{"case_id":"25010527","year":2025,"outcome":"DENIED","quote":"The veteran claims service connection for a left knee strain, asserting it is secondary to his service-connected right ankle disability, lower back disability, and bilateral lower extremity radiculopathy."}]},{"pathway":"Stress","issues":35,"granted_pct":40,"examples":[{"case_id":"A26020933","year":2026,"outcome":"GRANTED","quote":"Altered gait from ankle disability stressed the knee"},{"case_id":"21045522","year":2021,"outcome":"DENIED","quote":"Multiple VA examiners opined that the condition was less likely than not related to service, attributing it to aging and occupational stress, and found no chronic disorder or residuals from service."}]},{"pathway":"Chronic pain","issues":25,"granted_pct":20,"examples":[{"case_id":"A24040677","year":2024,"outcome":"GRANTED","quote":"The Board found that the veteran's left knee disability, specifically a complex meniscus tear and cartilage degeneration causing chronic pain, was directly related to the chronic instability of the service-connected right ankle."},{"case_id":"A25105989","year":2025,"outcome":"DENIED","quote":"The Board denied this claim, finding that the evidence showed only a noncompensable limitation of extension (5 degrees) and that using painful motion for a rating would constitute pyramiding, as a 10 percent rating for flexion..."}]}]},"how_va_rates":null,"requirements":"38 CFR 3.310: a current diagnosis, a service-connected disability, and medical evidence that it caused (3.310(a)) or aggravated (3.310(b)) the condition."}}