Secondary service connection
Ankle impairment secondary to a knee condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided ankle impairment claimed as secondary to a knee condition in 955 decisions. It granted the issue in 15.2% of them, below the 17.8% grant rate for all ankle impairment issues, denied it in 16.5%, and remanded it in 67.7%. Counting only decisions on the merits, 47.9% were granted.
Decisions
955
2017–2026
Granted
15.2%
All ankle impairment: 17.8%
Granted on the merits
47.9%
Granted ÷ (granted + denied)
Remanded
67.7%
Denied: 16.5%
See all ankle impairment decisions, direct and secondary.
Ankle impairment secondary to a knee condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 85 | 11.8% | 30.6% | 49.4% | 8.2% |
| 2018 | 99 | 12.1% | 22.2% | 65.7% | 0.0% |
| 2019 | 140 | 16.4% | 16.4% | 64.3% | 2.9% |
| 2020 | 125 | 7.2% | 16.0% | 76.8% | 0.0% |
| 2021 | 146 | 15.8% | 15.8% | 67.8% | 0.7% |
| 2022 | 129 | 11.6% | 14.0% | 74.4% | 0.0% |
| 2023 | 170 | 14.1% | 11.8% | 74.1% | 0.0% |
| 2024 | 131 | 13.0% | 12.2% | 74.0% | 0.8% |
| 2025 | 123 | 19.5% | 20.3% | 60.2% | 0.0% |
| 2026 | 44 | 36.4% | 13.6% | 50.0% | 0.0% |
Each row counts issues (each condition the Board decided), so the shares add up to 100%. Other: dismissed, withdrawn or no clear outcome. Years with fewer than 20 issues are left out.
Evidence in granted and denied ankle impairment decisions
For each kind of supporting evidence: how often the Board granted the ankle impairment issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 188 | 88.2% | 21.7% | +66.5 pts |
| Private medical opinion | 292 | 70.1% | 29.5% | +40.6 pts |
| Favorable VA exam | 113 | 76.1% | 39.8% | +36.3 pts |
| Treating physician opinion | 51 | 76.5% | 44.2% | +32.2 pts |
| Lay statement | 797 | 45.2% | 65.0% | −19.8 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 80.7% of the decisions that granted ankle impairment.
- The Board found the veteran's statements credible in 29.0% of grants and 10.8% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often ankle impairment was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Negative nexus opinion | 651 | 44.3% | 57.3% | −13.0 pts |
| Unfavorable VA exam | 785 | 45.8% | 61.0% | −15.2 pts |
How these claims are argued
A secondary claim says a knee condition caused ankle impairment or made it worse, and names how. Below: whether the Board's decision discussed aggravation, and the medical link each decision names, with how often those issues were granted.
Aggravation discussed
made worse by the disability, 3.310(b)
5.0%
granted, of 498 issues (41.8% of all)
Causation only
caused by the disability, 3.310(a)
21.3%
granted, of 694 issues (58.2% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Altered gait or overuse Granted “Opinions link left ankle condition to service-connected spinal and right knee issues and altered gait.” A26008103 (2026) Denied “The claim that the ankle condition is due to the service-connected left knee is contradicted by evidence of a normal gait and lack of association between the knee and ankle pain.” A26026839 (2026) | 217 | 23.5% |
Weight gain or obesity Denied “The Veteran claimed it was secondary to his service-connected left knee disability, but the VA examiner opined it was less likely than not caused or aggravated by the left knee, attributing the ankle issues to morbid obesity.” A24035001 (2024) | 40 | 0.0% |
Chronic pain Granted “The veteran's altered gait due to knee pain likely caused the left ankle defect.” A25077064 (2025) Denied “Appellant did not mention pain interfering with ministry..” A25005724 (2025) | 23 | 8.7% |
Stress Granted “While direct service connection was denied due to lack of evidence of an in-service ankle injury, the Board found the left ankle disability to be secondary to the Veteran's service-connected right knee disability, citing medical...” A26037161 (2026) | 10 | 100.0% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 23.2% of the 1,192 issues name at least one medical link; the rest only say “secondary to” the disability. One issue can name several links. Granted is the share of those issues granted (remands count as not granted). A link named in a denial was often the argument the Board rejected.
Why the Board granted or denied ankle impairment
Most common reasons in grants
- Caused by the service-connected disability35
- Current diagnosis established22
- Service connection established15
- Aggravated by the service-connected disability5
- VA examiner opinion inadequate2
- Resolving all doubt in veteran's favor2
- VA examiner: less likely than not related to service2
- Private opinion found probative2
Most common reasons in denials
- VA examiner: less likely than not related to service32
- No current diagnosis22
- Preponderance of the evidence against the claim20
- No in-service complaints, treatment or diagnosis14
- Aggravated by the service-connected disability13
- Service records negative or silent13
- Caused by the service-connected disability7
- Current diagnosis established6
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent ankle impairment decisions
Granted
Service-connected bilateral knee and low back disabilities established.; Private and VA opinions found bilateral ankle disability aggravated by service-connected knee/back conditions.; Opinions cited biomechanical relationship and overcompensation.
No direct service connection for left ankle sprain.; Secondary service connection granted based on right knee disability.; Benefit of the doubt applied to link ankle disability to knee injury.
Current disability conceded by AOJ; Service-connected left knee disability established; Private medical opinion found favorable nexus
Denied
Evidence persuasively against service connection; Lack of nexus to service-connected knee and feet disability
No current ankle disability or functional impairment.; No evidence of in-service complaints or diagnoses.; Claim of secondary ankle condition due to left knee is contradicted by evidence.
No evidence of current disability for right ankle; Lack of service treatment records or post-service medical records; Veteran's statements insufficient to trigger duty to assist
What VA needs to grant a secondary claim
Secondary service connection means VA disability benefits for a condition caused or made worse by a disability that is already service connected (38 CFR 3.310). The claim needs three things:
- A current diagnosis of ankle impairment.
- A knee condition is already service connected.
- Medical evidence linking them (a nexus opinion): ankle impairment was caused by a knee condition (3.310(a)), or was made worse beyond its natural progress by it (aggravation, 3.310(b)).
VA's procedures for these claims are in M21-1 V.ii.2.D. When the evidence for and against is about even, VA must decide in the veteran's favor (38 CFR 3.102).
Other conditions secondary to a knee condition
- Major depressive disorder secondary to a knee condition512 decisions · 49.4% granted
- Sleep apnea secondary to a knee condition983 decisions · 46.2% granted
- Osteoarthritis secondary to a knee condition535 decisions · 34.2% granted
- Degenerative arthritis of the spine secondary to a knee condition2,449 decisions · 24.1% granted
- Intervertebral disc syndrome secondary to a knee condition1,760 decisions · 19.7% granted
- Hip impairment secondary to a knee condition2,665 decisions · 19.0% granted
- Shoulder impairment secondary to a knee condition426 decisions · 15.0% granted
- Cervical spine limitation of motion secondary to a knee condition396 decisions · 10.6% granted
- Thoracolumbar or lumbar spine limitation of motion secondary to a knee condition636 decisions · 8.6% granted
- Foot impairment secondary to a knee condition445 decisions · 8.3% granted
Ankle impairment secondary to other conditions
See all conditions secondary to a knee condition or ankle conditions as a primary or secondary condition.
Rules that apply to secondary ankle impairment claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer
Research your ankle impairment case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a ankle impairment issue claimed as secondary to a knee condition, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.