Secondary service connection
Degenerative arthritis of the spine secondary to a knee condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided degenerative arthritis of the spine claimed as secondary to a knee condition in 2,455 decisions. It granted the issue in 24.0% of them, above the 21.2% grant rate for all degenerative arthritis of the spine issues, denied it in 19.6%, and remanded it in 55.0%. Counting only decisions on the merits, 55.1% were granted.
Decisions
2,455
2017–2026
Granted
24.0%
All degenerative arthritis of the spine: 21.2%
Granted on the merits
55.1%
Granted ÷ (granted + denied)
Remanded
55.0%
Denied: 19.6%
See all degenerative arthritis of the spine decisions, direct and secondary.
Degenerative arthritis of the spine secondary to a knee condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 225 | 17.8% | 29.3% | 48.0% | 4.9% |
| 2018 | 238 | 18.9% | 23.1% | 53.8% | 4.2% |
| 2019 | 281 | 19.2% | 21.7% | 56.9% | 2.1% |
| 2020 | 302 | 20.9% | 24.8% | 53.6% | 0.7% |
| 2021 | 289 | 21.5% | 23.5% | 54.3% | 0.7% |
| 2022 | 297 | 21.9% | 18.9% | 58.6% | 0.7% |
| 2023 | 297 | 24.9% | 14.5% | 59.9% | 0.7% |
| 2024 | 290 | 32.1% | 12.1% | 54.5% | 1.4% |
| 2025 | 216 | 35.2% | 11.1% | 53.7% | 0.0% |
| 2026 | 79 | 34.2% | 8.9% | 57.0% | 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 Other: dismissed, withdrawn or no clear outcome.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 degenerative arthritis of the spine decisions
For each kind of supporting evidence: how often the Board granted the degenerative arthritis of the spine 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 | 659 | 89.8% | 24.5% | +65.4 pts |
| Private medical opinion | 1,035 | 72.2% | 29.8% | +42.4 pts |
| Favorable VA exam | 273 | 79.9% | 49.5% | +30.4 pts |
| Treating physician opinion | 164 | 74.5% | 53.0% | +21.5 pts |
| Lay statement | 2,005 | 49.6% | 85.1% | −35.6 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 78.1% of the decisions that granted degenerative arthritis of the spine.
- The Board found the veteran's statements credible in 24.6% of grants and 9.0% 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 degenerative arthritis of the spine 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 |
|---|---|---|---|---|
| Unfavorable VA exam | 2,097 | 52.6% | 77.3% | −24.7 pts |
| Negative nexus opinion | 1,904 | 50.4% | 81.6% | −31.2 pts |
How these claims are argued
A secondary claim says a knee condition caused degenerative arthritis of the spine 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)
13.3%
granted, of 1,262 issues (50.2% of all)
Causation only
caused by the disability, 3.310(a)
34.4%
granted, of 1,252 issues (49.8% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Altered gait or overuse Granted “Competent and credible lay testimony regarding biomechanical cause” 26001008 (2026) Denied “Veteran's statements about back pain onset relative to knee surgery and antalgic gait were not fully accounted for in VA opinions.” 25003688 (2025) | 704 | 42.0% |
Weight gain or obesity Granted “Obesity found to be a substantial factor in causing low back disability, and would not have occurred but for obesity..” A25009172 (2025) Denied “Current back condition attributed to post-service scoliosis and morbid obesity.” 25005815 (2025) | 113 | 11.5% |
Nerve involvement Granted “Service connection for a low back disability, diagnosed as degenerative arthritis, degenerative disc disease, spinal stenosis, and right lower extremity radiculopathy, was granted on a secondary basis.” 25014049 (2025) Denied “Post-service records show spinal procedures for nerve issues and fusion surgery.” 24012505 (2024) | 78 | 37.2% |
Stress Granted “The Veteran's altered gait and knee instability from service-connected knee conditions led to abnormal stress on the lower back, causing worsening lumbar pain and documented degenerative changes.” A26019794 (2026) Denied “Medical opinions found mild limp unlikely to cause significant spinal stress or aggravation..” 22023089 (2022) | 40 | 77.5% |
Chronic pain Granted “The Veteran asserted that altered gait and posture due to decades of right knee pain caused this condition.” A24014608 (2024) Denied “The veteran claims service connection for a lumbar disability, alleging it is secondary to a left knee disability and due to back pain after a cesarean section.” A26005951 (2026) | 39 | 38.5% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 34.6% of the 2,514 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 degenerative arthritis of the spine
Most common reasons in grants
- Caused by the service-connected disability106
- Current diagnosis established69
- Service connection established56
- Aggravated by the service-connected disability29
- VA examiner: less likely than not related to service15
- New and material evidence received to reopen claim8
- Secondary service connection granted6
- New and material evidence submitted5
Most common reasons in denials
- VA examiner: less likely than not related to service96
- Preponderance of the evidence against the claim71
- No in-service complaints, treatment or diagnosis69
- Service records negative or silent53
- Aggravated by the service-connected disability28
- No continuity of symptomatology22
- Current diagnosis established22
- Caused by the service-connected disability13
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 degenerative arthritis of the spine decisions
Granted
Lumbar spine condition found secondary to left knee condition; VA and private opinions provided positive nexus; Resolved doubt in Veteran's favor
Secondary to service-connected right knee disability; Caused or aggravated by service-connected right knee disability; Resolved doubt in Veteran's favor
No in-service onset for lumbar spine disability.; Service-connected for right and left knee disabilities.; Private physician opinion linked lumbar spine disability to knee injuries.; Opinion was probative and supported by medical articles.; Evidence found in equipoise; doubt resolved in Veteran's favor.
Denied
Lack of in-service complaints or diagnosis of back condition; Medical opinions attributed condition to age and non-service factors; Veteran's lay assertions insufficient to establish nexus without medical evidence
Veteran not competent to provide nexus opinion; Private opinion lacked probative value and rationale; Issue raised late in appeal process, no duty to assist
No medical nexus found between service-connected knee/ankle conditions and lower back disability.; Examiner opined conditions are separate and distinct, developing from wear and tear.; Veteran's lay statements on etiology given little probative value due to lack of medical expertise.
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 degenerative arthritis of the spine.
- A knee condition is already service connected.
- Medical evidence linking them (a nexus opinion): degenerative arthritis of the spine 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
- 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
- Ankle impairment secondary to a knee condition952 decisions · 15.2% 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
Degenerative arthritis of the spine secondary to other conditions
See all conditions secondary to a knee condition or back conditions as a primary or secondary condition.
Rules that apply to secondary degenerative arthritis of the spine 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 - 38 CFR 4.71a · DC 5242
Schedule of ratings: musculoskeletal system
Read it in VA Law Explorer - M21-1 V.iii.1.B.3
Spine: evaluating manifestations of spine diseases and injuries
Read it in VA Law Explorer - M21-1 V.iii.1.C
Arthritis: degenerative arthritis and separately compensable joints
Read it in VA Law Explorer - M21-1 V.iii.1.A
Painful motion and functional loss (38 CFR 4.59, DeLuca, Mitchell, Correia)
Read it in VA Law Explorer
Research your degenerative arthritis of the spine case
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How these numbers are calculated
- Counts decisions in which the Board decided a degenerative arthritis of the spine 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.