Secondary service connection
Foot impairment secondary to a knee condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided foot impairment claimed as secondary to a knee condition in 447 decisions. It granted the issue in 8.3% of them, below the 11.0% grant rate for all foot impairment issues, denied it in 15.9%, and remanded it in 74.3%. Counting only decisions on the merits, 34.3% were granted.
Decisions
447
2017–2026
Granted
8.3%
All foot impairment: 11.0%
Granted on the merits
34.3%
Granted ÷ (granted + denied)
Remanded
74.3%
Denied: 15.9%
See all foot impairment decisions, direct and secondary.
Foot impairment secondary to a knee condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 28 | 10.7% | 35.7% | 42.9% | 10.7% |
| 2018 | 67 | 4.5% | 26.9% | 65.7% | 3.0% |
| 2019 | 59 | 10.2% | 10.2% | 74.6% | 5.1% |
| 2020 | 72 | 5.6% | 13.9% | 80.6% | 0.0% |
| 2021 | 62 | 6.5% | 14.5% | 75.8% | 3.2% |
| 2022 | 62 | 3.2% | 12.9% | 83.9% | 0.0% |
| 2023 | 64 | 10.9% | 6.3% | 82.8% | 0.0% |
| 2024 | 60 | 10.0% | 5.0% | 85.0% | 0.0% |
| 2025 | 54 | 18.5% | 20.4% | 61.1% | 0.0% |
| 2026 | 25 | 12.0% | 28.0% | 60.0% | 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 Other: dismissed, withdrawn or no clear outcome.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 foot impairment decisions
For each kind of supporting evidence: how often the Board granted the foot 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 | 66 | 68.8% | 19.7% | +49.0 pts |
| Private medical opinion | 130 | 47.7% | 25.0% | +22.7 pts |
| Lay statement | 359 | 30.9% | 57.1% | −26.3 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 70.3% of the decisions that granted foot impairment.
- The Board found the veteran's statements credible in 21.6% of grants and 5.6% 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 foot 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 |
|---|---|---|---|---|
| Unfavorable VA exam | 351 | 33.7% | 36.8% | −3.1 pts |
| Negative nexus opinion | 280 | 31.1% | 41.2% | −10.1 pts |
How these claims are argued
A secondary claim says a knee condition caused foot 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)
5.2%
granted, of 248 issues (44.8% of all)
Causation only
caused by the disability, 3.310(a)
11.5%
granted, of 305 issues (55.2% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Altered gait or overuse Granted “The Board found the Veteran's lay statements regarding functional impairment credible and relied on a private medical opinion that linked the foot pain to altered biomechanics and increased forces on the foot from the service-connected...” A26008110 (2026) Denied “VA treatment in 2019 noted foot pain and other diagnoses, but no provider linked these to service, and the veteran's gait was noted as normal.” A26024639 (2026) | 114 | 13.2% |
Weight gain or obesity Granted “Private medical opinion found likely connection via weight gain and overcompensation” A25069927 (2025) Denied “July 2006 VA exam diagnosed bilateral osteoarthritis of feet, found no etiological connection to right knee condition beyond age and obesity.” 20034577 (2020) | 22 | 9.1% |
Nerve involvement Denied “VA examinations did not support a diagnosis of a right foot disability or peripheral nerve condition.” 22056446 (2022) | 17 | 0.0% |
Chronic pain Granted “The Board found that the Veteran's left foot disability became severe, as indicated by symptoms including daily pain that worsens with walking and standing, difficulty walking, and two to three episodes per month of inability to stand...” A24048504 (2024) Denied “Insufficient evidence of functional impairment in earning capacity due to left foot pain.” A25005724 (2025) | 11 | 9.1% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 26.9% of the 553 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 foot impairment
Most common reasons in grants
- Caused by the service-connected disability8
- Service connection established5
- Current diagnosis established4
- Criteria for service connection met2
Most common reasons in denials
- VA examiner: less likely than not related to service10
- No current diagnosis10
- Aggravated by the service-connected disability8
- Preponderance of the evidence against the claim7
- Service records negative or silent4
- Caused by the service-connected disability4
- No in-service complaints, treatment or diagnosis4
- No continuity of symptomatology3
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 foot impairment decisions
Granted
Current disability documented; Service-connected left knee disability established; Private medical opinion found favorable nexus
Private medical opinion found adequate and probative; VA opinion found inadequate due to internal inconsistency and failure to address functional impairment and aggravation; Veteran's lay statements regarding functional impairment were found credible
Bilateral ankle pain constitutes current disability due to functional impairment; Secondary to service-connected bilateral knee disability; Benefit of the doubt applied
Denied
Did not manifest during active service; No indication of relation to active service or service-connected disability; 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310
Veteran failed to attend ordered VA examinations; No current diagnosis of foot disability found; Evidence weighs against finding of disability
Conceded current right foot condition.; No evidence of in-service injury to the right foot.; No continuity of symptomatology; pain began 40 years post-service.; Second element of service connection not met.
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 foot impairment.
- A knee condition is already service connected.
- Medical evidence linking them (a nexus opinion): foot 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
- 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 other conditions
See all conditions secondary to a knee condition.
Rules that apply to secondary foot 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 foot 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 foot 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.