Secondary service connection
Hip impairment secondary to a knee condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided hip impairment claimed as secondary to a knee condition in 2,669 decisions. It granted the issue in 19.0% of them, above the 15.8% grant rate for all hip impairment issues, denied it in 17.9%, and remanded it in 63.0%. Counting only decisions on the merits, 51.4% were granted.
Decisions
2,669
2017–2026
Granted
19.0%
All hip impairment: 15.8%
Granted on the merits
51.4%
Granted ÷ (granted + denied)
Remanded
63.0%
Denied: 17.9%
See all hip impairment decisions, direct and secondary.
Hip impairment secondary to a knee condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 218 | 12.4% | 28.0% | 57.8% | 1.8% |
| 2018 | 318 | 11.0% | 25.8% | 61.9% | 1.3% |
| 2019 | 368 | 12.2% | 22.6% | 64.4% | 0.8% |
| 2020 | 375 | 11.5% | 25.9% | 62.4% | 0.3% |
| 2021 | 390 | 17.2% | 14.1% | 68.5% | 0.3% |
| 2022 | 384 | 16.7% | 14.1% | 68.8% | 0.5% |
| 2023 | 416 | 15.6% | 13.5% | 70.7% | 0.2% |
| 2024 | 457 | 26.0% | 8.8% | 64.6% | 0.7% |
| 2025 | 396 | 32.8% | 10.4% | 56.6% | 0.3% |
| 2026 | 178 | 37.1% | 15.2% | 47.2% | 0.6% |
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 Other: dismissed, withdrawn or no clear outcome.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 hip impairment decisions
For each kind of supporting evidence: how often the Board granted the hip 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 | 621 | 86.6% | 23.1% | +63.5 pts |
| Private medical opinion | 1,002 | 70.4% | 28.5% | +41.9 pts |
| Treating physician opinion | 162 | 80.4% | 48.1% | +32.3 pts |
| Favorable VA exam | 275 | 74.7% | 46.3% | +28.4 pts |
| Lay statement | 2,165 | 46.6% | 75.3% | −28.7 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 78.5% of the decisions that granted hip impairment.
- The Board found the veteran's statements credible in 24.1% of grants and 9.2% 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 hip 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 | 1,883 | 49.0% | 60.2% | −11.2 pts |
| Unfavorable VA exam | 2,214 | 49.9% | 63.3% | −13.4 pts |
How these claims are argued
A secondary claim says a knee condition caused hip 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)
10.3%
granted, of 1,657 issues (47.3% of all)
Causation only
caused by the disability, 3.310(a)
26.6%
granted, of 1,843 issues (52.7% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Altered gait or overuse Granted “Hip pain began after knee injury in service, leading to altered gait mechanics and subsequent hip pain.” 26001800 (2026) Denied “Lack of chronic gait alteration and plausible nexus.” 26001600 (2026) | 837 | 33.9% |
Weight gain or obesity Granted “Service connection for a right hip disability was granted as secondary to service-connected right knee degenerative arthritis and lumbar spine disabilities, mediated by obesity.” 26001800 (2026) Denied “VA clinician opined condition likely due to occupation (EMT) and obesity” A25097298 (2025) | 139 | 10.1% |
Chronic pain Granted “Veteran has current right hip disability due to pain impairing earning capacity.” A26014840 (2026) Denied “Appellant did not mention pain interfering with ministry..” A25005724 (2025) | 59 | 35.6% |
Nerve involvement Granted “Service-connected disabilities (fibromyalgia, cervical degenerative arthritis, lumbar radiculopathy, lumbar degenerative arthritis, right knee degenerative arthritis) met.” 26001800 (2026) Denied “Hip pain attributed to radiculopathy.” A26035224 (2026) | 42 | 26.2% |
Stress Granted “The August 2024 VA examiner found it at least as likely as not due to the right knee disability, citing biomechanical changes and increased stress.” 26001914 (2026) Denied “The veteran claimed service connection for a right hip disorder, alleging pain from repetitive stress during service and alternatively, that it was secondary to right knee patellar tendinosis.” A22004102 (2022) | 34 | 41.2% |
Reduced activity or mobility Granted “VA treatment records note pain causing mobility issues” A25106823 (2025) | 10 | 10.0% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 29.2% of the 3,500 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 hip impairment
Most common reasons in grants
- Caused by the service-connected disability103
- Current diagnosis established63
- Service connection established58
- Aggravated by the service-connected disability21
- VA examiner: less likely than not related to service8
- Secondary service connection granted6
- Conflicting medical opinions on nexus4
- Conflicting medical opinions regarding nexus4
Most common reasons in denials
- VA examiner: less likely than not related to service92
- No in-service complaints, treatment or diagnosis84
- Preponderance of the evidence against the claim63
- Service records negative or silent47
- No current diagnosis38
- Aggravated by the service-connected disability25
- Current diagnosis established15
- No continuity of symptomatology15
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 hip impairment decisions
Granted
Secondary to service-connected right knee disability; Caused or aggravated by service-connected right knee disability; Resolved doubt in Veteran's favor
Private opinion found hip osteoarthritis at least as likely as not due to service-connected knee residuals.; Private opinion cited "knee-hip-spine syndrome" and multi-causal links.; VA opinion found inadequate due to internal inconsistency and failure to address aggravation.
Private medical opinion found left hip secondary to service-connected back and bilateral knee conditions; Satisfied elements for secondary service connection; Benefit of the doubt resolved in veteran's favor
Denied
No in-service onset; No continuity of symptoms; Not proximately due to service-connected disability; Hip pain attributed to radiculopathy
No objective findings of functional impairment; Insufficient evidence to support diagnosis; Symptoms only subjectively reported
No evidence of current disability for right hip; 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 hip impairment.
- A knee condition is already service connected.
- Medical evidence linking them (a nexus opinion): hip 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
- 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
Hip impairment secondary to other conditions
See all conditions secondary to a knee condition.
Rules that apply to secondary hip 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 hip 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 hip 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.