Secondary service connection
Knee conditions secondary to flat feet: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided knee claimed as secondary to flat feet in 820 decisions. It granted the issue in 23.9% of them, above the 19.1% grant rate for all knee issues, denied it in 15.5%, and remanded it in 60.5%. Counting only decisions on the merits, 60.7% were granted.
From Board of Veterans' Appeals decisions: appeals, not VA's first decisions. About these numbers
Decisions
820
2017–2026
Granted
23.9%
All knee: 19.1%
Granted on the merits
60.7%
Granted ÷ (granted + denied)
Remanded
60.5%
Denied: 15.5%
At a glance
- Most often argued link: altered gait or overuse, named in 142 issues, 39.4% granted. Details
- Causation only: 31.7% granted; when the decision discussed aggravation: 14.9%. Details
- Positive nexus opinion: 91.0% granted on the merits when in the record, 32.3% without. Details
- Private medical opinion: 78.4% granted on the merits when in the record, 40.8% without. Details
- Issues granted: 12.2% in 2017, 33.3% in 2025. Details
How these claims are argued
A secondary claim says flat feet caused knee 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)
14.9%
granted, of 530 issues (45.4% of all)
Causation only
caused by the disability, 3.310(a)
31.7%
granted, of 637 issues (54.6% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Altered gait or overuse Granted “Board found veteran's testimony regarding altered gait due to foot pain causing knee flare-ups to be competent and credible, establishing aggravation..” 26000556 (2026) Denied “Examiner noted no evidence that pes planus without severe limp causes knee symptoms.” A25061405 (2025) | 142 | 39.4% |
Weight gain or obesity Granted “Evidence in equipoise between private opinion linking knee to pes planus and VA opinion linking to age/obesity/post-service injury” 21011142 (2021) Denied “VA opinions attributed knee strain to obesity and natural aging” A26039074 (2026) | 30 | 10.0% |
Chronic pain Granted “Board found veteran's testimony regarding altered gait due to foot pain causing knee flare-ups to be competent and credible, establishing aggravation..” 26000556 (2026) | 21 | 9.5% |
Stress Granted “Private physician opined condition related to service-connected pes planus due to excess stress.” A25076897 (2025) | 13 | 76.9% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 17.0% of the 1,167 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.
Evidence in granted and denied knee decisions
For each kind of supporting evidence: how often the Board granted the knee 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 | 217 | 91.0% | 32.3% | +58.7 pts |
| Private medical opinion | 300 | 78.4% | 40.8% | +37.6 pts |
| Treating physician opinion | 52 | 85.7% | 57.6% | +28.1 pts |
| Favorable VA exam | 109 | 82.4% | 54.9% | +27.5 pts |
| Lay statement | 658 | 54.8% | 86.7% | −31.9 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 82.1% of the decisions that granted knee.
- The Board found the veteran's statements credible in 23.5% of grants and 9.4% 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 knee 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 | 691 | 60.1% | 65.0% | −4.9 pts |
| Negative nexus opinion | 595 | 57.4% | 71.6% | −14.2 pts |
Recent knee decisions
Granted
Private opinion linked knee condition to altered gait from pes planus; VA opinion found less than likelihood of service connection; Evidence found evenly balanced, benefit of doubt applied
Private opinion linked in-service injury to current conditions; Evidence in equipoise; Benefit of doubt applied in Veteran's favor
Favorable secondary opinion from February 2024 examiner.; Opinion cited change in biomechanics due to flatfoot severity causing knee disability.; No opposing secondary opinion found.
Denied
VA opinions found knee strain less likely than not related to pes planus; VA opinions attributed knee strain to obesity and natural aging; Private opinion deemed inadequate due to lack of supporting medical reasons
Evidence persuasively weighs against service connection; Evidence persuasively weighs against secondary connection to pes planus
Service treatment records are silent for knee pain complaints or diagnosis.; Post-service treatment records are silent for a specific knee diagnosis.; VA examiner found bilateral knee pain less likely than not caused by service.; Private opinion did not adequately address lack of in-service treatment or provide strong nexus.; Veteran's lay statements lacked credibility due to inconsistencies.
Knee conditions secondary to flat feet: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 74 | 12.2% | 31.1% | 51.4% | 5.4% |
| 2018 | 104 | 29.8% | 14.4% | 55.8% | 0.0% |
| 2019 | 106 | 28.3% | 5.7% | 63.2% | 2.8% |
| 2020 | 150 | 17.3% | 16.7% | 66.0% | 0.0% |
| 2021 | 142 | 20.4% | 14.8% | 64.8% | 0.0% |
| 2022 | 156 | 18.6% | 17.9% | 63.5% | 0.0% |
| 2023 | 131 | 23.7% | 14.5% | 61.8% | 0.0% |
| 2024 | 143 | 25.9% | 12.6% | 60.1% | 1.4% |
| 2025 | 117 | 33.3% | 7.7% | 58.1% | 0.9% |
| 2026 | 44 | 45.5% | 13.6% | 40.9% | 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.
Why the Board granted or denied knee
Most common reasons in grants
- Caused by the service-connected disability32
- Current diagnosis established29
- Service connection established21
- Aggravated by the service-connected disability8
- New and material evidence received to reopen claim3
- VA examiner: less likely than not related to service3
- Secondary to bilateral pes planus2
- New and relevant evidence submitted2
Most common reasons in denials
- No in-service complaints, treatment or diagnosis20
- VA examiner: less likely than not related to service20
- Preponderance of the evidence against the claim17
- Service records negative or silent16
- Aggravated by the service-connected disability8
- No current diagnosis7
- No continuity of symptomatology4
- Current diagnosis established3
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.
Background
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 knee.
- Flat feet is already service connected.
- Medical evidence linking them (a nexus opinion): knee was caused by flat feet (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).
How VA rates knee
Once service connection is granted, VA assigns a disability rating from the rating schedule, 38 CFR 4.71a. The Board rates knee under 8 diagnostic codes, shown here in the order it used them most. The rating is the same whether the condition is service connected directly or as secondary to another disability.
5256 Knee, ankylosis of
| Rating | Criteria |
|---|---|
| 60% | Extremely unfavorable, in flexion at an angle of 45° or more |
| 50% | In flexion between 20° and 45° |
| 40% | In flexion between 10° and 20° |
| 30% | Favorable angle in full extension, or in slight flexion between 0° and 10° |
5257 Knee, other impairment of
| Rating | Criteria |
|---|---|
| Recurrent subluxation or instability | |
| 30% | Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation |
| One of the following | |
| (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. | |
| 20% | (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation |
| 10% | Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation |
| Patellar instability | |
| 30% | A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker |
| 20% | A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker |
| 10% | A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker |
- Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon.
- Note (2): A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration).
5258 Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint
| Rating | Criteria |
|---|---|
| 20% | Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint |
5259 Cartilage, semilunar, removal of, symptomatic
| Rating | Criteria |
|---|---|
| 10% | Cartilage, semilunar, removal of, symptomatic |
Also in this range: 5260 Leg, limitation of flexion of; 5261 Leg, limitation of extension of; 5262 Tibia and fibula, impairment of; 5263 Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated). See 38 CFR 4.71a for their levels.
Text of 38 CFR 4.71a as of Feb 27, 2026. Confirm the current text at the source before relying on it.
See all knee decisions, direct and secondary.
Other conditions secondary to flat feet
Knee conditions secondary to other conditions
See all conditions secondary to flat feet or knee conditions as a primary or secondary condition.
Rules that apply to secondary knee 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 5256-5263
Schedule of ratings: musculoskeletal system (knee and leg)
Read it in VA Law Explorer - M21-1 V.iii.1.B.4
Knee: instability, meniscus, genu recurvatum, and when to rate them separately from limited motion
Read it in VA Law Explorer - M21-1 V.iii.1.A
Painful motion and functional loss (38 CFR 4.59, DeLuca, Mitchell, Correia), incl. knee replacement
Read it in VA Law Explorer
Research your knee 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 knee issue claimed as secondary to flat feet, 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.
Where this data comes from
- Claim
- Regional office decides
- Veteran appeals
- Board decides
- Granted · Denied · Remanded: back to the regional office
Board of Veterans' Appeals decisions show how VA's highest review body applies 38 CFR and weighs evidence on contested claims.
Each one is an appeal: a regional office decided the claim first, and the veteran appealed. So these rates describe the Board, not a veteran's odds at the regional office, where most claims are decided and whose decisions are not public.
More on what Board decisions can and cannot tell you