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.
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%
See all knee decisions, direct and secondary.
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 Other: dismissed, withdrawn or no clear outcome.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.
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 |
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.
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.
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.
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).
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.