Secondary service connection
Major depressive disorder secondary to a knee condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided major depressive disorder claimed as secondary to a knee condition in 516 decisions. It granted the issue in 49.4% of them, above the 35.3% grant rate for all major depressive disorder issues, denied it in 12.8%, and remanded it in 34.5%. Counting only decisions on the merits, 79.4% were granted.
Decisions
516
2017–2026
Granted
49.4%
All major depressive disorder: 35.3%
Granted on the merits
79.4%
Granted ÷ (granted + denied)
Remanded
34.5%
Denied: 12.8%
See all major depressive disorder decisions, direct and secondary.
Major depressive disorder secondary to a knee condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 40 | 22.5% | 27.5% | 37.5% | 12.5% |
| 2018 | 99 | 43.4% | 12.1% | 38.4% | 6.1% |
| 2019 | 78 | 56.4% | 10.3% | 29.5% | 3.8% |
| 2020 | 62 | 43.5% | 17.7% | 37.1% | 1.6% |
| 2021 | 45 | 35.6% | 8.9% | 53.3% | 2.2% |
| 2022 | 43 | 51.2% | 11.6% | 34.9% | 2.3% |
| 2023 | 43 | 46.5% | 11.6% | 39.5% | 2.3% |
| 2024 | 53 | 62.3% | 9.4% | 28.3% | 0.0% |
| 2025 | 41 | 78.0% | 9.8% | 12.2% | 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 Other: dismissed, withdrawn or no clear outcome.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 major depressive disorder decisions
For each kind of supporting evidence: how often the Board granted the major depressive disorder 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 | 250 | 94.7% | 51.8% | +42.9 pts |
| Private medical opinion | 296 | 86.6% | 64.8% | +21.8 pts |
| Favorable VA exam | 100 | 87.1% | 76.7% | +10.4 pts |
| Lay statement | 408 | 76.5% | 90.9% | −14.4 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 76.9% of the decisions that granted major depressive disorder.
- The Board found the veteran's statements credible in 20.4% of grants and 13.6% 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 major depressive disorder 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 | 399 | 78.7% | 81.9% | −3.2 pts |
| Negative nexus opinion | 301 | 77.4% | 81.9% | −4.5 pts |
How these claims are argued
A secondary claim says a knee condition caused major depressive disorder 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)
48.3%
granted, of 174 issues (33.4% of all)
Causation only
caused by the disability, 3.310(a)
49.9%
granted, of 347 issues (66.6% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Chronic pain Granted “The Board found that while the Veteran had pre-existing anxiety and trauma related to childhood abuse, his depressive disorder was at least as likely as not due to chronic pain from his service-connected knee conditions.” 26000344 (2026) Denied “The veteran claimed an acquired psychiatric disorder, including depression and bipolar disorder, secondary to his service-connected left knee disability, attributing the onset to chronic pain and life limitations.” 22062584 (2022) | 111 | 81.1% |
Stress Granted “The Board found a private medical opinion probative, linking the Veteran's stress, anxiety, and depressed mood to chronic pain from these service-connected conditions.” A25061319 (2025) Denied “The Board noted that the Veteran's psychiatric symptoms predated his knee condition and were more consistently linked to familial, financial, and social stressors.” 22045211 (2022) | 29 | 27.6% |
Sleep disruption Granted “Service connection for a psychiatric disorder, including insomnia and major depressive disorder with anxious distress, was granted on a secondary basis.” A25038858 (2025) Denied “Service connection for an acquired psychiatric disorder, specifically depression and insomnia, claimed as secondary to a right knee disability, was denied.” 24024613 (2024) | 20 | 50.0% |
Reduced activity or mobility Granted “The Board found that the Veteran's physical limitations from these service-connected conditions negatively impacted his mood and functioning, leading to the psychiatric conditions.” A26017814 (2026) | 15 | 86.7% |
Nerve involvement Granted “The Veteran claimed entitlement to service connection for an acquired psychiatric disorder, specifically major depressive disorder and generalized anxiety disorder, as secondary to his service-connected lumbar spine, bilateral...” A26017814 (2026) | 14 | 85.7% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 32.2% of the 521 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 major depressive disorder
Most common reasons in grants
- Caused by the service-connected disability65
- Aggravated by the service-connected disability36
- Service connection established26
- Current diagnosis established26
- New and material evidence submitted4
- VA examiner: less likely than not related to service4
- Criteria for service connection met3
- Criteria for secondary service connection met3
Most common reasons in denials
- Preponderance of the evidence against the claim10
- VA examiner: less likely than not related to service9
- Caused by the service-connected disability6
- No in-service complaints, treatment or diagnosis4
- No current diagnosis3
- Service records negative or silent3
- VA examiner provided negative nexus opinion2
- Current diagnosis established2
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 major depressive disorder decisions
Granted
Private medical opinion found depression secondary to knee issues; Veteran testimony corroborates depression linked to knee pain; Evidence in approximate balance, doubt resolved in Veteran's favor
Private physician opinion found condition more likely than not secondary to service-connected injuries.; Evidence found to be in equipoise regarding nexus.; Benefit of the doubt resolved in Veteran's favor.
Current diagnosis of depressive disorder with depressive features, melancholic features, and anxious distress.; Conflicting opinions from private psychologist (favorable nexus) and VA examiner (unfavorable nexus).; Evidence found to be at least evenly balanced.
Denied
No evidence of in-service psychiatric injury or disease.; Veteran's testimony regarding chronic psychiatric symptoms was not credible.; Private psychological evaluation was generalized and speculative.
No evidence of mental health issues during service.; Veteran's MDD claimed as secondary to service-connected back and knee pain.; VA examiner provided negative nexus opinion; private opinion found unpersuasive by Board.; Board found VA examiner more credible due to expertise and addressing veteran's history.
No current diagnosis of depression; Lay contentions lack probative value without objective medical evidence; Absence of diagnosis suggests symptoms did not begin in service
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 major depressive disorder.
- A knee condition is already service connected.
- Medical evidence linking them (a nexus opinion): major depressive disorder 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
- 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 a knee condition445 decisions · 8.3% granted
Major depressive disorder secondary to other conditions
See all conditions secondary to a knee condition or psychiatric disorders as a primary or secondary condition.
Rules that apply to secondary major depressive disorder 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 major depressive disorder 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 major depressive disorder 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.