Secondary service connection
Osteoarthritis secondary to a knee condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided osteoarthritis claimed as secondary to a knee condition in 538 decisions. It granted the issue in 34.2% of them, above the 19.5% grant rate for all osteoarthritis issues, denied it in 23.2%, and remanded it in 42.9%. Counting only decisions on the merits, 59.5% were granted.
Decisions
538
2017–2026
Granted
34.2%
All osteoarthritis: 19.5%
Granted on the merits
59.5%
Granted ÷ (granted + denied)
Remanded
42.9%
Denied: 23.2%
See all osteoarthritis decisions, direct and secondary.
Osteoarthritis secondary to a knee condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 48 | 29.2% | 39.6% | 31.3% | 0.0% |
| 2018 | 67 | 35.8% | 31.3% | 32.8% | 0.0% |
| 2019 | 53 | 30.2% | 17.0% | 52.8% | 0.0% |
| 2020 | 83 | 32.5% | 26.5% | 41.0% | 0.0% |
| 2021 | 74 | 27.0% | 28.4% | 44.6% | 0.0% |
| 2022 | 68 | 32.4% | 11.8% | 55.9% | 0.0% |
| 2023 | 57 | 31.6% | 14.0% | 50.9% | 3.5% |
| 2024 | 79 | 39.2% | 15.2% | 44.3% | 1.3% |
| 2025 | 66 | 36.4% | 25.8% | 34.8% | 3.0% |
| 2026 | 24 | 37.5% | 16.7% | 45.8% | 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 Other: dismissed, withdrawn or no clear outcome.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 osteoarthritis decisions
For each kind of supporting evidence: how often the Board granted the osteoarthritis 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 | 157 | 93.2% | 34.5% | +58.7 pts |
| Favorable VA exam | 75 | 87.7% | 52.0% | +35.6 pts |
| Private medical opinion | 197 | 77.9% | 42.5% | +35.4 pts |
| Treating physician opinion | 53 | 83.7% | 55.6% | +28.1 pts |
| Lay statement | 445 | 55.3% | 86.0% | −30.8 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 80.4% of the decisions that granted osteoarthritis.
- The Board found the veteran's statements credible in 30.4% of grants and 6.4% 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 osteoarthritis 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 | 476 | 58.8% | 70.0% | −11.2 pts |
| Negative nexus opinion | 411 | 56.9% | 73.5% | −16.5 pts |
How these claims are argued
A secondary claim says a knee condition caused osteoarthritis 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)
14.8%
granted, of 270 issues (43.6% of all)
Causation only
caused by the disability, 3.310(a)
47.3%
granted, of 349 issues (56.4% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Altered gait or overuse Granted “The Veteran asserted that the left knee disability caused altered gait and biomechanics, leading to the right knee condition.” A26008890 (2026) Denied “The examiner also found it less likely than not that the left knee disability was aggravated by the service-connected right knee disability due to a lack of evidence for significantly altered gait or increased treatment.” 26000034 (2026) | 159 | 56.6% |
Weight gain or obesity Granted “Obesity found to be intermediate step between service-connected knee/foot disabilities and ankle disabilities.” 22026241 (2022) Denied “Diagnosed conditions are more likely due to age, obesity, and diabetes.” 24025475 (2024) | 19 | 10.5% |
Chronic pain Granted “The Veteran's altered gait due to left knee pain led to increased biomechanical strain on the right knee, causing the osteoarthritis.” A25039197 (2025) | 13 | 69.2% |
Stress Granted “opined that pain in the knees and back could impact gait, leading to increased stress on the hips, and that the left hip pain was at least as likely as not related to service.” A26035267 (2026) Denied “The Veteran claimed service connection for left knee osteoarthritis, asserting it was secondary to his service-connected right knee osteoarthritis following a meniscal tear, due to an altered gait and increased stress.” A20013403 (2020) | 11 | 54.5% |
Nerve involvement Granted “This condition was found to be secondarily related to the veteran's existing service-connected right knee condition, right ankle condition, and radiculopathy associated with lumbar intervertebral disc syndrome.” A24030561 (2024) Denied “No evidence of significant muscle or nerve damage impacting opposite limb.” 21065154 (2021) | 10 | 40.0% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 31.5% of the 619 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 osteoarthritis
Most common reasons in grants
- Caused by the service-connected disability37
- Current diagnosis established20
- Service connection established16
- VA examiner: less likely than not related to service4
- Aggravated by the service-connected disability3
- Favorable private medical opinion2
- Service records negative or silent2
- New and relevant evidence submitted after prior denial2
Most common reasons in denials
- VA examiner: less likely than not related to service32
- No in-service complaints, treatment or diagnosis23
- Preponderance of the evidence against the claim16
- Service records negative or silent15
- Aggravated by the service-connected disability7
- Caused by the service-connected disability3
- Continuity of symptomatology since service2
- No continuity of symptomatology2
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 osteoarthritis decisions
Granted
Current diagnosis of left hip osteoarthritis.; Service-connected disabilities of bilateral knees and lumbar spine.; Private opinion from Dr. J.M. links hip pain to gait changes from knee/back conditions and service.; Opinion is probative and uncontradicted.
Evidence in approximate balance; Hip disability related to service-connected knee; Benefit of the doubt resolved in veteran's favor
Treating physician opined right knee degeneration likely secondary to overuse from left knee impairment.; Board found opinion persuasive, establishing nexus for right knee claim.; Service-connected left knee disability contributed to and accelerated right knee degeneration.
Denied
Service treatment records negative for left knee complaints/diagnosis; No specific in-service injury described for left knee; VA examiners opined left knee disability less likely than not related to service-connected conditions
No in-service complaints or documentation of bilateral hip issues in STRs.; Lay statements did not reference in-service hip problems.; VA clinician provided negative nexus opinion for secondary connection to knees.
No presumptive service connection for left knee arthritis.; In-service injury from jeep accident found, but no nexus to current arthritis.; March 2023 VA examiner opinion found highly probative, stating less likely than not related to service or aggravated by right knee disability.; Veteran's own statements indicated gradual onset of left knee pain post-service and secondary claim to right knee.
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 osteoarthritis.
- A knee condition is already service connected.
- Medical evidence linking them (a nexus opinion): osteoarthritis 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
- 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
See all conditions secondary to a knee condition.
Rules that apply to secondary osteoarthritis 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 osteoarthritis 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 osteoarthritis 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.