Secondary service connection
Shoulder impairment secondary to a knee condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided shoulder impairment claimed as secondary to a knee condition in 428 decisions. It granted the issue in 15.0% of them, close to the 15.2% grant rate for all shoulder impairment issues, denied it in 18.7%, and remanded it in 66.4%. Counting only decisions on the merits, 44.4% were granted.
Decisions
428
2017–2026
Granted
15.0%
All shoulder impairment: 15.2%
Granted on the merits
44.4%
Granted ÷ (granted + denied)
Remanded
66.4%
Denied: 18.7%
See all shoulder impairment decisions, direct and secondary.
Shoulder impairment secondary to a knee condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 34 | 14.7% | 38.2% | 41.2% | 5.9% |
| 2018 | 51 | 11.8% | 29.4% | 58.8% | 0.0% |
| 2019 | 46 | 17.4% | 21.7% | 58.7% | 2.2% |
| 2020 | 64 | 7.8% | 15.6% | 76.6% | 0.0% |
| 2021 | 69 | 8.7% | 27.5% | 63.8% | 0.0% |
| 2022 | 62 | 19.4% | 14.5% | 66.1% | 0.0% |
| 2023 | 71 | 11.3% | 14.1% | 74.6% | 0.0% |
| 2024 | 65 | 18.5% | 1.5% | 80.0% | 0.0% |
| 2025 | 51 | 9.8% | 17.6% | 72.5% | 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 Other: dismissed, withdrawn or no clear outcome.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 shoulder impairment decisions
For each kind of supporting evidence: how often the Board granted the shoulder 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 | 67 | 89.5% | 28.3% | +61.2 pts |
| Favorable VA exam | 42 | 72.0% | 38.7% | +33.3 pts |
| Private medical opinion | 134 | 64.0% | 34.0% | +30.0 pts |
| Lay statement | 370 | 43.1% | 71.4% | −28.4 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 78.1% of the decisions that granted shoulder impairment.
- The Board found the veteran's statements credible in 37.5% of grants and 10.0% 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 shoulder 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 |
|---|---|---|---|---|
| Unfavorable VA exam | 363 | 42.4% | 57.9% | −15.5 pts |
| Negative nexus opinion | 311 | 40.2% | 59.4% | −19.2 pts |
How these claims are argued
A secondary claim says a knee condition caused shoulder 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)
4.0%
granted, of 248 issues (46.7% of all)
Causation only
caused by the disability, 3.310(a)
22.3%
granted, of 283 issues (53.3% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Altered gait or overuse Granted “A November 2023 private opinion found it at least as likely as not due to altered gait from the right knee arthritis.” 26001914 (2026) Denied “Shoulder impingement likely due to overuse, not falls.” 23030719 (2023) | 39 | 10.3% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 11.1% of the 531 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 shoulder impairment
Most common reasons in grants
- Caused by the service-connected disability14
- Service connection established6
- Current diagnosis established4
- Granted service connection2
- New and material evidence received2
Most common reasons in denials
- Preponderance of the evidence against the claim14
- No in-service complaints, treatment or diagnosis14
- VA examiner: less likely than not related to service11
- Aggravated by the service-connected disability5
- No current diagnosis5
- Service records negative or silent4
- No continuity of symptomatology3
- Caused by the service-connected disability3
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 shoulder impairment decisions
Granted
Veteran's consistent reports of falls due to knee instability; Early statements predating claim corroborate injury theory; VA opinions inadequate for failing to address Veteran's theory
Private medical opinion found shoulder disability secondary to service-connected lower extremity disabilities.; VA examination was inadequate as it failed to address lay assertions and aggravation.; Resolving doubt in veteran's favor, private opinion deemed sufficient for grant.
Veteran's lay statements of fall injuring shoulder after knee injury are competent and credible; Negative VA opinions failed to address secondary connection theory; Board applied benefit of the doubt and afforded greater probative value to lay statements
Denied
No competent medical opinion linking left shoulder disability to service or left knee disability.; Veteran's lay opinion regarding nexus is not probative.; Lack of credible continuity of symptomatology for shoulder pain.; Duty to provide VA exam not triggered.
Not service connected for the primary right knee condition.; Failed to provide specifics of an in-service event related to the shoulder condition.; Did not meet McLendon test for remand.
Service treatment records did not reflect complaints or treatment for right shoulder disability.; Veteran's statements regarding knee issues causing shoulder pain were found not credible.; June 2025 VA opinion found right shoulder disability less likely than not related to 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 shoulder impairment.
- A knee condition is already service connected.
- Medical evidence linking them (a nexus opinion): shoulder 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
- Hip impairment secondary to a knee condition2,665 decisions · 19.0% granted
- Ankle impairment secondary to a knee condition952 decisions · 15.2% 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
Shoulder impairment secondary to other conditions
See all conditions secondary to a knee condition.
Rules that apply to secondary shoulder 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 shoulder 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 shoulder 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.