Hip claims secondary to a knee condition: Board grants more than doubled since 2018

The Board of Veterans' Appeals has granted hip impairment claimed as secondary to a knee condition far more often in recent years. In 2018 and 2019, it granted the claim in 12.4% of its decisions on the issue. In 2024 and 2025, it granted 29.3%, a share that rose 16.9 percentage points.

The figures come from 2,669 Board decisions from 2017 to 2026 on a hip condition claimed under 38 CFR 3.310 as secondary to a service-connected knee. Across all years, the Board granted 19.0%, denied 17.9% and remanded 63.0%. That grant share sits 3.2 percentage points above the 15.8% granted across all hip impairment decisions, direct and secondary.

Share of decisions each year. 2026 is a partial year.

Remands still dominate

Most of these appeals go back for more development. The remand share was 62.6% in 2018 and 2019 and 60.6% in 2024 and 2025, barely changed. It peaked at 70.2% in 2023, then fell to 56.4% in 2025 and 49.2% in 2026 so far.

The bigger shift is in the decisions the Board resolved. Leaving remands out, it granted 33.5% on the merits in 2018 and 2019 and 74.1% in 2024 and 2025. The yearly grant share climbed from 11.4% in 2020 to 33.0% in 2025, and stands at 36.9% in 2026 so far. The data does not show why.

Opinions track with outcomes

The medical opinion in the record lines up closely with how the Board ruled. With a positive nexus opinion linking the hip to the knee, the Board granted on the merits in 86.6% of decisions; without one, 23.1%.

Other favorable evidence showed a similar pattern. Records with a treating physician opinion were granted on the merits in 80.4%, against 48.1% without one. A private medical opinion went with 70.4%, against 28.5%. A favorable VA exam went with 74.7%, against 46.3%.

Unfavorable evidence did not end these claims. With a negative nexus opinion in the record, the merits grant share was still 49.0%; with an unfavorable VA exam, 49.9%. Records with a lay statement were granted on the merits in 46.6%, below the 75.3% for records without one. The data does not explain that gap.

In the recordNot in the record

Positive nexus opinion

86.6%

23.1%

Private medical opinion

70.4%

28.5%

Treating physician opinion

80.4%

48.1%

Favorable VA exam

74.7%

46.3%

Merits decisions only (granted or denied). Associations, not causes.

These are associations, not causes. A record with a strong opinion may be stronger in other ways too.

What the decisions say

In denials, the most cited reason was a VA examiner finding the hip "less likely than not related to service", in 92 decisions. Next came "no in-service complaints, treatment or diagnosis", in 84, a reason that speaks to direct service connection rather than the knee link. "Preponderance of the evidence against the claim" appeared in 63.

In grants, the Board most often found the hip "caused by the service-connected disability", in 103 decisions. It cited "current diagnosis established" in 63 and "service connection established" in 58. The Board applied the benefit of the doubt under 38 CFR 3.102 in 78.5% of grants.

Read the decisions

Recent examples, with the Board's reasons as summarized by AI:

• A26037582, granted in 2026: secondary to service-connected right knee disability.
• A26037367, granted in 2026: private opinion cited "knee-hip-spine syndrome" and multi-causal links.
• A26034668, granted in 2026: private medical opinion found left hip secondary to service-connected back and bilateral knee conditions.
• A26035224, denied in 2026: no in-service onset.
• A26032527, denied in 2026: no objective findings of functional impairment.
• A26025527, denied in 2026: no evidence of current disability for right hip.

For representatives

• A positive nexus opinion tying the hip to the knee went with a merits grant share of 86.6%, against 23.1% without one. A treating or private physician opinion showed a similar pattern.
• The VA examiner's negative opinion is the most cited reason for denial. Check whether it addresses both causation and aggravation under 38 CFR 3.310, not only in-service history.
• Because the Board applied the benefit of the doubt in 78.5% of grants, a record that brings the evidence into approximate balance can matter even when a negative opinion is present.