Secondary service connection
Knee conditions secondary to an ankle condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided knee claimed as secondary to an ankle condition in 1,754 decisions. It granted the issue in 18.3% of them, close to the 19.1% grant rate for all knee issues, denied it in 16.1%, and remanded it in 65.4%. Counting only decisions on the merits, 53.1% were granted.
Decisions
1,754
2017–2026
Granted
18.3%
All knee: 19.1%
Granted on the merits
53.1%
Granted ÷ (granted + denied)
Remanded
65.4%
Denied: 16.1%
See all knee decisions, direct and secondary.
Knee conditions secondary to an ankle condition: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2017 | 122 | 10.7% | 17.2% | 70.5% |
| 2018 | 194 | 15.5% | 25.8% | 58.8% |
| 2019 | 177 | 13.0% | 16.4% | 68.9% |
| 2020 | 207 | 12.6% | 19.8% | 67.6% |
| 2021 | 214 | 10.3% | 15.4% | 74.8% |
| 2022 | 214 | 15.0% | 13.6% | 71.5% |
| 2023 | 216 | 21.3% | 14.4% | 64.4% |
| 2024 | 194 | 28.4% | 8.2% | 63.4% |
| 2025 | 157 | 30.6% | 18.5% | 51.0% |
| 2026 | 59 | 44.1% | 6.8% | 50.8% |
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 | 392 | 87.4% | 24.2% | +63.2 pts |
| Private medical opinion | 663 | 72.2% | 26.3% | +45.9 pts |
| Treating physician opinion | 99 | 81.8% | 49.6% | +32.2 pts |
| Favorable VA exam | 153 | 73.9% | 49.4% | +24.5 pts |
| Buddy statement | 54 | 70.0% | 52.6% | +17.4 pts |
| Combat service | 55 | 68.2% | 52.6% | +15.6 pts |
| Lay statement | 1,467 | 49.5% | 79.5% | −29.9 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 80.4% of the decisions that granted knee.
- The Board found the veteran's statements credible in 30.8% of grants and 13.4% 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 |
|---|---|---|---|---|
| Negative nexus opinion | 1,268 | 51.0% | 62.1% | −11.0 pts |
| Unfavorable VA exam | 1,464 | 51.6% | 67.8% | −16.2 pts |
Why the Board granted or denied knee
Most common reasons in grants
- Caused by the service-connected disability66
- Service connection established37
- Current diagnosis established27
- Aggravated by the service-connected disability17
- Secondary service connection granted5
- VA examiner: less likely than not related to service4
- New and material evidence submitted4
- Private medical opinion found persuasive3
Most common reasons in denials
- VA examiner: less likely than not related to service58
- No in-service complaints, treatment or diagnosis43
- Preponderance of the evidence against the claim31
- Service records negative or silent29
- Aggravated by the service-connected disability15
- No current diagnosis12
- Current diagnosis established10
- Caused by the service-connected disability9
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
Service-connected right ankle condition satisfies first two elements of secondary SC.; Conflicting medical opinions regarding nexus between ankle and knee conditions.; Private opinions found more persuasive than VA opinions.; Evidence found to be in equipoise, conferring benefit of doubt.
Conflicting medical opinions on nexus; Benefit of the doubt applied due to equipoise; Later VA exam found at least as likely as not secondary
Secondary to service-connected left ankle disability; Pain causes functional impairment of earning capacity; Competent lay testimony regarding symptoms and work impact
Denied
Right knee disability not secondary to right ankle disability; Criteria for service connection not met
No service connection for left knee disorder; Claimed as secondary to right ankle disorder; Theory of entitlement raised after initial rating decision
Failure to report for VA examination without good cause.; No competent medical evidence of nexus to service.; Evidence persuasively weighs against causation by in-service locking, toxic exposures, or left ankle disability.
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 an ankle 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.