Secondary service connection
Knee conditions secondary to a back condition: BVA grant rates and what wins
From 2018 to 2026, the Board of Veterans' Appeals decided knee claimed as secondary to a back condition in 2,065 decisions. It granted the issue in 12.4% of them, below the 19.6% grant rate for all knee issues, denied it in 19.6%, and remanded it in 67.3%. Counting only decisions on the merits, 38.9% were granted.
Decisions
2,065
2018–2026
Granted
12.4%
All knee: 19.6%
Granted on the merits
38.9%
Granted ÷ (granted + denied)
Remanded
67.3%
Denied: 19.6%
See all knee decisions, direct and secondary.
Knee conditions secondary to a back condition: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2018 | 211 | 8.5% | 30.8% | 59.7% |
| 2019 | 225 | 10.2% | 17.3% | 72.4% |
| 2020 | 277 | 11.2% | 21.3% | 65.7% |
| 2021 | 275 | 7.3% | 28.4% | 65.1% |
| 2022 | 277 | 10.8% | 13.4% | 74.4% |
| 2023 | 282 | 13.8% | 17.4% | 67.7% |
| 2024 | 234 | 15.0% | 13.7% | 70.9% |
| 2025 | 190 | 21.6% | 18.9% | 58.9% |
| 2026 | 94 | 21.3% | 9.6% | 68.1% |
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 | 387 | 83.4% | 17.1% | +66.3 pts |
| Favorable VA exam | 209 | 73.3% | 32.4% | +41.0 pts |
| Private medical opinion | 653 | 57.2% | 23.2% | +34.0 pts |
| Treating physician opinion | 104 | 61.1% | 36.9% | +24.2 pts |
| Lay statement | 1,721 | 34.6% | 70.0% | −35.4 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 78.2% of the decisions that granted knee.
- The Board found the veteran's statements credible in 27.6% of grants and 11.1% 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 |
|---|---|---|---|---|
| Unfavorable VA exam | 1,717 | 36.6% | 54.8% | −18.2 pts |
| Negative nexus opinion | 1,446 | 34.7% | 53.8% | −19.1 pts |
Why the Board granted or denied knee
Most common reasons in grants
- Caused by the service-connected disability63
- Current diagnosis established28
- Service connection established19
- Aggravated by the service-connected disability15
- Continuity of symptomatology since service4
- Criteria for service connection met4
- New and material evidence received to reopen claim3
- Criteria for secondary service connection met3
Most common reasons in denials
- No in-service complaints, treatment or diagnosis77
- VA examiner: less likely than not related to service75
- Service records negative or silent43
- Preponderance of the evidence against the claim36
- Aggravated by the service-connected disability31
- No current diagnosis25
- Caused by the service-connected disability16
- No continuity of symptomatology15
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
Private medical opinion provided favorable nexus; Equipoise resolved in Veteran's favor; Secondary to service-connected lumbar spine disability
Favorable finding by RO adopted by Board; Secondary to service-connected lumbar spine disability
Private medical opinion found right knee osteoarthritis secondary to altered biomechanics from service-connected lumbar spine, left knee, and bilateral plantar fasciitis.; Opinion cited medical literature supporting the link between gait disturbances and adjacent joint stress.; Veteran diagnosed with right knee osteoarthritis; no in-service complaints noted.
Denied
Isolated in-service treatment for left knee pain with no further documentation or diagnosis.; March 2017 VA examiner opinion found less likely than not related to service.; Examiner noted mild degenerative arthritis consistent with aging/occupation.; Examiner attributed symptoms to low back disorder and radiculopathy.
No in-service complaints, treatment, or diagnosis of left knee disorder in STRs.; Separation exam showed no left knee issues; veteran denied relevant symptoms.; VA addendum opinion found osteoarthritis less likely than not due to service-connected back disability.
Service treatment records normal for left knee.; No in-service complaints or treatment for left knee.; Post-service treatment began over 40 years after service.; VA examiners opined less likely than not related to service.; Private opinions given minimal weight due to lack of in-service nexus and post-service delay.
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 a back 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 (2018–2026) and can contain errors. It is updated automatically as new decisions are added.