Secondary service connection
Knee conditions secondary to flat feet: BVA grant rates and what wins
From 2018 to 2026, the Board of Veterans' Appeals decided knee claimed as secondary to flat feet in 754 decisions. It granted the issue in 24.8% of them, above the 19.6% grant rate for all knee issues, denied it in 14.1%, and remanded it in 61.4%. Counting only decisions on the merits, 63.8% were granted.
Decisions
754
2018–2026
Granted
24.8%
All knee: 19.6%
Granted on the merits
63.8%
Granted ÷ (granted + denied)
Remanded
61.4%
Denied: 14.1%
See all knee decisions, direct and secondary.
Knee conditions secondary to flat feet: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2018 | 78 | 28.2% | 15.4% | 59.0% |
| 2019 | 76 | 26.3% | 7.9% | 63.2% |
| 2020 | 100 | 18.0% | 16.0% | 66.0% |
| 2021 | 100 | 19.0% | 17.0% | 66.0% |
| 2022 | 108 | 20.4% | 15.7% | 63.9% |
| 2023 | 92 | 25.0% | 14.1% | 62.0% |
| 2024 | 94 | 24.5% | 16.0% | 58.5% |
| 2025 | 74 | 33.8% | 8.1% | 58.1% |
| 2026 | 32 | 46.9% | 12.5% | 40.6% |
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 | 200 | 93.0% | 36.0% | +57.0 pts |
| Private medical opinion | 280 | 80.2% | 43.5% | +36.7 pts |
| Treating physician opinion | 49 | 85.7% | 60.9% | +24.9 pts |
| Favorable VA exam | 93 | 82.8% | 59.1% | +23.6 pts |
| Lay statement | 608 | 57.8% | 89.3% | −31.5 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 81.3% of the decisions that granted knee.
- The Board found the veteran's statements credible in 24.1% of grants and 8.5% 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 | 636 | 63.3% | 67.6% | −4.3 pts |
| Negative nexus opinion | 543 | 60.5% | 74.3% | −13.7 pts |
Why the Board granted or denied knee
Most common reasons in grants
- Caused by the service-connected disability31
- Current diagnosis established28
- Service connection established19
- Aggravated by the service-connected disability7
- New and material evidence received to reopen claim3
- VA examiner: less likely than not related to service3
- Secondary to bilateral pes planus2
- In-service injury documented2
Most common reasons in denials
- No in-service complaints, treatment or diagnosis18
- Service records negative or silent14
- VA examiner: less likely than not related to service14
- Preponderance of the evidence against the claim13
- Aggravated by the service-connected disability7
- No current diagnosis7
- No continuity of symptomatology4
- Current diagnosis established3
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 opinion linked knee condition to altered gait from pes planus; VA opinion found less than likelihood of service connection; Evidence found evenly balanced, benefit of doubt applied
Private opinion linked in-service injury to current conditions; Evidence in equipoise; Benefit of doubt applied in Veteran's favor
Favorable secondary opinion from February 2024 examiner.; Opinion cited change in biomechanics due to flatfoot severity causing knee disability.; No opposing secondary opinion found.
Denied
VA opinions found knee strain less likely than not related to pes planus; VA opinions attributed knee strain to obesity and natural aging; Private opinion deemed inadequate due to lack of supporting medical reasons
Evidence persuasively weighs against service connection; Evidence persuasively weighs against secondary connection to pes planus
Service treatment records are silent for knee pain complaints or diagnosis.; Post-service treatment records are silent for a specific knee diagnosis.; VA examiner found bilateral knee pain less likely than not caused by service.; Private opinion did not adequately address lack of in-service treatment or provide strong nexus.; Veteran's lay statements lacked credibility due to inconsistencies.
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 flat feet, 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.