How the Board ruled on hip claims, 2021–2025

Hip (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

37.1% granted of 3,064 decided cases (margin of error 35.4–38.9%). 1,138 granted, 1,926 denied, 5,038 sent back to VA (remanded, not decided), 625 dismissed.

What convinced the Board in granted cases

• The Board gave little or no weight to negative VA opinions that relied on missing records without the veteran's account, used too strict a standard, copied an old template, or skipped aggravation. (5 of 10 decisions read; e.g. 21026068, A21010280, A24014786)
• The Board accepted credible statements from the veteran and fellow service members describing an in-service hip injury and symptoms that continued after service. (5 of 10 decisions read; e.g. 21006542, A22015500, 22022569)
• A favorable medical opinion carried weight when it reviewed the record, gave supporting reasons or medical research, or came from a treating doctor who knew the history. (4 of 10 decisions read; e.g. 21020697, A21010280, A24026420)

Common reasons in denied cases

• The most common reason for denial was no current hip diagnosis; reported pain alone, without a diagnosed condition or functional loss, was not enough. (5 of 12 decisions read; e.g. A24032975, A22017214, 23056226)
• Claims failed when no medical opinion linked the hip to service and only the veteran's own belief about the cause was offered, which was not competent medical evidence. (4 of 12 decisions read; e.g. 21023022, 21069708, 22051779)
• The Board denied when VA examiners gave reasoned opinions against a link, based on the record and medical literature, with no comparable opinion on the other side. (2 of 12 decisions read, few decisions; e.g. 23010935, 21018924)

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Hip secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

43.7% granted of 782 decided cases (margin of error 40.3–47.2%). 342 granted, 440 denied, 1,682 sent back to VA (remanded, not decided), 50 dismissed.

What convinced the Board in granted cases

• The Board granted when a private or VA medical opinion explained how a service-connected knee, ankle, or back condition caused hip problems, such as through altered gait or extra strain, using an accurate history and literature. (6 of 11 decisions read; e.g. A24041400, 21016868, 23035952)
• Negative VA opinions lost weight when they skipped aggravation or the secondary theory, relied on missing records, or ignored the veteran's reports of limping or hip pain. (5 of 11 decisions read; e.g. 21016193, 21020992, A25006310)
• The veteran's credible statements about hip pain from compensating for a service-connected condition also supported grants. (3 of 11 decisions read; e.g. 21060493, 21020992, A21009089)

Common reasons in denied cases

• No persuasive medical opinion supported a link: VA opinions against went unrebutted, the veteran's belief was not competent, and private notes were tentative or showed no record review. (6 of 10 decisions read; e.g. 22002664, 21007958, 21023187)
• Another cause or timing problem was found, such as a post-service fall or back injury, or hip problems first appearing many years after normal service records. (4 of 10 decisions read; e.g. 21009381, 21064294, 22053135)

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Hip secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

34.7% granted of 199 decided cases (margin of error 28.4–41.5%). 69 granted, 130 denied, 439 sent back to VA (remanded, not decided), 5 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion explained how the back condition affected the hip, such as an altered gait, weight shifting, strain passed along the leg, or limited activity leading to weight gain. (5 of 20 decisions read; e.g. 23000795, A23000571, A24045411)
• A negative VA opinion lost weight when it was conclusory, wrongly said there was no current hip disability, skipped the secondary question, ignored the veteran's own reports, or leaned only on a lack of records. (6 of 20 decisions read; e.g. A24013003, 23051418, A23000571)
• A private or treating clinician's opinion was given more weight than the VA opinion when it gave clear reasons, relied on an accurate history, and sometimes cited medical literature. (5 of 20 decisions read; e.g. A23026606, A23021955, 22030798)

Common reasons in denied cases

• The Board denied when a VA examiner explained that the hip problem was a separate condition (for example, bursitis or arthritis that develops on its own, or no gait abnormality found) and no medical opinion said otherwise. (9 of 14 decisions read; e.g. 21055879, 22017293, 23003712)
• The veteran's own belief, or a report that a doctor had told him the back caused the hip, was not enough without a medical opinion that explained why. (6 of 14 decisions read; e.g. 21024948, 21062999, 22040832)
• Some claims failed because the record did not show a current hip disability or hip pain that limited the ability to work. (5 of 14 decisions read; e.g. A24042641, A25013461, 21060102)

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Hip secondary to knee

Secondary (caused or worsened by a service-connected condition)

57.1% granted of 189 decided cases (margin of error 50.0–64.0%). 108 granted, 81 denied, 441 sent back to VA (remanded, not decided), 19 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion explained that the knee condition caused a limp or altered gait that put extra load on the hip, often backed by medical literature. (6 of 17 decisions read; e.g. A25014482, 23025134, 22016683)
• A private opinion was given more weight than the VA opinion when it cited medical literature, reflected a full review of the record or long-term treatment, and fit the veteran's credible reports. (7 of 17 decisions read; e.g. A24062050, 23025134, A25014482)
• A negative VA opinion lost weight when it did not address aggravation, gave a direct-service answer to a secondary question, relied on a lack of records, addressed an outdated diagnosis, or contradicted itself. (8 of 17 decisions read; e.g. A25026701, 24030127, 21020992)

Common reasons in denied cases

• The Board denied when a VA examiner gave a complete, reasoned opinion against a link and no medical opinion of comparable quality supported the claim. (12 of 15 decisions read; e.g. A24046955, 21032638, 21071763)
• Examiners found the hip problem was better explained by other causes, such as aging, wear and tear, arthritis that started before the knee problem, or no meaningful change in gait. (5 of 15 decisions read; e.g. A24046955, 21071763, 24002532)
• Some claims failed because there was no current hip diagnosis, and the veteran's own view of the cause was not treated as medical evidence. (3 of 15 decisions read; e.g. 23015383, 21040892, 24009383)

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Hip secondary to foot (flat feet / plantar fasciitis)

Secondary (caused or worsened by a service-connected condition)

40.6% granted of 64 decided cases (margin of error 29.5–52.9%). 26 granted, 38 denied, 119 sent back to VA (remanded, not decided), 2 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion explained how the foot condition altered gait or biomechanics and so strained the hips, based on an accurate history. (5 of 13 decisions read; e.g. A24047447, 23041851, 21015163)
• Negative VA opinions lost weight when they were conclusory, missed the altered-gait theory, addressed only causation and not aggravation, or said an answer would be speculation. (4 of 13 decisions read; e.g. A25008596, A24055543, 21015163)
• Private physician opinions linking the hips to the feet were weighed favorably, sometimes against negative VA opinions. (3 of 13 decisions read; e.g. A24017457, 21015163, 24015189)

Common reasons in denied cases

• The Board denied when a VA opinion with a clear rationale, based on the record and examination, found no causation or aggravation and was not outweighed. (7 of 15 decisions read; e.g. 22002328, 21046740, 22025541)
• There was no competent medical opinion linking the hip to the feet; the veteran's own belief was not enough. (4 of 15 decisions read; e.g. 21003139, 24004390, A21009014)
• Other denials found no current hip disability at all during the claim. (3 of 15 decisions read; e.g. 22042090, 23030166, 21036926)

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Hip secondary to ankle

Secondary (caused or worsened by a service-connected condition)

52.8% granted of 53 decided cases (margin of error 39.7–65.6%). 28 granted, 25 denied, 85 sent back to VA (remanded, not decided), 3 dismissed.

What convinced the Board in granted cases

• The Board gave more weight to private medical opinions that reviewed the full history, examined the veteran, and clearly explained how the ankle condition caused altered gait and compensation that led to or worsened the hip problem. (7 of 14 decisions read; e.g. A24045411, A24055021, A25000809)
• VA opinions against the claim lost weight when they relied only on a lack of records, skipped whether the ankle worsened the hip, missed an existing diagnosis, or ignored the veteran's report of limping. (4 of 14 decisions read; e.g. A25006772, 21015163, A25012973)
• Some grants rested on a favorable VA opinion, such as one finding the veteran compensated for the ankle injury, or that ankle limits on activity led to weight gain that harmed the hip. (3 of 14 decisions read; e.g. A25006772, A24067302, 22048839)

Common reasons in denied cases

• A thorough VA opinion, often citing medical literature, found no link because there was no significant or long-lasting change in gait, or because disease in one joint does not spread to another, and nothing rebutted it. (10 of 14 decisions read; e.g. A23016956, A21002415, 21061598)
• The only evidence of a link was the veteran's own belief, which the Board did not accept as competent medical evidence; one claim also lacked a current hip diagnosis. (4 of 14 decisions read; e.g. A25025956, 22036531, 24027653)
• Where the hip was also claimed as directly related to service, normal separation exams and long gaps before treatment weighed against it, and a private opinion that ignored the gap got little weight. (3 of 14 decisions read; e.g. 23003873, 21038793, 21034504)

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Hip secondary to the other hip

Secondary (caused or worsened by a service-connected condition)

54.5% granted of 33 decided cases (margin of error 38.0–70.2%). 18 granted, 15 denied, 52 sent back to VA (remanded, not decided), 4 dismissed.

What convinced the Board in granted cases

• The Board gave more weight to private opinions that reviewed the records and explained how a bad hip or knee changes gait and loads the other joint, often citing medical literature. (5 of 13 decisions read; e.g. A24003003, A22015922, A24021775)
• Negative VA opinions lost weight when they skipped in-service records, lay statements, or earlier opinions, relied on inaccurate facts, or did not account for the full record. (5 of 13 decisions read; e.g. A24003003, 21045032, 21026507)
• The Board credited veterans' own testimony about hip pain since service or about overcompensating on the other hip because of the service-connected one. (3 of 13 decisions read; e.g. 23035306, 21026507, A24003003)

Common reasons in denied cases

• A thorough VA opinion against the claim, based on a full record review with a clear rationale, went unrebutted by any other medical opinion. (4 of 10 decisions read; e.g. 22025010, 21038083, 21028214)
• The veteran's own belief that one hip caused the other was not competent medical evidence of cause. (3 of 10 decisions read; e.g. 21038083, 21008236, 21028214)
• Other denials rested on no current hip diagnosis, the first hip not being service-connected, or a long gap after service with no continuity of symptoms. (4 of 10 decisions read; e.g. 24015830, 21022828, 21069501)

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Hip secondary to radiculopathy / peripheral neuropathy

Secondary (caused or worsened by a service-connected condition)

Small sample: 11 decided cases, too few for a reliable percentage. 0 granted, 11 denied, 16 sent back to VA (remanded, not decided), 1 dismissed.

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