How the Board ruled on knee claims, 2021–2025

Knee (direct service connection)

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

43.8% granted of 10,080 decided cases (margin of error 42.8–44.7%). 4,411 granted, 5,669 denied, 14,764 sent back to VA (remanded, not decided), 1,687 dismissed.

What convinced the Board in granted cases

• The Board accepted the veteran's credible, consistent account of a knee injury or knee pain in service (parachute jumps, kneeling, ruck marches, falls) that continued after service, sometimes backed by a spouse or a single in-service record. (15 of 18 decisions read; e.g. 21013776, A25007668, A24005264)
• The Board gave little weight to VA opinions that ignored the veteran's account, relied on silent service records or a lack of ongoing treatment instead of ongoing symptoms, or overlooked an in-service knee record. (6 of 18 decisions read; e.g. A24041033, A25018743, 22019028)
• The Board favored private opinions that reviewed the record, noted the in-service knee complaints and duties, and drew on the veteran's history, an exam, or medical literature, over VA opinions that missed those facts. (3 of 18 decisions read; e.g. 24007630, 21008295, 23005927)

Common reasons in denied cases

• The Board denied when service records showed no knee injury, the first knee treatment came many years later, and no medical professional linked the knee to service; the veteran's own view of the cause was not competent medical evidence. (7 of 15 decisions read; e.g. 22046645, A21010678, 22023971)
• The Board relied on thorough VA opinions that reviewed the service and post-service records and explained why an in-service complaint was minor or temporary, or why the long gap or a later work injury pointed elsewhere. (4 of 15 decisions read; e.g. 21018570, A25001736, 21019705)
• The Board found no current knee disability during the claim period. (3 of 15 decisions read; e.g. 23017151, A24034540, A24068637)

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Knee (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

15.4% granted of 52 decided cases (margin of error 8.0–27.5%). 8 granted, 44 denied, 124 sent back to VA (remanded, not decided), 1 dismissed.

What convinced the Board in granted cases

• For Gulf War veterans, the Board granted when knee pain fit the undiagnosed illness or chronic multisymptom illness rules, even where a clinician's negative opinion was given little weight. (2 of 3 decisions read, few decisions; e.g. 23035047, 24015787)

Common reasons in denied cases

• Most denials rested on a VA examiner's opinion, based on the records and an exam, that the knee condition was not caused by service or the exposure, with no medical opinion on the other side. (8 of 14 decisions read; e.g. 21031022, 21036654, 21037614)
• The veteran's own belief that an exposure caused the knee condition was not competent medical evidence, because the cause of a knee condition is a complex medical question. (6 of 14 decisions read; e.g. 22047490, 21010712, 21060042)
• Service records silent for knee problems and long gaps before first treatment weighed against the claims; for Gulf War claims, a known diagnosis ruled out the undiagnosed illness presumption. (6 of 14 decisions read; e.g. 22023915, A25004320, 21062955)

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Knee secondary to any service-connected condition

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

42.9% granted of 1,213 decided cases (margin of error 40.1–45.7%). 520 granted, 693 denied, 2,524 sent back to VA (remanded, not decided), 91 dismissed.

What convinced the Board in granted cases

• The Board credited private or treating doctors' opinions that explained how the service-connected condition changed gait or caused compensation and overload on the knee, based on an accurate history. (5 of 11 decisions read; e.g. A22017183, A24007537, 21007083)
• Opinions against the claim lost weight when they rested on wrong facts, contradicted themselves, ignored the veteran's account of an altered gait, called a treated condition absent, or skipped whether the knee was worsened (aggravation). (6 of 11 decisions read; e.g. 23016126, 24009725, 23047981)
• Credible lay and buddy statements about years of limping or overuse, or continuous knee symptoms, helped the claim, sometimes outweighing VA exam findings. (2 of 11 decisions read, few decisions; e.g. 24009725, 24005884)

Common reasons in denied cases

• The Board relied on reasoned VA opinions, unrebutted, explaining that one joint's disease does not spread to another, that limping can reduce load on the other knee, or that age, work or weight explained the knee. (6 of 13 decisions read; e.g. A25014235, 21044383, 21076098)
• No competent medical opinion linked the knee to the service-connected condition, and the veteran's own belief about cause was not competent medical evidence. (5 of 13 decisions read; e.g. A23015429, A24045990, 21037836)
• Other denials found no current knee diagnosis, a long gap before knee problems, or a veteran's account of an in-service knee injury that was not credible. (5 of 13 decisions read; e.g. A24070808, 21045306, 23025552)

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Knee secondary to the other knee

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

48.9% granted of 401 decided cases (margin of error 44.0–53.8%). 196 granted, 205 denied, 719 sent back to VA (remanded, not decided), 31 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion explained that the service-connected knee caused a limp or overcompensation that strained the other knee, backed by medical literature or sound medical principles. (5 of 12 decisions read; e.g. 22001107, A24045634, A23015293)
• A negative VA opinion lost weight when it never answered the secondary question or aggravation, relied on a lack of documented evidence, ignored the veteran's statements, or came from a one-time exam versus a long-term treating doctor. (5 of 12 decisions read; e.g. A25030851, A25037224, 23011861)
• Some grants also rested on a VA examiner's own favorable opinion about gait changes, or on the veteran's credible, uncontradicted reports of symptoms. (3 of 12 decisions read; e.g. 21006329, 23047243, 21015568)

Common reasons in denied cases

• The Board denied when VA examiners reviewed the records and explained why one knee was unlikely to damage the other, such as no major gait change, and no contrary medical opinion existed beyond the veteran's own view. (7 of 11 decisions read; e.g. 24003215, 22049156, A24049151)
• Some claims failed because there was no current knee diagnosis or no pain causing functional impairment. (3 of 11 decisions read; e.g. A24056623, 21056736, A24034571)
• Other denials pointed to a different cause, such as a work injury, a car accident, or age-appropriate arthritis, along with a long gap after service. (2 of 11 decisions read, few decisions; e.g. 21047682, 21059846)

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Knee secondary to low back (lumbar spine)

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

32.1% granted of 215 decided cases (margin of error 26.2–38.6%). 69 granted, 146 denied, 468 sent back to VA (remanded, not decided), 13 dismissed.

What convinced the Board in granted cases

• Medical opinions or treatment records explained that back pain caused a limp, altered gait, instability or falls that damaged or worsened the knees. (9 of 14 decisions read; e.g. 21070034, A24056179, 23030151)
• VA examiner opinions lost weight when they blamed aging without a real rationale, ignored evidence of altered gait or the veteran's own reports, relied on wrong facts, mixed up the conditions, or did not address worsening. (8 of 14 decisions read; e.g. 21022042, 22030798, 21060080)
• Private or treating-physician opinions were favored when they reviewed the full record, cited medical literature, directly answered the VA opinions, or came from a doctor who had treated the veteran over time. (5 of 14 decisions read; e.g. 21022042, 21070034, A24030561)

Common reasons in denied cases

• The Board relied on VA opinions it found well explained, which said the knee condition was unrelated to the back or followed its natural course, and that disease in one joint does not spread to another. (6 of 11 decisions read; e.g. 22040832, 21062999, 21042920)
• The only support was the veteran's own belief, which the Board found not competent on this medical question; no supporting medical opinion was in the record. (4 of 11 decisions read; e.g. 21005744, 21020194, 22040832)
• The knee problem was tied to a separate post-service injury such as a car accident or work injury, or no current knee disability was diagnosed. (4 of 11 decisions read; e.g. A25035386, 21013791, A24055072)

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Knee secondary to ankle

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

51.1% granted of 133 decided cases (margin of error 42.7–59.5%). 68 granted, 65 denied, 256 sent back to VA (remanded, not decided), 8 dismissed.

What convinced the Board in granted cases

• The Board granted when the evidence showed the ankle condition caused a limp, altered gait, instability, or giving way that put extra strain on the knee or led to a fall. (9 of 19 decisions read; e.g. A21008925, 24001286, 22036265)
• A private or treating clinician's opinion was given more weight than the VA opinion when it reflected a full record review or long-term treatment, an exam, and a clear explanation. (9 of 19 decisions read; e.g. 21048120, 22036265, 24001286)
• Negative VA opinions lost weight when they were conclusory, leaned on missing records, overlooked a diagnosis, gave one rationale for both causation and aggravation, or addressed only direct service. (8 of 19 decisions read; e.g. A24014465, A24020878, A25006310)

Common reasons in denied cases

• The Board denied when a VA opinion with a sufficient rationale found no link and there was no contrary medical opinion; the veteran's own belief did not outweigh it. (8 of 16 decisions read; e.g. A25005708, 22036531, 24031118)
• Examiners found the knee problem came from another cause, such as age-related arthritis, excess weight, or separate knee arthritis, or that any altered gait was not severe enough to cause or worsen the knee. (5 of 16 decisions read; e.g. 22048765, 21076535, 23004864)
• Some claims failed because there was no current knee diagnosis or the ankle itself was not service connected. (3 of 16 decisions read; e.g. 24027653, 23018701, 21040192)

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Knee secondary to foot (flat feet / plantar fasciitis)

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

61.3% granted of 124 decided cases (margin of error 52.5–69.4%). 76 granted, 48 denied, 265 sent back to VA (remanded, not decided), 7 dismissed.

What convinced the Board in granted cases

• The Board credited opinions and credible lay accounts showing the foot condition changed how the veteran walked or stood (altered gait, poor alignment, uneven weight bearing, or falls), which strained or wore down the knees. (9 of 20 decisions read; e.g. 21027687, A25005180, A24049823)
• Private opinions were found at least as persuasive as VA opinions when they explained the foot-to-knee link with a clear rationale, considered the medical history, and in some cases cited studies the VA examiner did not dispute. (7 of 20 decisions read; e.g. 21012246, 21065617, 21011142)
• Negative VA opinions lost weight when they called the foot and knee 'separate joints' without explanation, gave no rationale, mishandled aggravation, or looked only at one injury instead of the overall knee condition. (5 of 20 decisions read; e.g. A25005180, 21027687, 21015163)

Common reasons in denied cases

• A VA opinion with an adequate rationale went unrebutted and tied the knee problem to aging and wear, weight, work, or treated it as a separate condition from the feet. (7 of 15 decisions read; e.g. 21027164, 22020484, 21009812)
• There was no medical opinion supporting the link, only the veteran's own belief, which the Board said required medical expertise about how joints relate. (5 of 15 decisions read; e.g. A24049358, 21072516, 24027270)
• The record undercut the gait theory or pointed elsewhere, such as the veteran denying gait problems during treatment, knee surgeries after work injuries, or an inconsistent account. (3 of 15 decisions read; e.g. A24068899, 21072516, 21021259)

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Knee secondary to hip

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

Small sample: 21 decided cases, too few for a reliable percentage. 3 granted, 18 denied, 59 sent back to VA (remanded, not decided), 3 dismissed.

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Knee secondary to PTSD

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

Small sample: 11 decided cases, too few for a reliable percentage. 5 granted, 6 denied, 31 sent back to VA (remanded, not decided), 2 dismissed.

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Knee secondary to depression / psychiatric disorder

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

Small sample: 11 decided cases, too few for a reliable percentage. 7 granted, 4 denied, 19 sent back to VA (remanded, not decided), 2 dismissed.

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