Knee conditions: what the Board looked for

Why knee claims get denied

We read 125 knee denials from the 1,721 Board rulings in our 2022 to 2026 study. The main reason the Board gave:

• 32% The Board found the VA’s own exam or opinion more convincing (40 of 125)
• 26% No current knee diagnosis (32 of 125)
• 17% No knee injury or event in service on record (21 of 125)
• 9% Nothing in the file linked the knee condition to service (11 of 125)
• 6% A long gap after service, with nothing to bridge it (7 of 125)
• 4% The link to another service-connected condition wasn’t supported (5 of 125)

The Board also often said the veteran’s own view of the cause wasn’t medical evidence (89 of the 125) and noted a long gap after service (79). It found the link to another service-connected condition unsupported in 28, and faulted private opinions for giving no reasoning in 16 and for a wrong history in 13.

Counts come from what the Board wrote in each decision. None were Anchorpoint cases. How we counted

Where the VA exam and private letters fell short

These come from the decisions themselves.

• The VA exam blames age or weight, or calls knee pain in service a short-term problem that went away.
• The VA exam misses a key record, like knee complaints on your separation exam.
• When one knee is claimed as caused by the other knee, or by a back or ankle condition, the VA exam asks only “did it cause it?” and skips “did it make it worse?”
• Private letters fall short when they give a bare conclusion, skip normal knee exams and later knee injuries, or rely on general statements that soldiers get hurt.

What the Board looked for

“Probative” is the Board’s word for convincing.

What the opinions that won had in common

In 68 grants, the Board credited a veteran’s private medical opinion. Here is how often the Board said that opinion:

• 78% Explained its medical reasoning (53 of 68)
• 62% Used the VA’s standard, “at least as likely as not” (42 of 68)
• 54% Showed the clinician reviewed the records (37 of 68)
• 50% Named the clinician’s profession or specialty (34 of 68)
• 50% Considered the veteran’s own account (34 of 68)
• 34% Came from a clinician who examined or interviewed the veteran (23 of 68)
• 32% Cited medical studies (22 of 68)
• 15% Took on the VA examiner’s opinion (10 of 68)
• 5 of 28 Addressed whether a service-connected condition made it worse (secondary claims only)

Counts come from what the Board wrote in each decision. None were Anchorpoint cases. How we counted

What a strong nexus letter for a knee condition does

From the opinions the Board found convincing:

• Points to the exact service records: the injury, sick call visits, profiles, the separation exam.
• Explains how that injury or condition became what you have now, such as cartilage damage turning into arthritis.
• Deals with what came after: normal exams, later injuries, weight, age, and work.
• If another service-connected condition changed how you walk, explains that change and covers both “caused” and “made worse.”
• Cites studies and ties them to your knee.
• Uses the VA’s standard, “at least as likely as not,” which means a 50 percent or better chance.