Home › Conditions › Secondary claims › Knee & Hip Conditions ← Flat Feet
A secondary claim is a condition caused or worsened by one the VA has already service-connected (38 CFR 3.310). The causation fight is already half-won — the VA agreed your flat feet came from service; the question is only whether it caused or aggravated the knee & hip conditions. That's a medical question with a recognized answer.
The connection
Altered biomechanics travel up the chain: flat feet or plantar fasciitis change how you stand and stride, and years of that altered gait load the knees, hips, and low back abnormally. Podiatric and orthopedic literature both document the cascade — which is why a service-connected foot condition so often anchors claims for everything above it.
How the VA rates knee & hip conditions
DC 5257 — Knee, other impairment of (instability)
| Rating | Criteria (38 CFR Part 4 wording) |
|---|---|
| 30% | Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (cane, crutch, walker) and bracing for ambulation |
| 20% | Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability with a prescribed brace and/or assistive device; or unrepaired/failed repair of a complete tear with a prescribed assistive device or bracing |
| 10% | Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription for an assistive device or bracing |
Patellar instability has its own 10/20/30 ladder keyed to recurrent instability after surgical repair and whether a brace, cane or walker is prescribed.
Full criteria, exam and evidence guide: VA rating for Knee, Hip and Shoulder Conditions. And the anchor: VA rating for Plantar Fasciitis and Flat Feet.
What the claim needs — the three legs
- The anchor: service connection for the flat feet (see how that condition is rated). Not connected yet? File both in the same claim — the VA decides the anchor first, then the secondary against it.
- A current diagnosis of knee & hip conditions — the VA rates diagnosed conditions. If you only have the symptoms, file them anyway: the C&P exam supplies the diagnosis, and a "no diagnosis" denial is repaired with a supplemental claim that keeps your date.
- The medical link. An opinion stating it is "at least as likely as not" that the flat feet caused or aggravated the knee & hip conditions. The VA's own C&P examiner supplies this free in most cases; your own doctor can too. A paid independent opinion is the answer to a denial, not the first move.
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See If You Qualify →Frequently asked questions
Can I claim knee & hip conditions secondary to flat feet?
Yes, if three things hold: the flat feet (or its equivalent) is service-connected, you have a current diagnosis of knee & hip conditions, and a medical opinion connects the two. The connection described on this page is a recognized pathway raters see regularly.
Do I need to pay for a nexus letter for knee & hip conditions secondary to flat feet?
Usually not. The VA's own C&P examiner can supply the connecting opinion at your exam for free, and your own treating doctor can also provide it. A paid independent opinion is worth buying only after a denial for lack of nexus — a supplemental claim within one year keeps the original effective date.
What if the primary condition isn't service-connected yet?
File them together in the same claim. The VA decides the primary first and then the secondary against it in the same decision; a secondary filed alone against a condition the VA has not connected fails. Filing both at once under one Intent to File protects the effective date for both.
Last reviewed 2026-09-19.