A Lower Back Condition Claimed as Secondary to Your Knee

Step 3 of the method is secondary conditions. A secondary condition is one that grew out of a condition the VA already rates.

A lower back condition claimed as secondary to a knee is one of those claims. In the Board of Veterans' Appeals decisions we have indexed since 2019, it shows up in 1,785 issues.

Already rated for a knee? Add it to the free Claim Map to see the conditions the Board has seen claimed with a knee.

What a secondary claim needs

Here's the rule on secondary conditions, starting in the middle of its first sentence.

… disability which is proximately due to or the result of a service-connected disease or injury shall be service connected.

Proximately due to means the first condition led to the second. Three things have to be in your file. A diagnosis of the back condition. A knee that is already service connected. And a medical opinion tying the one to the other that says why.

If your knee isn't service connected yet, there's nothing for the back to attach to. That isn't a reason to wait. File both, and say in writing that the back is claimed as secondary to the knee.

The same rule holds a second route, aggravation, for a back condition you already had that the knee made worse. It needs a baseline, which is medical evidence of how bad the back was before the knee started making it worse. Or it's the earliest record after that and before the evidence of how bad it is now. Without a baseline, the VA will not concede aggravation. The first route doesn't need one.

What a doctor would have to find

A claim here needs a doctor to find that the knee changed how you walk, which led to or worsened the back condition. It isn't a finding of ours. Whether it's true for you is a question for your doctor.

An opinion that only says the two are connected leaves the rater nothing to weigh. Ask your doctor for the reasoning. How it happened in you, and what in your records shows it. The phrase to ask for is at least as likely as not. Step 1 covers that letter and the records that go with it.

How the lower back is rated

One formula covers nearly every back diagnosis. Lumbosacral strain (code 5237), degenerative arthritis and degenerative disc disease (5242) and intervertebral disc syndrome (5243) all run through it. The name of the diagnosis doesn't change the math.

The formula measures forward flexion, which is how far you can bend forward at the waist. For the thoracolumbar spine, meaning the middle and lower back, normal is zero to 90 degrees. Every measurement is rounded to the nearest five degrees.

If you can bend forward more than 60 degrees but not past 85, that is 10. More than 30 but not past 60 is 20. Thirty degrees or less is 40. Those are percentages. A back fixed in one position is called ankylosis. That runs from 40 to 100, depending on how much of the spine is fixed and how.

The 20 step can be reached without a tape measure. It also reads

… muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis

Guarding is tensing to protect the back. An abnormal gait is a changed walk. If your knee changed how you walk, ask that the examiner write down what they see when you walk.

The Claim Map lists these codes with their rating steps. Choose the lower back to find them.

Nerve pain down the leg is rated on its own

The spine formula carries a note.

Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

Separately means its own rating, on top of the back rating. Sciatica or numbness running down a leg from a back condition isn't folded into the back percentage. Claim it by name. Nerve damage in the legs and feet walks through those nerve codes. How the VA combines ratings shows what a second rating does to your number.

Disc syndrome has a second formula, built on incapacitating episodes. An episode means bed rest prescribed by a physician, with treatment by a physician. A bad week you handled at home isn't one. At least one week in the past 12 months is 10, and at least six weeks is 60. The rater uses whichever formula gives the higher result.

Pain that limits you counts

A separate rule in the rating schedule says this.

It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.

Minimum compensable means the lowest rating above zero, which is 10 for the back. At the exam, say where in the movement the pain starts and where you stop.

What our counts show

This pairing has its own page of Board counts, lower back conditions secondary to knee conditions. Since 2019 the Board granted 236 of these issues and denied 310, which is 43 percent granted of the ones it decided.

It sent 1,155 back for more work, which is 65 percent of the 1,785. A remand isn't a yes and it isn't a no. The claim goes back to the regional office for a new exam or a missing record, then gets decided again.

Across every year we have indexed, the pairing runs to 7,153 issues, 36 percent granted of the ones decided and 55 percent sent back.

The claim the other way round, a knee claimed as secondary to a back condition, comes up far less. Since 2019 it appears in 1,086 issues, 27 percent granted of the ones decided.

Two things those counts are not. Every decision counted here is an appeal, so the regional office decided the claim first and the veteran disagreed. These are not the odds on a first claim. And past decisions don't predict yours. A Board decision binds only the case it decided.

One more count, off the lower back page. Across every year we have indexed, 70 percent of granted issues and 68 percent of denied ones sit in decisions that mention a medical opinion. A mention is not a reason for the outcome. The first condition has its own page, knee.

The written playbook gives up to eight of your main conditions a chapter each. A chapter has the rating ladder and what the Board granted and denied in cases like yours. See what the playbook covers.

What to do

1. Send VA an intent to file first. If your complete claim reaches VA within a year of it, VA counts the claim as filed on the day the intent to file arrived. It doesn't have to name a condition, so you don't need the diagnosis or the opinion to send it. It doesn't work for a supplemental claim, where you add evidence and ask VA to decide again.
2. Get the back diagnosis in writing, by name. If you've had an X-ray or an MRI, short for magnetic resonance imaging, ask for the report.
3. Check that your knee is service connected. If it is, name it in the claim as the condition the back is secondary to.
4. Ask for the range of motion numbers from your exam, and what the examiner wrote about your walk.
5. Say what you've lost, not only what you feel. What you can't lift, how far you can walk.
6. File the claim with all of it attached, within a year of your intent to file.

The nine steps lays out the rest. I'm not your representative.