One of the most commonly missed VA claims is the hip that went bad because something else already was. A veteran is service connected for a knee, favors it for fifteen years, and the opposite hip wears out. Nobody files for the hip, because it was never injured in service.
Under 38 CFR 3.310 that hip is compensable anyway, if the record establishes the connection.
What secondary service connection requires
Three elements, and the third is where these claims are won or lost.
- A service-connected primary disability - a rated back, knee, ankle, or foot condition
- A current diagnosed hip condition - arthritis, labral tear, bursitis, impingement, or a strain pattern
- Medical evidence that the primary disability caused or aggravated the hip condition, with reasoning
Aggravation matters as much as causation. Where a hip condition existed already and a service-connected disability made it measurably worse, the VA compensates for the degree of aggravation. That is a lower bar than proving the service-connected condition started the hip problem.
Hip secondary to a knee condition
This is the classic altered-gait claim. A painful or unstable knee changes stride length, stance time, and pelvic rotation. Over years, the opposite hip absorbs load it was not built for, and the contralateral hip degenerates faster than the ipsilateral one.
The strongest version of this claim has an observed antalgic gait in the clinical record, imaging showing asymmetric hip changes, and an opinion that explains the biomechanics. Our knee series covers the primary condition, including knee conditions secondary to the back and hip, which is the same mechanism running the other direction.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your condition and your service or an already service-connected disability.
Hip secondary to a lumbar spine condition
A service-connected lumbar spine disability affects the hip in two distinct ways, and they call for different opinions. Mechanically, reduced lumbar motion and paraspinal guarding change pelvic tilt and hip loading. Neurologically, radiculopathy produces pain in the buttock and lateral thigh that is often mistaken for a hip problem, and weakness in the hip abductors that destabilizes the joint.
Distinguishing the two is important. Radicular pain radiating from the spine is rated as a neurological manifestation of the spine disability, not as a separate hip condition, and claiming it as both risks a pyramiding denial under 38 CFR 4.14. Our back series covers the spine ratings and radiculopathy.
Hip secondary to a foot or ankle condition
Plantar fasciitis, pes planus, an ankle fusion, or a foot deformity all change the gait at its foundation, and the hip sits at the top of that chain. These claims work the same way as knee-based claims and are evidenced the same way. Our feet and lower legs series covers the primary conditions.
What a strong opinion looks like
The opinions that fail simply assert that the knee caused the hip. The opinions that work explain the mechanism in clinical terms: the specific gait deviation documented in the record, the altered loading it produces at the hip, the time course over which degeneration would be expected, and why that explanation fits this veteran's imaging better than age alone.
It also has to address the alternatives. Body weight, occupation, civilian sports, and age will all be raised, and an opinion that ignores them is easy for a VA examiner to discount. Our guide to what a nexus letter is describes the format, and our medical evidence guide covers which records support it.
Where to go next
See the hip rating code guide for the percentages a successful secondary claim would produce, and nexus letters and increased ratings for how an added rating claim is supported. The evidence guide covers what to gather.