My knee injury in service was never written up. Can I still get a letter?

It is harder, not impossible. The clinician looks for anything in your records that places the knee problem in service, including later notes that record the history and statements from people who saw the injury. If your records do not support an opinion, the clinician declines and you get your money back.

Not always. An X-ray can confirm arthritis, and many knee diagnoses rest on exam findings. An MRI matters most when the question is a meniscus or ligament injury.

My other knee started hurting after VA connected the first one. Is that a secondary claim?

It can be. A clinician may consider whether favoring the service-connected knee strained the other one, under 38 CFR 3.310, when your records show the change in how you walk or bear weight.

Will a knee DBQ replace my C&P exam?

Not necessarily. VA can accept a private DBQ that is adequate for rating, but it can still schedule its own exam, and VA decides the rating.

A knee nexus letter for your VA claim, built from your imaging and service records

Nexus Letter: $500 flat

Updated October 4, 2026

Commander Health writes knee nexus letters for VA disability claims for a flat $500, clinical review included. A licensed clinician reviews your knee imaging, exam findings and service records and signs only if your records support it. If they do not, the clinician declines and you get your money back. There are no calls or video visits; everything works from your records. VA's public Knee and Lower Leg DBQ can be added for $200, or both for $550.

What the clinician looks for in your knee records

For the $500 fee, the clinician reviews three things for a knee: a current diagnosis, an event or demand in service, and the medical reasoning that connects them. Knee claims usually turn on how well the records document the first two.

A named diagnosis, such as patellofemoral pain syndrome, a meniscus tear, a ligament injury, chondromalacia, or degenerative arthritis. Arthritis needs imaging that shows it; an X-ray report usually covers that.
Imaging reports: X-rays, and an MRI when soft tissue such as a meniscus or ligament is involved, with the dates they were taken.
Range-of-motion findings measured in degrees for bending and straightening the knee, and any notes on instability, locking, swelling or giving way.
Service treatment records of the knee: sick call visits, a twisting or landing injury, physical therapy, a brace, or a profile or limited-duty slip that kept you from running, rucking or jumping.
The physical demands of your job as your records show them, such as airborne duty, long ruck marches, or work on ladders and vehicles.
Notes after discharge showing the knee kept bothering you, which help tie today's diagnosis back to service.

Common service-connection routes for a knee condition

Direct service connection under 38 CFR 3.303 fits when the knee was injured or worn down in service and your records connect that to today's diagnosis. A single documented injury, or repeated treatment for knee pain under heavy physical demands, can each be the starting point.

Secondary service connection under 38 CFR 3.310 covers a knee condition caused by a condition VA already connected. A clinician may consider whether a service-connected ankle, foot, hip or back condition changed the way you walk enough to load the knee abnormally, or whether years of favoring a service-connected knee strained the other one. These routes depend on records that show the altered gait or the favoring, not just the two diagnoses.

Aggravation counts as well: 38 CFR 3.310 also reaches a knee condition that a service-connected condition made worse, even if it did not cause it.

Is there a DBQ for a knee condition?

Yes. VA's public Knee and Lower Leg DBQ covers the knee. Commander Health completes it for $200, or with the nexus letter for $550, and the licensed clinician completes and signs it only when your records hold the findings it asks for, chiefly recent range-of-motion measurements and notes on flare-ups and stability.

A DBQ from records cannot invent a measurement. If your last knee exam did not measure range of motion, the screen says so before you pay, and VA may order its own exam either way.

What it is not

Physical conditions only: Commander Health does not write PTSD or other mental health opinions, or secondary opinions that run through a mental health condition.
Not an exam or an appointment. There are no calls or video visits; the clinician works from your records, and any follow-up comes by email.
Not a filing service. Commander Health does not file claims and is not a VSO, a law firm, or a VA-accredited representative. Free help filing a claim is available from a VA-accredited Veterans Service Organization.
Not a guarantee. Clinical review never guarantees an outcome. A clinician signs only if your records support the opinion, and VA decides the claim.

Frequently asked questions

My knee injury in service was never written up. Can I still get a letter?: It is harder, not impossible. The clinician looks for anything in your records that places the knee problem in service, including later notes that record the history and statements from people who saw the injury. If your records do not support an opinion, the clinician declines and you get your money back.
Do I need an MRI?: Not always. An X-ray can confirm arthritis, and many knee diagnoses rest on exam findings. An MRI matters most when the question is a meniscus or ligament injury.
My other knee started hurting after VA connected the first one. Is that a secondary claim?: It can be. A clinician may consider whether favoring the service-connected knee strained the other one, under 38 CFR 3.310, when your records show the change in how you walk or bear weight.
Will a knee DBQ replace my C&P exam?: Not necessarily. VA can accept a private DBQ that is adequate for rating, but it can still schedule its own exam, and VA decides the rating.