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Let’s clear this up fast: VA did not eliminate secondary claims.
Anything you read or hear to the contrary is false.
What actually happened is this: On May 1, 2026, the VA updated the M21-1 to reflect Spicer v. McDonough, a major Federal Circuit case about secondary service connection.
The big change is simple:
- The VA can no longer look only at whether your service-connected condition directly caused another condition from scratch.
- The VA must also consider whether your service-connected disability caused the condition, aggravated it, delayed treatment, prevented treatment, interfered with treatment, or made it worse than it otherwise would have been.
For secondary aggravation and treatment-interference claims, the key Spicer question is: Would this condition be less severe today BUT FOR your service-connected disability?
That is the core Spicer issue.
Secondary claims are not dead.
But vague, unsupported secondary claims could be easier for VA to deny.
Okay, let’s explore what did and didn’t happen because of Spicer.
Summary of Key Points
- VA did not eliminate secondary claims. Veterans can still win secondary service connection when a condition is caused by, the result of, or aggravated by an already service-connected disability.
- Spicer changed the VA’s causation analysis — not the standard of proof. “At least as likely as not” still applies. But the VA must consider whether the claimed condition would not have occurred, or would be less severe today, but for the veteran’s service-connected disability.
- Treatment interference can matter. A service-connected condition may support a secondary claim if it delayed treatment, prevented surgery, limited care options, interfered with treatment, or blocked recovery.
- Nexus letters are now even more important. A strong nexus letter should identify the exact secondary theory and explain the medical bridge: Did the service-connected condition cause the disability, aggravate it, interfere with treatment, or make it worse than it otherwise would have been?
Table of Contents
BLUF: From VA Disability Expert Brian Reese
The VA did not eliminate secondary claims.
And Spicer v. McDonough did not eliminate the “at least as likely as not” standard.
Under 38 C.F.R. § 3.310, a condition can still be service connected if it is caused by or aggravated by an already service-connected disability.
Here’s the key:
- “At least as likely as not” is still the standard of proof.
- “But for” is the causation question VA must consider, especially in secondary aggravation and treatment-interference cases after Spicer.
For secondary causation, the question is:
“Is it at least as likely as not that the service-connected disability caused the claimed condition?”
For secondary aggravation, the better Spicer question is:
“Is it at least as likely as not that the claimed condition would be less severe today BUT FOR the service-connected disability?”
That can include cases where the service-connected condition delayed treatment, prevented surgery, interfered with care, caused medication side effects, or blocked recovery.
Pro Tip: A strong secondary nexus letter should answer the right question: causation, aggravation, or both.
What Actually Happened in Spicer v. McDonough
Veteran Luther Spicer was service connected for leukemia.
He also had severe arthritis in both knees.
He needed knee replacement surgery.
But his leukemia medication lowered his red blood cell level, making surgery unsafe.
Because he had to stay on the medication for life, he likely could not get the surgery at all.
So he argued: My service-connected leukemia treatment prevented my knee surgery, and because I could not get surgery, my knees are worse today than they otherwise would have been.
The VA denied him.
The Board denied him.
The Veterans Court agreed with the VA.
But the Federal Circuit said the VA used too narrow of a standard.
What Spicer Changed
1. VA Must Use “But-For” Causation
The Court said VA must apply what’s called “but-for” causation.
Here’s what it means: But for the service-connected disability, would the second condition be less severe today?
That is different from asking only: Did the service-connected disability directly cause the second condition?
In Spicer, leukemia did not cause the knee arthritis.
But leukemia treatment prevented surgery that could have improved the knees.
That mattered.
2. Treatment Interference Can Matter
This is the big one.
VA’s May 1, 2026 M21-1 update now says secondary aggravation can include cases where a service-connected disability interfered with or impeded treatment for a non-service-connected disability.
That means a veteran may have a valid secondary claim if a service-connected condition:
- Prevented surgery
- Delayed treatment
- Limited treatment options
- Made recovery harder
- Kept another condition from improving
- Made another condition worse than it otherwise would have been
3. Permanent Worsening Is Not Required
VA’s updated M21-1 says permanent worsening is not required to establish secondary service connection based on aggravation.
This matters because veterans often see C&P exam language like: “No permanent aggravation beyond natural progression.”
That may not answer the right question anymore.
The better question is: Would the condition be less severe today “but for” the service-connected disability?
4. Natural Progression Is Not the Same Escape Hatch
Natural progression did not disappear from VA claims.
But after Spicer, VA should not use “natural progression” as an automatic escape hatch to deny secondary aggravation.
VA may still look at baseline severity and how much the condition worsened.
But the key question is simple:
Would the condition be less severe today but for the service-connected disability?
5. VA Also Updated Its DBQ Guidance for Aggravation
VA also updated its Medical Opinion DBQ guidance after Spicer and Allen.
This matters because a negative secondary opinion should not always end the analysis.
If a VA examiner says your claimed condition was not caused by your service-connected disability, VA may still need the examiner to answer a second question:
Was the claimed condition aggravated by the service-connected disability?
For example, “not caused by” is not always the same as “not worsened by.”
That matters for veterans.
A condition might not be directly caused by a service-connected disability, but it could still be aggravated by it, made harder to treat, kept from improving, or made worse than it otherwise would have been.
Pro Tip: If VA denies your secondary claim based only on a “not caused by” opinion, check whether the examiner also addressed aggravation.
What Spicer Did NOT Change
1. It Did Not Eliminate Secondary Claims
This is the biggest myth.
VA’s updated guidance still says to award secondary service connection when a disability is the result of, or would not have occurred but for, a service-connected disability.
So no—secondary claims are not gone.
2. It Did Not Make Every Secondary Claim an Automatic Win
The Spicer decision is a powerful one.
But it is not a magic bullet.
For secondary claims:
- You still need medical evidence.
- You still need a current disability.
- You still need a service-connected primary disability.
- You still need a medical nexus connecting the two.
3. It Did Not Remove the Baseline Requirement for Aggravation Claims
For secondary aggravation claims, VA still wants a baseline.
That means evidence showing how bad the condition was before the service-connected disability made it worse.
VA says the baseline is needed to determine what part of the current disability resulted from the service-connected condition.
4. It Did Not Mean “Just Say Secondary”
A veteran cannot simply say: “My condition is secondary.”
That is too vague.
VA’s exam guidance says the threshold for ordering an exam is low, but a generalized statement alone is not enough.
Veterans need evidence of a current disability or symptoms, an already service-connected disability, and some indication that the claimed condition may be associated with or aggravated by the service-connected disability.
Translation: Tell the VA exactly what happened.
Myths and Truths
Myth #1: VA eliminated secondary claims.
Truth: False.
Secondary claims are still alive.
Myth #2: Spicer means every secondary claim wins.
Truth: False.
You still need medical evidence and a strong nexus connecting the current service-connected disability to the new secondary disability.
Myth #3: The service-connected condition must directly cause the second condition.
Truth: Not always.
The question may be whether the secondary (new) condition would be less severe but for the service-connected condition.
Myth #4: Permanent worsening is required.
Truth: No.
VA says permanent worsening is not required for secondary aggravation.
Myth #5: Vague claims are good enough.
Truth: No.
Specific wins.
Vague loses.
Easy Examples for Veterans
Example #1: Cancer Treatment Prevents Surgery
A veteran is service connected for cancer.
Cancer medication makes surgery unsafe.
The veteran cannot get knee surgery.
The knee condition stays severe.
Possible theory: But for the cancer treatment, the veteran could have had surgery, and the knee condition would be less severe.
Example #2: Diabetes Delays Surgery
A veteran is service connected for diabetes.
Diabetes creates wound-healing or infection risk.
A needed surgery gets delayed.
The condition worsens.
Possible theory: But for diabetes, the veteran would have received treatment sooner, and the condition would be less severe.
Example #3: PTSD Interferes With Treatment
A veteran is service connected for PTSD.
PTSD causes panic, avoidance, missed appointments, or inability to complete treatment.
Another condition gets worse.
Possible theory: But for PTSD, the veteran could have better followed treatment, and the second condition would be less severe.
Example #4: Back Pain Causes Weight Gain, Then Another Condition
A veteran is service connected for a back condition.
The back condition limits exercise.
The veteran becomes obese.
The obesity contributes to sleep apnea, hypertension, or joint problems.
VA says obesity is not a stand-alone VA disability, but it can be an intermediate step between a service-connected disability and another disability.
Example #5: Medication Side Effects Create a Chain Reaction
A veteran takes medication for a service-connected condition.
The medication causes dizziness, weight gain, GERD, fatigue, or sexual dysfunction.
That creates or worsens another disability.
Possible theory: But for treatment of the service-connected condition, the second condition would not have developed or would be less severe.
Pro Tips and Strategies
Pro Tip #1: Do Not File a Lazy Secondary Claim
Do not just write:
“My knee condition is secondary to leukemia.”
Write:
“My service-connected leukemia treatment prevented knee replacement surgery, and because treatment was prevented, my current knee disability is worse than it otherwise would have been.”
That is much stronger.
For more information, read How to File a Secondary VA Claim Online.
Pro Tip #2: Build the Bridge
VA needs the bridge.
Explain how the service-connected condition negatively affected the new secondary condition.
Did it delay treatment?
Prevent surgery?
Limit medication options?
Stop physical therapy?
Cause missed appointments?
Prevent exercise?
Make recovery harder?
Tell the story clearly.
Pro Tip #3: Get the Nexus Opinion Right
A strong medical nexus opinion should identify the exact secondary theory and answer the right question.
For causation:
“It is at least as likely as not that the veteran’s claimed condition is proximately due to or the result of the veteran’s service-connected condition.”
For aggravation or treatment interference:
“It is at least as likely as not that the veteran’s claimed condition was aggravated by, or would be less severe today but for, the veteran’s service-connected condition, including because the service-connected condition delayed, prevented, limited, or interfered with treatment.”
A negative causation opinion does not automatically answer aggravation.
A strong medical opinion should address both when the facts support both theories.
Pro Tip #4: Show the Baseline
For aggravation claims, show how bad the condition was before it got worse.
Use medical records, imaging, treatment notes, private records, C&P exams, or lay statements.
Pro Tip #5: Be Specific
Specific wins.
Vague loses.
Do not make VA guess.
Conclusion and Wrap-Up
Here’s the bottom line:
VA did not eliminate secondary claims.
What changed is VA’s causation analysis for secondary claims—not the veteran-friendly standard of proof.
After Spicer and the May 1, 2026 M21-1 update, VA must recognize that a service-connected disability can matter even when it did not directly cause another condition from scratch.
A service-connected disability can still support a secondary claim if it caused, worsened, delayed treatment for, prevented treatment for, interfered with treatment for, or blocked improvement of another condition.
But the claim still needs evidence.
It still needs a medical bridge.
It still needs a strong nexus.
So do not stop with one question:
“Did my service-connected condition cause this?”
Also ask:
“Was this condition aggravated by my service-connected disability?”
And for treatment-interference or aggravation claims:
“Would this condition be less severe today but for my service-connected disability?”
That is the core Spicer question.
And for many veterans, that may be the missing link.
Frequently Asked Questions
Did VA eliminate secondary claims?
No. VA did not eliminate secondary claims.
Secondary service connection still exists under 38 C.F.R. § 3.310.
A disability can still be service connected if it is caused by, the result of, or aggravated by an already service-connected condition.
The real change is not that secondary claims are gone.
The real change is that veterans need to be more specific and better supported with evidence.
What changed on May 1, 2026?
On May 1, 2026, VA updated the M21-1 to reflect Spicer v. McDonough and the broader but-for causation standard.
This matters because VA now recognizes that a secondary condition may qualify if it:
Was caused by a service-connected disability.
Was made worse by a service-connected disability.
Would have been less severe but for a service-connected disability.
Was worsened because a service-connected disability delayed, prevented, or interfered with treatment.
That is the big update.
What does “but-for causation” mean?
“But-for causation” means VA should ask:
Would this disability have happened—or would it be this bad today—but for the veteran’s service-connected condition?
In plain English, the service-connected condition does not always have to directly cause the second condition from scratch.
It can also matter if it made the condition worse, delayed treatment, prevented surgery, limited recovery, or created a chain reaction.
That is the heart of Spicer.
Does Spicer mean my claim automatically wins?
No.
Spicer gives veterans a stronger legal pathway, but it does not guarantee approval.
You still need:
A current disability or symptoms.
An already service-connected primary condition.
A clear medical bridge between the two.
A strong nexus opinion.
For aggravation claims, evidence showing the baseline level of severity before the worsening.
The law may open the door, but evidence gets the claim through it.
What is the biggest mistake veterans make with secondary claims?
The biggest mistake is being too vague.
Do not just say:
“My condition is secondary.”
That is usually not enough.
Instead, explain exactly what happened:
“My service-connected condition caused, worsened, delayed treatment for, prevented treatment for, or blocked improvement of my second condition.”
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The Quality Assurance (QA) team at VA Claims Insider has extensive experience researching, fact-checking, and ensuring accuracy in all produced content. The QA team consists of individuals with specialized knowledge in the VA disability claims adjudication processes, laws and regulations, and they understand the needs of our target audience. Any changes or suggestions the QA team makes are thoroughly reviewed and incorporated into the content by our writers and creators.
About The Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
