When you’re on the path to securing your VA disability benefits, wrapping your head around the concept of an aggravated service connected disability can be a game-changer.
This is especially true if you came into the military with a pre-existing condition that got worse because of your service.
But it doesn’t stop there, it also applies when a service-connected disability makes a new, non-service-connected condition worse.
This is where secondary service connection by aggravation comes into play.
In this blog post, I’ll define service connection by aggravation, explain the two types, how it fits into your VA disability claim, some tips and strategies to prove it to the VA, and why nailing this concept is crucial to getting the benefits you deserve.
Pro Tip: The most important step to strengthen your VA claim for service connection by aggravation is getting a Nexus Letter from a qualified private healthcare provider. It should explain how your military service worsened a pre-existing condition or how a service-connected condition aggravated a non-service-connected disability. A well-documented Nexus Letter can make the difference between approval and denial!
Table of Contents
Summary of Key Points
- Service Connection by Aggravation applies when a pre-existing condition worsens due to military service or a service-connected condition aggravates a non-service-connected disability. It allows veterans to secure VA disability compensation for conditions aggravated beyond their natural progression.
- Proving Aggravation requires medical evidence showing that the condition worsened during service or due to a service-connected condition. Key documents include medical records, a nexus opinion from a healthcare provider, and supporting lay evidence.
- Legal Framework for service connection by aggravation is outlined in 38 U.S.C. § 1153 and 38 CFR § 3.306, which require clear evidence that the worsening of the condition is due to service and not solely the natural progression of the pre-existing condition.
- Common Examples of Aggravation include asthma worsened by service, back pain exacerbated by military duties, and secondary conditions like PTSD aggravating hypertension, providing multiple pathways for veterans to claim service connection by aggravation.
VA Disability Aggravated Service Connection Defined
Service connection via aggravation occurs when a veteran has a pre-existing condition that was present before military service but worsened during their time in the military.
The VA recognizes that while the condition may not have originated from your service, the challenges and stresses of military life can aggravate it.
This worsening, beyond what would be expected from the natural progression of the condition, is what the VA compensates.
Service connection by aggravation also applies when a primary service-connected disability worsens a new condition that wasn’t initially related to your service.
This is known as secondary service connection by aggravation, and it can open additional avenues for VA disability compensation benefits.
The Legal Framework Behind Service Connection by Aggravation
According to 38 U.S.C. § 1153 and 38 CFR § 3.306, service connection by aggravation can be established if the following criteria are met:
- Pre-Existing Condition: You must have clear and unmistakable evidence that the condition existed before your military service. Typically, this is proven through medical records or physical examination reports from the time you entered the military.
- Aggravation of the Condition: The condition must have worsened during your service. Importantly, this worsening must be more than a temporary or intermittent flare-up of symptoms. The VA requires evidence that your service caused the condition to worsen beyond its natural progression.
- No Evidence of Natural Progression: The VA must determine that the worsening wasn’t solely due to the natural course of the pre-existing condition. If the VA concludes that the condition worsened naturally, they may deny service connection by aggravation.
How to Prove VA Service Connection by Aggravation
To secure service connection by aggravation, you need to provide compelling evidence that your military service significantly worsened your pre-existing condition.
Here’s how to strengthen your claim:
- Medical Records from Before and During Service: Provide medical records that detail your condition before you enlisted and how it deteriorated during your service. These might include enlistment exams, in-service medical reports, and post-service evaluations.
- Expert Medical Opinion: A medical nexus opinion from a healthcare provider can be crucial. This opinion should clearly state that it is “at least as likely as not” that your military service aggravated your condition beyond its natural progression.
- Lay Evidence: Statements from fellow service members, friends, or family who witnessed the worsening of your condition during service can support your claim. Their observations can provide context and corroborate your medical evidence.
- Documenting Triggers or Events in Service: Identify specific events or duties during your service that may have triggered or worsened your condition. This could include physical stress, environmental factors, or traumatic incidents documented in your service records.
Examples of Service Connection by Aggravation
Here’s five common examples of service connection by aggravation of a pre-service disability:
- Asthma: If you had asthma before enlisting, but the condition worsened significantly due to harsh environments or physical exertion during service, you could qualify for service connection by aggravation.
- Back Pain: If you had mild back pain before joining the military, but it became severe and debilitating after years of carrying heavy equipment, service connection by aggravation could apply.
- Mental Health Conditions: If you had anxiety or depression before service, and military stressors worsened your condition, leading to a more severe diagnosis, this could also be grounds for service connection by aggravation.
- Flat Feet (Pes Planus): If you had flat feet prior to service and the condition was worsened by extended periods of standing, marching, or other physical activities during service, it could be service-connected by aggravation.
- Knee Problems: If you had a minor knee issue before service and the physical demands of military duty caused it to worsen into chronic pain or instability, this could also qualify for service connection by aggravation.
What is the Presumption of Soundness in VA Disability Claims?
The presumption of soundness is a legal principle that assumes a veteran was in good health when they entered military service, except for any conditions that were noted at the time of their entrance examination.
This presumption can be rebutted if there is clear and unmistakable evidence that a condition existed prior to service and was not aggravated by service.
This is crucial when determining whether a pre-existing condition was worsened by military service, impacting the veteran’s eligibility for service-connected disability benefits.
How Does the VA Determine if a Pre-Existing Condition Was Aggravated by Service?
To establish that a pre-existing condition was aggravated by service, the VA requires evidence that the condition worsened during service beyond its natural progression.
This includes a thorough evaluation of medical records before, during, and after service, as well as expert medical opinions.
If the condition worsened due to service-related activities and not just due to natural progression, the VA may grant service connection by aggravation.
What Role Do Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) Findings Play in Aggravation Claims?
MEB and PEB findings are considered by the VA when assessing whether a condition pre-existed service and whether it was aggravated during service.
However, these findings alone are not sufficient to rebut the presumption of soundness unless they are supported by a comprehensive medical analysis.
The VA cannot deny a claim based solely on MEB or PEB reports without additional supporting evidence.
How Does the VA Handle Flare-Ups of Pre-Existing Conditions in Aggravation Claims?
Temporary or intermittent flare-ups of symptoms of a pre-existing condition are generally not considered sufficient to establish service connection by aggravation.
The VA requires evidence that the underlying condition, not just the symptoms, worsened during service.
If a flare-up leads to a permanent increase in the severity of the condition, then it may be considered aggravation.
What is the Presumption of Aggravation in the Context of Combat Conditions?
For combat veterans, the presumption of aggravation is applied when a pre-existing condition worsens during combat service.
The VA is required to accept satisfactory lay or other evidence of service-related aggravation, even in the absence of official records, if the evidence is consistent with the conditions of combat service.
This presumption can only be rebutted by clear and convincing evidence that the worsening was due to the natural progression of the condition and not due to combat service.
VA Secondary Service Connection by Aggravation
Secondary service connection by aggravation occurs when a service-connected disability aggravates another, separate disability that wasn’t originally related to your service.
The VA acknowledges that the primary service-connected condition has made the secondary condition worse beyond its natural progression, which can entitle you to additional compensation.
Examples of Secondary Service Connection by Aggravation
Here’s five common examples of secondary service connection by aggravation:
- Diabetes and Peripheral Neuropathy: If you have a service-connected diabetes condition that worsens a non-service-connected condition like peripheral neuropathy, leading to significant progression, you could claim secondary service connection by aggravation.
- Knee Injury Leading to Back Problems: If you have a service-connected knee injury and, due to compensatory movements, you develop and worsen a back problem, this could qualify as secondary service connection by aggravation.
- Tinnitus Aggravating Depression: If you are service-connected for tinnitus and the persistent noise worsens an existing, non-service-connected depression, leading to increased severity, you can claim secondary service connection by aggravation.
- PTSD Aggravating Hypertension: If you have service-connected PTSD that aggravates a non-service-connected hypertension condition, making the hypertension worse than its natural progression, this could qualify for secondary service connection by aggravation.
- Foot Condition Aggravating Hip Pain: If a service-connected foot condition, such as flat feet, causes compensatory walking patterns that aggravate a non-service-connected hip condition, leading to further deterioration, you can claim secondary service connection by aggravation.
What is Secondary Service Connection Under 38 CFR 3.310(a) and (b)?
Secondary service connection (SC) under 38 CFR 3.310(a) and (b) applies when a non-service-connected (NSC) disability is either caused or aggravated by an existing service-connected (SC) condition.
This can include disabilities that have worsened due to an SC condition beyond their natural progression.
Notably, a permanent worsening is not required to establish SC by aggravation under these provisions.
What Medical Evidence is Required to Show Aggravation of an NSC Disability by an SC Disability?
To prove that an NSC disability was aggravated by an SC disability, there must be baseline medical evidence showing the severity of the NSC condition before it was aggravated.
This baseline is determined using medical records created either before the onset of aggravation or as soon as possible after aggravation but before the current severity was documented.
Without establishing this baseline, the VA cannot concede aggravation.
How is Causation Established for Secondary Service Connection?
Causation for secondary service connection requires showing that the secondary condition is proximately due to or the result of a primary SC condition.
It is not necessary for the primary condition to have been diagnosed or service-connected at the time the secondary condition arose.
What matters is credible evidence linking the secondary condition to the SC disability.
What Information Must an Examiner Include in a Report for Secondary Service Connection by Aggravation?
The examiner’s report must address the current severity of the NSC disability, provide an opinion on whether the SC disability caused an increase in the severity of the NSC condition, and include a detailed analysis with medical reasoning to support the opinion.
This comprehensive information is critical for the VA to accurately rate a claim for secondary service connection by aggravation.
How is the Extent of Aggravation Determined for an NSC Disability?
The extent of aggravation is determined by comparing the baseline severity of the NSC disability to its current severity.
The VA deducts the baseline severity and any progression that is deemed natural from the current severity to determine how much the SC condition aggravated the NSC disability.
This policy applies even if the NSC disability has a 100 percent evaluation, including temporary evaluations.
Why Service Connection by Aggravation Is Important
Understanding and applying for service connection by aggravation is essential for veterans who had pre-existing conditions before service.
The concept of “aggravation” is also crucial when considering secondary service connection, where a new disability is aggravated by an already service-connected condition.
The VA has a responsibility to compensate for these aggravations, recognizing the impact of military service on your health.
However, the process can be complex, and claims are often denied if not properly substantiated.
By thoroughly documenting your condition before, during, and after service, and by obtaining a strong medical nexus opinion, you can significantly improve your chances of securing the benefits you deserve.
Conclusion & Wrap-Up
Service connection by aggravation is a critical yet often misunderstood component of VA disability benefits.
It ensures that veterans are fairly compensated for conditions that worsened due to their service, even if those conditions weren’t directly caused by their time in uniform.
If you believe your pre-existing condition was aggravated by your service, don’t hesitate to seek the benefits you’re entitled to.
With the right evidence and support, you can successfully navigate the VA claims process and receive the compensation you deserve.
Fellow veterans, remember: YOU SERVED; YOU DESERVE!
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.
