When veterans seek VA disability benefits, they often think about the direct injuries or conditions that resulted from their military service.
However, it’s essential to understand that VA disabilities connected to service don’t always have to be direct.
Perhaps you have a new disability that’s “proximately due to” or “aggravated by” a current service-connected condition.
This is called secondary service connection.
It’s a critical concept that expands a veteran’s ability to claim benefits by recognizing disabilities that stem from an already service-connected condition.
Let’s explore the definition of secondary service connection, how it works step-by-step, medical evidence requirements, pros tips and strategies, and why it’s vital for veterans seeking comprehensive VA disability compensation.
Table of Contents
Summary of Key Points
- Secondary Service Connection Overview: Secondary service connection occurs when a current service-connected condition causes or aggravates another disability, expanding the scope of VA disability claims. For example, your service-connected knee issues have caused you to develop lower back problems.
- Establishing Secondary Service Connection: Veterans must provide a current diagnosis and medical nexus evidence linking the secondary condition to their primary service-connected condition. This is best done with a strong nexus letter from a private healthcare provider.
- Common Examples: Conditions like headaches secondary to tinnitus or sleep apnea secondary to PTSD are common examples of secondary service-connected disabilities. Here’s a list of the top 100 secondary claims for VA disability.
- Importance of Medical Evidence: Medical records, a nexus letter, and consistent documentation are crucial in proving the relationship between primary and secondary conditions to successfully secure VA benefits. Consider finding medical research reports on PubMed to help explain the connection between your primary and secondary condition.
Understanding Secondary Service Connection
Secondary service connection occurs when a service-connected condition causes or aggravates another disability.
For instance, let’s say a veteran is service-connected for a knee injury.
Over time, this knee injury might cause the veteran to walk differently, leading to back problems.
In this case, the back condition could be claimed as secondary to the service-connected knee injury.
Similarly, if a veteran’s service-connected diabetes leads to peripheral neuropathy, the neuropathy can be claimed as a secondary condition.
The key here is establishing that the secondary condition is either “proximately due to” or aggravated by the primary service-connected condition.
The VA requires clear medical evidence that links the secondary condition to the primary service-connected condition.
Pro Tip: If you’re filing for secondary service connection, a Nexus Letter is highly recommended. Why? Because secondary service connection requires “Medical Nexus Evidence” that your new disability is proximately due to or aggravated by a current service-connected disability.
38 CFR Secondary Service Connection: Legal Definition of Secondary Service Connection to Include Aggravation
According to 38 CFR 3.310(a) and (b), service connection can be granted for disabilities that are either directly caused by or aggravated by a service-connected condition.
This includes:
- Secondary Causation: Where the new secondary disability is proximately due to or the result of a current a service-connected condition.
- Aggravation: When a non-service-connected disability is aggravated (e.g., made worse) by a service-connected disability. It’s important to note that this does not require the aggravation to be permanent.
How to Establish Secondary Service Connection
To establish a secondary service connection, veterans need to provide the VA with two primary pieces of evidence:
- Current Diagnosis: The veteran must have a current diagnosis of the secondary condition. This diagnosis must be documented in a medical record by a qualified medical professional.
- Nexus Evidence Between the Two Conditions: The veteran must provide medical evidence that links the secondary condition to the already service-connected condition. Ideally, you submit a Nexus Letter for a secondary condition that explain how the new disability is proximately due to or aggravated by the primary service-connected condition.
Common Examples of Secondary Service Connected Disability Claims
When a veteran’s primary service-connected disability leads to another condition, they may be eligible for secondary service connection.
Here are five of the most common secondary disabilities veterans experience, and how they relate to primary service-connected conditions:
1. Headaches Secondary to Tinnitus
Tinnitus, a common service-connected condition involving ringing or buzzing in the ears, can lead to frequent and severe headaches. Many veterans report experiencing chronic headaches as a result of constant tinnitus, which can interfere with daily life and overall well-being. If you’re already service-connected for tinnitus and develop headaches as a result, you may be eligible for secondary service connection for this condition.
2. Sleep Apnea Secondary to PTSD
Sleep apnea is another common secondary disability, especially in veterans diagnosed with PTSD (Post-Traumatic Stress Disorder). PTSD can cause issues such as sleep disturbances, nightmares, and heightened stress, which can exacerbate or lead to sleep apnea. Veterans with service-connected PTSD who experience difficulty breathing during sleep or require a CPAP machine may qualify for secondary service connection for sleep apnea.
3. Depression Secondary to Chronic Pain
Chronic pain conditions, often stemming from service-connected musculoskeletal injuries or other medical issues, can lead to mental health challenges like depression. Veterans suffering from constant pain may develop depression due to the toll that ongoing physical limitations take on their quality of life. If your chronic pain is service-connected, depression can be claimed as a secondary condition.
4. Radiculopathy Secondary to Back Conditions
Radiculopathy, which involves nerve pain that radiates from the spine to the limbs, is frequently secondary to service-connected back conditions such as degenerative disc disease or herniated discs. Veterans who experience shooting pain, numbness, or weakness in their legs or arms due to a spinal issue may be eligible for secondary service connection for radiculopathy.
5. Gastroesophageal Reflux Disease (GERD) Secondary to Medication Side Effects
Veterans taking medications for service-connected conditions like pain or mental health disorders may develop GERD (acid reflux) as a side effect. Common medications such as NSAIDs or antidepressants can irritate the stomach lining and lead to GERD. If your service-connected condition requires medication that causes GERD, you can apply for secondary service connection for this condition.
Pro Tips and Strategies for VA Secondary Service Connection
Navigating the complexities of secondary service connection claims can be challenging, but here are some pro tips and strategies to help you succeed:
Ensure Consistent Medical Documentation
Ensure that your medical records clearly document the development of your secondary condition over time. Regularly follow up with your healthcare provider, and make sure your condition is fully documented in your VA and private medical records. Consistent and detailed documentation is key to proving the secondary connection and securing your benefits.
Get a Nexus Letter from a Private Healthcare Provider
Getting a detailed nexus letter from a private healthcare provider is one of the most critical actions you can take to establish secondary service connection. This letter should explain how your secondary disability is linked to your primary service-connected condition. To bolster your claim, ensure the letter includes a solid medical rationale and specific references to your condition.
Consider Getting a Disability Benefits Questionnaire (DBQ)
A Disability Benefits Questionnaire (DBQ) is a form that helps document your condition in detail. Having your private healthcare provider complete a DBQ can provide the VA with the specific medical information it needs to evaluate your secondary condition. This can speed up the claims process and give the VA a clearer picture of your disability. If you submit a DBQ and a nexus letter together at claim submission, it’s possible to get your VA claim approved without a C&P exam.
Submit Personal Statements in Support of Your Claim
Your personal statements about how your secondary condition affects your daily life can provide crucial context. Be specific about the symptoms you experience and how they have developed due to your primary service-connected disability. This testimony can strengthen your claim and demonstrate the real impact of your condition.
Why Secondary Service Connection is Important
Secondary service connection claims are vital because they acknowledge the ongoing and often interconnected nature of health issues that arise from military service.
Veterans may suffer from cascading health problems that start with a service-connected condition and lead to additional disabilities.
By claiming secondary conditions, veterans can receive compensation that reflects the full scope of their disabilities, leading to more comprehensive benefits and better access to healthcare.
Conclusion & Wrap-Up
Secondary service connection is an essential aspect of the VA disability claims process that can help veterans secure the benefits they need for conditions related to their service-connected disabilities.
By understanding how secondary service connection works and using the strategies outlined above, veterans can strengthen their claims and ensure they receive the compensation they deserve.
If you’re dealing with a secondary condition, take the time to gather the necessary evidence, work with your healthcare providers, and don’t hesitate to seek expert advice to navigate the claims process successfully.
Secondary Service Connection and VA Claims: Frequently Asked Questions (FAQs)
What is Secondary Service Connection?
Secondary service connection refers to a disability that is caused or aggravated by an existing service-connected condition. For example, if you have a service-connected knee injury that alters your gait and later causes back problems, the back condition could be considered secondarily connected to the knee injury.
How Do I Establish Secondary Service Connection?
To establish secondary service connection, you must provide medical evidence showing that your secondary condition is “proximately due to” or directly caused by your primary service-connected condition. This usually involves a medical diagnosis of the secondary condition and a nexus letter or medical opinion linking the secondary condition to the service-connected disability.
What Kind of Medical Evidence is Needed for a Secondary Service Connection Claim?
You will need a current diagnosis of the secondary condition, along with a medical opinion or nexus letter from a healthcare provider that clearly links the secondary condition to your primary service-connected condition. The medical evidence should explain how the primary condition caused or aggravated the secondary condition.
Can Mental Health Conditions Be Considered for Secondary Service Connection?
Yes, mental health conditions can be considered for secondary service connection. For instance, if you have a service-connected physical disability that leads to depression or anxiety, these mental health conditions may be secondarily service-connected.
What is Aggravation in the Context of Secondary Service Connection?
Aggravation refers to the worsening of a non-service-connected (NSC) condition due to a service-connected (SC) condition. To receive secondary service connection on the basis of aggravation, you must provide evidence showing that your SC condition has made the NSC condition worse beyond its natural progression.
How is the Baseline Severity of a Condition Established in Aggravation Claims?
The baseline severity of a condition is established using medical evidence that shows the level of severity before the condition was aggravated by the SC condition. This evidence is crucial for the VA to determine the extent of aggravation and calculate the appropriate disability rating.
What Role Does a Nexus Letter Play in Secondary Service Connection Claims?
A nexus letter is a medical opinion that directly links your secondary condition to your primary service-connected condition. It is a critical piece of evidence in secondary service connection claims, as it provides the necessary medical rationale to establish the causal relationship required by the VA.
Can I Claim Secondary Service Connection for Conditions Caused by Medications?
Yes, conditions that arise as side effects of medications prescribed for a service-connected condition can be claimed as secondary conditions. For example, if you develop gastrointestinal issues due to medications prescribed for a service-connected condition, these issues can be claimed as secondary service-connected disabilities.
What Happens If My Secondary Service Connection Claim is Denied?
If your secondary service connection claim is denied, you have the option to appeal the decision. During the appeal, you can submit additional medical evidence or a more detailed nexus letter to strengthen your case. If you didn’t have a nexus letter for a secondary condition when the VA denied your claim, we highly recommend you get one and submit a Supplemental Claim.
Can a Secondary Condition Be Service-Connected If the Primary Condition Was Not Diagnosed at the Time?
Yes, a secondary condition can be service-connected even if the primary condition was not formally diagnosed at the time the secondary condition developed. The key is to establish a medical link between the secondary condition and the primary service-connected condition, regardless of when the primary condition was diagnosed. Note: we recommend having the primary condition already service-connected and the secondary condition medically diagnosed before filing for secondary service connection.
Does the Secondary Condition Have to Be Diagnosed at the Same Time as the Primary Condition?
No, the secondary condition does not need to be diagnosed at the same time as the primary condition. What matters is that the secondary condition is medically linked to the service-connected condition, even if it is diagnosed later.
What Is the Difference Between Direct and Secondary Service Connection?
Direct service connection refers to disabilities directly caused by military service, while secondary service connection refers to disabilities that result from a condition that is already service-connected. Both require medical evidence, but secondary service connection specifically focuses on the relationship between the primary service-connected condition and the new secondary condition.
Can I Receive Compensation for Both the Primary and Secondary Conditions?
Yes, if you are granted secondary service connection, you can receive compensation for both the primary and secondary conditions. The VA will assign a separate disability rating for the secondary condition based on its severity.
How Does the VA Rate Secondary Conditions?
The VA rates secondary conditions using the same criteria as primary service-connected conditions, according to the VA’s Schedule for Rating Disabilities from 0% to 100% in increments of 10%. The rating is based on the severity of the secondary condition and its impact on your ability to function.
Is There a Time Limit for Filing a Secondary Service Connection Claim?
There is no specific time limit for filing a secondary service connection claim. However, it is in your best interest to file as soon as possible after the secondary condition develops to ensure that you receive the maximum benefits available.
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.
