What Veterans Should Know About VA Secondary Service Connection
For many Veterans, the effects of a service-connected disability do not remain isolated to one diagnosis.
A knee injury may change the way you walk and eventually affect another joint. A service-connected condition may require medication that creates additional health problems. A physical disability may contribute to another physical or mental health condition.
When that happens, Veterans sometimes assume the new condition does not qualify for VA disability compensation because it did not begin during military service.
That is not always the case.
VA recognizes what is called secondary service connection. Under federal law, a disability may be service connected when it is caused by, or in certain circumstances aggravated by, a disability that VA has already determined is service connected.¹
The important question is not simply whether you developed another medical condition.
The question is:
Can the evidence establish a legal and medical connection between the new condition and an existing service-connected disability?
That distinction matters.
What Is Secondary Service Connection?
Most Veterans are familiar with direct service connection.
With a direct claim, the Veteran is generally trying to establish a connection between a current disability and an injury, disease, or event that occurred during military service.
A secondary claim works differently.
The Veteran already has at least one service-connected disability. A second condition develops, and the argument is that the existing service-connected disability caused or contributed to the second condition.
VA describes a secondary service-connected claim as a claim for a new disability that is linked to a disability VA has already determined is service connected.²
For example, VA itself uses the example of a Veteran who develops arthritis as a result of a service-connected knee injury.
But secondary claims can arise in many different ways.
The important point is that the second condition does not necessarily have to begin during military service.
Its connection to service may run through the disability that is already service connected.
There Are Two Important Ways a Secondary Claim May Arise
When we review potential secondary conditions, one of the first questions is how the existing service-connected disability affected the new condition.
There are generally two concepts to consider.
The Service-Connected Disability Caused the New Condition
The first is causation.
Federal regulations provide that a disability that is proximately due to or the result of a service-connected disease or injury can itself be service connected.³
In practical terms, that means the evidence needs to support a connection between the existing service-connected disability and the new diagnosis.
That connection should not be assumed simply because two medical conditions exist at the same time.
The relationship between them needs to be supported by the evidence.
The Service-Connected Disability Made Another Condition Worse
Secondary service connection can also involve aggravation.
A Veteran may have a medical condition that was not originally caused by military service, but an existing service-connected disability causes that condition to become more severe.
Federal regulations allow compensation for qualifying increases in severity that are attributable to the service-connected disability rather than the natural progression of the other condition.⁴
This distinction can become important because a claim based on aggravation may require evidence establishing the condition's baseline level of severity as well as evidence showing how it worsened. VA's current adjudication guidance specifically addresses development of baseline evidence in secondary aggravation claims.⁵
That can make an aggravation claim more complicated than simply telling VA, “My service-connected disability makes this condition worse.”
The Medical Connection Often Becomes the Key Issue
Secondary claims frequently turn on the evidence linking the two conditions.
According to VA's current evidence guidance, a Veteran filing a secondary claim generally needs evidence showing:
- A new physical or mental health condition; and
- A connection between that condition and a disability VA has already determined is service connected.⁶
VA explains that medical records or medical opinions are often used to establish that link, although lay evidence may also be relevant in certain circumstances.
This is where Veterans can run into problems.
The medical record may clearly show both conditions, but no doctor has explained whether one caused or aggravated the other.
Or a medical opinion may discuss only whether the second condition was caused by the service-connected disability without addressing whether it was aggravated by it.
Those are different legal theories.
Before filing a secondary claim, we want to understand exactly what relationship the evidence can support.
Do Not Assume VA Will Make the Connection for You
Imagine a Veteran has been service connected for an orthopedic condition for years.
Over time, the Veteran begins experiencing additional symptoms and eventually receives another diagnosis.
The treatment records may document both conditions.
But the existence of those records does not necessarily mean VA will independently determine that the conditions are connected.
VA must evaluate the evidence under the applicable legal standard.
That is why simply listing a new condition on a claim without thinking through the theory of service connection can create problems.
When evaluating a possible secondary claim, Veterans should consider questions such as:
What is the existing service-connected disability?
What is the new diagnosis?
When did the new symptoms begin?
What do the medical records say about the relationship between the two conditions?
Has a medical provider explained whether the service-connected disability caused or aggravated the second condition?
Could medication or treatment for the service-connected disability be relevant?
Does the Veteran's history show a progression that supports the claimed relationship?
Answering those questions before filing can help identify gaps in the evidence.
Your Medical Records Matter
A strong secondary claim often requires looking beyond the Veteran's current diagnosis.
We may want to review records showing:
- When the secondary symptoms began
- How the symptoms progressed
- Treatment for the original service-connected condition
- Medications and their documented effects
- Changes in mobility or physical functioning
- Referrals to specialists
- Diagnostic testing
- Statements from treating physicians
- Prior C&P examinations
- Previous VA decisions involving related conditions
The timeline can be particularly important.
If a Veteran is claiming that a service-connected disability caused another condition, the medical history should be reviewed to determine whether it supports that theory.
For an aggravation claim, earlier records may become even more important because VA regulations address establishing the severity of the condition before the aggravation occurred
Lay Statements May Help Tell the Rest of the Story
Medical records are important, but they do not always capture how a disability affects someone every day.
Veterans may also be able to submit lay evidence.
VA recognizes supporting statements from Veterans and people who know about the Veteran's condition, including family members, friends, and others with firsthand knowledge.⁸
A spouse may have watched a Veteran's mobility steadily decline.
A family member may have observed new limitations that appeared after another service-connected condition worsened.
The Veteran may be able to describe symptoms, when they began, and how they have changed over time.
Lay witnesses generally cannot provide medical conclusions that require professional expertise, but their observations can provide important context when considered with medical evidence.
Be Prepared for a C&P Examination
VA may schedule a Compensation and Pension, or C&P, examination when deciding a secondary claim.
The examiner may be asked to provide an opinion about whether the claimed condition is related to the existing service-connected disability.
This examination can become a critical part of the claim.
Veterans should be prepared to accurately explain:
- When their symptoms began
- How the condition developed
- Relevant treatment history
- How the service-connected disability affects the claimed condition
- Any relevant medication or treatment
- Functional limitations they experience
- This is not the time to exaggerate symptoms.
It is also not the time to minimize them.
The goal is to provide an accurate history so the examiner understands the complete picture.
VA advises Veterans to attend required claim examinations and explains that medical examinations or opinions may be requested when necessary to decide a disability claim.⁹
A Secondary Condition Is Not the Same as an Increased Rating
This distinction is especially important after our discussion last month about increased-rating claims.
An increased-rating claim generally argues:
My already service-connected disability has become more severe.
A secondary service-connected claim generally argues:
My service-connected disability caused or aggravated another disability.
Those are two separate issues.
A Veteran may potentially have both.
For example, the original service-connected condition may have worsened enough to justify an increased rating while also contributing to another condition that may warrant consideration for secondary service connection.
That is why we encourage Veterans to look at the overall disability picture rather than evaluating each symptom in isolation.
What If VA Denied the Secondary Claim?
A denial does not necessarily answer whether a secondary condition can ever be service connected.
The reason for the denial matters.
VA might determine that:
- There is no current diagnosed disability
- The evidence does not establish a connection between the conditions
- A C&P examiner gave an unfavorable medical opinion
- The evidence supports neither causation nor aggravation
- An aggravation claim lacks sufficient evidence concerning baseline severity
- Before choosing the next step, the decision should be reviewed to determine what VA believed was missing.
Depending on the circumstances, the Veteran may have options through a Supplemental Claim, Higher-Level Review, or Board Appeal.¹⁰
The best strategy depends on the problem with the decision.
If evidence is missing, one approach may make sense.
If VA misapplied the law or overlooked evidence already in the record, another may be more appropriate.
That is why simply refiling the same argument after a denial may not solve the underlying problem.
Look at the Full Disability Picture
Military service can have consequences that develop over time.
Sometimes the disability VA originally recognizes is only part of that story.
If you already have a service-connected disability and another medical condition has developed, it may be worth asking whether those conditions are medically and legally connected.
But secondary service connection is not automatic. The diagnosis matters.
The medical history matters.
The evidence linking the conditions matters.
And whether the second condition was caused by or aggravated by the service-connected disability can matter significantly.
At Obsidian Ridge Law, we help Veterans look beyond the name of a diagnosis and understand how the evidence fits within VA law.
We review existing service-connected disabilities, medical records, VA decisions, C&P examinations, and potential secondary conditions to help Veterans understand the strongest path forward.
If you are a Veteran with a service-connected disability and believe it has caused or worsened another condition, schedule a free 15-minute consultation with Obsidian Ridge Law. We can help you understand the evidence, the applicable VA rules, and what options may be available.
¹ 38 C.F.R. § 3.310, Disabilities that are proximately due to, or aggravated by, service-connected disease or injury. The regulation recognizes secondary service connection for qualifying disabilities caused by or aggravated by service-connected diseases or injuries.
² U.S. Department of Veterans Affairs, Types of Disability Claims and When to File. VA describes a secondary service-connected claim as a claim for a new disability linked to a disability VA has already determined is service connected.
³ 38 C.F.R. § 3.310(a). A disability proximately due to or resulting from a service-connected disease or injury may be service connected and treated as part of the original condition.
⁴ 38 C.F.R. § 3.310(b). The regulation addresses an increase in severity of a non-service-connected disease or injury attributable to a service-connected disease or injury and distinguishes such aggravation from the condition's natural progression.
⁵ U.S. Department of Veterans Affairs, M21-1, Part V, Subpart ii, Chapter 2, Section D, Secondary Service Connection and Aggravation of Non-Service-Connected Disabilities. VA's adjudication guidance addresses causation, aggravation, baseline severity, medical opinions, and evaluation of secondary claims.
⁶ U.S. Department of Veterans Affairs, Evidence Needed for Your Disability Claim. VA explains that a secondary service-connected claim generally requires evidence of a new physical or mental condition and evidence linking that condition to an already service-connected disability.
⁷ 38 C.F.R. § 3.310(b); VA, M21-1, Part V, Subpart ii, Chapter 2, Section D. VA's rules and adjudication guidance address establishing a baseline level of severity when secondary service connection is claimed on the basis of aggravation.
⁸ U.S. Department of Veterans Affairs, Evidence Needed for Your Disability Claim. VA recognizes lay evidence, including statements from Veterans and other people with knowledge of the claimed condition, as potential supporting evidence in disability claims.
⁹ U.S. Department of Veterans Affairs, How to File a VA Disability Claim and Standard Disability Claims. VA explains that it may schedule a claim examination or obtain a medical opinion when additional medical information is necessary to decide a claim.
¹⁰ U.S. Department of Veterans Affairs, VA Decision Reviews and Appeals. Veterans who disagree with qualifying VA decisions may have options that include a Supplemental Claim, Higher-Level Review, or appeal to the Board of Veterans' Appeals.
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