The VA uses the term nexus to describe the connection between a veteran’s in-service injury or illness to their current disability, and there are 5 ways in which to establish service connection: direct service connection, service connection through aggravation, presumptive service connection, secondary service connection, and service connection for injuries cause by VA health care.
- Direct service connection – A veteran must show, through their military or service medical records, that he or she presently suffers from a chronic condition that began during service. An example of this is an ulcer. The veteran doesn’t have to show that he/she has suffered constantly from the condition since service. They only have to be show there was a pattern of suffering after service, and that it is currently a problem. A doctor may not necessarily have treated them, although, this is probably preferable to the veteran claiming he/she treated the condition at home. The VA has to consider testimony from friends and family members about the veteran’s symptoms. This testimony, along with the veteran’s own testimony, may be enough to prove the ongoing symptoms of the particular disability. To successfully win a claim, though, a veteran will likely need a medical opinion to establish a link (nexus) to his/her current condition.
- Service Connection Through Aggravation – A veteran can get service connection for a disability that existed before service, but was aggravated while in service. Unless the veteran’s entrance exam says otherwise, the VA must presume that the veteran was of sound mind and body when he/she entered the service. This is called presumption of soundness. If there was not a disability present upon the entrance exam, then the VA must prove that the condition existed prior to service. If there was a preexisting condition mentioned on the entrance exam and it got worse during service, then the veteran can still get it service connected.
- Presumptive Service Connection – There is a presumptive period of time after service when an illness or disease appears. When this happens, the VA will assume these are service connected, as long as the veteran can show the disease or illness was severe enough to warrant a compensable disability evaluation. Eligibility for presumptive service connection requires the veteran to have served on active duty for at least 90 continuous days.
- Secondary Service Connection – This is granted if a service-connected disability aggravates a non service-connected disability worse. The more common type of secondary service connection is where a service-connected disability causes another disability. An example of this would be a case of a veteran’s diabetes causing his/her peripheral neuropathy. Another example would a veteran’s service-connected back ailment or injury causing radiculopathy, or the same back ailment or injury leading to knee problems.
- Service Connection Based on VA Medical Care – Often times, an injury or aggravation can be caused by poor care and treatment by VA hospitalization, VA medical or surgical treatment, VA exams, or VA vocational rehabilitation, and can be service-connected. If a veteran dies due to VA health care, eligible survivors can receive certain VA benefits.
In most or all of the ways a veteran can receive service connected disability benefits, it is vital to the success of the claimant to have a physician’s medical opinion, that “it is more likely than not” the injury or illness was incurred or aggravated during active service.