Secondary disabilities may not be the first thing that comes to mind while filing your VA compensation claim, but they can be integral. A secondary disability is when a service-connected disability has caused or aggravates a new or pre-existing condition, illness, or injury.
See our previous blog for a more detailed look at the definition of Secondary Service Connection.
Types of Claims for Secondary Conditions
There are two distinct categories of claims: secondary service connection and secondary service connection by aggravation.
Secondary Service Connection
This means that a service-connected illness or injury caused another illness or injury. For example, diabetes is one of the most common service-connected illnesses.
If a veteran with diabetes develops complications from diabetes such as stroke, kidney failure, peripheral neuropathy, vascular disease, etc., they could then claim those conditions as secondary to a service-connected disability.
There must be evidence that the service connected disability directly caused the secondary illness or injury. So, you cannot claim that diabetes caused Parkinson’s Disease, but you can claim it caused blindness or loss of a limb if you have evidence showing the diagnosis and progression.
Secondary Service by Aggravation
Secondary service by aggravation is a little different in that it is not something that was directly caused by the service-connected illness or injury but was aggravated by it enough that it is now an issue of its own.
An example of this would be that someone has flat feet diagnosed in service and is service connected for that illness. Now, several years later, they are diagnosed with rheumatoid arthritis in their back.
As time goes on, the arthritis progresses to the point where they have to have surgery and possibly assistance walking such as with a cane or walker. While rheumatoid arthritis is genetic, and therefore cannot be service connected; it can be aggravated by the abnormal gait caused by the flat feet condition.
Also, something to note, while the initial service connected disability may have a low rating, the aggravated secondary condition may get a much higher one.
In this case, the flat feet may have only been rated at 0-10% but the debilitating effects of rheumatoid arthritis in the back being aggravated may have now caused loss of independence and could possibly be rated up to 100% or warrant unemployability, aid and attendance, or special adaptive home grants.
Progression
Progression is shown by first having a primary diagnosis that is service connected. Second, you must show treatment for that primary diagnosis and either the onset of the new illness or injury or the aggravation of the existing one.
There must be a diagnosis of the new/aggravated illness or injury before you can file the claim. For example, you can’t file for blindness secondary to diabetes just because you may go blind, only once you have already gone blind.
Having statements from your treating physicians showing how the existing illness/injury caused or aggravated the other will give you the best chance at a positive claim outcome.
Building Your Claim
The most difficult part of proving your claim is connecting your condition to an event or injury in service. Filing for secondary disabilities may help you over this hurdle.
While medical documentation and exams can help you prove service connection, even when it seems impossible. For example, PTSD is a disability that continues to change and affect you in new ways as time goes on. PTSD is not a static disability. This disability can cause many other issues in your life. For example, PTSD can aggravate sleep apnea.
While there has been no event or injury in service that directly caused the development of sleep apnea, when you are service-connected for PTSD, with the correct evidence, you may be awarded disability for your new condition of sleep apnea aggravated by PTSD.
Perhaps the VA has not rated you correctly for the PTSD, but by claiming the additional secondary disability claim of sleep apnea, you may increase your overall rating. As you go through the lengthy appeal process, this may be especially beneficial.
Proving the Connection
The VA usually requires a nexus Letter when granting a secondary service connection, similar to primary service connection. Though the nexus letter will not need to prove the condition is from service itself, it will need to prove the condition is caused or aggravated by the already service-connected disability.
These letters are most often needed from medical professionals to show the connection between the primary and secondary diagnosis. You may still need this nexus letter even if the VA has conceded to the condition being caused/aggravated by your service-connected disability.
The VA has before recognized that sleep apnea can be aggravated by PTSD, but a letter may still be required by a professional making the connection.
When to File
If you have knowledge that a disability may be from your service-connected disability, keep the following in mind for when you want to file for a secondary disability:
- You are showing symptoms of a disability
- Your doctor has mentioned you are more likely to develop a disability
- Others around you have noticed symptoms (snoring while sleeping, for example)
Before you file for a secondary disability, you do not have to be diagnosed with this condition. You will need to be able to show a formal diagnosis and medical treatment for this condition later in the claim for support. For example, if you are having symptoms of sleep apnea or your doctor orders a sleep study, you may consider filing this claim.
If you feel you have a condition, seek treatment for this condition as soon as possible. Having these records and statements from your physician(s) will be a great leg up in creating the nexus letter mentioned earlier. Having this evidence prior to filing will give you the best chance of having your claim resolved as smoothly as possible.
Be sure to let your attorney or representative know if you receive any new diagnosis from your doctor. There may be benefits you are not aware that your representative can assist you with.
Not all Secondary Conditions will Receive a Rating
Oftentimes, because every person is different, someone will develop an illness that may be related to a service-connected disability, but the VA doesn’t award secondary connection for it. This could be the case in such issues as depression caused by diabetes or sleep apnea caused by a spinal condition.
Unless you have a nexus letter from your doctor that can convince the VA of the connection, it is rare that the VA awards secondary service connection for issues that are not normally associated with the service-connected issue. Sometimes, medical personnel can find new and emerging studies and journal articles that can support the connections which will help a claim.
Also, be aware of whether you are claiming that the injury or illness was caused by or aggravated by the service connected disability. If you have a genetic or hereditary issue you can not claim it was caused by the S/C issue, only aggravated.
Note that a simple mistake leads to a claim denial. Then the claim may remain in appeals for years until someone discovers the mistake. Because the claim wasn’t filed correctly, the effective date is delayed. Then the veteran must file a new claim.
Be sure to review this with your representative or attorney when you are filing for secondary issues.
