There are five main methods that are used to establish service connection: direct service connection, service connection through aggravation, presumptive service connection, secondary service connection, and service connection for injuries caused by VA health care. We will discuss each of these in turn.
Direct service connection is the most common way that a veteran is able to establish service connection for his or her disability. Using this method, the veteran must show, typically through service medical records, that he or she currently suffers from a disability that began during service. A medical opinion from a doctor which states that it is as likely as not that the current disability is linked to service, which is supported by reason and references the veteran’s medical record, is very helpful due to the requirement that the VA give a veteran the benefit of the doubt if there is equal evidence for both sides.
The second way that service connection can be established is by service connection through aggravation. Under this theory, a veteran can be awarded service connection for a preexisting condition that was noted in his or her military entrance examination and that was aggravated during service, unless the VA is able to show that the condition is worsening because of the natural progression of the disease. The veteran must show that the aggravation of the condition is a non-temporary increase in the severity of the underlying condition. Again, the best evidence for this type of service connection is a medical opinion from a doctor which states that the aggravation of the condition was caused by service and not by the natural progression of the disease.
Service connection can also be established by presumptive service connection. There are some disabilities that are presumed to be service connected under certain circumstances. These disabilities must appear within a certain period of time, which ranges from one year to any time after service depending on the disability, and some require the veteran to have served for a specific length of time, during a specific time period, or at a specific location. There are special rules for a presumptive service connection for Agent Orange exposure and Gulf War veterans. In order to establish a presumptive service connection, it is necessary to show that either the disability was diagnosed during the presumptive period or that symptoms of the disability manifested during that time, even if the diagnosis did not come until years later. A medical opinion from a doctor which states that the symptoms during the presumptive period were a manifestation of the disability is essential, especially when combined with lay evidence from friends or family establishing that they observed such symptoms during that time period.
The fourth way that service connection can be established is through secondary service connection. This is applicable where a service-connected disability causes an additional disability or aggravates a non-service-connected disability. Secondary service connection can also be awarded due to “paired organs,” such as eyes, kidneys, ears, hands and feet, and lungs. Again, a medical opinion from a doctor linking the two disabilities is the best evidence for this type of service connection.
The fifth way that service connection can be established is through service connection based on VA medical care. This type of service connection exists where there has been an injury or aggravation to an injury caused by VA hospitalization, VA medical surgery or treatment, a VA exam, or VA vocational rehabilitation. With this type of service connection, the veteran (or eligible survivors if the veteran died as a result of VA medical care) can receive compensation benefits through a section 1151 claim or may pursue an action under the Federal Tort Claims Act.