Whenever you see that the VA has denied your claim for a condition that pre-existed prior to service, you should see a red flag. Often, this decision signals that the VA has made an error in deciding your claim by misapplying the law.
Sometimes, if a veteran’s condition is preexisting and was not aggravated by the veteran’s time in service, the VA is well within the letter of the law to deny that claim. However, the law is written in favor of granting the benefits and denying for preexisting conditions is not an easy case for the VA to make.
What Does the VA Consider a Pre-Existing Condition?
A pre-existing condition is any injury, illness, or medical condition you had before entering military service. It doesn’t matter whether it was formally diagnosed or not. A condition noted at your entry medical exam is clearly pre-existing. However, if you had symptoms or treatment for a condition but it wasn’t noted on your entry exam, the VA will still investigate whether your condition pre-existed your service.
The VA is perfectly within its rights to deny service connection if a disease or disability actually did exist prior to entry into the military (sometimes this is noted in the file as EPTE—existing prior to entrance) and was not worsened by the veteran’s service. But this isn’t something that can be done lightly. The law is written to favor the veteran.
To start with, veterans are entitled to a presumption of soundness. This means that unless the veteran’s entrance examination into the military specifically notes that there is a pre-existing condition, VA must presume that the veteran did not have a pre-existing condition. If the veteran then develops a disability or disease during service, VA must presume that the condition is service-connected unless VA can show evidence that it is not.
It’s important to know that in this situation, where there is no notation of a pre-existing condition on entrance but the veteran develops one during service, the veteran is not required to prove the origins of that disability.
Once the presumption of soundness attaches to a case, the burden is not on the veteran to prove he or she was in sound condition when entering service, the burden is on the VA to prove that he or she was NOT in sound condition. And unlike the standard for evidence supplied by the veteran, where the veteran only has to show that something is 50/50 or “as likely as not,” the VA has to provide evidence that is “clear and unmistakable,” about which there can be no debate.
In other words, if there is evidence to support a finding that the condition pre-existed service, along with other evidence that shows that the condition did NOT pre-exist service, the VA’s evidence is not undebatable and cannot be used to rebut the presumption of soundness. The VA can only overturn the presumption of soundness by providing clear and unmistakable evidence that the condition pre-existed service and was not aggravated or worsened by service.
There are exceptions: conditions which, by their nature, can be deemed to have pre-existed service. If a service member is diagnosed with a congenital defect in service (assuming that the diagnosis is correct), one which is known to be something that a person is born with, the VA may bypass the presumption of soundness.
For instance, VA does not grant service connection for personality disorders which are known to be lifelong conditions, nor will it grant service connection for a birth defect or a congenital or developmental defect. A congenital defect is one which does not change and which is not capable of being caused of aggravated by the veteran’s circumstances or surroundings. There is a difference, however between a congenital defect and a congenital disease. A disease can, under the VA’s definition, change and deteriorate in response to the veteran’s circumstances and is entitled to the presumption of soundness if not noted in the entrance examination.
When Can Veterans Receive VA Disability for a Pre-Existing Condition?
Veterans may still receive VA disability benefits even if their medical conditions existed before service. The key factor is proving that military service aggravated (made worse) these pre-existing conditions. Two legal presumptions help veterans establish claims for aggravated conditions:
- Presumption of Soundness – If your condition wasn’t documented during your entry medical exam, the VA must assume you entered the service healthy. The VA would then have to prove that your condition existed before your service began.
- Presumption of Aggravation – If your condition existed before you joined and it worsened during service; the VA must assume military service aggravated it. The VA then has the responsibility to prove the condition was not made worse by your military service.
Eligibility requires meeting specific criteria. To receive VA disability benefits for pre-existing conditions, veterans must:
- Demonstrate their condition worsened during service.
- Provide medical evidence clearly connecting military service to the aggravation.
- Prove the condition’s aggravation resulted in current disability symptoms or limitations.
Service Connection by Aggravation
Service connection by aggravation applies when a veteran’s condition existed before service but significantly worsened because of active duty. If your pre-existing condition deteriorates beyond its natural progression, the VA may award disability compensation. There are two situations:
- Known Conditions – If your condition was documented at entry and later worsened, this supports service-connected aggravation.
- Unknown Conditions – If not noted at entry but symptoms existed, veterans rely on the presumption of soundness. The VA must then prove your condition existed before service and was not aggravated by service.
Examples of Preexisting Conditions with Successful Claims
Many veterans join the military despite having health conditions that existed before enlistment. In many cases, these pre-existing conditions are allowed through medical waivers, which are granted for conditions that would normally disqualify someone, but have been stable or resolved and are not expected to interfere with duty.
Veterans who entered service with such a waiver to the military’s standard enlistment rules should keep a copy of the documentation, as it can help prove a condition existed at enlistment. Common pre-existing conditions accepted into service either noted during entrance exams or formally waived include:
Mental Health Conditions
- Resolved childhood behavioral issues
- Conditions like seizures, mild traumatic brain injury, or chronic headaches that were stable and asymptomatic for months with no medication
- History of ADHD, anxiety, depression, and mild eating disorders
Example: A veteran enters with mild anxiety but later develops severe anxiety disorder or major depressive disorder due to military experiences. Medical evidence linking increased severity directly to service can result in successful claims. See all ratings for mental health conditions.
Musculoskeletal Conditions
- Chronic or recurrent low back pain, including previous herniated discs, spinal fusion, or congenital spine issues like scoliosis, are frequently waived
- Old fractures or ligament injuries (e.g. knee ACL/PCL tears now healed) may be accepted if they’re asymptomatic but can worsen with service demands
- Joint laxity or prior sprains
Example: Rigorous physical training or activities such as parachuting cause an old fracture or mild scoliosis to worsen, resulting in increased pain or limited mobility.
Foot Conditions
- Prior MCL repair with full functional recovery
- Mild flat feet (pes planus) worsened by marching, running, or heavy lifting
Example: Mild flat feet not initially serious but aggravated by extensive physical demands of military service leading to chronic foot pain or limited mobility.
Hearing, Vision & Skin Conditions
- Acne and skin conditions (eczema, psoriasis, severe acne) can be waived if stable
- Athlete’s foot (tinea pedis)
- Hearing loss that still allows unaided understanding of speech and alarms may be service-eligible via waiver
- Corrective eye surgeries (like LASIK/PRK)
Example: Exposure to harsh environmental conditions or chemicals worsens mild eczema, leading to chronic skin irritation or flare-ups.
Other Stable or Occasional Conditions
- Occasional acid reflux
- Seasonal allergies controlled by over-the-counter medication
- Ectopic kidney or other anatomical anomalies that cause issues during service-related activities have been used in aggravation claims
- Mild asthma
- Hypertension, hyperlipidemia, or an innocent heart murmur might qualify for a waiver if stable and well-controlled for months pre-entry
Example: Exposure to stressful conditions, environmental hazards, or dietary changes causes occasional acid reflux to become chronic gastroesophageal reflux disease (GERD).
How Do I Prove Aggravation of a Pre-Existing Condition?
Proving aggravation involves clearly showing your pre-existing condition worsened because of your military service. You can strengthen your claim by following these steps:
- Identify Baseline Severity: Document how often symptoms occurred and how severe they were before your service. Medical records and treatment history before joining are valuable.
- Explain Service Circumstances: Clearly describe specific duties, incidents, or conditions that made your pre-existing health issue worse. Statements from fellow service members (buddy statements) can greatly support your claim.
- Provide Accurate History to C&P Examiners: When attending a VA Compensation & Pension (C&P) exam, ensure the examiner understands your condition’s complete history, especially noting if the problem had resolved before service and reoccurred or worsened during service.
- Private Medical Opinions: If treated by a private doctor, obtain a clear medical opinion stating your pre-existing condition was likely worsened by your military service. These private opinions can significantly support your claim.
- Consistent Medical Documentation: Regular, thorough medical records from before, during, and after service are critical. The VA relies heavily on medical evidence when evaluating claims.
Winning VA claims involving pre-existing conditions and aggravation can be difficult. Hill & Ponton specializes in successfully appealing denied cases and can help ensure your evidence is clear, compelling, and legally sound. Our attorneys handle complex cases regularly, helping veterans secure the compensation they deserve. Contact us today for a free case evaluation and support throughout your appeal process.
Content Reviewed by
Attorney Rachel Cheek
Rachel Cheek is an attorney at Hill & Ponton dedicated to helping veterans secure the benefits they deserve. A University of Florida graduate, she combines her passion for social justice with legal expertise to serve those most in need.
Written by
