What is Secondary Service Connection for VA Disability Compensation?

Often a service-connected condition will result in a disability or disease that was not incurred in service but because the service connected condition caused it, VA will also pay a benefit. This is called secondary service connection.

Secondary service-connected claims and requests for increase in rating are the most prevalent types of claims VA receives for compensation. In 2019 the department anticipates that 74% of all applications will come from veterans who are already receiving benefits. The other 26% of applications are original claims or other issues that need to get solved. Many of those 74% of applications from veterans who are already on claim will be for secondary disability.

Summary of the Rules Pertaining to Secondary Disability

Currently there are two categories of claims that can be granted secondary service connection under Title 38 CFR 3.310. The first category includes claims for which there is an existing service connected disability and a subsequent disability or disabilities is found to be proximately due (caused by) the service-connected disability. One example of this type of claim would be loss of limb due to amputation occurring subsequent to service-connected diabetes. Diagnosis due to the loss of a limb should be service-connected in addition to the diabetes because the amputation may not have been needed had the veteran not developed diabetes which was service-connected.

The second category of secondary disability is granted in accordance with a 1995 court decision (Alan v Brown 7vet. app. 439). This ruling forces VA to grant service connection under 38 CFR 3.310 in claims where there is an increase in the severity of a non-service-connected disability that is found to be due to aggravation by a service-connected disability. The nonservice connected disability can exist prior to establishing service connection for the disability that aggravates it. This second category is called secondary service connection by aggravation.

The baseline of the non-service connected disability which was aggravated by a service-connected disability must be established by medical evidence created before the onset of aggravation. Or if this is not possible, the earliest medical evidence that can be created between the onset of aggravation and receipt of medical evidence establishing the current level of severity of the non-service connected disability.

If it is impossible to establish a baseline to determine the severity of aggravation, it is unlikely that there will be an award. Medical records are critical to this type of claim. The veteran must furnish medical evidence of the current level of severity of the non-service connected disability and medical evidence of its level of severity prior to the point at which it was being aggravated by the service-connected disability.

Once the rating authority has this information, a medical examination will be requested directing an opinion by the examiner to establish whether the examiner feels that the severity of the non-service connected disability is proximately due to the service-connected disability. The examiner must have all of the private records of the veteran establishing the baseline for review when providing an opinion on the issue of aggravation. The examiner's report must separately address all of the following medical issues in order to be considered adequate for rating a claim for secondary service connection based on aggravation:


The rating activity will use this information as the primary source of evidence for making a decision whether there was aggravation or not and whether it is ratable or not.

If enough evidence is produced to show that there is a reasonable assumption or inference that the non-service connected secondary disability is due to the service-connected disability, then a strong opinion letter from a physician might sway VA to make a favorable decision. With these particular kinds of claims you may also want to provide your own private doctor's opinion.

Establishing Secondary Disability with an Initial Claim

Secondary disability can be awarded for a claimant who has never made application and thus never received award for direct service connection. The service-connected disability that has led to that non-service-connected secondary disability or that has aggravated an existing non-service-connected disability does not have to be awarded first. Or, a rating for service connection has been issued at 0%, but the service-connected condition has resulted in a secondary disability that can be rated. A rating for service connection can be based on secondary disability as long as it is caused by a service-connected disability.

For example suppose a veteran develops diabetes from exposure to herbicides while serving in the Republic of Vietnam. He has never made a claim for disability compensation. However, his diabetes is severe enough to have caused an amputation of his foot. He makes an initial application based on his amputation, and he will receive an award based on the amputation. VA will also grant service connection for his diabetes even though he never initiated a claim for diabetes.

Most Common Claims for Secondary Disability

Here are the 10 most common types of claims for secondary disability in order of importance.

  1. sciatic nerve damage
  2. erectile dysfunction
  3. median nerve damage (paralysis)
  4. external popliteal nerve damage
  5. arteriosclerotic heart disease
  6. arterial sclerosis obliterans
  7. hypertensive vascular disease
  8. renal involvement in systemic diseases
  9. sciatic nerve (neuritis)
  10. degenerative arthritis of the spine


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