The Department of Veterans Affairs (VA) provides monthly disability compensation to veterans for illnesses or injuries incurred or aggravated during active military service. Compensation is awarded based on a rating schedule that determines the severity of the service-connected condition and its impact on the veteran’s life. While many claims focus on conditions directly caused by military service, a significant number involve secondary conditions. These secondary claims recognize that a single service-connected disability often has a cascading effect, leading to new or worsened health issues over time. Understanding how the VA recognizes and rates these secondary service-connected disabilities is an important part of maximizing earned benefits.
Defining Secondary Service Connection
A secondary service-connected condition is a disability that is proximately due to, or the result of, an already established service-connected condition. This means the secondary condition was not caused by military service directly, but rather developed because of the primary condition that is already recognized by the VA. The distinction lies in the origin of the disability: a primary condition is directly linked to an in-service event, injury, or exposure.
The VA considers a secondary condition to be an extension of the original service-connected disability once the link is proven. This connection is established when the primary condition either causes a new disability to develop or aggravates a pre-existing, non-service-connected condition beyond its natural progression. For example, a service-connected back injury may cause a veteran to alter their gait, which then leads to a secondary knee condition.
The process for claiming a secondary condition requires two components: a diagnosis of the new disability and medical evidence that links it to the already service-connected condition. Successfully establishing this secondary connection means the new condition is rated and compensated just like a primary disability.
Establishing the Crucial Medical Nexus
The most important step in a secondary claim is establishing the medical nexus, which is the link between the primary service-connected condition and the claimed secondary condition. This connection must be supported by medical evidence and professional opinion to meet the VA’s legal requirements. Without this link, the secondary claim cannot be approved, regardless of the severity of the new disability.
The VA’s standard of proof for this connection is known as “at least as likely as not.” This means that the medical evidence must show there is a 50% or greater probability that the primary condition caused or aggravated the secondary condition. If the evidence is equally balanced for and against the connection, the VA must resolve the doubt in favor of the veteran.
The strongest evidence for establishing this nexus is typically a medical opinion from a qualified professional, often referred to as a nexus letter. This opinion must explicitly use language consistent with the VA’s standard. The medical professional should provide a logical rationale that cites medical literature, reviews the veteran’s service and treatment records, and explains the biological or physiological mechanism of the connection.
The VA may also schedule a Compensation and Pension (C&P) exam with a VA physician or contract examiner to evaluate the claim. During this exam, the physician assesses the severity of the claimed condition and provides an opinion on the medical nexus. A negative opinion from a C&P examiner can be countered with a strong, well-reasoned independent medical opinion from a private doctor. The ultimate goal is to provide a clear, evidence-based argument about the relationship between the two conditions.
Common Types of Secondary Conditions
Secondary service connection frequently involves conditions where a physical disability precipitates a mental health issue or where musculoskeletal problems cascade throughout the body.
Musculoskeletal Cascades
A service-connected orthopedic injury, such as a severe knee disability, can lead to an altered gait or posture. This change in mechanics places abnormal stress on other joints, resulting in secondary conditions like hip pain, back strain, or arthritis in the opposite leg.
Mental Health Disorders
Chronic pain from a service-connected physical injury is a common precursor to mental health disorders. A veteran dealing with persistent back pain or a traumatic amputation may develop secondary conditions like depression, anxiety, or insomnia. The psychological toll of living with a long-term disability establishes this connection.
Medication Side Effects
If a veteran is prescribed long-term medication for a service-connected condition, and that medication causes another disorder, the second disorder can be claimed as secondary. For instance, Gastroesophageal reflux disease (GERD) or other digestive issues may develop as a side effect of nonsteroidal anti-inflammatory drugs (NSAIDs) taken regularly for service-connected joint pain.
Sleep Apnea
Conditions like sleep apnea are often claimed secondary to mental health disorders like Post-Traumatic Stress Disorder (PTSD) or severe depression. Physiological changes associated with these mental health conditions, such as weight gain or muscle tension, can contribute to the onset or worsening of sleep-disordered breathing.
Calculating Disability Compensation
Once a secondary condition is service-connected, it is rated using the same criteria and Schedule for Rating Disabilities as a primary condition. The VA assigns a percentage rating, typically in 10% increments, that reflects the severity of the disability and its effect on earning capacity. This rating is then incorporated into the veteran’s overall compensation using the VA’s combined rating system.
The combined rating system does not simply add up the individual disability percentages, a concept often referred to as “VA Math.” Instead, it is based on the idea of the “whole person remaining” after accounting for the most severe disability. For instance, if a veteran has a 60% disability and a 30% disability, the 30% condition is applied to the remaining 40% of the veteran’s “whole person,” not the original 100%.
This calculation method results in a combined rating that is mathematically lower than a simple addition of the percentages. The VA uses a specific combined ratings table to determine the final percentage, which dictates the monthly compensation amount. The combined rating is always rounded to the nearest 10% increment.
A separate rule in this calculation is the rule against “pyramiding,” which prohibits rating the same symptom multiple times under different diagnoses. If two service-connected conditions, one primary and one secondary, both cause the same symptom, like chronic fatigue, the VA can only assign one rating for that specific manifestation. The VA must, however, assign the symptom to the condition that results in the highest possible compensation for the veteran.