Secondary Service Connection: How One VA Disability Can Lead to Another

Many veterans are service-connected for one condition but do not realize they can also claim conditions that developed as a direct result of that service-connected disability. This is called secondary service connection and it is one of the most commonly missed opportunities in VA claims.

What secondary service connection means

A condition qualifies for secondary service connection when it is caused or aggravated by an already service-connected condition. The secondary condition does not need to have any direct connection to your military service. The link runs through the primary service-connected condition.

Common examples include knee problems caused by a service-connected back condition that altered your gait, sleep apnea caused or worsened by service-connected PTSD, erectile dysfunction caused by service-connected diabetes, depression or anxiety caused by the chronic pain and functional limitations of a service-connected physical condition, and diabetes caused by Agent Orange exposure that then leads to peripheral neuropathy.

How to establish secondary service connection

You need three things. First, an existing service-connected condition that serves as the primary diagnosis. Second, a current diagnosis of the secondary condition. Third, a medical nexus connecting the two, either through a physician's statement or through medical literature establishing the known relationship.

The standard is the same as for direct service connection: the nexus needs to establish that the secondary condition is at least as likely as not related to the primary service-connected condition. This is a relatively low bar compared to what many veterans assume.

Filing a secondary claim

File using the same VA Form 21-526EZ used for initial claims. In the condition description, note that the condition is secondary to your existing service-connected condition (naming it specifically). Attach medical evidence supporting the relationship.

Your treating physician's statement is often the most effective evidence. A letter stating that your knee condition is at least as likely as not caused by the altered gait mechanics resulting from your service-connected lumbar spine condition provides the VA with exactly what it needs.

Aggravation claims

Even if your secondary condition existed before service or before the primary service-connected condition developed, you may be able to claim it on an aggravation theory. If a service-connected condition has made a pre-existing condition worse beyond its natural progression, you can claim service connection for the degree of aggravation.

Common secondary conditions worth reviewing

If you are service-connected for PTSD, review whether you have developed any of the following: sleep apnea, hypertension, depression, alcohol or substance use disorders, or gastrointestinal conditions. Medical literature supports causal relationships between PTSD and all of these.

If you are service-connected for a musculoskeletal condition, review whether you have developed arthritis in affected or adjacent joints, nerve conditions in the same region, or cardiovascular conditions caused by reduced mobility and activity.

---

Bill Advantage is a document literacy tool. Nothing in this article constitutes legal or medical advice.