What is a Secondary Service-Connected Disability?
CCK Law: Our Vital Role in Veterans Law
If you are a veteran suffering from a service-connected disability that in turn causes or aggravates a different medical condition, then you may qualify for additional VA compensation due to secondary service connection.
Key Takeaways:
- A secondary service-connected disability is one that has developed due to another, already service-connected condition. There are various factors—including medication and health complications—that can cause a primary disability to give rise to a secondary disability.
- Prominent VA-rated conditions like back pain, sleep apnea, tinnitus, and PTSD all have secondary conditions associated with them that can place further strain on a veteran’s ability to live and work.
- Oftentimes, for veterans to prove to VA that they deserve a secondary service-connected disability rating, they must present a current diagnosis of a secondary condition, as well as a medical nexus opinion linking it to their primary condition.
- The ratings for secondary-service-connected disabilities are added to a veteran’s existing rating using “VA math.”
What Counts as a Secondary-Service-Connected Disability?
Watch VA-accredited attorneys and advocates from CCK Law explain secondary conditions:
A secondary service-connected disability is a disability that results from a condition that is already service connected. Claire Babcock, a VA-Accredited Claims Agent with CCK Law, provides further context:
“You can think of secondary service-connected disabilities as a domino effect. The veteran suffers an initial injury or illness (the primary condition) that triggers a chain reaction that leads to other health problems (the secondary conditions) that might not have been diagnosed or noticed in service. The secondary condition is therefore directly caused or aggravated by the primary condition.”
Some examples of secondary conditions include:
- If a veteran’s service-connected traumatic brain injury (TBI) causes them to develop serious migraines, then the migraines may count as a secondary service-connected disability.
- Similarly, if a veteran’s service-connected chronic back pain limits their activity level and they develop depression as a result, that depression could count as a secondary service-connected disability.
In the above examples, the veteran’s already service-connected TBI and chronic back pain would serve as their primary disabilities when it comes to their VA claim. On the other hand, the veteran’s migraines and depression would be their secondary disabilities, since they had their root causes in the TBI and back pain, respectively.
To successfully file for secondary service connection, veterans generally need to provide two key pieces of evidence to VA:
- A current diagnosis of a secondary disability; and
- A nexus opinion or other medical evidence linking the veteran’s primary service-connected disability to their secondary disability.
How Do I Prove a Secondary-Service-Connected Disability to VA?
There are several potential ways that a primary disability can cause a secondary disability.
Health Complications from Primary Disability
Some diseases lead to other health complications that can become serious enough to be considered secondary disabilities. For example:
- A veteran who is service connected for diabetes mellitus type 2could have numerous other health complications due to their diabetes, including diabetic retinopathy, which can cause blindness in serious cases.
- In this case, the veteran could file a claim that their diabetic retinopathy is a secondary disability to their service-connected diabetes.
- With medical evidence supporting that the retinopathy is due to the diabetes, the retinopathy could then be service connected on a secondary basis.
Can Medication or Treatment Side Effects Qualify as Secondary-Service-Connected Disabilities?
Sometimes, medication or other medical treatments can have adverse effects on the body. If side effects from medications or other treatments for service-connected disabilities cause a new disability, this new condition could be classified as a secondary disability that could be service connected. For example:
- A veteran with service-connected PTSD could be taking an antidepressant like sertraline to help treat their symptoms.
- Unfortunately, one of the side effects of sertraline can be gastrointestinal issues, and the veteran eventually develops GERD as a result of their sertraline use.
- If the veteran can secure a nexus opinion from their doctor that their GERD is a result of the medication they use to treat their service-connected PTSD, then they could earn a secondary disability rating for GERD.
Wear and Tear Due to Primary Disability
Completing everyday tasks or working with a primary disability can also lead to health problems, particularly if the veteran overcompensates in an attempt not to exacerbate their disability. For example:
- A veteran with a service-connected knee injury might alter their gait to account for the pain their knee causes.
- Unknowingly, by doing this, the veteran puts added stress on their hip joints, eventually developing hip pain as a result.
- If the veteran can prove that their knee condition was the root cause of their change in gait and subsequent hip pain, they might be able to earn secondary service connection for their hip pain.
Aggravation of a Non-Service-Connected Condition
Secondary service connection may even be granted when the primary disability aggravates a non-service-connected condition (Allen v. Brown, 7 Vet. App. 439 (1995)). In this case, the veteran can be compensated for the amount of harm caused beyond the condition’s natural progression.
Watch VA-accredited attorneys from CCK Law explain aggravation:
Common Secondary Service-Connected Disabilities Among Veterans
The following list is not exhaustive but contains some of the most common secondary conditions veterans have pursued with VA. Some of the most common secondary disabilities relate to having diabetes, back pain or conditions, or orthopedic conditions involving the knee, foot, or ankle. These conditions include:
- Peripheral Neuropathy Secondary to Diabetes Mellitus Type 2
- Radiculopathy Secondary to Back Disabilities
- Depression Secondary to Parkinson’s Disease or Cancer
- Depression and Anxiety Secondary to Orthopedic Pain
- Hypertension Secondary to Post-Traumatic Stress Disorder
- Erectile Dysfunction Secondary to Prostate Cancer
Additional secondary conditions tied to specific primary disabilities include the following:
Secondary Conditions to Migraines
Migraines are a type of serious headache that can cause severe pain, nausea, light sensitivity, dizziness, and more. Some veterans suffer from recurring migraines, each of which can persist for hours on end.
Migraines have been connected to several prominent secondary conditions. Some of these conditions include:
- GERD
- Sleep apnea
- Insomnia
- Anxiety
- Depression
Secondary Conditions to Sleep Apnea
Sleep apnea is a condition that affects a veteran’s ability to breathe while they are asleep. Typical symptoms include loud snoring, a lack of restful sleep, gasping for air during sleep, and more.
Sleep apnea can cause or be caused by several secondary conditions, including the following:
- Asthma
- GERD
- PTSD
- Hypothyroidism
Secondary Conditions to Tinnitus
Tinnitus occurs when a veteran has the perception of a buzzing or ringing sound in their ears. Frustrating and sometimes debilitating, tinnitus is often associated with conditions like hearing loss.
Some conditions secondary to tinnitus include:
- Migraines
- Depression
- Somatic symptom disorder
- Sleep apnea
Secondary Conditions to TBI
Traumatic brain injuries (TBIs) are when the brain is severely impacted by some kind of blow to the head, which can result from a car accident, a physical altercation, an explosion, or some other source.
TBIs can often lead to lasting effects on the body. According to 38 C.F.R. §3.310 (d), there are some conditions that are “held to be the proximate result of service-connected traumatic brain injury.”
Some conditions secondary to TBI include:
- Parkinsonism
- Seizures
- Certain dementias
- Depression
- Hormone deficiency diseases are presumptively considered to be secondary disabilities to service-connected TBI.
Eligibility depends on the severity of the TBI and the time between the initial injury that caused the TBI, as well as the appearance of the secondary disability.
Secondary Conditions to PTSD
Post-traumatic stress disorder (PTSD) is a psychological condition that can result from exposure to a distressing or shocking incident. This condition is unfortunately common amongst veterans due to the traumatic events that can arise from military service.
PTSD has been linked to several secondary conditions, including:
- Hypertension
- Migraines
- Erectile dysfunction
- Depression
- GERD
Secondary Conditions to Back Pain
Back pain is a common disability that veterans suffer from, often arising due to the physically intense nature of serving in the military. This pain can manifest as a stabbing, shooting, aching, or burning sensation in the back.
Some conditions secondary to back pain include:
- Cervical radiculopathy
- Thoracic radiculopathy
- Arthritis of the back
- Depression
Secondary Conditions to Depression
Depression is a mental disorder often characterized by persistent feelings of sadness or hopelessness, loss of interest in hobbies, low energy, difficulty concentrating or remembering, and thoughts of self-harm or suicide.
Depression is a common secondary condition veterans can develop due to a primary disability. Alex Gamache, an Accredited Claims Agent with CCK Law, provides some context as to why: “Oftentimes a veteran’s condition will lead to depression if it prevents the veteran from participating in activities they used to enjoy, finding a steady job, or living their day-to-day life.”
Disabilities secondary to depression include:
- PTSD
- Migraines
- Insomnia
- Restless leg syndrome
- Seizures
- Liver conditions
Secondary Conditions to Diabetes
Diabetes is a chronic condition that interferes with the body’s ability to successfully process sugar. This can be a serious disorder if not managed properly, with symptoms including increased hunger or thirst, fatigue, frequent infections, weight loss, and more.
Some conditions secondary to diabetes include:
- Peripheral neuropathy (nerve damage)
- Kidney dysfunction
- Eye conditions
- Peripheral vascular disease
- Arteriosclerosis
Watch VA-accredited attorneys and advocates from CCK Law discuss high-value secondary VA claims:
Can I Earn Total Disability Through Secondary Conditions?
Yes, secondary conditions can help you attain total disability.
One method to accomplish this is through total disability based on individual unemployability (TDIU), which is a monthly benefit that allows veterans to be compensated at VA’s 100 percent disability rate, even if their combined schedular rating does not equal 100 percent.
TDIU is awarded in circumstances where veterans are not able to secure substantially gainful employment as a result of their service-connected conditions. This includes secondary service-connected conditions.
VA outlines TDIU regulations under 38 CFR § 4.16, which encompasses subsections (a) and (b). Each subsection describes the ways in which veterans can meet the eligibility requirements for TDIU. To qualify for TDIU under 38 CFR § 4.16(a), or schedular TDIU, a veteran must have:
- One service-connected condition rated at 60 percent or higher; or
- Two or more service-connected conditions, one of which is rated at 40 percent or higher, with a combined rating of 70 percent or higher.
Secondary service-connected conditions do contribute to a veteran’s combined rating. Therefore, secondary service connection can be very beneficial in allowing a veteran to meet the qualifications for TDIU.
Veterans who do not meet the schedular requirements under 38 CFR § 4.16(a) may still be considered for extraschedular TDIU under § 4.16(b). Extraschedular TDIU does not have any rating requirement. If veterans do not meet the criteria for schedular TDIU, VA will determine if their case should be referred to the Director of Compensation Services for extraschedular consideration.
If their TDIU claim is referred, the Director will look at their case and write an opinion on whether their service-connected conditions prevent them from securing and following substantially gainful employment. VA will then agree or disagree with the Director’s opinion to either grant or deny TDIU on an extraschedular basis.
For most veterans, pursuing TDIU can be a complicated, confusing process. However, with the help of an experienced veterans law attorney, it becomes much easier to navigate. If you think TDIU may be a good fit for you, but are not sure where to start, consider reaching out to CCK Law for a free evaluation of your case.
Watch VA-accredited attorneys and advocates from CCK Law discuss the most common secondary VA claims:
Was Your Secondary Service-Connected Disability Claim Denied?
If the Department of Veterans Affairs (VA) denied your secondary service connection claim, CCK Law’s team of VA-accredited veterans law attorneys can review your case and develop the medical evidence needed to win.
As the country’s leading firm in the area of veterans law, our team of accredited advocates have successfully represented tens of thousands of veterans before VA.
Call CCK Law today at (800) 544-9144 or contact us online for a free case evaluation.
