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Veterans Law

What is a Secondary Service-Connected Disability?

May 25, 2017
What is a Secondary Service-Connected Disability

Veterans who have been through the VA disability claims process understand the importance of proving service connection for a disability. However, service connection on a direct basis is not the only way to get a disability service connected, particularly in the case of service connection for a disability that is secondary to an already service-connected condition.

A secondary service-connected disability is a disability that resulted from a condition that is already service-connected. In claims for secondary service connection, proving a nexus is especially important. A nexus is a medical opinion that, in cases of secondary service connection, links a veteran’s secondary disability to their already service-connected disability. The nexus between your primary disability and your secondary disability must be clearly established in order to be granted secondary service connection for the disability. This is different than a claim for an increased rating because you are claiming an entirely new disability instead of asking for an increase for a service-connected disability.

Common Secondary Service-Connected Disabilities Among Veterans

The following list is not exhaustive but lists some of the most common secondary conditions.  Some of the most common secondary disabilities relate to having diabetes, back pain or conditions, or orthopedic conditions involving the knee, foot, or ankle.  Below are some of the most common secondary conditions:

  • 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

Secondary Conditions to TBI

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.” Parkinson’s disease, seizures, certain dementias, depression, and 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.

How Secondary Disabilities Occur

There are several ways that a primary disability can cause a secondary disability. Some diseases lead to other health complications that could become serious enough to be considered a secondary disability.

For example, a veteran who is service-connected for diabetes mellitus type 2 could have numerous other health complications due to their diabetes, including diabetic retinopathy, which can cause blindness in serious cases. The diabetic retinopathy would be considered a secondary disability to the veteran’s 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.

Conditions Due to Treatment

Treatment of a primary service-connected disability could also result in a secondary disability. If side effects from medications or other treatment cause a disability, this could be classified as a secondary disability that could be service-connected.

Wear and Tear

Completing everyday tasks or working with a primary disability can also lead to other problems. When you compensate to make up for a knee injury, you may put added stress on other joints, such as your other knee or your hips.

Types of Evidence to Support Secondary Service Connection VA Claims

There are specific types of evidence that a veteran may need to prove entitlement to secondary service connection.

  • Nexus Opinion—A Nexus opinion can link the secondary condition to the condition which has already been service-connected, or the primary service-connected condition. This can be provided by a medical professional.
  • Studies that Link the Two Conditions—Studies that link the veteran’s two conditions can be submitted as evidence to the veteran’s claim. An example of this might be if medication a veteran is taking for a service-connected mental health condition causes a gastrointestinal disability and there is a study that supports this connection.
  • Lay Evidence—Lay evidence is a statement written by someone who knows the veteran, such as a spouse, friend, or family member. In these statements, the layperson may speak to who the secondary condition is related to the primary one.  Importantly, the veteran themselves may provide lay evidence.

How to Apply for VA Benefits for a Secondary Disability

You can file a claim for service connection for a secondary disability the same way you filed your initial claim for service-connected disability compensation. You will need to demonstrate two things to VA to be granted a secondary service-connected disability:

  • a diagnosis for your secondary disability
  • Medical evidence showing the relationship between your service-connected disability and secondary disability

If your secondary condition could have many possible causes, you may need a doctor’s opinion or other medical evidence showing that your primary service-connected disability was the actual cause.

Compensation and Pension (C&P) Exams for Secondary Conditions

Once a claim for secondary service connection has been filed, VA may request a Compensation and Pension, or C&P exam.  These are medical exams to evaluate a veteran’s condition or conditions.  In the instance of secondary service connection, the examiner will usually examine both the primary service-connected condition and the condition for which the secondary service connection claim has been filed.  The exam will usually be conducted by a VA physician or a VA-contracted physician.

Before the exam, the examiner will typically review the veteran’s c-file.  The c-file contains any documentation that has been submitted to VA previously, as well as the veteran’s service records.  During the exam, the examiner may ask questions regarding the veteran’s conditions, symptoms, or their service.  In exams for secondary conditions, the examiner will usually ask questions regarding how the secondary condition was caused or aggravated by the primary service-connected condition.

The examiner may also ask how the veteran’s secondary condition impacts their day-to-day life.  If VA should award secondary service-connection, the information from the exam will be used as evidence for VA to assign a disability rating.  The rating determines the monthly disability compensation award the veteran will receive.

Total Disability Based on Individual Unemployability (TDIU) and Secondary Service Connection

Total disability based on individual unemployability (TDIU) 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.  In order to qualify for TDIU under 38 CFR § 4.16(a), or schedular TDIU, a veteran must have:

  • One service-connected condition rated at 60% or higher; or
  • Two or more service-connected conditions, one of which is rated at 40% or higher, with a combined rating of 70% or higher.

Secondary service-connected conditions do contribute to the 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 Service 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.

Whether you qualify for TDIU on a schedular or an extraschedular basis, the amount of monthly compensation you receive will be the same.

Was Your VA Disability Claim Denied?

If your VA disability claim was denied, whether for secondary service connection or not, the dedicated team of VA disability attorneys and advocates may be able to help. Contact us today at 800-544-9144.