Service Connection on a Secondary Basis
A veteran must establish “service connection” to be eligible for VA disability compensation benefits. Service connection refers to an injury, disease, or other disability related to a qualifying veteran’s service. Once service connection is achieved, VA will compensate the veteran based on the degree of their disability.
Yet, often our disabilities do not happen in isolation, and over time, additional disabilities may manifest because of our original conditions. Sometimes it can feel like the domino effect - one condition causing another, causing another, etc. These acquired disabilities, while not incurred in service, may also be service connected as “secondary” to the underlying condition.
For an acquired disability to be service connected on a secondary basis, VA must find that the new disability is “proximately due to or the result of a service connected disease or injury.”
Once the disability is recognized as secondary to an existing service connected disability, it will be rated in the same way as if it had been directly related to service.
Below are a few common examples of how secondary service connection might arise:
Diabetes: Diabetes can cause many significant complications. One complication that we see regularly is peripheral neuropathy of the upper and lower extremities. But other complications such as eye conditions, skin conditions, heart conditions, or kidney disease are also common complications for which secondary service connection may be sought.
How would this impact your combined rating? Let’s look at a conservative example. A conservative rating for diabetes requiring daily medication management is 20%. If diabetes is the only service connected condition, a 20% rating would correspond to a $327.99 monthly payment (2023 payment rates). However, if we add diabetic neuropathy of both legs, and once again, assuming a conservative 10% rating for each leg for mild neuropathy, our combined rating increases to 40% and a corresponding $731.86 monthly payment. If the veteran also has upper extremity neuropathy, our combined rating would increase to 50%, and a corresponding $1,041.82 monthly payment.
Once again, those are conservative ratings and your combined rating could be higher (or lower) depending on the severity of your condition(s) and whether you have other complications or other service connected disabilities.
Lumbar & Cervical Spine Conditions: Lumbar and cervical spine conditions that involve disc compression may cause nerve impingement, resulting in conditions such as sciatica (lumbar spine compression) or other radiculopathy. This radiculopathy can also be service connected, and a similar analysis to diabetes would be expected.
Psychiatric Conditions: Sometimes the combined impact of our service connected disabilities have such a profound impact on our lives that we begin experiencing psychiatric symptoms such as depression or anxiety. Often as chronic disabilities worsen, we lose the ability to engage in favorite hobbies, lose our ability to earn our livelihoods, and may even lose a certain amount of independence or decision-making. If you experience psychiatric symptoms due to your service connected disabilities, you should seek treatment, and also consider filing a claim for service connection.
If we use the example above regarding diabetes with upper and lower extremity peripheral neuropathy, adding a conservative 50% disability rating or a mental disorder, such as depression, that causes “occupational and social impairment with reduced reliability and productivity,” our new combined rating is 80%, with a corresponding monthly payment of $1,933.15. In addition, with an 80% disability rating, if you were unable to work due to your service connected conditions, you may be entitled to a total disability rating based on Individual Unemployability (and a corresponding $3,621.95 monthly payment rate).
Recent Developments: Spicer v. McDonough
Recently, the U.S. Court of Appeals for the Federal Circuit in Spicer v. McDonough analyzed 38 U.S.C. § 1110, the statute regarding secondary service connection. The Court clarified that not only is secondary service connection warranted in the above situations (where a service connected disability is the “proximate cause” of a new disability), but that secondary service connection is also warranted when a non-service connected condition is made worse because of a service connected condition, such as when a service connected condition prevents treatment for the non-service connected condition.
The case facts of Spicer were relatively straightforward, and illustrative of the Court’s holding. There, Mr. Spicer was service connected for myeloid leukemia, a blood cancer. Later, he developed arthritis in both knees. As Mr. Spicer’s knee disabilities continued to worsen, knee replacement surgery was warranted. However, the medication required to manage his leukemia was incompatible with knee surgery. As a result, without the ability to have surgery, his knees continued to worsen. Mr. Spicer filed a claim for service connection for his knees, as secondary to his leukemia. While the Federal Court is not able to award service connection, its holding suggests that Mr. Spicer would indeed be entitled to service connection for his bilateral knee arthritis as the condition was made worse by a service connected condition.
Have questions?
We’re here to help! If you think you may be entitled to additional compensation for a condition related to your service connected disabilities, please contact us for a free case evaluation.