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Thursday, January 18, 2018

Claiming Secondary Conditions for VA Disability

For a condition to be eligible for VA Disability, you must be able to prove that it is service-connected. The best way to do this is to provide medical records from your time on active duty showing thorough evidence of the condition, especially its original diagnosis. As long as a condition was first diagnosed and developed while on active duty, it is considered connected to service (the rules are a bit different for Reservists).

However, for any condition that develops more than a year after separation from the military, proving service-connection can be pretty difficult. Unless it is on the VA’s Presumptive List for things like Agent Orange exposure, etc., the only surefire way to ensure service-connection is to prove that the condition was caused by (“secondary to”) another service-connected condition.

What is a Secondary Condition?

A secondary condition is a condition that develops directly because of another condition, not just on its own. Arthritis, for example, can naturally develop on its own from overuse or misuse of a joint over time. It can also, however, develop as a secondary condition. For instance, a spinal injury can result in extra pressure being applied to the hip joints, which could result in arthritis that probably would not have occurred without the spinal injury. The hip arthritis would then be considered secondary to the spinal injury.

In this case, if the spinal injury occurred while on active duty (thus service-connected), and the hip arthritis developed over time and was diagnosed 6 years after service, it should still be considered service-connected since it was caused by a service-connected condition. Military service caused one, which caused the other, so the logic is that military service caused both, even though the secondary condition wasn’t diagnosed until after service.

How to Claim a Secondary Condition

To be able to successfully claim a secondary condition, you must prove that 1.) the original condition was service-connected and 2.) the secondary condition was definitely caused by the original service-connected condition.

If you are submitting a VA Disability Claim for both conditions for the first time, then you must provide proof that the original condition was diagnosed and significantly present while on active duty. Make sure to submit all service treatment records that show the diagnosis and treatment of the condition.

For the secondary condition, submit all records that demonstrate the development, diagnosis, and treatment of the condition and its relationship to the original condition. A NEXUS letter from your physician stating that the secondary condition was “more likely than not” caused by your original condition will also be very helpful to your case. A NEXUS letter is simply a letter from a qualified specialist that medically establishes a link between two conditions. If there is not enough evidence to clearly connect the two conditions, service-connection may be denied. It must be clear that the condition is unlikely to have developed without the original condition.

If you have already claimed the original condition and it was granted service-connection by the VA, then all you have to do to claim the secondary condition is submit VA-Form 21-526b along with all the evidence listed above for secondary conditions.

Rating Secondary Conditions

Once the VA grants service-connection for your secondary condition, it will be rated on the VASRD the same way every other condition is rated. In most cases, it will be assigned a code and given a rating based on the severity of its symptoms.

In some cases, however, the rules of the VASRD may limit a secondary condition’s ability to be rated separately. For example, nephrosclerosis is kidney disease caused by high blood pressure. Although blood pressure and kidneys are technically two separate body systems, the VASRD states that only one or the other can be rated, whichever gives the higher rating. This is because they are so closely connected and their rating requirements so similar, that rating both would violate the Pyramiding Principle.


Even in cases like this, it is undeniably worth it to claim the secondary condition. As long as it is granted service-connection, it qualifies for full medical coverage, it could increase the ratings for the original condition, it could eventually cause its own secondary conditions that would then qualify for their own ratings, etc. Ultimately, it never hurts to submit a claim for a secondary condition.  As long as you carefully construct your claim and provide sufficient evidence, you’ll ensure that you continue to receive the benefits you deserve as your conditions progress.

23 comments:

  1. How does the system work for full time ANG technicians doing their military job during the week? I had to have back surgery for an injury suffered while working on jets.

    ReplyDelete
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    1. If the condition occurred while on active duty (sounds like it did), then it will definitely qualify for disability. Guards and other Reservists must have their conditions occur in the line of duty in order to be service-connected.

      http://www.militarydisabilitymadeeasy.com/service-connected.html#reservists

      As soon as you are off active duty, you can apply for VA Disability for this condition.

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  2. I am service connected for sleep apnea. I believe I have a couple of conditions that are likely to be secondary to the sleep apnea as both occurred or started before I started using a CPAP. Are you familiar with this :

    https://www.va.gov/health/NewsFeatures/2013/July/VAs-Telesleep-a-Breath-of-Fresh-Air.asp

    It lists impotence and stroke as conditions that might have been avoided if I had been using a CPAP. I suffered a subarachnoid hemorrhagic stroke in 2009 and ED was first noted in my medical records in 2011 or 12. I finally went on a CPAP in 2015 and inadvertently discovered that sleep apnea could cause so many different conditions after doing a DBQ with a VA contract doctor. Basically he seemed more interested in the fact that I had a stroke than in the sleep apnea.

    ReplyDelete
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    1. Yes, both ED and stroke have been significantly tied to sleep apnea. Depending on the exact circumstances of your case, the first diagnosis of sleep apnea, etc., it is possible that your conditions are connected and will also qualify for disability. Sounds like the physician correctly recorded the issues on the DBQ, so you should be good to go, depending on your medical evidence.

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    2. I was diagnosed with sleep apnea in 2005 and had the stroke in 2009,developed ED in 2010. When I had my DBQ exam for a rate increase in 2015 the doctor asked me about scars. When I told him i had one on top of my head where they drilled a hole to drain fluid due to my stroke he became excited and started putting info into the computer he was using. I was wondering why he got excited about that and went home and googled it. That's when I realized the stroke was probably caused by the sleep apnea. However when I requested a copy of the DBQ the question about scars was checked no and there was no supporting notes. When I asked my pulmonologist about sleep apnea causing strokes he didn't seem to think so. He also didn't seem to like that I was getting disability for the sleep apnea. Would you know any doctors in the Dallas, TX area that are familiar with VA disabilities? I would like to get an opinion statement and claim these as secondary conditions.

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    3. We are a national site, and so can't give local recommendations, unfortunately.

      A second opinion is always a good idea, though, especially since you'll need the seizures directly tied to the sleep apnea in your case. They are not definitively connected, so depending on your evidence, it may not be enough to connect them.

      Scars are only ratable if they are significantly large, so yours is probably not, so I wouldn't be too concerned about that. As long as the VA has the record of that procedure, the scare is not important.

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  3. Can a claim be changed to a secondary condition after I have already filed, at the discretion of the VA?

    What if I am not sure if something is secondary to an already service connected condition? For example, if I have 10% patella femoral syndrome in one knee, and a secondary 10% sublaxation in the other knee--I am not sure if my low back pain and arthritis would be interpreted as connected to this?

    Lastly and somewhat unrelated, if I am filing for 8 separate conditions, it will be up to the VA to determine whether one is related to the other and essentially combine them correct?

    Thank you

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    Replies
    1. Yes, the VA will look at all of your conditions and combine them as needed to rate them correctly. That's why it is better to list everything that has been diagnosed than to assume you know how to combine them and end up leaving something off.

      If you can prove service-connection for any condition without needing the secondary connection, then that is always the best. Secondary conditions are only important if they cannot be connected to military service by themselves. So if you have evidence of all of these conditions while in service, then it doesn't matter if they are secondary or not. Just list them all and then provide evidence of their diagnosis while in service, and you'll be good to go.

      However, if you do not have evidence of your back pain and arthritis in service, then you definitely need to establish them as secondary if the VA is going to consider them service-connected. You'll need sufficient medical records and probably a NEXUS letter to do this, because if you are unsure, the VA will be too. They won't consider them secondary unless you can show proof.

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  4. Colonel,

    First of all, thanks so much for having this wonderful site!

    I was rated 20% for gout in both feet. In addition, I was rated 10% for degenerative arthritis with bone spurs on the spine. It’s been 6-years since I was rated by VA.

    Two years ago I had my right knee operated on for a torn meniscus. The Surgeon stated that I had severe arthritis and would eventually need a knee replacement (looks like within the next year or two). Every six months I receive a series of five Hyalgan Injections to help with the pain in the right knee. Recently my left knee began bothering me with pain and swelling as well. After my surgeon’s examination he stated that I had arthritis in my left knee too. My question: I’ve established gout & spine arthritis issues with the VA. Will the arthritis for both knees qualify for VA compensation (I left the service 11-years ago)? I have good motion with both knees. However, both swell frequently and are painful quite often (5-6 times monthly).

    V/R,
    Steve

    ReplyDelete
    Replies
    1. Hi Steve -

      Unfortunately, the knees won't qualify unless you can prove that they are the direct result of the feet/back issues that are service-connected. And that is going to be tricky at best. Unfortunately, in 11 years, that is plenty of time to knee issues to develop, so it'll be easy for the VA to say that they would have developed regardless. You'll need a strong NEXUS letter from a specialist if your claim is going to be successful.

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  5. I am currently SC for Meniere's disease and I'm on the process to submit a claim for anxiety and Depression secondary to the Meniere's. Someone told me that you can only claim either anxiety or depression ( not both at once). Also, on my DBQ the ENT wrote Cervicalgia and shoulder pain (decreased range of motion and stiffness) as related to the Meniere's because they aggravate my condition and trigger my headaches and vertigo/dizziness. My question is... Do you think I have a case? Should I go ahead and submit my secondary condition claim. I am 30% for the Meniere's but I suffer of dizziness and vertigo almost every day. Is that something that justifies a request for increase in rating? Thank you.

    ReplyDelete
    Replies
    1. You can list both anxiety and depression, but they are correct that you will only be given a single overall mental health rating. The VA will combine all of your symptoms and just give a single rating that covers everything.

      For your Meniere's, definitely submit for an increase. A 30% rating is only if there is dizziness less than once a month. Daily is 100% if it includes staggering while walking. At minimum, it sounds like you qualify for the 60%:

      http://www.militarydisabilitymadeeasy.com/theears.html#j

      It definitely does not hurt to submit for the cervicalgia and shoulder pain as secondary. Since they aren't caused by the condition, but instead just exacerbate it, they may not be ratable, but doesn't hurt to try.

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  6. Hello Doctor Johnston,
    Great site. I'm a retired veteran and from time to to I assist other veterans with their claims. Which brings me to this question. I have a veteran that's receiving a va rating of 30% for bronchitis with sarcoidosis (claimed as sarcoid). His records clearly show treatment for sarcoidosis throughout his military career yet his claim was denied for sarcoidosis. Should he submit sarcoidosis as a secondary to bronchitis? He's also being treated for sinusitis, sleep apnea, and thromboid veins which are not service connected.

    Thanks,

    ReplyDelete
    Replies
    1. Since he is already receiving a rating for bronchitis, he cannot receive a second rating for sarcoidosis. Because of the Pyramiding Principle, only a single lung rating can be given at a time, even if multiple lung conditions are present. Since "bronchitis with sarcoidosis" is already rated 30%, both conditions are being covered by that rating.

      So even if you submit sarcoidosis as secondary to bronchitis, the VA won't give him a second rating. They will rate only one or the other, whichever gives the higher rating.

      And they already have it on the claim if they are recognizing the "bronchitis with sarcoid".

      What you should do is check the ratings for Sarcoidosis and see if his test results would qualify him for a higher rating than 30%. If so, then submit for an "increased evaluation" for the bronchitis with sarcoidosis.

      If the sarcoidosis ratings do not qualify him for a higher rating, then just leave as is.

      http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#w

      Delete
  7. I have a few questions, in 2010 I was diagnosis with prostate cancer due to being sprayed with agent Orange while in Vietnam. Surgery was done 09/2011 for removal of the prostate, I developed incontinence and ED, but as you may know VA rated me at a temporary 100%. But since the surgery I applied for a rating for the residuals already mention, after years of fighting VA for the claim on the residuals Incontinence and ED , I was awarded 40% and 20% for the cancer. if the residuals are from the surgery and I had to make a claim for them, am I entitled to additional compensation for the residuals, even if I'm already 100% total and permanent? I had applied for the residuals before they made me total and permanent, I wear and average of 7 depends a day, make 5 to 6 trips to urinate at night, have to have a bed pad incase I urinate before I can get up. I have type two diabetes I stay thirsty all the time and I'm on 15 different medications for other service connected issues. does VA owe me compensation for those residuals, and by the way they gave me service connected for ED, but because the penis is not deformed I do not get compensated . VA had me go to four C&Ps and each have given the same outcome, all were do to the Cancer and the surgery, even the Chief of surgery (urology) supported my claim.

    ReplyDelete
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    1. So the cancer is rated 100% temporarily after the surgery is over, then it is rated on residuals. You said you were rated 40% and 20%. What were those for? There isn't a rating for "the cancer" anymore, just the residuals. So if those ratings were for the cancer, then those are for the residuals.

      I'm assuming (maybe incorrectly), that the 40% is for your incontinence. A 40% is given if you have to urinate more than every hour during the day.

      http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#urinary

      As for ED, there isn't a rating for ED at all, so that is correctly rated 0%. However, it does qualify for special monthly compensation K for loss of use of a creative organ.

      http://www.militarydisabilitymadeeasy.com/specialmonthlycompensation.html#k

      Since I'm not sure exactly what your rating breakdown is, so I'm not sure what the 40% and 20% and your P&T 100% are for, but hopefully what I've said applies to your case. If not, please clarify.

      Delete
  8. What if a total combined rating equate to more than 100%, how are the conditions "lowered" to equate to 100%? Are some given 0% service connected?

    ReplyDelete
    Replies
    1. No. Each condition is still rated as is. The total combined is just capped at 100%. You can't receive more than 100% of benefits, but individual condition ratings could qualify you for additional benefits, like special monthly compensation, CRDP, etc. So those remain in case they help you qualify for those other benefits, but you only receive 100% compensation.

      Delete
  9. I have a right elbow injury that limits the range of motion. The limited range of motion caused my right arm to become shorter and I can not reach as far. This condition has caused my right shoulder to drop causing my back to be out of alignment resulting in lower back pain and pain down my leg. would this shoulder and back trouble be considered a secondary condition?

    ReplyDelete
    Replies
    1. Yes, if you can get your physicians to show medical evidence and opinion that the shoulder and back issues are directly due to the limited motion in your elbow, you can definitely claim them as secondary.

      Delete
  10. You've likely heard this a million times but I need advice on how to approach my claims based on the following. I entered the service in 1979, commissioned a 2LT. Throughout my career, I was told by leaders at all levels that I should never give appearance to the troops that I was 'riding sick-call'. Subsequently, many things that have followed me throughout my career are a chronic problem to me, but because of the culture I served in, most of the problems I have are not captured in my records. Do you have advice on how to make legitimate claims for conditions that originated while I was in the military, but cannot claim because they are not in my records? Thanks for the great forum.

    ReplyDelete
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    1. Yes, you are definitely not alone in this very large problem. Luckily, that culture has started to change, but not until it left too many veterans in a rut.

      The VA legally must have proof that conditions are service-connected before they can grant disability benefits. There are a few different ways to do this. Thoroughly check our Service-Connected page and our VA Presumptive List page:

      http://www.militarydisabilitymadeeasy.com/service-connected.html
      http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html

      If you can show proof that your conditions meet any of these circumstances, then the VA will grant service-connection. If not, then there unfortunately, isn't much that can be done.

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  11. I filed a claim in March 2017, but I was homeless at the time & VA had no way to get in touch w/ me. Since then thanks to the homeless vets program I'm now in a home & filed a new claim w/ the same stuff. My question is can I somehow get retro pay back to my original claim?

    ReplyDelete