VietNow National Magazine
Secondary Service Connection
Do you have a non-service-connected disability that you think is related to your service-connected disability? Our VA rating expert explains the details of how you might get the two linked together.
F. Gustavson, Jr.
A non-service-connected disability can be linked to a service-connected disability very easily. For example, a veteran with a service-connected right-knee injury claims he has developed arthritis of the right hip. In essence, his right knee throws his gait off, and this affects his right hip. Service connection can thus be granted for the arthritis of the right hip. Federal law under 38 CFR 3.310 governs these claims, and once granted, the secondary condition is considered a part of the original condition. The only exception to this rule is when the right hip gets worse solely by itself, which is called a "natural progression."
When asked by the VA to submit current medical evidence for your claim, have your physician submit a report showing the severity of your non-service-connected disability. The VA Rating Specialist will then order a VA examination, and ask the examiner for a medical opinion. The examiner will review the claims file, and list the current level of severity of the NSC disability. Next, he will state one of the following: the NSC disability was caused by the SC disability; or there was a natural progression of the NSC condition.
To make a grant of benefits, the Rating Specialist will establish a baseline (or starting point) by reviewing the medical evidence before the onset of aggravation and comparing it to the current level of severity shown on the VA examination. He then deducts the baseline level (as well as any increase due to natural progression) from the current level to arrive at the percentage evaluation of the disability.
Service medical records can also serve as a basis for establishing secondary service connection. For example, if a veteran is service connected for diabetes, and has complications such as peripheral vascular disease or coronary artery disease, service connection can be granted for these disabilities. It is not necessary for the examiner to establish a causal connection between military service and the present disabilities because these conditions are listed in medical journals (such as the Merck Manual) as common complications of diabetes.
When a veteran who has hypertension comes in with an additional diagnosis of coronary artery disease, the coronary artery disease is lumped together with the hypertension. This is because coronary artery disease is considered a natural progression of the hypertension. To avoid pyramiding (the evaluation of the same disability under different diagnoses) these disabilities will be combined to read as one disability: hypertension with coronary artery disease.
Similarly, a case arises where a veteran who is service connected for hypertensive cardiovascular disease has a stroke. After reviewing the hospital report to verify that there was, in fact, a stroke, payment of benefits at the one hundred percent rate would be granted for the stroke (a neurological condition) for a period of six months during the course of the condition. After that, an immediate VA medical examination will be scheduled to determine the current level of disability for the stroke.
Many cases arise when a veteran has, for example, a lower leg or ankle condition, and now complains of back pain. On a VA medical examination the veteran will state that with any prolonged standing or walking he begins to have pain over the lumbar region. The examiner will have the veteran perform tests with his leg/ankle to determine ranges of motion. Next, the examiner will determine range of motion in the back, and note any complaints of pain.
X-rays will be reviewed to verify evidence of degenerative disc disease. The examiner may then make the medical nexus that it is as likely as not that the veteran has low back pain with degenerative changes secondary to the left leg/ankle condition.
A denial of secondary service connection will most certainly result when no medical evidence is submitted to substantiate the claim. For example, a veteran claims service connection for arthritis of the back as secondary to his service connected left ankle condition. The veteran is asked to submit medical evidence, and fails to do so. First, his service medical records will be reviewed, and if they are negative for complaints for any arthritis of the back, his claim will be denied.
As with any denial, do not lose hope. Read the letter the VA sent you, and look specifically at the reasons why your claim was denied. Then send a one-sentence letter to the VA stating that you disagree with the decision. This protects your appeal rights; however, your letter must be received within one year of the VA denial letter. In your letter, you can submit any additional evidence you feel is relevant to your claim, or any information the VA requested but you failed to send.
Raymond Gustavson served
with the U.S.
Army in Vietnam, and is a retired
VA Rating Specialist. He is currently
working on a novel about the Civil
War, and also is writing a self-help
book for veterans who want to better
understand the complexities of the
VA claims process.
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