There are five ways to establish service connection for a disability:
- Direct service connection
- Secondary service connection
- Service connection by aggravation
- Presumptive service connection
- Service connection for injuries caused by VA health care
Direct service connection is the most common way to acquire benefits for a disability. It is when the disability can be linked to service through a medical nexus. You need evidence of 3 things: 1) a disability 2) an incident in service, such as a disease, injury, or event and 3) a nexus linking the two. The nexus is usually going to be a medical statement concluding that it is at least 50% likely that the current disability is related to the incident in service. This is the direct way to establish service connection.
Secondary service connection is when a disability is caused by or aggravated by an already service connected condition. The burden of proof remains that it is as likely as not that the second disability was caused or aggravated by the first. An example of this would be if the veteran has a service connected ankle injury that causes the veteran to develop a limp, which then causes back problems for the veteran. If there is medical evidence that the back problem is as likely as not caused by the limp and ankle injury, the veteran can be compensated for the back problems through secondary service connection.
Service connection by aggravation is when a veteran has a preexisting condition that is aggravated during service. If a pre-existing condition worsens during service, it is presumed that it was aggravated by service, and therefore service connected. The preexisting condition has to have been noted in the military entrance examination. The VA may try to show that the condition was aggravated due to the natural progression of the disease, and if they succeed, the veteran will not be entitled to service connection. The veteran also has to be able to prove that the aggravation of the condition is not a temporary increase in the severity of the condition. A medical opinion stating that the aggravation of the condition was caused by service is the best evidence to prove the condition was not worsened from the natural progression of the disease. This then establishes service connection by aggravation.
Presumptive service connection is when the veteran’s disability did not start in service, but is presumed to be connected to service because of a VA regulation. The veteran does not have to prove a connection between the condition and service, it is already presumed. There are however, certain requirements to qualify under these presumptions, such as the disability appearing within a certain period of time, or the veteran having served for a specific amount of time, during a specific time period, or at a specific location. The veteran will need to show either that the disability was diagnosed during the specific period required, or that the symptoms of the disability manifested during that time. There are conditions presumed connected to service based on VA laws. For example, there are certain diseases presumed to be service connected for veterans exposed to Agent Orange, such as diabetes mellitus type 2, Hodgkin’s disease, Ischemic heart disease, coronary artery disease, and Parkinson’s disease. There are also chronic conditions that are granted service connection if they arose within an applicable time limit after service, usually one year following service with a few exceptions. Some examples of these chronic conditions are arthritis, diabetes mellitus, schizophrenia, lupus, and multiple sclerosis. Then there are conditions that are presumptively service connected for service in the Persian Gulf, known as Gulf War Syndrome. The veteran must have served in Southwest Asia from August 1990 through the present, in operations such as Desert Shield, Desert Storm, Iraqi Freedom, and New Dawn. The conditions are either undiagnosed illnesses (cannot be diagnosed by a physician), or medically unexplained chronic multi-symptom illnesses (the illness is diagnosed but the cause is unknown). A few examples of these are fibromyalgia, chronic fatigue syndrome, and functional gastrointestinal disorders. The full list of diseases and conditions can be found here.
The last way to establish service connection comes from injuries caused by VA medical care. When there is an injury or aggravation of a previous injury that was caused by VA hospitalization, VA medical surgery or treatment, a VA exam, or vocational rehabilitation, it will be presumed that the injury is service connected. The veteran can seek compensation through service connection, or file a completely separate claim under the Federal Tort Claims Act or under 38 USC § 1151, similar to a medical malpractice claim against the VA.
Each of these ways of establishing service connection presents its challenges but arrive at the ultimate goal of establishing service connection to be compensated for your injury or disability.
Author Melanie Franco, Hill & Ponton, P.A. Attorney