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.
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Military Disability Made Easy

Yes, absolutely! As long as you provide evidence that the knee instability is the cause of the falls, any resulting injuries can be granted secondary service-connection and rated. Hopefully the medical records following the falls document the cause, but you can also submit letters from the witnesses noting the knee instability as the cause.

bill
8 months ago

i have a va rated disability for my left knee, after multiple surgeries were unsuccessfull it dislocates on a regular bases. this causes me to fall and have to put it back in before i can stand again. saying this i was on my roof doing an emergency repair when knee dislocated causing me to fall and injure my neck pretty severely, it also dislocated on another occassion causing me to fall and fracture my hip which still hasnt healed after 3 years. i have been treated by va and they want to do fusion and replacement surgeries. can i file for secondary to my knee since it caused falls causing injuries? there were multiple witnesses on both of these occasions. if so i dont know where to begin and would like help

DanWeaver
1 year ago

I to have ITP and am working to connect it to JP4 exposure. I was wondering if you had any luck. I have much to say as there is a Citation where and airman won his appeal on this. Please get back to me.

DanWeaver
1 year ago

I too have ITP diagnosed Dec 2019. I am trying to connect it to jp4 exposure as there is a Citation where and Airman won. Let me know how you faired in your endeavor as I am struggling.

Military Disability Made Easy

Was tinnitus on the original claim in 2014? If so, then the VA is denying the dizziness because there is no new evidence to prove service-connection. Even though it was claimed as secondary to a different condition, the VA reviews it in view of all of the claimed conditions. They basically considered it in light of the tinnitus and decided there was not enough proof of secondary connection there either.

The best way to fix this is to provide NEW evidence regarding the dizziness. A NEXUS letter from his ENT clearly stating that the dizziness is directly caused by the tinnitus could help. Any other additional new evidence that links the conditions together will help strengthen his case.

It's also important to note that the VA will only rate dizziness if it is officially diagnosed as a peripheral vestibular disorder. As only a condition of tinnitus, it won't qualify for an additional rating.

https://militarydisabilitymadeeasy.com/earratings.html#balance

Ashley
1 year ago

Hey all, veteran wife here!
I have been helping my husband file his VA claim. I am very knowledgeable in the medical field and prepared his entire medical record myself to submit to the VA. I have one question. In 2014 he submitted a claim trying to link Dizziness to a service connection disability that was later denied. When he filed a new claim this year he field another dizziness claim to different service connection (tinnitus) but I was removed from the claim stating it was previously denied in 2014. 1. This is for a totally different service connection(prior to 2014) already established, and I have all the records linking vertigo(dizziness) to tinnitus. Any idea why the would remove the secondary condition from the claim? What do I do now? How do I get it back on the claim?

Military Disability Made Easy

Unless you can prove that the kidney stones were directly caused by one of your other service-connected conditions, then no, too many years have passed to prove that your kidney stones are the result of your military service.

Unknown
2 years ago

discharged in 1972. kidney stones in 2004 and just had surgery nov 2020 for kidney stone. is this a filable claim.

Military Disability Made Easy

There are some cases where sleep apnea secondary to a musculoskeletal condition has been successful. You will definitely need a strong NEXUS letter from your physician clearly showing how your knees resulted in your sleep apnea. Here are a few cases that have been successful:

https://www.va.gov/vetapp14/Files4/1424567.txt (considered aggravated instead of secondary)

https://www.va.gov/vetapp14/Files5/1435836.txt (to low back, but could have similarities)

Charlesmiller.cc@gmail.com
2 years ago

Can service connected bilateral knee injuries, with sleep apnea as a secondary with the use of a cpac

Military Disability Made Easy

Yes, From 20-0995 is the correct way to go. You need to submit ample evidence of the secondary status of the condition and "new and relevant evidence," including full evidence of your PTSD, the prescribed medications, and the subsequent development of ED. You'll also want to submit a NEXUS letter from your physician stating that your ED is the result of the medications.

Vet in need
2 years ago

In 2016 DAV “helped” me file service connected claim for ED and I was denied. I didn’t know at the time it should have been filed secondary due to anti anxiety medications for PTSD.
I recently submitted a new Secondary claim for ED, but the VA sent me a letter stating I was previously denied and I need to submit VA form 20-0995 (review request: supplemental claim).
Since I started taking anti-anxiety medications, I have complaints of ED in my records and have medications prescribed for years now.

Should I fill out VA Form 20-0995 stating the claim should have been submitted as a secondary claim and not as a service connected disability?
Or is there different route I should take?
Please help me this issue, thank you for all that you guys do for vets.

Military Disability Made Easy

They really got you on a technicality. The VA did have the right to deny your claim since the diabetes isn't proven to have manifested enough within that 1-year mark since the diagnosis is just shy. You have a case, however, in that diabetes is a slow-onset condition, so with only a 4-day window, you clearly had it during the 1-year period.

Since it has been more than a year since your first claim, it's too late to appeal the original decision, so you will need to submit a new claim for the same condition (this will effectively reopen the original claim).

You have 3 different options for claiming diabetes:

– fight for service-connection on its own using the slow-onset factor as proof that it was present during the 1-year period. Your claim will probably be denied in the first round out of technicalities, but an appeal could definitely be successful with a strong letter from your physician clearly detailing that the condition was sufficiently present during the applicable time.
– claim as secondary to hypothyroidism. There is a strong connection between diabetes and hypothyroidism, so with a solid NEXUS letter, this has a strong chance of success.
– do both. Officially claim your diabetes as secondary to hypothyroidism and submit a NEXUS letter, but also include a statement and doctor's note that details that the diabetes was manifested to 10% within the 1-year mark due to its slow-onset nature and thus meets the requirements for the Presumptive List.

https://militarydisabilitymadeeasy.com/vapresumptivelist.html#chronic

L2dee2
2 years ago

Hi, I retired 1 Mar 2009 and was diagnosed with diabetes 4 Mar 2010 with a HB A1c of 12.4. Prior to this, the only HB A1C test was 2008 with was 5.8 ( pre-diabets) and fasting blood test of 324 Feb 2009. I was denied service connection because I wasn't officially diagnosed until 4 days outside the one year window. That was over 10 years ago and I am thinking of reopening the claim because diabetes manifested within a year of discharge. What are my chances of getting this service connected? should I open the old case from 2010 or start a new claim? Also, I am service connected for Hypothyroidism. Perhaps I can diabetes secondary to hypothyroidism. Your thoughts.

Military Disability Made Easy

Congrats! So glad to hear you were successful.

jet
jet
2 years ago

Thank Doc! That's what finally got tinnitus approved.

jet
jet
2 years ago

Thanks Doc. I finally got service connected for tinnitus. I told them about my specific job.

Military Disability Made Easy

If they are not rating your depression because it is not service-connected, then yes, your main focus needs to be establishing service-connection. In order to get it connected as secondary to your ankle and back issues, then it will have to be very clear in your mental health records that those physical issues ARE the stressors causing the depression. A NEXUS letter from your mental health provider clearly stating this connection will help. It will also have to be logical in the progression of your conditions, i.e. the depression developed in an appropriate timeline for it to have been the result of your back/ankle.

Unknown
2 years ago

I was turned down already but found me favorable for unspecified depression but not depression for service connected. Feel like I should maybe should have filed it depression secondary to me pain in left ankle and lower back pain since they're service connected. I don't know what they meant by unfavorable for depression but favorable for unspecified depression. Can you help me out that way

Military Disability Made Easy

In order to get the depression connected, it needs to be officially diagnosed and regularly being treated by a mental health professional. In their clinical notes, they also need to note that the depression is directly connected to your service-connected medical conditions. If there is enough evidence that you clearly have depression severe enough to require regular treatment and that it is the result of your conditions, then it is more likely to be successful.

You can apply for an increased evaluation for you lumbar spine. Just check the box on the claim form. Do note that they do not rate on level of pain, so it will only qualify for an increased rate if your range of motion is more limited.

For additional conditions, you can claim them as secondary, but will need to provide NEXUS letters and further evidence of their relation to at least one of your other conditions.

Unknown
2 years ago

Dear Sir I'm a 50% service connected vet. 20 % left ankle 20% lower back and 10% combined hearing loss and tinnitus. I have been diagnosed with unspecified depression. The local dad. Vet rep filed a claim for depression due to chronic pain in left ankle and lower back. I was denied my claim for depression. But found my favorable for unspecified depression. My first c&p exam the psychiatrist said I had anxiety,depression, and PTSD. That was her diagnosis. Then va sent me to another c&p exam and this psychiatrist said my depression was unspecified. VA threw out the first one as misdiagnosed and denied my claim for depression. What should my next steps be as far as my claim. I also have right knee problems. My back pain is worse. I have stenosis in my neck joint. Please help in any way possible. And I thank you for all the help you provide us veterans.

Military Disability Made Easy

Yes, definitely file a claim. Even though your base conditions existed prior to service, the VA will compensate for service-aggravation of the conditions. Since you meet the requirements for the Presumptive List, they should grant your claim for service-aggravation of your conditions.

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

Unknown
2 years ago

I was drafted in 1970 and joined the Army that same year. I am a situs inversus (internal organs in opposite positions – noted in my army medical records) yet I passed the physical. I served in Korea from Jun 1971 to Jul 72. I came to find out lately that I have and had Kartagener's syndrome because of my situs inversus. This means that I have been open to develop Bronchiectasis since birth, which is exacerbated by exposure to environmental toxins. I had a terrible health history in Korea with hives, welts and breathing issues, but the Army would not address them as there was no CT scan tests for Bronchiectasis at the time. I have come to find out that agent Orange was being used at my camp during my tour of duty in Korea. I have a boatload of nodules in my lungs due to infections brought on by my Bronchiectasis through exposure to agent orange and tear gas. I should have never been drafted, I should not have passed the physical, and I have just suffered a heart attack, yet I don't smoke, I don't drink, and I am not overweight or obese. Both Bronchiectasis and Heart attacks are presumptive for agent orange exposure. I have always held a white-collar office job, so I have never been exposed to chemical pollutants outside of my Army service. Should I file a VA disability claim?

Military Disability Made Easy

Hearing loss cannot physiologically cause low back problems, so a claim to make that secondary is highly unlikely to be successful. Sinusitis can cause tinnitus symptoms but they are rarely chronic without severe chronic sinusitis, but tinnitus cannot cause sinusitis.

Unknown
2 years ago

It's possibly to connect lower back secondary to hearing loss. And chronic sinusitis secondary to tinnitus.

Military Disability Made Easy

Yes, once you can show proof that your lumbar issues started while in service and have required regular medical care over the years, they should grant your claim for the lumbar condition. As for the cervical, yes, you can apply for these as secondary to the service-connected lumbar condition. Make sure to include a NEXUS letter from your physician detailing that the cervical spine issues are the result of the lumbar spine condition.

Unknown
2 years ago

Dr. I was treated for arthritis of the thoracic spine while stationed
in Germany in 66-67 and was given injections in the back along with therapy that did not help at all so the doctors shut me down completely
with no prolong standing, no prolong walking, no extra duty at all, They basically disabled me for the rest of my time until discharged.
the problem still exist and now it's causing problems with cervical
spine with stiff neck ad headaches, I have X-Rays showing all of this
and I am now waiting to receive my outpatient records. I filed less than a year ago and was denied because I did show that the problem was still there. I just need my in-service outpatient records of which I am waiting for and when they arrive should I refile with a secondary claim for the cervical spine problem also?

Unknown
2 years ago

Do you have any citations for approved claims for vertigo claimed as secondary to hearing loss and tinnitus ?

Military Disability Made Easy

Yes. If you can show proof that the fall was a direct result of the service-connected condition (weakness and instability of the ankle, etc.), then any conditions resulting from that fall would be considered secondary.

Military Disability Made Easy

In order for the VA to recognize aggravation, the condition must be aggravated to a compensable degree. The increase of medications alone does not qualify hypertension for a higher rating and so does not count as aggravation. If the diastolic pressure increased enough to qualify for a higher rating post-diabetes as it did pre-diabetes, then the VA would more likely consider it aggravated.

http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#high

Unknown
3 years ago

Hello, what if a service connected ankle injury caused one to fall and accidentally injure the left shoulder, can that be file as secondary injury? I think the chance is slim but better to find out for sure. Thanks.

Unknown
3 years ago

I have sleep apena, hypothyoidism , high cholesterol , gout, carry a epipen hypertion, type 2 diabetes hearing loss,tinnitus macula degeneration . The only ratings of 10% each are tinnitus , type 2 diabetes (10 and 10) total of 30%. I filed for aggervated hypertension after being diagnosed with type 2 diabetes . As a short time after the diagnosis of type 2, the va Dr doubled my hypertension meds from 5th to 10mg. Va denied claim, that type 2 didn't impact the hypertension . So why did they double my meds? If I hadn't got type 2 they would have kept at 5 MG correct?

Military Disability Made Easy

The unfortunately reality is that you may not have enough. But it's worth a shot to try. If the records from before show a severe enough disability or at least one consistent with the current, then that supports that the accident wasn't the cause of the exacerbation. If it does not, then it will be difficult, if not impossible to prove. Always worth a shot, though.

TSN18
3 years ago

Thank you so much for your response. I honestly don't know where to begin trying to show this proof. I've been to the VA a couple times prior to the accident for my shoulder and back pain, but I don't know if that would be enough evidence.

Military Disability Made Easy

That is tricky. You will need to show definite proof that your secondary conditions existed prior to the accident and were severe enough to justify a rating before they were aggravated by the accident. If you can submit enough proof that clearly separates them from the accident and strongly connects them to your service-connected conditions, you'll have a strong chance of a successful claim.

TSN18
3 years ago

I have a bit of a situation and would like to get some insight. I am currently rated 60% for my right shoulder, lower back, knees, tinnitus and left ankle. I would like to file for secondary conditions for scoliosis, hip pain/arthritis in the hip, left shoulder pain, anxiety, and migraines. I have VA records and X-rays showing anxiety, scoliosis, and degenerative change in the hip.

My dilemma is, in April I was involved in a car accident, which I mentioned to my primary VA physician. What are my chances of being granted increases and secondary conditions with this information being disclosed? Am I able to submit the X-rays and other physical therapy findings as evidence, without it being linked to the accident?

Military Disability Made Easy

The connection between tinnitus and insomnia is still weak based on medical evidence. There is more evidence that tinnitus can cause mood disorders (depression, etc.) and that mood disorders can cause insomnia. If you have a mood disorder as well, then that could bridge the gap between the conditions. As for the connection between insomnia and sleep apnea, this is also tricky. There is evidence of that sleep apnea is the cause of many insomnia cases, but less that insomnia actually causes the sleep apnea.

Ultimately, you have a very tricky case to prove. The more official studies that can connect your conditions, the better. Strong NEXUS letters connecting your conditions is also going to be essential.

Military Disability Made Easy

The VA will only rate conditions that are directly listed on the claim, so you will need to submit a new claim to include any conditions you'd like considered that were not listed on previous claims.

Military Disability Made Easy

Since the secondary condition is a foot condition, your podiatrist is better able to speak to its cause and so would have a more powerful NEXUS. It isn't an undeniable connection since plantar fasciitis can be caused by just wearing bad shoes. Your NEXUS letter will have to solidly draw a connection to make it clear that the strain on your feet from the knee replacement is the definite cause.

Military Disability Made Easy

Congrats!

Unknown
3 years ago

service connected for bi lateral hearing loss and tinnitus can insomnia be secondary to tinnitus and then be linked to sleep apnea I had a va sleep study and was told I have sleep apnea and was givin a machine and mask I feel that years of bad sleep trying to fall asleep waking up constantly has caused sleep apnea ever hear of this link thank you

Unknown
3 years ago

I recently was seen for my diagnosis of Fibromyalgia which is a presumptive illness for Gulf Era. However, during my VA doctor acknowledged my Irritable Bowel Syndrome, Chronic Fatigue and a couple other things that are typically rated as secondary claims. Will the VA rate them during my decision or will I need to file another claim and just use the same evidence?

Unknown
3 years ago

Greetings!I recently developed plantar F on both of my feet. I had a knee replacement (SVC connected at 30%)just over a year ago. Would it be better to go to a podiatrist or my ortho DR to get a nexus statement? Can this be rated as a secondary condition? Thanks for your help.

BamBam
3 years ago

I won my appeal on 10/16/19, the judge said everything being equal they sided with me. Final, now have to wait for back pay from 2012, this will bring me up to 70%, thank you for your answer

Military Disability Made Easy

It never hurts to submit VA Form 21-4138, but in all honesty, these aren't as effective as pure evidence that directly supports your claim (medical records, commander statements, etc.). It all depends on the strongest evidence you can possibly give to prove your case. Your personal testimony is always going to rank fairly low in comparison to official documents and notes from specialists that are qualified to speak to the case at hand, etc. Again, though, shouldn't hurt your case.

As for the timeline, it all depends. There is no definite answer. However, since they are collecting additional evidence, that means that you did not submit enough evidence to support your claims. It is ultimately your responsibility to ensure that they have the evidence needed to correctly rate your conditions, so you can help expedite this process by proactively collecting the additional evidence and submitting it yourself. They won't be able to process the claims until sufficient evidence is received or until it is clear that there isn't sufficient evidence, whereupon they will deny the claim.

Unknown
3 years ago

Wow, thanks for the quick reply…I'm new to the VA claims filing process and appreciate the information. I have a couple more questions. Do you recommend completing the VA FORM 21-4138, "STATEMENT IN SUPPORT OF CLAIM"? I have three claims that are recently open with the VA and I'm wondering if I should complete this form for each claim to tell my story? Also, when I go to eBenefits they show that they have had my claims since 24 September and are collecting additional information, etc. How long does it take for them to show the actual individual claims on eBenefits? Thanks again for the help and whatever information and advice you can offer. Gary

Military Disability Made Easy

The secondary status has nothing to do with the rating, but the condition itself. If the VA approves and decides there is sufficient proof that the right knee is secondary, then they will look at the right knee condition overall and determine the best rating for that condition based on the severity of its symptoms.

Unknown
3 years ago

I am new to this blog and have a question regarding secondary ratings. I currently have a 10% rating for my left knee. I am submitting a secondary claim for my right knee. I have a nexus letter from the doctor saying the right knee problem is more than likely caused by the service connected left knee. If approved does the right knee only get a maximum 10% rating like the left knee, or can the right knee get a higher rating? Thanks for the help! Gary

Military Disability Made Easy

There isn't a database or system for finding doctors that are familiar with writing NEXUS letters. However, any doctor can do it, and if you prepare the letter as much as possible for them before hand, it will save them time if they only have to fill in the details.