A 21st Century System for Evaluating Veterans for Disability Benefits (2007) / Chapter Skim
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9 Service Connection on Aggravation and Secondary Bases
9 Service Connection on Aggravation and Secondary Bases
Pages 272-286
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From page 272... ...
9 Service Connection on Aggravation and Secondary Bases The Veterans' Disability Benefits Commission asked the committee to From a medical perspective, analyze the current Department of Veterans Affairs (VA) practice of assigning service connection on "secondary" and "aggravation" bases.
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From page 273... ...
273 SERVICE CONNECTION ON AGGRAVATION AND SECONDARY BASES in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. In the two-year period ending September 30, 2006, more than 21,000 veterans were service connected on the basis of aggravation of a preservice disability by military service, constituting less than two percent of disabilities that were service connected during that time period.
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274 EVALUATING VETERANS FOR DISABILITY BENEFITS TABLE 9-1 10 Most Common Conditions Service Connected on the Basis of Aggravation, FY 2005–FY 2006 Diagnostic Code Disability Number of Cases 6100 Hearing loss 3,066 5276 Flat feet 1,737 5260 Leg, limitation of flexion of 1,043 5010 Traumatic arthritis 832 5237 Lumbrosacral/cervical strain 772 7101 Hypertensive vascular disease 586 5242 Major depression 572 5257 Knee, other impairment of 538 6602 Bronchial asthma 493 5271 Ankle, limited motion of 485 SOURCE: Communication from Bradley G Mayes, director, C&P Service, Department of Veterans Affairs, December 14, 2006.
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From page 275... ...
If the injury or disease occurred before active service, describe any worsening of residuals due to being in military service."3 If medical records indicate that the claimant had an illness or injury prior to enlistment, this will not confirm that the condition existed, but will be used as one piece of evidence in an overall evaluation "with due regard to accepted medical principles pertaining to the history, manifestations, clinical course, and character of the particular injury or disease or residuals thereof."4 Under the presumption of soundness principle, if a preservice disability is not noted in the veteran's medical records, VA has the burden of showing by clear and unmistakable evidence that the disease or injury existed prior to service, and was not aggravated by service.5 Aggravation vs. Natural Process of Disease According to VA rating policy instructions, "Where the advancement in severity is beyond that to be expected by natural progress of the condition, service connection is warranted.6 This will require analysis of the facts in the individual case and knowledge of the particular condition concerned" (VA, 2005)
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276 EVALUATING VETERANS FOR DISABILITY BENEFITS acceleration in progress was that normally to be expected by reason of the inherent character of the condition, aside from any extraneous or contributing cause or influence peculiar to military service."8 The places, types, and circumstances of service are also taken into consideration for veterans who served during wartime. For example, if there are found to be manifestations of a preservice disease or injury during or soon after combat, or following status as a prisoner of war, aggravation of a preservice condition will be established.9 Hardships of service may also be considered in claims for veterans who served during peacetime.
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From page 277... ...
The specified period is within one year (except for leprosy and tuberculosis within three years, and multiple sclerosis within seven years) from the date of separation from service.12 The presumption may be rebutted by evidence showing that the chronic illness has not manifested itself to a degree of at least 10 percent within the specified period or, if it has, that the disability is due to a disease or injury acquired after separation from service.13 Despite their hereditary origin, diseases such as sickle cell anemia, polycystic kidney disease, and retinitis pigmentosa, are included in the Rating Schedule and can be service connected if symptoms of these diseases first manifest themselves after entry into service.
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VHA health care providers shall provide a statement or opinion describing a patient's medical condition. If the health-care provider is the veteran's treating physician, and is unable, or deems it inappropriate, to provide an opinion or statement, such physician shall refer the veteran's request to another health-care provider for the opinion or statement (VHA, 2000)
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27 SERVICE CONNECTION ON AGGRAVATION AND SECONDARY BASES TABLE 9-2 10 Most Common Diagnoses Service Connected as a Secondary Condition, FY 2005–FY 2006 Diagnostic Code Disability Number of Cases 8520 Sciatic nerve, paralysis 40,761 7522 Erectile dysfunction 24,406 8515 Median nerve, paralysis 17,790 8521 External popliteal nerve 13,685 7005 Arteriosclerotic heart disease 10,188 7114 Arteriosclerosis obliterans 8,538 7101 Hypertensive vascular disease 7,103 7541 Renal involvement in systemic diseases 7,008 8620 Sciatic nerve, neuritis 6,476 9434 Degenerative arthritis of the spine 5,371 SOURCE: Communication from Bradley G Mayes, director, C&P Service, Department of Veterans Affairs, December 14, 2006.
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These can be considered secondary manifestations because they are expressions of the person's underlying diabetes and share the same underlying pathophysiology. At times the Rating Schedule treats what are in fact secondary manifestations as secondary conditions.
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From page 281... ...
Cardiovascular Disease Ischemic or other cardiovascular disease that develops in a veteran with a service-connected amputation of a lower extremity at or above the knee, or service-connected amputations of both lower extremities at or above the ankles, is presumptively secondary to the amputation or amputations.17 Alcohol and Drug Abuse In some cases there are nonmedical considerations in allowing service connection for secondary conditions. Examples in training materials include alcohol or drug abuse resulting secondarily from a service-connected disorder, such as posttraumatic stress disorder (PTSD)
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From page 282... ...
The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities and determine the extent of aggravation by deducting the baseline level of severity as well as any increase in severity due to the natural progress of the disease from the current level. According to the Veterans Benefits Administration (VBA)
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283 SERVICE CONNECTION ON AGGRAVATION AND SECONDARY BASES An examination that fails to identify baseline findings, or the increment of increased disability due to service-connected causes, should not be considered adequate for rating purposes. In the event that the report does not meet these requirements and also fails to explain why it would be mere speculation to comment on these matters, the rater is instructed to send the report back to the examiner.
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284 EVALUATING VETERANS FOR DISABILITY BENEFITS under secondary conditions in VA regulations) , or omitted it unintentionally from the statement of task.
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285 SERVICE CONNECTION ON AGGRAVATION AND SECONDARY BASES priate expertise for evaluating the condition(s) in question in individual claims.
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286 EVALUATING VETERANS FOR DISABILITY BENEFITS 3. inadequate to infer the presence or absence of a causal relationship 4.
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