Five Pathways to a Service Connection

Knowledge NinjaThere are multiple ways for a service connection to be established for a veteran’s disability. They are:

1. Direct

There is clear evidence in service medical records that a veteran’s injury, disease or illness was caused or aggravated by active duty service.

Making the direct service connection lies in the Rule of 3:

1. A current diagnosis of a chronic physical or mental disability
2. In-service documentation of an injury or disease
3. A medical nexus connecting 1 and 2

2. Aggravated

A pre-existing condition was aggravated by military service, increasing the veteran’s disability, unless the increase is caused by a natural progression, such as aging (an example might be a veteran’s previous left knee injury was aggravated by military service).

Pursuant to 38 CFR 3.310, the VA will not concede that a nonservice-connected disease or injury has been aggravated unless a baseline severity of the disease or injury was established by medical evidence prior to the aggravation of the disease or injury, followed by current medical evidence of the aggravated disease or injury.

3. Secondary

• Primary disability must be service-connected
The rule of three applied to establish the connection: Current diagnosis, event in service, and nexus.

• Medical evidence must show a causal relationship
A specialist can provide the veteran with a letter documenting that the secondary disability was more likely than not related to military service. This letter will be added to the veteran’s medical record.

4. Presumptive

• Congress has determined illness caused by conditions during military service
Congress established through law presumptions for tuberculosis and neuropsychiatric diseases after World War I. Over the years, Congress has established presumptions for diseases of former prisoners of war, Agent Orange, diseases associated with ionizing radiation, and undiagnosed illnesses and chronic multisymptom illnesses in Gulf War veterans.

• Cases where there exists no evidence in military records
These are instances where records need to be declassified by the Department of Defense for use by the VA to establish the service record.

In each individual case, service location, time period and diagnosis requirements, and medical evidence of the claimed disability or illness are required. If no treatment has occurred, the VA will request an examination.

5. Title 38 USC 1151 Claims

• Malpractice
U.S. Code provides that a veteran will be awarded for a qualifying additional disability or a qualifying death of a veteran in the same manner if the disability or death were service-connected, provided the disability or death was caused by hospital care, medical or surgical treatment, or examination through carelessness, negligence, lack of proper skill, or error in judgment by the VA.

• The VA has paid out nearly $850 million to settle 4,426 claims of malpractice over the past 10 years, including $98 million in 2012 alone.

• This section of U.S. Code also includes vocational rehabilitation programs, which allows the VA to pay compensation for death or disability based on the causation outlined above. But the disability is considered service-connected for payment purposes only.

In addition to filing a USC 1151 suit, the veteran client may wish to file a civil action with the federal court system under the Federal Tort Claims Act.