Establishing Service-connection
What are the three “pillars” of service-connection? In order to receive compensation from the VA, Veterans must show that their current disability is somehow related to military service. There are three main elements to service-connection:
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This is the first element of service-connection. Were you injured while on patrol? Were you exposed to toxic fumes during the Gulf War? There must be some even that occurred during your service that has caused the second element of service-connection.
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There must be a current disability that has been diagnosed by a medical professional. For example, following a sleep study, you were diagnosed with sleep apnea. Or, after an x-ray, you were diagnosed with degenerative disc disease.
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The third and most important element is a nexus. When the VA sends you to a C&P exam, this is their version of seeing if a nexus between your service and your current disability exists. Without this link, the VA cannot grant service-connection.
Types of service-connection
Direct Service-connection
Direct service-connection is based on an event or injury that was caused or incurred by active-duty service. This means there is a direct link between military service and a current diagnosed disability. For example, a veteran who sustained a back injury during a training exercise is currently diagnosed with lumbar strain. If a nexus can be established, then direct service-connection is warranted. Similarly, a veteran who was directly exposed to hazardous waste and now has severe migraines could qualify for direct service-connection.
Secondary Service-connection
Often times, service-connected disabilities cause other disabilities. For example, studies show that veterans diagnosed with PTSD are also likely to have Obstructive Sleep Apnea (OSA). If a veteran has a disability that exists as the result of a service-connected disability, then secondary service-connection can be granted.
Obesity can also serve as the basis for secondary service-connection. Obesity is an “intermediary” step if the veteran would not have become obese if not for the service-connected injury. Consider a veteran who has a service-connected ankle and knee injury. As a result, he cannot adequately exercise. He later becomes obese which causes or aggravates his OSA. Secondary service-connection is still warranted since the obesity would not have existed without the ankle and knee injury.
Presumptive Service-connection
In certain cases Congress can establish certain disabilities to be “presumptive”. Other times, it is based on medical research and the VA takes their own action to make these conditions presumptive. Usually, a veteran has to serve in a specific area during a specific time to meet presumptive service-connection. For example, under the recent PACT Act legislation, Veterans who served outside of Vietnam in certain areas are now presumed to have been exposed to Agent Orange. For more recent veterans, sinusitis and rhinitis are now presumptive.
Aggravation
Injuries or disabilities that pre-existed service may still be subject to service-connection on the basis of aggravation. A common example is a veteran who obtains an entry waiver for asthma. During service, the veteran is deployed where they are exposed to dust, sand, and breathed in toxic fumes from burn pits. After deployment, the veteran’s asthma became permanently worse. Service-connection based on aggravation is warranted in these types of cases.
Section 1151 Service-connection
Section 1151 service-connection refers to section 1151 of Chapter 38 of the United States Code. This law provides that veterans who suffer from a disability as a result of healthcare received by the VHA may file a claim for service-connection. The evidence for this type of service-connection must show “carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination”, or “an event not reasonably foreseeable”.