There is not always a nice straight line between an in-service injury and a medical condition.
Sometimes a service-connected injury can cause another injury or condition.
The parts of the human body do not work in isolation. Your heart pumps oxygen to your body, so if you have a problem with your "pump", you may likely have problems with your blood pressure. If you have problems with your blood pressure, you may cause problems with your vascular system. Vascular problems can lead to organ problems. Organ problems can lead to cancers. You get the idea.
Because the parts of the human body do not work in isolation, you can service-connect injuries that did not occur in or because of service, but were diagnosed as a result of another service-connected injury.
Here's what the VA says: secondary service connection occurs when a service-connected condition causes a new disability.
(Don't confuse this with the theory of service connection by aggravation - when a service-connected condition makes another pre-existing or non-service connected condition worse).
You will not succeed in a secondary service-connection claim without sufficient medical evidence.
The legal burden of proof you need to meet is whether it is "at least as likely as not" that the second medical condition was caused by the first. You do NOT need to provide clear and convincing evidence that the secondary condition is caused by the service-connected condition, as I have seen many, many Ratings Decisions state. Nor do you need to show that the service-connected condition is the sole cause of the second condition.
To meet your burden of proof, you will likely need at least one medical expert opinion.
As anyone who has dealt with doctors knows, opinions can vary from doctor to doctor. You might choose to consult with a private medical expert to establish the required proof rather than wait on the VA to schedule a C&P Exam.
Scenario 1: As a result of a combat injury, you are diagnosed with post-traumatic stress (aka, PTSD), depression or any other mental health condition. Is this a secondary connection?
Answer: Probably. You will need a psychiatrist to provide a written expert opinion to the VA that connects the PTSD to the service-connected injury.
Scenario 2: (This general scenario appears in the Veterans' Benefits Manual, page 132.) A veteran has a 30% rating for a service-connected knee injury. As a result of that injury, the veteran now complains of chronic back-pain and walks with a limp. Is the low-back pain and limp a secondary connection?
Answer: It depends. If you have an opinion from a private medical expert, you may be able to establish that the second injury, the low back pain, is connected to the original knee problem. This is a tougher claim, because there are many causes for low back-pain.
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