The importance of VA secondary condtions.

When a Veteran files the initial claims with the Veteran Administration, he usually files for a primary medical condition. Besides filing the online VONAPP (www.ebenefits.va.gov)or the VA Form 21-52.

The evidentiary requirement are rigid and Rightardia has recommended using the Disability Benefits Questionnaires (DBQ) to make sure all the "T" are crossed and the "I's are dotted.

It is important that the doctors check the box indicating the Service Medical Records (SMR) have been  reviewed. A nexus statement connecting the military service to the medical condition must  also be written in the remarks.

In the example below,  a serviceman loses his pituitary by being exposed to radiation or chemicals in an industrial environment. Hypopituitraims is the primary condition, but the vet could also lose adrenal, thyroid and sexual function. Hypopituitarism cal also cause anosmia (loss of sense of smell ) and diabetes insipidus.  All of the latter are secondary conditions.

Many Army solders were exposed to agent orange in Vietnam which led to many cancers and heart conditions. For example a veteran could revive an award for non-Hodgins lymphoma. With chemo-therapy, the vet might survive. But there are a lot of residuals or secondary conditions associated with non-Hodgkins lymphoma.

• Immune deficiency
• Chylothorax
• Coin lesion (chest x-ray)
• Ichthyosis
• Coombs positive, direct
• Leucoerythroblastic anaemia
• Lacrimal gland enlarged
• Red cell production reduced
• Splenomegaly
• Pruritus
• Peripheral demyelination
• Thrombocytopenia
• ESR raised
• Mediastinal enlargement
• Autoimmune haemolytic anaemia, warm antibody
• Erythema nodosum
• Paraproteinaemia
• Lymphadenopathy
• Lymphocytosis
• Pyoderma gangrenosum
• Monocytosis
• Cold agglutinins
• Renal metastases
• Abdominal mass
• Peripheral neuropathy
• Orbital mass
• Osteosclerosis

If the vet develops any of these conditions, they should file for a secondary condition. Filing for a secondary condtion  has some big advantages.

38 CFR § 3.310 says:

"When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition."

This means the effective date of the secondary condition is given the date of the primary condition.  In addition, the doctors does not need to review the SMRs or write a  nexus statement. The doctor must indicate the secondary condition is  a consequence of, and linked to the primary condition. 

The vet may use a DBQ to document a secondary condition. Some DBQs are written to identify secondary conditions, other are not. A doctor's letter my suffice for a secondary condition. The letter should show:

A diagnosis for a compensable condition
A link between the secondary condition and an already service connected condition

You may think the primary condition would have a higher disability rating that secondary, but it is usually the other was y around. In fact the 38 CFR makes it clear that secondary condition may have a higher disabiliy rating than the primary.

sources:

http://www.vba.va.gov/pubs/forms/VBA-21-526-ARE.pdf
http://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp
http://www.rightdiagnosis.com/n/non_hodgkins_lymphoma/complic.htm#complication_list
http://vets.yuku.com/topic/12131


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