Featured
> Master Condition List
> Federal Benefits List by Combined Ratings
> Insight into the Claims Process (VBA Perspective)
> Rating Schedule Index
> Filing a VA Disability Claim
> Filing an Appeal

> Death/Survivor Benefits

> Education & Employment

> Health care

> Housing

> Miscellaneous

> VA Disability Compensation

> VA Pension

Tertiary Service-Connection

(Intermediate Step AKA Service-Connection Twice Removed)

Tertiary conditions are conditions that are the direct result of Secondary condition(s) OR as the result of a intermediate step AKA Service-connected condition twice removed.

Common examples of intermediate steps include:

  • Service-connected condition causes instability leading to a fall; which causes another chronic disability;

  • Service-connected condition causes you to pass out while driving leading to an accident; which causes another chronic disability;

  • Service-connected condition requires medications; which have side effects that cause another chronic disability;

  • Veteran self medicates with drugs/alcohol to deal with a service-connected Mental condition; the abuse causes another chronic disability; and

  • Chronic pain from service-connected conditions prevent exercise leading to obesity; which causes another chronic disability.

IMPORTANT NOTES:

  • You MUST explain the logic in your claim HOW your service-connected condition caused your claimed condition!

    • The VA in most cases will NOT assume you meant the medications you take for your Back condition caused your Acid Reflux AKA Gastroesophageal Reflux Disease (GERD)! The VA will generally assume you are claiming your back literally causes GERD; which most examiners will not consider reasonable. So please state in the claim exactly what you think the linkage is!

  • For VA purposes, tertiary conditions are simply considered secondary.

  • Tertiary and secondary conditions are NOT treated any differently than other forms of service-connection.

Strengthening Your Claim

To increase your chances of getting service-connection you should provide the VA with evidence that your tertiary condition is related to either your primary service-connected condition via an intermediate step or a secondary condition.

This can be done in several ways:

  • Buddy statements;

  • Establishing chronically - medically speaking SIX months is generally when a condition is considered chronic in nature;

  • Medical records;

  • Medical studies showing causation between conditions;

  • Nexus Letter;

  • Personal statements; or

  • Police reports.

Click on the specific links for more information

In the end, these pieces of evidence should paint the picture that your tertiary condition was caused by a service-connected condition.

IMPORTANT NOTE:

  • You do NOT need to submit a nexus with your claim in order to get service-connection! While it would certainly help, you can still get by without one if your evidence is strong enough!

Example: Service-Connection Intermediate Step (Obesity-Medication)

You have a bad case of Psoriasis that has constant flare-ups that require near continuous treatment with Prednisone for management. The near continuous use of Prednisone on a long-term basis resulted in obesity, which is medically known to lead to the development of Coronary artery disease (CAD).

Strengthening your claim

Too long didn't read (TLDR):

  1. Psoriasis medication;

  2. Obesity; leads to

  3. Coronary artery disease.

Example: Service Connection Intermediate Step (Obesity-Pain)

IMPORTANT NOTE:

  • While you CANNOT get service connection for obesity, you CAN get service connection for the conditions obesity cause or make worse!

Chronic debilitating pain can make it impossible to exercise and make it easier to gain a lot of weight and becomes obese.

A common issue that can develop due to obesity is Sleep apnea.

Strengthening your claim

Too long didn't read (TLDR):

  1. Lower back strain;

  2. Obesity; leads to

  3. Sleep apnea.

Example: Service-Connection Two Degrees of Separation (Accident)

A third (let's call it Tertiary) example.

You are service connected for Kneecap instability, as you walk down some stairs, your service-connected knee acts up and you lose grip on the railing!

During your tumble you do a number to your head and neck and also end up knocking yourself out. Luckily, your wife heard the commotion and called for an ambulance!

While in the hospital you are diagnosed with a TBI and a Neck fracture.

IMPORTANT NOTE:

  • Remember to Contact the VA if you ever use a Non-VA ER due to a genuine medical emergency! So you do not end up getting a bill!

Strengthening your claim

  • Be sure to submit those hospital records with your claim - if you are unable to get them yourself, you can provide a Release to the VA.

  • If your hospital records did not state the cause of the accident being your service-connected condition then submit a Statement with your claim explaining what happened.

Too long didn't read (TLDR):

  1. Kneecap instability;

  2. Accident on the stairs; leads to

  3. TBI and neck fracture

Example: Secondary Condition Causing a Tertiary Condition

Say you were originally service connected for Degenerative Disc Disease (DDD) of your neck.

As time keeps on ticking ticking ticking into the future, your neck condition worsens and you develop nerve issues in your arms (Radiculopathy) - pain and tingling in the shoulders, arms and/or hands). Radiculopathy is caused by narrowing of the spine. Since our spine narrowing is caused by our DDD, radiculopathy is our secondary condition.

Fast forward, you Filed a claim and were granted secondary service-connection for the radiculopathy!

Now your radiculopathy really sucks! So you start taking medication to help you deal with the pain. This can be prescribed or over-the-counter medication. (Ibuprofen, Tylenol etc.)

PRO TIP:

  • You should seek treatment with the VA or via a private doctor whenever possible to establish an ongoing record of regular treatment. For instance, VA medical visits and prescriptions will be recorded in the your medical records which will act as evidence you can use in your claims.

Because of your chronic radiculopathy pain, you end up taking Ibuprofen 4-6 times a day. Ibuprofen has been shown to cause Acid Reflux AKA Gastroesophageal Reflux Disease (GERD) is listed as a Side effect of the drug. So it is not surprising when you start developing symptoms of GERD.

Strengthening your claim

  • Six month wait - remember, you can only get a rating for chronic conditions. But be sure to put in an Intent to file!

  • Get a formal diagnosis.

  • You should write a personal statement stating the connection between your taking Ibuprofen for your service-connected condition to treat your pain and when your GERD started and how the symptoms have continued since.

    • Personal statements can hold great sway in VA claims process. Telling your story is important to the success of your claim.

With all this evidence in hand you should not have trouble getting tertiary service connection.

Too long didn't read (TLDR):

  1. DDD in neck;

  2. Radiculopathy pain + medication; leads to

  3. GERD.

Frequently Asked Questions

    • Yes, it does not matter.

Thanks

  • Thanks to u/ModusMan for contributing to this page.

References