What is secondary aggravation in a VA claim?

Secondary aggravation is a grant under 38 C.F.R. § 3.310(b) for the worsening of a condition that is not service connected, when a service-connected disability made it worse. The underlying condition stays nonservice connected. What becomes service connected is the increase in severity.

Does the condition have to be related to my service?

No. That is the point of the rule. The condition can pre-date your service, can have started decades after you got out, and can have nothing to do with the military at all. The question under 3.310(b) is not where the condition came from. It is whether a service-connected disability has made it worse.

How much does VA pay on an aggravation claim?

The increase, not the whole condition. VA rates where the condition stood before the aggravation began, called the baseline, rates where it stands now, and pays the difference between the two. A condition that rates 30 percent now with a 10 percent baseline produces a 20 percent evaluation for the aggravation.

What does natural progression mean in an aggravation claim?

It is the decline the condition would have had on its own, without any influence from the service-connected disability. The regulation only service connects worsening beyond that. A denial that says the worsening was natural progression has to actually explain why, based on the medical evidence, rather than stating it as a conclusion.

Why do so many aggravation claims get denied?

The most common reason is that nobody was ever asked the question. VA examination requests frequently pose the causation question only, the examiner answers that the condition was not caused by the service-connected disability, and the decision denies on that record without anyone addressing whether it was made worse. Half the regulation goes unadjudicated.

Can I still file if my condition existed before I joined the military?

Yes. A condition that pre-dates your service can be aggravated by a service-connected disability years or decades later, and the claim is evaluated under 3.310(b) like any other. The fact that you had the condition before service does not remove it from the rule. It is the reason the rule exists.

You Had It Before. A Service-Connected Condition Made It Worse. That's Still a Claim.

Q: What is the baseline and why does it matter so much?

The baseline is the level of severity the condition had before the service-connected disability started making it worse. The regulation says VA will not concede aggravation unless the baseline is established by medical evidence, either created before the aggravation began or the earliest medical evidence created after it. Without that evidence in the file, VA is not supposed to concede aggravation at all, which makes the baseline the single most important piece of evidence in these claims.

Q: Is this the same as aggravation of a condition during service?

No, and the two get confused constantly. 38 C.F.R. § 3.306 covers a condition you had before you entered service that got worse during service. 38 C.F.R. § 3.310(b) covers a nonservice-connected condition that a service-connected disability made worse, at any point, including decades after discharge. Different rules, different evidence, different questions.

Almost nobody files these claims, and the reason is a sentence veterans hear early and take as final.

“That condition isn’t related to your service.”

Sometimes that is completely true. You had the arthritis before you enlisted. The diabetes runs on both sides of your family. The back went out on a civilian job site in 2011. None of it has anything to do with the military, and you know it.

Then the sentence does its damage, because it sounds like the end of the analysis. It is not even the right question.

How VA decides a secondary aggravation claim under 38 C.F.R. 3.310(b): the condition itself does not have to be service connected, a service-connected disability has to have made it worse, the worsening cannot be natural progression, a baseline level of severity has to be established by medical evidence, and the benefit is the increase above that baseline rather than the whole condition.

The half of the rule nobody uses

38 C.F.R. § 3.310 has two paragraphs that do two different jobs.

Paragraph (a) is the one everyone knows. A service-connected condition caused a new one, so the new one gets service connected too. That is the version covered in our guide to secondary service connection.

Paragraph (b) is the one that goes unfiled. Any increase in severity of a nonservice-connected condition that is proximately due to a service-connected disability, and not due to the natural progress of the condition, is service connected.

Read what that does. The condition stays nonservice connected. VA does not have to agree it came from your service, because it did not. What becomes service connected is the worsening, and the worsening alone.

So a veteran with degenerative arthritis that predates their enlistment, and a service-connected knee that has been throwing off their gait for twenty years, is not out of the rule because the arthritis came first. The arthritis coming first is the entire premise of the paragraph.

Causation is not required, and that is the whole point

Under paragraph (a) you have to show the service-connected condition caused the new one. That is a demanding thing to prove. Bodies do not come with clean causal chains, and a clinician who is honest about it will often say the relationship cannot be untangled.

Paragraph (b) asks for less. Not “would this condition exist without the service-connected disability,” but “is this condition worse than it would otherwise be because of the service-connected disability.”

That is a question a treating physician can frequently answer with confidence when the causation question defeats them. The veteran with an old civilian back injury and a service-connected ankle does not need anyone to say the ankle caused the back problem. It did not. What they need is someone to explain that fifteen years of walking on a bad ankle has accelerated a back condition that would otherwise have declined slowly.

The baseline decides what you actually get paid

This is the mechanical part, and it is where aggravation claims differ from every other kind.

You are not paid for the condition. You are paid for the increase. The regulation sets out how VA gets there:

Rate the baseline. Where the condition stood, under the rating schedule, before the aggravation began.
Rate the current level. Where the condition stands now, under the same criteria.
Deduct the baseline from the current level. What is left is the evaluation for the aggravation.

A knee condition that rates 30 percent today, with a baseline that rates 10 percent, produces a 20 percent evaluation. Not 30. Not zero.

The regulation is specific about where the baseline comes from, and this is the sentence to know: VA will not concede aggravation unless the baseline level of severity is established by medical evidence, either created before the aggravation began, or the earliest medical evidence created at any time between the onset of aggravation and the evidence establishing the current level.

That requirement cuts in both directions, and an honest description has to say so.

Against you, it means an aggravation claim with no medical evidence of the condition’s earlier state is in real trouble. If the first record of your arthritis is from last year, after two decades of the service-connected knee doing its work, there may be nothing in the file capable of establishing a baseline. That is a genuine hurdle, not a technicality someone can argue around.

For you, it means the baseline has to come from medical evidence. It is not a number an adjudicator arrives at by impression. A decision that deducts a baseline without identifying the medical evidence establishing it has not followed the rule it is applying.

Natural progression is a finding, not a phrase

The regulation excludes worsening that is due to the natural progress of the condition. Most things get worse on their own. Arthritis progresses. Diabetes progresses. The rule only reaches the worsening beyond what the condition would have done anyway.

That exclusion is legitimate, and it is also the most overused sentence in these denials.

“The worsening is consistent with the natural progression of the disease” is a conclusion. On its own it explains nothing. An adequate opinion has to say what the expected course of this condition looks like, what this veteran’s actual course looked like, and why the difference between them is or is not attributable to the service-connected disability. When a denial rests on natural progression with no reasoning behind it, the problem is not the finding. It is that no finding was actually made.

Do not confuse this with in-service aggravation

Two different rules use the same word, and mixing them up sends claims in the wrong direction.

38 C.F.R. § 3.306 covers a condition you had when you entered service that got worse during service. It deals with your entrance examination, the presumption of soundness, and what happened between induction and discharge.

38 C.F.R. § 3.310(b) covers a nonservice-connected condition that a service-connected disability made worse. It has nothing to do with your entrance exam and no relationship to what happened in service at all. The aggravation it covers can have started thirty years after you got out.

If you were told your claim fails because the condition preexisted service and there is no evidence it worsened in service, that is an answer to the 3.306 question. It says nothing about 3.310(b).

Where these claims actually come up

A service-connected joint and a preexisting condition somewhere else. Altered gait and altered mechanics accelerate what is already there. The arthritis was going to progress. It did not have to progress at that rate.

Mental health and physical conditions in both directions. A service-connected mental health condition affects sleep, weight, activity, medication compliance, and follow-up care, all of which change the course of conditions like diabetes and hypertension. The reverse also happens, where chronic pain from a service-connected condition worsens a mental health condition that was already there.

Medication. Treatment for a service-connected disability can accelerate a condition you already had. The claim is not that the medication created it.

Immobility. A service-connected condition that takes away your ability to move worsens a long list of things that were already in progress.

None of these decide an individual claim. They are the shapes these cases tend to take.

Where they get denied

Nobody asked. The examination request posed the causation question only. The examiner wrote that the condition was not caused by the service-connected disability. The decision denied on that record. Nothing in the file addresses whether it was made worse, because nobody was ever asked to address it. This is the most common defect in these claims by a wide margin.

The opinion stopped at causation. Even when aggravation was in the request, plenty of opinions answer the first question and go quiet on the second. An opinion that does not reach aggravation leaves half the regulation undecided, and an examination that fails to answer the question it was ordered to answer is inadequate. More on that in The Exam Is the Appointment. The Opinion Is What Decides the Claim.

Natural progression, asserted and unexplained. Covered above. The finding needs reasoning attached to it.

The wrong rule. A denial written around the entrance examination and the presumption of soundness, when the claim was filed under 3.310(b).

No baseline in the file. Sometimes this is correct and the evidence genuinely is not there. Sometimes the baseline evidence exists in private treatment records nobody requested.

What to do with this

Take the conditions you have that are not service connected and ask a different question about each one. Not whether it came from service. Whether it is worse than it would be, because of something that is service connected.
Go get the old records. The baseline requirement makes the earliest medical evidence of that condition the most valuable document in the claim. Private records, records from before you enlisted, records from the years before the service-connected condition took hold.
Ask for the right opinion. The clinician needs to address aggravation directly, in probability terms, and say what the condition’s expected course would have been without the service-connected disability. An opinion that only addresses causation will not carry an aggravation claim.
If you were denied, find out whether the question was ever asked. Read the examination report and the decision for the word aggravation. If it appears nowhere, the claim was decided on half a record.
Check which aggravation rule the denial was answering. If it discusses your entrance examination, it answered a question you did not ask.

Whether any particular claim succeeds depends on the evidence, the records that exist, and how the file is built. Nobody can tell you your outcome. But “that condition isn’t related to your service” is a description of the condition, not an answer to this rule.

Blackmore Veterans Law, P.C. is a solo practice representing veterans in VA disability claims and appeals. Contact us to discuss your situation.

This article is general information about VA disability law and is not legal advice for any individual case. Reading it does not create an attorney-client relationship. Attorney advertising.