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Week 3

Principles of Service Connection

Service Connection requires a requisite Duty Period: 38CFR 3.6…includes active duty, any period of active duty for training during which…was disabled or died from a disease or injury incurred or aggravated in line of duty, or any period of inactive duty for training during which…was disabled or died from an injury…

Methods of Service ConnectionDirectPresumptiveSecondary / AdjunctAggravationVA Medical Care (1151)

There are conditions / disabilities which cannot be service connected:38 CFR 3.303(c)

Congenital conditions

Hereditary conditions

Constitutional abnormalities

Presumption of Soundness

38 CFR 3.303 (c)

38 CFR 3.304 (b)

Service Connection requires three components: 38 CFR 3.303, 3.304

1.Current disability

2.In service event

3. Causal link (nexus) between 1 & 2

Evidence for ConsiderationService medical recordsMilitary personnel fileUnit recordsSecondary military recordsPersonal recordsLay (buddy) statementsPost service medical recordsPre service medical records

Direct Service Connection

38 CFR 3.303(a) The facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces. Each disabling condition shown by a veteran’s service records or for which he seeks service connection must be considered on the basis of the places, types and circumstances of his service as shown by service records, official history of each unit in which he served, his medical records, and all pertinent medical and lay evidence.

Combat: 38CFR 3.304(d)Satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service…

Line of Duty:38CFR 3.30138CFR 3.1(m)(n)…service connection may be granted only when a disability or cause of death was incurred or aggravated in line of duty, and not the result of the veteran’s own willful misconduct…..

Direct Service Connection Exclusions

Venereal disease (3.301(c1))

Alcohol use (3.301(c2)

Drug use (3.301(c3))

Direct Service Connection

EXAMPLES

Combat Wound

Injury

Disease

Chronicity & Continuity:38CFR 3.303(b)…chronic disease shown as such in service (or presumptive period) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected….

Direct Service Connection

Chronicity and Continuity

EXAMPLES

Bronchitis

Injury

Direct Service Connection

Post Traumatic Disorder (PTSD)

38CFR 3.304 (f) (three legs)

1. Verification of in-service Stressor

2. Diagnosis by Competent Medical Authority

3. Medical evidence of a link between symptoms and verified stressor

Presumptive Service Connection

Theory of Presumption

Presumptive Service Connection

Chronic Disease

38CFR 3.307 (a), 3.309, 3.311, 3.317, 3.318

Tropical Disease

Former Prisoner of War

Herbicide Exposure

Radiation Exposure

Persian Gulf War – Undiagnosed illness

ALS

Presumptive Service Connection

38CFR 3.307 (a)(3), (c)

Chronic Disease

38CFR 3.309 (a)

EXAMPLE

Tumors, malignant

Hypertension

Organic diseases of nervous system

Psychoses

Presumptive Service Connection

Tropical Disease

38CFR 3.307 (a)(4)

38CFR 3.309 (b)

EXAMPLE

Malaria

Leishmaniasis

Former Prisoner of War

38CFR 3.304 (e)

Circumstances of the veteran’s confinement together with medical principles will be used in determining whether disability manifest subsequent to service is etiologically related to POW experience.

Presumptive Service Connection

Former Prisoner of War

38CFR 3.307 (a)(5)

38CFR 3.309 (c)

EXAMPLE

Psychosis or Anxiety State

AHD, HHD, MI, CHF, CVA

Post-traumatic osteoarthritis

Presumptive Service Connection

Radiation Exposure

38CFR 3.309 (d), 3.311

Verified participation in an event or verification of exposure (occupational)

Leukemia (other than CLL)

Lymphomas (other than Hodgkin’s)

Multiple Myeloma

List of Cancers

Presumptive Service Connection

Herbicide Exposure

38CFR 3.309 (e)

Service in Vietnam or other specific locations or proof of exposure

Presumptive Service Connection

Persian Gulf War – Undiagnosed illness

38CFR 3.317

Signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness during the Persian Gulf War or to a degree of 10% or more not later than December 31, 2011.

Presumptive Service Connection

ALS

38CFR 3.318

Service connection at any time after service.

Secondary Service Connection

38CFR 3.310 (a), (c)

Disability which is proximately due to or the result of a service connected disease or injury shall be service connected.

Conditions, disabilities, deemed to be the consequence of treatment for a service connected disability.

Cardiovascular disease in a veteran with a single AK amputation or with bilateral BK amputations.

Service Connection by Aggravation

Pre-existing Condition

38CFR 3.306(a)

A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service unless there is a specific finding that the increase in disability is due to the natural progress of the disease.

Service Connection by Aggravation

Non SC condition

38CFR 3.306, 3.310 (b), 3.222

Any increase in severity of a non service connected disease or injury that is proximately due to or the result of a service connected disease or injury and not due to natural progress will be service connected.

Service Connection – Other Methods

Result of VA Medical Treatment

Result of VA Voc Rehab

Service Connection – Other Methods

VA Medical Treatment

38CFR 3.358, 3.800

Disability caused by hospital care or medical / surgical treatment.

Disability caused by carelessness, negligence, lack of proper skill, error in judgment.

Event not foreseeable.

Evaluations - Ratings

38CFR 4.1

The rating schedule is a guide in the evaluation of disability resulting from disease or injury as a result of military service. The percentage ratings represent the average impairment in earning capacity in civil occupations.

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