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Appendix C: Glossary of Terms
Appendix C: Glossary of Terms
VA Claims Terminology
Understanding the specialized terminology used in VA claims is essential for navigating the secondary service connection process. This comprehensive glossary provides clear definitions of key terms you’ll encounter throughout your claims journey.
Aggravation
A permanent worsening of a non-service-connected condition beyond its natural progression due to a service-connected condition. Aggravation is an alternative basis for secondary service connection when the service-connected condition did not cause but has worsened another condition.
Appeals Modernization Act (AMA)
Legislation implemented in February 2019 that created three new options for appealing VA decisions: Higher-Level Review, Supplemental Claim, and appeal to the Board of Veterans’ Appeals. This system replaced the previous legacy appeals process.
Board of Veterans’ Appeals (BVA)
The component of VA that conducts hearings and decides appeals of VA Regional Office decisions. Appeals are decided by Veterans Law Judges who review the evidence and issue written decisions.
C-File (Claims File)
The complete record of a veteran’s claims history maintained by VA, including applications, medical records, service records, correspondence, rating decisions, and other documents related to claims. Veterans can request a copy of their C-file through a Privacy Act request.
Compensation & Pension (C&P) Examination
A medical examination conducted by VA or a VA-contracted provider to evaluate a claimed disability. For secondary claims, the examiner assesses both the diagnosis and whether it is connected to a service-connected condition.
Combined Ratings Table
The table used by VA to calculate a veteran’s overall disability rating when multiple conditions are service-connected. VA does not simply add ratings together but uses a formula that accounts for the impact of multiple disabilities.
Decision Review Officer (DRO)
A senior VA claims processor who conducts Higher-Level Reviews of decisions made by VA Regional Offices. DROs have the authority to reverse or modify prior decisions based on difference of opinion or clear error.
Diagnostic Code
A numerical code from VA’s Schedule for Rating Disabilities that identifies specific conditions and provides criteria for assigning disability ratings. Each service-connected condition is assigned a diagnostic code in rating decisions.
Direct Service Connection
The establishment of a connection between a current disability and an injury, disease, or event that occurred during military service. This is distinguished from secondary service connection, which connects a condition to an already service-connected disability.
Disability Benefits Questionnaire (DBQ)
Standardized forms used by healthcare providers to document the existence and severity of a veteran’s disability. DBQs are designed to provide the specific information VA needs to make decisions on disability claims.
Effective Date
The date from which VA benefits are payable when a claim is granted. For secondary service connection claims, this is typically the date VA received the claim or the date the disability arose, whichever is later.
Evidence-Based Medicine
The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. In VA claims, evidence-based medicine supports the connection between conditions through scientific research and clinical practice.
Fully Developed Claim (FDC)
A VA claims process that allows for faster decision if the veteran submits all evidence at the time of claim filing and certifies that no additional evidence is needed. FDCs can be used for secondary service connection claims.
Higher-Level Review
An AMA appeal option that provides a new review of a claim by a senior VA employee. No new evidence can be submitted, but the reviewer can identify errors in the prior decision.
Independent Medical Examination (IME)
A medical examination performed by a healthcare provider who is not affiliated with VA, often used to provide an alternative opinion to VA examiners. IMEs can be particularly valuable for complex secondary connection claims.
Intent to File
A form (VA Form 21-0966) that establishes a potential effective date for benefits while giving the veteran up to one year to gather evidence and submit a complete claim. This can be useful for secondary claims requiring extensive evidence development.
Lay Evidence
Non-expert evidence provided by the veteran, family members, friends, or others without specialized medical knowledge. Lay evidence can address observable symptoms and the impact of conditions on daily life.
Medical Nexus
The causal link or connection between two medical conditions. For secondary service connection, a medical nexus must be established between the service-connected condition and the secondary condition.
New and Relevant Evidence
Under the AMA, evidence that was not previously submitted to VA and is relevant to the claim. This standard applies to Supplemental Claims and is less stringent than the previous “new and material” standard.
Presumptive Service Connection
A process by which VA presumes certain disabilities are related to military service based on specific circumstances, such as exposure to Agent Orange or service during specific time periods and locations.
Rating Decision
The formal determination issued by VA regarding a veteran’s claim, including whether service connection is granted, the disability rating assigned, and the effective date. Rating decisions include a narrative explaining the basis for the decision.
Secondary Service Connection
The establishment of service connection for a disability that is caused or aggravated by an already service-connected condition. This creates entitlement to compensation for conditions that did not directly begin during service.
Special Monthly Compensation (SMC)
Additional compensation paid to veterans with certain severe disabilities or combinations of disabilities. Some secondary conditions may qualify a veteran for SMC, such as loss of use of a creative organ or need for regular aid and attendance.
Supplemental Claim
An AMA appeal option that allows veterans to submit new and relevant evidence for consideration. This is often the best option for secondary claims initially denied due to insufficient evidence of the connection.
Veterans Service Organization (VSO)
An organization that assists veterans with VA claims and appeals, often at no cost. VSOs can provide valuable guidance on developing evidence for secondary service connection claims.
Medical Terminology
Understanding medical terminology is crucial for developing effective secondary service connection claims. This section provides definitions of key medical terms relevant to establishing connections between conditions.
Acute
A condition with sudden onset, severe symptoms, and short duration. Acute conditions may become chronic if they persist or recur. In secondary claims, acute conditions may be less likely to support service connection than chronic conditions.
Aggravation (Medical)
The worsening of a medical condition beyond its expected natural progression. In secondary claims, medical evidence must distinguish between natural progression and aggravation caused by a service-connected condition.
Chronic
A condition that persists for a long time, often throughout a person’s lifetime. Chronic conditions typically require ongoing management and may cause permanent changes to body systems. Many secondary conditions are chronic in nature.
Comorbidity
The presence of two or more medical conditions in the same person, especially when they interact with each other. Comorbidities are relevant to secondary claims as they may involve complex relationships between conditions.
Contraindication
A factor that makes a particular treatment inadvisable. Service-connected conditions may create contraindications for treatments of other conditions, potentially supporting secondary service connection through treatment limitations.
Degenerative
Characterized by progressive deterioration of physical or mental faculties. Degenerative conditions may be secondary to service-connected conditions that alter body mechanics or function over time.
Diagnosis
The identification of a medical condition based on signs, symptoms, and diagnostic tests. A clear, specific diagnosis is essential for secondary service connection claims.
Etiology
The study of the causes or origins of diseases. In secondary claims, medical opinions should address the etiology of the secondary condition and how it relates to the service-connected condition.
Exacerbation
A temporary worsening of a condition’s symptoms, as opposed to permanent aggravation. VA distinguishes between temporary exacerbations and permanent aggravation when evaluating secondary claims.
Functional Impairment
Limitation in a person’s ability to perform normal daily activities due to a medical condition. Functional impairments from service-connected conditions may lead to secondary conditions.
Iatrogenic
A condition caused by medical treatment. Secondary conditions may be iatrogenic when they result from medications or treatments for service-connected conditions.
Idiopathic
A condition that arises spontaneously or from an unknown cause. For secondary claims, it’s important to distinguish between idiopathic causes and those related to service-connected conditions.
Multifactorial
A condition caused by multiple factors or mechanisms. Many secondary conditions are multifactorial, with the service-connected condition being one of several contributing factors.
Neuropathy
Damage or dysfunction of peripheral nerves, causing numbness, weakness, or pain. Neuropathy is a common secondary condition to diabetes, toxic exposures, and other service-connected conditions.
Pathophysiology
The functional changes associated with or resulting from disease or injury. Understanding pathophysiology is crucial for explaining the medical mechanism connecting primary and secondary conditions.
Prodromal
Early symptoms that may indicate the onset of a disease before more specific symptoms appear. Prodromal symptoms may help establish the timeline of a secondary condition’s development.
Prognosis
The likely course and outcome of a disease or condition. Prognosis may be relevant to secondary claims when a service-connected condition worsens the expected outcome of another condition.
Sequela (plural: Sequelae)
A condition that follows and is the result of a previous disease or injury. Many secondary conditions are sequelae of service-connected conditions.
Side Effect
An unintended effect of medication or treatment. Side effects of treatments for service-connected conditions may qualify for secondary service connection.
Symptom
A physical or mental feature that indicates a condition or disease, especially one apparent to the patient. Symptoms help establish the existence and severity of both primary and secondary conditions.
Syndrome
A group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition. Some secondary conditions manifest as syndromes rather than single diagnoses.
Legal Terminology
Understanding legal terminology is important for navigating the VA claims process and interpreting VA decisions. This section defines key legal terms relevant to secondary service connection claims.
At Least As Likely As Not
The standard of proof for VA claims, meaning there is at least a 50% probability that the claimed condition is related to service or a service-connected condition. This is a lower standard than “beyond reasonable doubt” used in criminal cases.
Benefit of the Doubt
A legal doctrine requiring VA to resolve issues in the veteran’s favor when the evidence for and against a claim is approximately balanced. This doctrine is codified in 38 U.S.C. § 5107(b).
Burden of Proof
The obligation to present evidence supporting a claim. In VA claims, the veteran has the burden of proving entitlement to benefits, but this burden is lower than in other legal contexts.
Clear and Unmistakable Error (CUE)
A specific type of error in a final VA decision that is undebatable and would have manifestly changed the outcome if it had not been made. CUE claims are a way to revise otherwise final decisions.
Competent Evidence
Evidence provided by a person who has the knowledge, training, or experience to offer the testimony or opinion. Medical nexus opinions must come from competent medical sources.
Credible Evidence
Evidence that is believable, plausible, and consistent with other evidence of record. VA must assess the credibility of all evidence submitted in support of a claim.
Duty to Assist
VA’s legal obligation to help veterans develop their claims by obtaining relevant records, providing medical examinations, and providing other assistance. This duty is codified in 38 U.S.C. § 5103A.
Extraschedular Rating
A disability rating assigned outside VA’s standard rating schedule when the schedule does not adequately reflect the veteran’s disability picture. These are rare but may be relevant for secondary conditions with unusual presentations.
Jurisdiction
The legal authority of a court or administrative body to hear and decide a case. Different parts of VA have jurisdiction over different types of claims and appeals.
Precedential Decision
A court decision that establishes a rule or principle that must be followed in similar cases. Decisions from the Court of Appeals for Veterans Claims and higher courts can establish precedent for VA claims.
Probative Value
The tendency of evidence to establish the proposition for which it is offered. Evidence with high probative value strongly supports or refutes a claim.
Remand
The return of a case from an appellate body to a lower decision-maker for further action. The Board of Veterans’ Appeals may remand a case to the Regional Office for additional development.
Statute of Limitations
A law that sets the maximum time after an event within which legal proceedings may be initiated. There is no statute of limitations for filing initial VA disability claims, but there are time limits for appeals.
Tolling
The pausing or delaying of a time period specified by statute. In some circumstances, the time limit for filing VA appeals may be tolled due to circumstances beyond the veteran’s control.
In This Appendix
Key Concept
The Language of VA Claims
Understanding the specialized terminology used in VA claims is essential for effective communication with VA and healthcare providers. Using the correct terminology in your submissions demonstrates knowledge of the process and helps ensure your claim is properly evaluated.
When discussing your secondary conditions, using precise medical and legal terms can help clarify the relationship between your conditions and strengthen your claim.
Quick Tips
- Use the term “secondary service connection” rather than “secondary condition” in your claim documents
- Specify whether you are claiming causation, aggravation, or both
- Reference the “at least as likely as not” standard in your submissions
- Ask your healthcare providers to use precise medical terminology in their opinions
- When in doubt about terminology, consult with a VSO or accredited representative