1. WELCOME Week 3 Principles of Service Connection

2. 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…

3. Methods of Service Connection Direct Presumptive Secondary / Adjunct Aggravation VA Medical Care (1151)

4. There are conditions / disabilities which cannot be service connected: 38 CFR 3.303(c) Congenital conditions Hereditary conditions Constitutional abnormalities

5. Presumption of Soundness 38 CFR 3.303 (c) 38 CFR 3.304 (b)

6. 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

7. Evidence for Consideration Service medical records Military personnel file Unit records Secondary military records Personal records Lay (buddy) statements Post service medical records Pre service medical records

8. 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.

9. 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…

10. Line of Duty: 38CFR 3.301 38CFR 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…..

11. Direct Service Connection Exclusions Venereal disease (3.301(c1)) Alcohol use (3.301(c2) Drug use (3.301(c3))

12. Direct Service Connection EXAMPLES Combat Wound Injury Disease

13. 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….

14. Direct Service Connection Chronicity and Continuity EXAMPLES Bronchitis Injury

15. 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

16. Presumptive Service Connection Theory of Presumption

17. 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

18. 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

19. Presumptive Service Connection Tropical Disease 38CFR 3.307 (a)(4) 38CFR 3.309 (b) EXAMPLE Malaria Leishmaniasis

20. 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.

21. 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

22. 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

23. Presumptive Service Connection Herbicide Exposure 38CFR 3.309 (e) Service in Vietnam or other specific locations or proof of exposure

24. 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.

25. Presumptive Service Connection ALS 38CFR 3.318 Service connection at any time after service.

26. 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.

27. 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.

28. 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.

29. Service Connection – Other Methods Result of VA Medical Treatment Result of VA Voc Rehab

30. 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.

31. 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.

32. Questions?

33. Quiz