- Two types of aggravation - pre-service conditions worsened by military service, or post-service conditions worsened by a service-connected disability
- Presumption of soundness - if nothing was recorded at MEPS, the VA assumes you entered service healthy
- Rating calculation is different - aggravated ratings subtract preexisting severity from current severity
- Medical evidence required - you need proof showing severity before AND after aggravation
There are two flavors of service-connection by aggravation:
Aggravation of a preexisting (pre-service) condition by military service; and
Aggravation of a existing (post-service) by a service-connected condition.
Unlike the other forms of service-connection, aggravation has an extra layer of complication in determining your rating.
Aggravation of a Preexisting (Pre-service) Condition
When your military service worsens a preexisting condition
Before you joined the military you underwent a physical examination at a Military Entrance Processing Station (MEPS). During this examination any preexisting issues is recorded. Anything NOT recorded during that examination, the VA is instructed to 'presume soundness' - that is, if nothing is recorded that the Veteran came in with nothing wrong!
Now with that said, there are exceptions:
If a chronic condition is diagnosed shortly after service starts, AND it could be medically concluded (more likely than not) that this condition existed before service - the VA will just NOT assume the condition just popped up during service.
This said, it is still possible to get service-connection!
If medical evidence shows a condition existed prior to service.
Examples include: medical records dated BEFORE service or x-rays done in service that show well healed preexisting bone fractures.
IMPORTANT NOTES:
Statements from the Veteran themselves or others that a condition existed BEFORE service hold ZERO WEIGHT! UNLESS, there is medical evidence that backs up those statements!
If DoD LOST your entrance physical paperwork, the VA is to assume you entered into service with no issues (barring the previously mentioned exceptions).
Periods of IADT service; which did NOT have an entrance physical conducted prior to the period of service do NOT carry this presumption of soundness!
Setting Up Consideration
So medical records indicated that a condition existed before service:
In order for the VA to consider a condition under aggravation of a preexisting (pre-service) condition the VA must establish two things:
What the level of severity* was BEFORE service; and
What the level of severity was DURING/AFTER service.
*severity for VA purposes is as established by the Rating schedule.
For number one, in most cases (unless you say got a medical waiver), your severity before service will be established as 0%.
Now number two, is where things get tricky for a lot of Veterans...
The VA NEEDS proof that your service made your condition worse! If there are NO complaints or treatment made in service for the preexisting condition - You Lose! Good day sir! For the most part...
However, there is still some hope! You can submit Buddy statements in support of your claim! Alternatively, if the source of your aggravation is related to combat then you do NOT need documentation! You just need to submit a Personal statement explaining how the injury that aggravated your condition occurred.
Additionally, if your aggravation occurred as a result of a specialized skill IE parachutist. You can state as much, as it is fairly well established that taking hard landings can mess stuff up.
Making a Decision
The VA now armed with elements one and two - can now get a medical opinion on aggravation.
The VA will now ask a medical professional to provide a medical opinion as to if your military service permanently worsened your preexisting condition at least as likely as not beyond it's natural progression.
If the opinion is favorable then you are good to go.
Aggravation of an Existing (Post-service) Condition
If your service-connected condition (or a condition that eventually becomes service-connected) aggravates an existing condition it can be service-connected.
Setting Up Consideration
In order for the VA to consider a condition under aggravation of an existing (post-service) condition the VA must establish two things:
What the level of severity* was BEFORE aggravation; and
What the level of severity was AFTER aggravation.
*severity for VA purposes is as established by the Rating schedule.
It is REQUIRED that you supply medical evidence to the VA that shows the level of severity of the condition BEFORE aggravation, OR as soon as possible after aggravation, but before the date of receipt of the evidence establishing the current level of severity of the aggravated condition.
In short - if you do not show the VA how much your service-connected condition aggravated a condition, you CANNOT get service-connection!
Making a Decision
The VA now armed with elements one and two - can now get a medical opinion on aggravation.
The VA will now ask a medical professional to provide a medical opinion as to if your service-connected condition worsened your existing condition at least as likely as not beyond it's natural progression.
If the opinion is favorable then you are good to go.
Rating Aggravated Conditions
Rating service-connected aggravated conditions has an additional layer of complication. Instead of the traditional assigning a rating based upon the rating schedule, aggravated conditions involve some subtraction:
Current severity - preexisting condition severity = aggravated rating
IMPORTANT NOTES:
If the preexisting (pre-service) condition would rate 100% severity, the final aggravated rating WILL BE 100%!
This does NOT apply to aggravations of conditions AFTER separation!
If the VA cannot determine the severity of a preexisting (pre-service) condition, the VA will assume the severity was 0%.
Examples Preexisting (Pre-Service)
| Current Severity | Preexisting Severity | Aggravated Rating |
|---|---|---|
| 0% | -0% | =0% |
| 30% | -30% | =0% |
| 50% | -10% | =40% |
| 70% | -50% | =20% |
| 100% | -100% | =100% |
Examples Existing (Post-Service)
| Current Severity | Preexisting Severity | Aggravated Rating |
|---|---|---|
| 0% | -0% | =0% |
| 30% | -30% | =0% |
| 50% | -10% | =40% |
| 70% | -50% | =20% |
| 100% | -100% | =0% |