Transcription
A federal court just forced the VA to change the way it decides one of the most common claims veterans ever file. And almost nobody is talking about it yet.
If the VA has ever denied you for a condition and told you it was not connected to your service, you need to hear this because the exact reason they used to deny people like you just got struck down by the second highest court that handles these cases. Conditions the VA has been rejecting for years now have a clear path to getting approved. And the wildest part is the VA is quietly updating its own internal rule book right now to match what the court told them, which means the window to use this is open today and most veterans have no idea it exists.
I am going to walk you through exactly what the court said in plain English. No legal fog. I read the ruling so you do not have to. And I am going to show you the precise sentence you can put in a new claim to use it. Stay with me because near the end I am going to show you the one catch the VA is counting on you to miss. And if you miss it, this whole thing works against you instead of for you.
First, let me tell you who this is for because it is a lot bigger group than you think. This is for every single veteran. Any era, Vietnam, Gulf War, post 911, peace time, does not matter. Any rating, whether you are sitting at 10%, sitting at 90, or you have zero right now because they denied you flat out. It does not matter if you filed a claim last week, or if you got a denial letter a decade ago and gave up. If you have a condition that got worse because of something the military already pays you for, this ruling is about your money. So, if that is you or it is somebody you served with, keep watching because I do not want you leaving money on the table that the government now owes you.
Let me back up for one second and make sure we are all on the same page about what a secondary claim even is because this is where the money is hiding. A primary condition is the thing the VA already agreed is connected to your service. Say it is your back. Your back is service connected. You get paid for it. A secondary condition is a new problem that your back caused. Your back hurts so bad you stopped moving. You gained weight. You developed a nerve problem in your leg. You got depressed from living in pain every day. Those downstream problems, the ones that grew out of the first one, those are secondaries.
And here's why I'm telling you this. Secondary conditions are the single biggest pile of money that veterans leave behind. Most guys stop at the one thing they got rated for and never realize that everything that first injury dragged down with it is also supposed to be on the books. That is how a 30% veteran is actually a 70% veteran and does not know it.
Now, here is the wall you have been running into. For years, if you tried to file one of these, the VA would deny it with language that sounded official and final. They would say your condition was not approximately caused by your service connected disability. Or they would say you had to prove that the first condition permanently worsened the second one and prove exactly how much of the damage came from which cause. It was a maze. They set the bar so high that a normal human being with a real disability and a stack of medical records still could not clear it. And a lot of you, I know this, a lot of you got that denial, read that wall of text and figured the VA must be right and you must not qualify. You put the letter in a drawer. That is exactly what the system is built to make you do.
So, let me tell you about the man who did not put the letter in a drawer. His name is in the case Spicer. Here is what happened to him. And I want you to listen to this because your situation is probably a cousin of it. Mr. Spicer had a service connected condition that the VA was already paying him for. The treatment for that condition, the medication, lowered his blood counts. Because his blood counts were low, the doctors had to cancel a knee replacement surgery he needed. He could not get the surgery. And because he could not get the surgery, his knees got worse and worse until he was in a wheelchair. So, think about the chain there. The service connected problem did not directly attack his knees. What it did was block him from getting the treatment that would have saved his knees. And the VA looked at that and said, "Sorry, not connected. Denied."
Mr. Spicer took that denial and he pushed it all the way up to the Court of Appeals for the Federal Circuit. That is a real federal court, the same one that handles patents and big federal cases. And when they rule on a veterans law question, the VA has to listen. On March 8th of 2023, that court handed down a decision. And they did not just side with Mr. Spicer. They went after the rule the VA had been using to deny people like him. And they struck down the way the VA was applying it. Case number 22, 1239. If you ever want to look it up yourself, here is what the court actually said. And this is the sentence that changes everything for you.
They said the VA had been reading the law too narrowly and that the real standard is simpler than the maze they built. The question is not whether your service connected condition was the fancy legal proximate cause. The question is whether your other condition would have been less severe but for your service connected disability but for that is the whole ballgame. If your other condition would be in better shape today if not for the thing the VA already pays you for that is a secondary connection. And the court went one step further. The step that matters most. They said this specifically includes the situation where your service connected disability made you unable to treat the other condition. That is the Spicer situation. The medication blocked the surgery. The blocked surgery wrecked the knees and the court said yes that counts. That is connected.
Let me put that in your language. The way it actually shows up in real life. You have service connected sleep apnea and the exhaustion and the strain put pressure on your heart. Would your heart be in better shape but for the apneoa? You have a service connected knee and you have leaned on the other knee and your back for 15 years to compensate. Would that other knee and that back be better but for the bad one? You are on a service connected medication and it tore up your stomach or it drove your blood sugar up or it killed your energy so you stopped exercising and everything else slid. Would your body be better but for that medication? That is the test now not a maze. One question. Would it be less severe, but for the thing the VA already admits it caused?
Let me walk you through the most common chains I see because I want you to hear your own life in at least one of these. Start with sleep apnea because it is one of the most underclaimed secondaries in the whole system. Say your apnea is service connected. Apnea starves your body of oxygen every single night for years and that grinds on your heart and drives your blood pressure up. So you develop hypertension or your heart gets weak. Would that heart trouble be as bad? But for years of your service connected apnea choking off your oxygen? Probably not. That is a secondary. And under this standard, you have a real shot at it now.
Take the knees and the back. The classic one. Your right knee is service connected and it has been bad for a decade. What does a human being do with a bad knee? You favor it. You shift all your weight onto the left knee and onto your lower back day after day, year after year. And eventually the left knee and the back break down too from carrying a load they were never meant to carry alone. Would that other knee and that back be in the shape they are in but for the service connected knee that made you lean on them? That is the butt for test and that is money the VA has been denying with the old narrow rule.
Now think about mental health because this one is huge and guys leave it on the table constantly. Say your PTSD is service connected. Living with that level of stress hammers your body. It spikes your blood pressure. It tears up your stomach and gives you acid reflux. What the doctors call GERD? It wrecks your sleep, which wrecks everything else. Would your blood pressure, your gut, your sleep, be in better shape, but for carrying that service connected condition every day? The link is real. And now the standard is built to recognize it.
And here is the one that is pure Spicer. The one most veterans never even think to file, the medication chain. Your service connected condition requires medication. That medication has side effects. The pain pills tore up your stomach. The mental health medication put 40 pounds on you and pushed you toward diabetes. The blood pressure medication wiped out your energy so you stopped moving and everything else slid downhill. Or exactly like Spicer, the treatment for one thing made it impossible to treat another thing and that second thing got worse. Would any of that have happened but for the medication you have to take for a service connected disability? The court said that counts. The thing the VA pays you for created a problem directly or by blocking your treatment. And that problem is now on the books, too.
And notice what the court took off the table. They took away that requirement that you prove permanent worsening down to the percentage. You do not have to hand them a medical formula splitting the blame. You have to show the link. Your service connected condition made this other thing worse or blocked you from fixing it. And it would be less severe if the first problem had not been there. That is a bar a real veteran with real records can actually clear.
Now, before I show you exactly how to use this and the trap you have to avoid, I want to make sure you can actually do something with all of it, not just this one ruling. I put together a plain English guide called the Veterans Benefits Playbook. It walks through how to build a secondary claim step by step. How to connect the dots between your primary and everything it dragged down and the wording that actually moves a rater. All in the same no fog language I am using right now. It is $19.99. The link is down in the description. And honestly, if this one ruling gets you a single secondary approved, it pays for itself a thousand times over.
All right, back to it. Because this next part is where people win or lose. Let me talk about who needs to act and when because it depends on where you are sitting right now. If you got denied for a secondary in the past, this is the big one for you and I do not want you to hear this wrong. So listen close. An old denial is not the end. When the law that governs your claim changes, you have a path to bring it back to life. You can file what is called a supplemental claim and you point to this ruling and the updated standard as the reason your case should be looked at fresh. The denial they gave you three years ago was based on the old narrow rule. That rule got struck down. So the ground under that denial moved.
If you are pending right now waiting on a decision, even better because this standard applies to you already and you can put it in writing while your claim is still open. And if you have never filed at all because you assumed you would not qualify, you are actually in the cleanest spot of anyone because you get to build it right the first time with the new standard baked in from the start. Best team.
Now let me knock down the excuses your own brain is going to throw at you because I have heard all of them and most of them are wrong.
Excuse one. They already denied me so it is over. No, I just told you the rule they denied you under changed. A supplemental claim exists exactly for this.
Excuse two. My claim is too old. Age does not lock a door here. If anything, the older claims are the ones that were judged under the worst version of the rule, which means they are the ones most likely to have been wrongly denied.
Excuse three. I do not have some fancy nexus letter from a specialist. You need a logical medical link and you need it stated clearly. But the whole point of this ruling is that the bar for that link came down. You are showing but for not a courtroom level proof splitting hairs.
Excuse four. It is a hassle and the VA is just going to deny me again. Maybe they will make you fight. But the standard is now on your side in writing from a federal court. And that is the difference between fighting uphill and fighting downhill. I would rather you fight downhill.
So here is what you actually do.
Step one, pull your records. Get your denial letters out of the drawer and figure out which conditions the VA turned down as not connected. Those are your targets.
Step two, map the chain for each one. Write the simple story. This service connected condition caused or worsened or blocked treatment for this other condition and that other condition would be less severe but for the first one. Keep it that plain.
Step three, get the medical link on paper. That can be a doctor who agrees with the chain in writing or your existing records that show the timeline.
Step four, file the supplemental claim if you were denied before or the regular claim if you were new. And in your own statement, you write the magic words. You state that under the current standard your condition would be less severe but for your service connected disability and where it fits that your service connected disability impaired your ability to treat it. You are handing the rater the exact language the court used. You are not leaving them room to fall back on the old maze.
Let me get specific about the evidence because this is where good claims and dead claims split apart. The heart of a secondary claim is the link. What the VA calls a nexus. In plain terms, it is a medical opinion, usually a sentence or two, from a doctor, that connects the dots. And the good news is that the ruling changed what that sentence has to say. It used to need to sound like courtroom proof. Now, it needs to track the but for standard. A strong one sounds like this: "In my medical opinion, it is at least as likely as not that this veteran's condition is worse than it otherwise would be, but for his service connected disability because that service connected disability did this specific thing." That is it. "At least as likely as not" is the VA's own standard of proof. And it means 50/50 is enough. You do not need to be certain. You need it to be a coin flip or better. And the court just made that coin much easier to flip in your favor.
Where do you get that sentence? Your own treating doctor is the best source, the one who already knows your history because a rater gives real weight to the doctor who has actually been managing you. Bring them the chain written out simple the way I showed you and ask if they agree with it in writing. If your own doctor will not, that is what a private nexus opinion is for. And there are providers who do exactly these for veterans. Either way, that one clear sentence is worth more than a hundred pages of records that never come out and say the magic words.
Now, a word on the mechanics of the supplemental claim because I do not want you to trip on the paperwork. A supplemental claim is the lane you use when you have new and relevant evidence, and a change in the law that governs your case counts as a reason to bring it back. Your new nexus statement built on the new standard is your new and relevant evidence. There is also a timing wrinkle worth knowing. If you file within a year of certain decisions, you can sometimes protect an earlier effective date, which matters because the effective date is what decides how far back your money goes. That is exactly the kind of detail that can be the difference between a few months of back pay and a few years of it. So, do not sleep on filing once you have your evidence together.
Now, the catch. I told you at the start, there is one thing the VA is counting on you to miss. And here it is. When a court strikes down how the VA reads a rule, the VA does not send everybody a happy letter saying, "Come get your money." What they do is go update their internal manual, the M21-1, the rule book their raters actually use day-to-day, and they update it in the narrowest way they can get away with. So, the raters on the ground are working off language that technically follows the court, but is written to give you as little room as possible.
What that means for you is simple, but critical. You cannot just file and assume the rater is going to connect the dots in your favor because they are trained not to. You have to spell it out. You have to name the standard, state the but for link in plain words, and where it applies, say directly that your service connected condition kept you from treating the other one. Just like in Spicer, if you leave it vague and hope they are generous, the narrow manual language gives them a way to deny you again. If you spell it out and put the standard in their hands, you take that escape hatch away from them. That is the whole game. The ruling gave you the key. Whether the door opens depends on you actually using the words.
Let me tie this all back together because I do not want you to walk away with just a nice story about a court case. I want you to walk away knowing your money moved. For years, the VA used a narrow rule to deny secondary claims, telling veterans their downstream conditions were not connected and telling them they had to prove permanent worsening down to the percentage. A veteran named Spicer took his denial to the federal circuit and in 2023 that court struck down the narrow rule and said the real test is whether your condition would be less severe but for your service connected disability including when your service connected disability stopped you from getting treatment. The VA is now updating its own rule book to match and they are doing it as narrowly as they can which is exactly why you have to state the standard yourself. This is open to every veteran. Any era, any rating, whether you were denied, are pending, or never filed. The money that has been sitting in your secondary conditions this whole time finally has a clear road to your bank account. And you do not have to wait for anyone to invite you. You can start pulling your denials today.
If you want the full step by step for building these claims and the wording that works, the Veterans Benefits Playbook is linked in the description for $19.99. Do me one favor before you click away. Send this to one veteran you know who got denied and gave up because that is the exact person this ruling was built for and they are never going to hear about it from the VA.
One last thing, and I say this on every video because it matters. I am a veteran advocate, not your attorney. And this is general information, not legal advice for your specific case. Your claim is yours and the details matter. So, use this to get informed and then make your move. Take care of yourself. Take care of the veteran next to you.