Jim,
I read the vast information available and admire your perseverance in the dissemination of this knowledge upon various websites. I have an inquiry with regard to VA claim submittal that you may or may not have insight to:
If a service connected disability is part of an initial claim, should possible aggravated or secondary injury / illness be included? Rational would be that since the folder of a claim could only be in one place at one time within the VA, will the mixing of the two slow down possible rating / exam scheduling while the secondary are considered for application?
Reply:
"If a service connected disability is part of an initial claim, should possible aggravated or secondary injury / illness be included?"
Yes. If you are reasonably confident that you are able to support your primary claim and you are also able to provide the nexus that supports a secondary condition, you should file each in the application for disability benefits.
An example of such my be the veteran who had a severe injury to his left ankle during combat or training. We'll assume that the injury required surgery and that the surgery didn't go well. There may have been an infection, subsequent surgeries and ultimately bone grafting and screw fixation resulting in a "frozen" and immobile ankle.
Due to the limp and/or the use of crutches or braces, the veteran may develop a painful knee or hip joint with a rapid progression of arthritis. This may occur on the left or the right side, depending on the anatomy and the changes in gait. There could be effects up into the spine.
Of importance is that the veteran should consider whether the claim is that the secondary claim is a condition that was directly caused by the primary condition or if there was an existing condition that has been aggravated by the primary condition? This can be addressed by using the term "caused and/or aggravated by..." when dealing with conditions of arthritis. In a case where a primary service connected cancer has metastasized, the veteran may assume that the secondary cancer is caused by the primary cancer...if the treating physicians also agree.
The primary claim (the ankle problem) is pretty clear cut and shouldn't cause any problems to rate. To be successful with a secondary claim, the veteran must provide a good nexus letter by a physician who is expert in such things. In this case a board certified orthopedic surgeon who has examined the veteran and reviewed his complete records would be the best choice. That physician must then provide a nexus statement that the secondary condition claimed "is more likely than not" caused by or aggravated by the primary condition. That verbiage is critical. Anything less and VA is likely to deny it.
This shouldn't slow the process down if the veteran is careful to clearly state that there are 2 claims (or more) and to clearly delineate and identify the claims. I like numbered bullet points to do such a thing. (1) Claim one. (2) Claim Two. (3) etc.
I do not recommend that the veteran "pile on" once the claim is in process. If you file for that ankle and 6 months later a buddy tells you that you should have filed for the knee too, to add it in at that point could slow down the whole thing. In that case, wait until the original claim is adjudicated and then file a new claim for the secondary condition. Yes, you may lose a few months of benefit. You may also avoid your claim becoming confused, denied and then you can fall into the trap of endless appeals.
As a general rule, any claim of a secondary condition will be argued by VA. Anything less than an affirmative nexus statement by a well qualified expert will be dismissed by VA. Planning your strategy is important so that you won't end up in appeals.
Will VA look for such connections? If you believe the VA, yes they will. VA should fully develop any conditions that may be in your records even if you don't claim them. This falls into the "duty to assist" provisions of the process. However, they don't do a very good job of this. In the example we used, the person who reviews the file may default to the thinking that any other joint pain or limited motion is the fault of a process of arthritis not attributable to the primary claimed condition. Without the nexus letter and your claim, they will not investigate any further.
I've observed vets who claim heart disease as an agent orange condition secondary to DMII who receive a 20% rating even though they have an AICD. The DMII is primary, heart disease is secondary to the DMII and the AICD is secondary to heart disease. The AICD is a 100% benefit, no way around it...VA ignored it as if it didn't exist.
The clinical nexus...the cause and effect documentation...is critically important to the VA claim. A bit of thought and planning ahead of time is the key to success.
More reading is here http://www.jimstrickland912.com/Nexus_Letter.html