Did you know?

Conditions service made worse

You do not have to prove service caused a condition from scratch. If service made it worse, that can be service connected too. VA calls this aggravation, and it covers two different situations.

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Why I built this page. I have watched too many Soldiers and veterans read the word "aggravated," decide it does not describe them, and never file. Service connection has more than one door. Direct, secondary, presumptive, and aggravated are all real routes. Aggravated by itself means two different things under two different rules, and a veteran who only hears about one of them can walk away from a claim he would have won. Both are below.
Path one

You came in with it. Service made it worse.

This is the one most people never hear about.

You had a bad knee, a bad back, asthma, migraines, a mental health condition — something that existed before you raised your hand. It got worse while you were on active duty. That worsening can be service connected. The rule is 38 CFR 3.306, Aggravation of preservice disability.

VA's own words: a preexisting condition "will be considered to have been aggravated by active military, naval, air, or space 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."
Read that twice. The increase in disability is presumed to be aggravation. For wartime service and peacetime service after 1946, VA can only knock that presumption down with clear and unmistakable evidence — a high bar, and the burden is on VA, not on you. There is a companion rule called the presumption of soundness at 38 CFR 3.304(b) that works alongside it.

Read 38 CFR 3.306 yourself · for 3.304(b), search section 3.304 at ecfr.gov/current/title-38.

★ It did not have to start in service.
Path two

A rated condition made something else worse.

Different situation. Different rule. Same word.

You have a disability VA already pays you for. It is making a second condition worse — a condition that is not service connected on its own. That increase can be service connected. The rule is 38 CFR 3.310(b).

VA's own words: "Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury ... will be service connected."

The paragraph right above it, 38 CFR 3.310(a), is plain secondary service connection: "Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected." That one is for a whole new condition your rated condition caused. Paragraph (b) is for one that already existed and got worse.

The worsening does not have to be permanent. A denial that says only "the worsening is not permanent" may be using the wrong test. In Ward v. Wilkie (Nos. 16-2157 and 17-1204, decided June 14, 2019), the Court of Appeals for Veterans Claims held that the “permanent worsening” standard has no application to an incremental increase in disability of a nonservice-connected condition that is proximately due to a service-connected one, and that conditions can “wax and wane in severity” and still show a compensable increase. The Court also said an examiner must evaluate whether additional disability arises during flare-ups, particularly for musculoskeletal conditions. Example: your service-connected back worsens another condition during flare-ups or over time; that worsening can still count.
What you still need. A current diagnosis, a service-connected condition, and medical evidence or an opinion showing your service-connected condition made the other one worse. Section 3.310(b) also says VA will not concede aggravation unless the baseline level of severity is established by medical evidence from before the aggravation began (or the earliest medical evidence after it). VA then compensates only the increase above that baseline, not the natural progress of the condition. Keep your old records.
Do not mix the two paths up. If your condition existed before service and got worse on active duty, 3.310 is not your rule — 3.306 is. Ward is a case about 3.310(b) and secondary aggravation; it does not change the 3.306 rule for a condition that got worse during service. Reading only about 3.310 is how a qualified veteran talks himself out of filing.
A related court decision. In Spicer v. McDonough (Federal Circuit, No. 22-1239, March 8, 2023), the court held that “disability resulting from” a service-connected condition uses ordinary but-for causation, so a service-connected condition that makes a disability worse — even by getting in the way of treating it — can be compensable. That case is about causation; it does not itself decide whether a worsening must be permanent.

Read 38 CFR 3.310 yourself

★ Two doctrines. One word.
How to file

The forms, in order

  1. VA Form 21-0966, Intent to File. File this first. It locks in your effective date, and you then have 1 year to complete and file the claim. This is the cheapest money-protecting step there is, and almost nobody does it.
  2. VA Form 21-526EZ — the disability compensation claim itself.
  3. Say plainly on the claim which path you are on: the condition existed before service and worsened during service, or your service-connected condition is worsening this one.

VA: your intent to file · va.gov/disability

★ Intent to file costs you nothing.

The forms, in order

Page reviewed September 2026.VA Form 21-09661 yearVA Form 21-526EZdisability compensation claim itself
VA Form 21-0966, Intent to File. File this first. It locks in your effective date, and you then have 1 year to complete and file the claim.VA: your intent to file
Your records

Your entrance exam is the evidence

A worsening claim is won on before-and-after.

You need what your condition looked like when you came in, and what it looked like later. Three different places hold those papers, and sending everyone to one of them wastes months.

  • Military personnel file and DD214 — archives.gov/veterans. Online at vetrecs.archives.gov (identity verification through ID.me is required), or mail Standard Form 180.
  • DoD records and DD214 for a recent separation — milConnect.
  • VA medical records — your VA.gov account or My HealtheVet.
★ Get the paper before you argue the point.
If VA said no

A denial is not the end

A denied worsening claim can be taken through a Higher-Level Review, a Supplemental Claim, or a Board Appeal. Pick the lane that matches your evidence, and know that a Supplemental Claim filed within 1 year of the decision protects your effective date. The forms, deadlines and lane rules are laid out at vsgsolutions.org/mental-health-secondaries.

va.gov/decision-reviews

★ Match the lane to your evidence.
Getting help

Free help exists. Know the fee rules.

An accredited Veterans Service Organization representative's help on your VA claim is always free (VA Form 21-22). Fee limits for accredited attorneys and claims agents are explained at vsgsolutions.org/mental-health-secondaries.

Find an accredited representative · Read 38 CFR 14.636

★ Free help first. Always.
Where to call and where to go

Real numbers and official pages

★ Call first, then file.
Straight talk. Knowing the rule does not guarantee eligibility. Every claim is unique and eligibility turns on your own facts and your own records. Laws and benefits change over time, so verify against VA's own pages before you act. But a rule you never heard of cannot help you either, and that is the part I can fix. If a claim for a worsened condition has already been denied, that is not the end — read the decision review panel above and pick the right lane. For VA phone numbers, use VA's own list at va.gov/resources/helpful-va-phone-numbers.

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