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As the title of the regulation suggests, there are two categories of claims that can be granted secondary service connection under VA regulation 3.310, “Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.”

The first category includes claims for which there is an initial service-connected disability, and then a subsequent disability or disabilities found to be proximately due to (caused by) the service-connected disability. One example of this type of claim would be loss of limb due to amputation occurring subsequent to a service-connected diabetes diagnosis.15 The loss of a limb, it might be argued, should be service connected in addition to the diabetes because the amputation may not have been needed had the veteran not developed diabetes.

In the two-year period from October 2004 through September 2006, nearly 260,000 veterans were service connected for conditions proximately due to service-connected disabilities. This accounted for approximately 19 percent of the more than 1.3 million disabilities that were service connected during that period. Most of the disabilities were rated at 10 or 20 percent (Figure 9-2). Less than 10 percent were rated at 50 percent or higher.

Ten conditions (Table 9-2) accounted for 55 percent of the disabilities compensated as secondary to service-connected disabilities in 2005–2006.

In accord with a 1995 court decision (Allen v. Brown, 7 Vet. App. 439), VA will also grant service connection under this regulation in claims where there is an increase in the severity of nonservice-connected disability that is found to be due to aggravation by a service-connected disability. These are called secondary service connection by aggravation claims or, after the


In people with diabetes, an increased risk of amputation comes from damage to nerves and blood vessels through decreased circulation efficiency and diabetic neuropathy. According to the American Diabetes Association, more than 60 percent of nontraumatic lower-limb amputations occur in people with diabetes and the rate of amputation for people with diabetes is 10 times higher than for people without diabetes (ADA, 2007).

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