Where you are

A Higher Rating or a New Condition

Two claims walk in this door

You already have a rating. Either the rated condition got worse, or you have a new problem you think the rated condition caused. The VA calls the first a claim for increase. It calls the second secondary service connection.

Every condition on this site has a free page under Decisions, built from what the Board actually did. Nothing to sign up for.

Path one: the rated condition got worse

The VA already agrees the condition came from service. The only question is how bad it is now, on the same ladder that set your current rating. Each diagnostic code in the rating schedule lists its levels. Each level names findings, such as degrees of motion, episodes a year, or the words a mental health examiner uses. Know which rung you're claiming before you file.

Two rules help you. When your condition sits between two levels, you get the higher one if your condition more nearly matches it. And a rating rests on how well your body or mind works in daily life, including work. That rule makes the examiner describe those effects in full.

What proves worsening

Treatment records that show the change over time. Each disability must be viewed in relation to its history.
The findings the next rung names, such as degrees of motion or episodes a year. The record has to show them.
Your own statement, and statements from the people who see you every day. Say what you could do at the last exam and can't do now.
Timing. An increase can reach back to the date the worsening could first be shown. That needs VA to receive your complete claim or intent to file within a year of that date. Otherwise the date is the day VA receives the claim.

Send an intent to file first, before any private exam. VA then counts your complete claim as filed on the day it received the intent to file. That holds if the claim arrives within a year of that day. You don't have to wait for the VA's examiner to measure you. A private doctor can complete the Disability Benefits Questionnaire (DBQ) for the condition, if VA publishes one for it on its public list. Then the measurements that decide the rung go in with your claim.

The DBQ has to be done the way a VA exam is done. For a joint or the spine, that means a goniometer, the tool that measures how far a joint bends. VA's rules call it indispensable in VA's own exams. The exam also has to test for pain, measure again after repeated movement, note where pain starts, and record what a flare-up takes away. A DBQ that estimates motion by eye carries little weight. An adequate private report can be accepted for rating without a VA exam. If it falls short, the VA orders its own exam. Step 1 lists the conditions VA keeps off the public list and the joint tests the rules ask for.

The risk: a re-exam cuts both ways

When you file for an increase, the VA often orders a new exam. It can ask for one whenever it needs to check how bad a disability is now. If the exam shows improvement, the VA can propose a reduction.

However old your rating is, a reduction needs a real change in the condition. A more thorough exam or different words from the examiner aren't enough. The reduction has to be judged against the whole history. And the exam has to be adequate. For a joint, that includes pain testing and the repeated-use testing the Court of Appeals for Veterans Claims requires. The knee decision on the home page restored two ratings that were under five years old on exactly that ground. Know how much more protection your rating has before you file.

Under five years. The protections in the next point don't apply yet, so a re-exam that shows real improvement can reduce the rating.
Five years or more at the same level. The VA can't use an exam less thorough than the one that set your rating. For a condition that comes and goes, it can't reduce on a single exam unless the whole record clearly shows lasting improvement. And it must be reasonably certain the improvement will hold up in ordinary life.
Ten years. This protects the service connection itself, not the percentage. The VA can't take service connection away unless the original grant was based on fraud. The one other exception is military records that clearly show you lacked the required service or character of discharge. Your rating can still be reduced on an adequate exam that shows real improvement.
Twenty years. A rating held at or above a level for twenty years straight can't drop below that level unless it was based on fraud.

A proposed reduction has to come in writing, with the reasons. You get 60 days to send evidence. If VA receives your request for a hearing within 30 days of the notice, payments stay at the current level until the decision.

Path two: a new condition caused by a rated one

This is a secondary condition. A disability caused by a service-connected condition is service connected too.

The same rule covers a condition that didn't come from service but was made worse by a rated one. Only the added harm counts, not the normal course of the disease. And it counts only if medical records show how bad it was before the worsening began, or in the earliest records after that.

Step six of the nine steps is mental health caused by your rated conditions. Depression or anxiety caused by chronic pain, tinnitus, sleep apnea, a brain injury, or any other rated condition is service connected too. The VA rates it on its own.

What a secondary needs

A current diagnosis, or competent evidence of symptoms that persist or keep coming back.
The rated condition, which you already have.
A doctor's written opinion that the new condition is at least as likely as not caused or made worse by the rated one. The opinion needs its reasoning spelled out.

The record may not be enough to decide the claim. If so, a sign the new condition may be tied to a rated one is part of what requires a VA exam or opinion. And when the evidence for and against is about evenly balanced, the doubt goes to you.

File the opinion with the claim, not after. If the opinion will take time, send an intent to file first. Then file the complete claim, opinion included, within a year of the day VA receives the intent to file. VA counts it as filed on that day. If VA already denied this condition, new evidence goes in a supplemental claim, and an intent to file does not apply to it. One intent to file covers only one complete claim, the first one filed after it. If you're on both paths, the increase and the new condition can go in that one claim.

Don't claim a rung the record can't support. The same exam that rates the new condition looks at the old one. This site is education, not representation. You file on VA.gov or with a free accredited representative.

Where to read next

Every condition on this site has a free page under Decisions, built from what the Board actually did. Nothing to sign up for.

Reading the criteria rung by rung is what a condition pack sets out, alongside what the Board did with claims like it. The decision pages show the decisions behind each pair today.

Know your combined rating first

The VA doesn't add ratings, it combines them. The combined rating calculator shows the math.

See what the next rating level is measured on

The free page for your condition carries the rating criteria the VA publishes, which is what an examiner measures against, and what the Board did with the claims it has seen. You file your own claim.

A rated condition got worse A new condition caused by a rated one

Sources

Secondary conditions, 38 CFR 3.310(a) and (b).
The rating schedule, 38 CFR Part 4.
The higher of two ratings, 38 CFR 4.7.
Daily function, 38 CFR 4.10.
A disability's history, 38 CFR 4.1.
Effective date of an increase, 38 CFR 3.400(o)(2).
The intent to file, 38 CFR 3.155(b).
Measuring with a goniometer, 38 CFR 4.46.
Private exam reports, 38 CFR 3.326(a) and (c).
Painful motion, 38 CFR 4.59.
Functional loss, 38 CFR 4.40.
What a joint exam checks, 38 CFR 4.45.
Re-exams, 38 CFR 3.327(a).
A real change, 38 CFR 4.13.
Reading exam reports, 38 CFR 4.2.
Ratings held five years or more, 38 CFR 3.344(a) and (c).
The ten-year rule, 38 CFR 3.957.
The twenty-year rule, 38 CFR 3.951(b).
Reduction notice and hearing, 38 CFR 3.105(e) and (i).
When the VA must get an exam or opinion, 38 CFR 3.159(c)(4).
Reasonable doubt, 38 CFR 3.102.
An intent to file doesn't apply to a supplemental claim, 38 CFR 3.155, first paragraph.
One intent to file, one complete claim, 38 CFR 3.155(d)(1)(ii).

This page is education, not legal advice. Rules quoted are from 38 CFR Parts 3 and 4, as published on the government's eCFR website. Board decisions are public records, linked at their source.