Cindy Speaker: Good afternoon, and welcome to our Facebook Live broadcast today. My name is Cindy Speaker. I have with me today Nathan Guin of Gardberg & Kemmerly. He’s going to talk with us about service connections and rather specifically about secondary service connections. Nathan, thanks for being with us today.

Nathan Guin:  Thank you for having me. I always enjoy it.

Cindy Speaker:  Yeah. I always enjoy talking to you. It’s great. We’re getting a nice rhythm going here, so it’s good.

Nathan Guin: Yeah, absolutely.

Cindy Speaker:  Let’s start off by talking about a service connection. What exactly is that, and also, let me clarify that we’re talking about veterans disability claims.

Nathan Guin: Right. A service connection as it pertains to the disability claims for veterans is essentially the technical term for … Okay. You’re going to get disability compensation for a particular injury or disease that occurred in service. A typical example would be if you hurt your knee in service and you apply for a claim, you prove that you had an injury in service, there’s a medical nexus linking it to your currently diagnosed knee disability, then they would grant you what’s called service connection. It’s VA’s acknowledgement that your current disability is related to an injury or an event that occurred at service.

Cindy Speaker:  Okay. Let me just say that last time Nathan talked with us about nexus medical opinions. You can follow up on the Gardberg & Kemmerly various sites on YouTube or Facebook to find out more about the nexus medical opinion that you mentioned. Go ahead. Okay. You talked about the service connection. What are the different types of service connection?

Nathan Guin:  There’s two basic types and then beyond that there’s subsections. There’s direct service connection and there’s secondary service connection. I know we’re going to talk specifically about secondary service connections, so direct service connection I just want to touch on for a second. That would be like the example I just gave you, knee injury in service or you fall in service and you hurt your back, your knee, whatever it may be. You show a medical link between that injury and a current diagnosis. That is direct service connection. There’s a direct link between service and your disability that you have now.

Beyond that in terms of direct service connection, there’s also presumptive service connection, and those are for particular groups of veterans. If you were in country in Vietnam, there are some presumptive conditions that are still technically direct service connections, so if you were in country in Vietnam and you have diabetes or coronary artery disease or diabetes, those are direct service connection, but they are given on a presumptive basis. If you can prove that you stepped foot in Vietnam and you have a current diagnosis of any of those conditions … And there’s more than the ones I just named, but they’re pretty voluminous. If you can show that, then they’ll grant you service connection on a direct basis. Those are the two types of direct service connection.

Secondary service connection doesn’t have to be related to service. It just has to be related to a service connected condition. For example, if you hurt your right knee in service and there is a back disability or your left knee has a disability and you have a doctor or medical expert say but for this right knee disability that’s service connected and occurred in service and the VA recognizes that service connection, your left knee or your back or whatever it may be wouldn’t be injured or be disabled, so you can connect it because the service connected injury caused a disability that would not otherwise have occurred.

Cindy Speaker:  Okay. Is that harder to prove?

Nathan Guin:  Not necessarily. In some cases, it is easier. Well, maybe not easier, but there’s less steps. With direct service connection, you have to show something in service, a nexus, and then a current disability. With secondary, you don’t have to prove that anything occurred in service, because there’s already a service connected condition. That part of it is already conceded. You just have to prove a current diagnosis, a current disability, whatever that may be, and then a medical link between the two. There’s one less step that you have to go through. I don’t know if it’s necessarily easier. I should say that it’s one step less. Yeah.

Cindy Speaker:  Okay. Are the evidentiary requirements the same for secondary service connection as direct service connection?

Nathan Guin:   Yeah. They are, other than, of course, the injury in service. That would be eliminated, but it’s the same in terms of you have to have a current disability, a currently diagnosed disability, and then a nexus opinion that links that particular disability to your service connected disability that caused it.

Cindy Speaker:  Okay. Give us some common instances of this secondary service connection.

Nathan Guin:   A lot of times, if a veteran has an issue with their feet or their ankles or their knees, most of the time, that will … We see a lot of left knee or right knee total knee replacement. Then that alters your gait. It alters the way that you distribute your weight, and then it puts more pressure on the knee that didn’t get replaced. A lot of times you end up having to have a knee replacement there due to your service connected total knee replacement for whichever knee it may be. We see a lot of that.

A lot of them involve the lower extremities, your legs, knees, feet, like I said. A lot of that stuff travels up and affects your back. Anything that really affects your gait is usually where we see a lot of secondary connection claims.

Cindy Speaker:   Okay. Interesting. Let me ask you about a couple of the other ones. You mentioned presumptive, so there are different types of service connection. You mentioned presumptive, so is it just direct, secondary, and presumptive?

Nathan Guin:  Unless there’s a new one they’ve come up with that I’m not aware of. Those are the three main ways to do it. Yeah.

Cindy Speaker:   Can you just mention a little … Help us understand the presumptive a little better?

Nathan Guin:   Right. The two major groups of veterans who will be affected by presumptive disabilities will be Vietnam veterans, specifically those who were in Vietnam and in some instances were on bases in Thailand. If you had boots on the ground in Vietnam, you’re presumed to have been exposed to Agent Orange or herbicides. Agent Orange is the common term or the slang term for it. You’re presumed to have been exposed to Agent Orange, and there are a list of, I believe, eight diseases that are related or they have been conceded as related to Agent Orange exposure. If you were in Vietnam, and the dates … I can’t remember of the top of my head. There’s a specific range of dates. It’s over about 12 years. If you stepped foot in Vietnam and in some cases if you were in Thailand and you can prove you worked around the perimeter of your base, then you can get service connection for coronary artery disease, multiple myeloma, diabetes. Those are the main ones for that.

Then there’s another group, Camp Lejeune Marines. For a period of about 30 years from the ’50s to the ’80s, there was a contaminated water issue at Camp Lejeune. A lot of those overlap, but if you were at Camp Lejeune for 30 days between that 30-year period … It doesn’t have to be consecutive days. It just has to be 30 cumulative days … and you have, let’s say, for instance, bladder cancer or kidney cancer. There’s a number of different other issues, obviously, that are listed … and you can just show that you were there and that you are currently diagnosed with one of those conditions, then that will be service connected on a presumptive basis as well.

Cindy Speaker:   Is there a time period once you return from service wherein you need to establish that, or is it whenever?

Nathan Guin:  For presumptive illnesses, all you have to prove is that you were there at the specified time that the VA lays out and that you’re currently diagnosed. The only reason that claiming it earlier would be better would be to protect your effective date. Generally speaking, you’ll already be diagnosed with whatever the condition is, because otherwise, you probably wouldn’t be filing a claim for it.

Cindy Speaker:   Right, right.

Nathan Guin: The date of your claim is going to act as your effective date for the initial rating. Other than protecting the … To maximize your benefits, there’s no statutory limit to when you can file.

Cindy Speaker:  Yeah. Nathan, let me ask you this. Are there any connections in the process of being made in the medical field that could emerge?

Nathan Guin:  What we’re seeing claimed a lot and actually seeing some support for … We’ve got some nexus opinions from doctors for and there’s a lot of studies on it, even on the VA’s website you can find it … is sleep apnea as secondary to PTSD. There’s a lot of these studies coming out showing that a sleep impairment and a lot of the symptoms of PTSD can put veterans who have PTSD at a high risk for sleep apnea. It’s not conceded. The VA hasn’t said if you have PTSD, you can get sleep apnea service connected as secondary to that, but we have had cases where we’ve had their psychiatrist, veterans psychiatrist, write up a nexus opinion and say, “I think this is well-linked, that the sleep apnea is linked to the PTSD,” and there are studies that show a high risk. Whether that becomes a presumptive secondary condition down the road, we’ll have to see. I would certainly hope so. That would be great for our veterans, because most of our veterans that have PTSD also have sleep apnea, just because that seems to go hand in hand.

Cindy Speaker:   Yeah. Yeah. That’s very interesting. So the sleep apnea would clearly be either secondary or, as you said, presumptive. It would not be the direct. Is that correct?

Nathan Guin:   Right. It would be secondary to PTSD. Whether they wanted to make a presumptive secondary issue, I don’t know if they would, but they’re definitely … It seems to be more coming around that that is an issue that is more prevalent in those veterans with PTSD than the average veteran or the average person.

Cindy Speaker:  Okay. Okay. Nathan, if people had questions, specific questions, about veterans disability law, how can they reach you or someone in your office?

Nathan Guin:   There’s a couple of different ways you can get in touch with us. You can call us. We’re here five days a week, regular business hours. 251-343-1111. You can also get to us at our website, gardberglaw.com. That’s G-A-R-D-B-E-R-G-L-A-W dot com. Lastly, you can email us through that as well, or if you want to send us an email at vacontact@gardberglaw.com, that’s also another way that you can reach us.

Cindy Speaker:   Okay. VA contact. Am I correct? You handle these cases across the country.

Nathan Guin:   We do. Currently, we’ve got clients that are veterans that are spread out everywhere. We have veterans in Idaho, Connecticut, Michigan, Texas. If you name it, they’re probably there. We can handle claims from Mobile to California to Maine, wherever. Wherever the veteran is, if they need help, we can help them.

Cindy Speaker:  Excellent. Excellent. Well, Nathan, thanks a lot for your time today.

Nathan Guin:   Absolutely. Thank you for having me. I appreciate it.

Cindy Speaker:  Yeah, and we’ll talk again soon.

Nathan Guin:   All right. Sounds good. I’m looking forward to it.

Cindy Speaker:    Okay. Bye bye.