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For three decades, secondary service connection by aggravation has run on a rule from Allen v. Brown: if a service-connected disability makes a separate, non-service-connected condition worse, VA compensates the veteran for the added disability. A 2023 Federal Circuit decision, Spicer v. McDonough, and a May 1, 2026 update to VA's M21-1 adjudication manual have now widened that door. This is a plain-language summary of what the court actually held and how VA says it will apply the rule going forward.
Start with the baseline. In Allen v. Brown, 7 Vet. App. 439 (1995), the Court of Appeals for Veterans Claims held, en banc, that when aggravation of a non-service-connected condition is proximately due to a service-connected condition, the veteran is compensated for the degree of disability over and above the level that existed before the aggravation. VA wrote that principle into 38 C.F.R. § 3.310(b), which also requires the pre-aggravation baseline to be established by medical evidence.
Spicer v. McDonough arose from a harder fact pattern. Luther Spicer was exposed to benzene in jet fuel and developed chronic myeloid leukemia, which VA service-connected at 100 percent. His leukemia treatment, however, made him unable to undergo knee surgery that could have improved a separate knee condition. VA denied secondary service connection. The Federal Circuit reversed, holding that to the extent 38 C.F.R. § 3.310(b) was used to reject that theory, the regulation is unlawful as inconsistent with the broad language of 38 U.S.C. § 1110. Put plainly: a service-connected disability that prevents or interferes with treatment for another condition can be a but-for cause of the resulting disability.
On May 1, 2026, VA updated the M21-1 (Part V, Subpart ii, Chapter 2, Section D) to bring its adjudication procedures in line with Spicer. The practical shift is that secondary aggravation is no longer limited to a service-connected condition that directly worsens another condition; it can also include a service-connected condition that delayed, prevented, or impeded treatment for the non-service-connected condition.
What does this mean in practice? The legal test for secondary service connection is broader than the older, narrower reading of § 3.310(b), but the evidentiary work has not changed. A claim still turns on a competent medical opinion connecting the service-connected disability to the worsening or the impeded treatment, and the Allen baseline still matters: benefits are measured against the level of the non-service-connected condition before the aggravation began. The change is in the range of theories VA must consider, not in any guarantee of outcome.
ClaimRecon publishes this as an educational explanation of published case law (Spicer v. McDonough, Fed. Cir. 2023; Allen v. Brown, 7 Vet. App. 439 (1995)), the governing regulation (38 C.F.R. § 3.310), and VA's own May 2026 M21-1 guidance. It is not legal or medical advice, and it does not predict how VA will decide any particular claim. Free, accredited representation is available through DAV, VFW, the American Legion, AMVETS, and other Veterans Service Organizations.
Written by ClaimRecon Editorial