How Spicer v. McDonough Changed Secondary VA Disability Claims

Court decisions can significantly affect how the Department of Veterans Affairs (VA) evaluates disability claims. One of the most important recent decisions involving secondary service connection is Spicer v. McDonough. The case clarified how VA should evaluate disabilities that worsen because treatment is prevented by a service-connected condition and expanded the interpretation of “but-for” causation under federal law.

By Jaylee Pace

What Is Spicer v. McDonough?

Overview

In Spicer v. McDonough, determined on March 8, 2023, the court clarified the proper interpretation of 38 U.S.C. § 1110 and the requirements for establishing secondary service connection. The Board previously applied a stricter proximate causation standard in these cases, which led to the denial of secondary service connection for disabilities that could not be treated due to service-connected issues. This decision established a broader “but-for” causation standard, allowing secondary service connection if the condition would not have worsened or appeared “but for” the service-connected disability.

Which Court Decided Spicer v. McDonough?

Jurisdiction

Spicer v. McDonough was decided by the United States Court of Appeals for the Federal Circuit. The Federal Circuit has jurisdiction to interpret the law and resolve appeals in specialized areas, including veterans’ benefits. Although the court primarily addresses administrative, monetary, and patent law, it has also issued decisions on significant veterans’ benefits claims.

Background of the Case

Spicer served in the U.S. Air Force from May 1958 to September 1959. He was exposed to hazardous aircraft chemicals that eventually developed into chronic myeloid leukemia. The U.S. Department of Veterans Affairs recognized his cancer as service-connected and granted a 100% rating.

Spicer later developed arthritis in both knees, requiring surgery. Because of medications used to manage his cancer, he was unable to undergo the necessary procedure. He filed a claim with the VA seeking secondary service connection for his knee disability. The VA denied his claim, stating that there was no causal link between his cancer and his knee problems. The Board found that Spicer’s inability to undergo surgery due to his service-connected leukemia did not meet the legal standard for secondary service connection. Spicer appealed the VA’s decision, and the Board affirmed the denial.

The Veterans Court’s Decision

Court of Appeals for Veterans Claims

After this decision, Spicer appealed to the next court, the United States Court of Appeals for Veterans Claims. Before the Veterans Court, Spicer argued that the Board erred in interpreting 38 U.S.C. § 1110. He contended that this section of the U.S. Code required only a worsening of function to establish secondary service connection. In Spicer’s case, the inability to treat his knee disability surgically because of his service-connected cancer was an example of a worsening of function supported by section 1110.

The Veterans Court reviewed the Board’s decision and held that an existing etiological link, in this case between the cancer and the knee disability, was necessary to establish secondary service connection. The majority argued that although but-for causation under § 1110 permits a multi-link causal chain, there must also be a direct originating cause to show that the knee condition resulted from the service-connected cancer.

What Is But-For Causation in VA Disability Claims?

But-for causation is the test used under 38 U.S.C. § 1110 to establish secondary service connection. In Spicer’s case, it would mean “but for the existence of the service-connected leukemia, would his knee disability have occurred?” The Veterans Court argued that answering this question would require speculation about whether there is any difference between Spicer’s current knee disability and what it could be post-surgery.

Because the Veterans Court found that Spicer’s knee disability was the natural progression of problems independent of service and did not originate from his service-connected cancer, they affirmed the Board’s denial.

The Federal Circuit’s Decision

United States Court of Appeals for the Federal Circuit

The United States Court of Appeals for the Federal Circuit agreed with the Veterans Court that “resulting from” in 38 U.S.C. § 1110 indicates but-for causation. However, it diverged on the interpretation of this phrase. The Federal Circuit determined that this broad standard encompassed multi-link causal chains and does not require an etiological link, which means it includes cases where the service-connected disease or injury hinders the treatment of another disability.

Further, the Court concluded that but-for cause is not limited to a single cause-and-effect relationship but also includes inaction or a lack of surgery as evidence supporting secondary service connection. Thus, 38 U.S.C. § 1110 provides compensation for a worsening of functionality, whether as a direct result or due to an inability to treat, and is not limited to a direct, originating cause.

How Spicer v. McDonough Affects VA Disability Claims

Implications

The Federal Circuit’s interpretation of 38 U.S.C. § 1110 allows for a broader standard of causation, increasing the opportunity for secondary service connection claims based on treatment interference. The Court also determined that it was within the Board’s authority to conclude whether there may have been a difference in Spicer’s knee disability post-surgery. Estimating treatment-related outcomes relies more heavily on current medical examinations and may place less burden on harder-to-obtain archival records.

However, while Spicer v. McDonough increased access to secondary service connection on many fronts, its implementation may have inadvertently created barriers for others.

VA M21-1 Changes Following Spicer v. McDonough

VA raters evaluate evidence for claims using their internal adjudication manual, known as M21-1. To account for the new interpretation of Spicer v. McDonough, M21-1 was updated on May 1, 2026. The manual previously allowed a “proximately due to” standard of causation when evaluating direct secondary causation and replaced that phrase with a but-for test.

While the Spicer decision helps veterans establish secondary service connection when their service-connected disability impedes treatment of another disability, the VA used this opportunity to rewrite all the standards for secondary causation claims under 38 C.F.R. § 3.310. But-for causation allows cases like Spicer to receive secondary connection, but requiring all secondary claims to meet this test raises the evidentiary requirements for cases not involving treatment interference.

What This Means for Veterans

Secondary service connection is essential for many veterans. Military service rarely results in a single, isolated injury; one service-related condition often leads to additional disabilities over time. These secondary claims are among the most common and important ways for veterans to receive the full compensation they deserve.

Spicer v. McDonough expanded the framework for establishing secondary claims regarding obstacles to treatment by recognizing that it is not limited to a single cause-and-effect relationship. This decision paves the way for broader treatment-based and aggravation-related theories of entitlement, which advocates should continue to explore through creative avenues rather than focusing solely on direct causation.

Navigating the evolving standards for secondary service connection can be difficult, which is why we’re here to help. We can ensure that your claim is supported by the appropriate evidence and arguments in line with current VA regulations.

At Stevens & Sullivan, we focus on helping veterans understand the VA disability process and navigate claims-related matters. Our team assists veterans with disability claims, Supplemental Claims, Higher-Level Reviews, Board of Veterans’ Appeals cases, and other VA disability matters.

Contact our office today at 404-467-9017 to schedule a consultation or complete a Free Case Evaluation to learn how we can help with your VA disability claim.