Primary (direct) claims assert that a condition started in or was aggravated by service. You must show: (1) a current diagnosis, (2) an in-service event/injury/exposure, and (3) a medical nexus linking the two. File these first — they anchor your claim file.

Secondary claims assert that a service-connected condition caused or worsened another condition. You do not need a new in-service event — only a nexus between the already-service-connected primary and the new secondary. This is often easier to prove and is one of the most powerful ways to increase your combined rating.

• File primary first when you have a clear in-service origin (injury, exposure, onset documented in records).
• File secondary when a new condition is caused or worsened by an already-service-connected condition (e.g., sleep apnea secondary to PTSD, knee pain secondary to flat feet).
• You can file both on the same form (VA Form 21-526EZ). Each secondary claim still needs its own nexus — typically a nexus letter or medical opinion.
• Tip: If you're unsure whether a condition is primary or secondary, claim it both ways in the alternative — the VA must consider every theory of entitlement you raise.

A presumptive condition means the VA presumes service connection without you having to prove a direct in-service cause. If you have the condition and meet the service requirements, service connection is granted automatically.

• Burn pit / airborne hazards (PACT Act): Asthma, rhinitis, sinusitis, certain cancers, and more — presumptive for veterans who served in qualifying locations after 9/11.
• Agent Orange: Diabetes Type 2, ischemic heart disease, Parkinson's, several cancers, and more — presumptive for Vietnam-era and certain Korea/Thailand veterans.
• Gulf War undiagnosed illness: Chronic multisymptom illness, functional GI disorders, sleep disturbances, fatigue — presumptive for Gulf War veterans.
• Former POW: Psychosis, anxiety, dysthymic disorder, heart disease, stroke — presumptive for former POWs.
• Radiation exposure: Certain cancers — presumptive for atomic veterans.

→ PACT Act information (va.gov)

A personal statement (VA Form 21-4142 or a free-form statement statement) tells your story in your own words. It fills gaps your medical records don't cover — how your condition started, how it affects your daily life, and what changed. A buddy statement is the same thing written by someone who served with you or knows you well (spouse, friend, coworker, family member).

What makes a strong statement:

• Be specific and factual — dates, locations, events. "On [date] during [training/deployment], I [describe what happened]."
• Describe the onset or aggravation — when symptoms started or got worse, and what triggered them.
• Explain the functional impact — how the condition affects your work, relationships, sleep, daily activities. This is what raters look for.
• Connect to service — name the in-service event, exposure, or injury. For secondary claims, name the primary condition.
• Keep it under 2 pages — be concise. Raters read hundreds of these.
• Be honest — never exaggerate or fabricate. False statements are punishable under 18 U.S.C. § 1001.

A Compensation & Pension (C&P) exam is the VA's evaluation of your condition. The examiner's report heavily influences your rating. Prepare thoroughly:

• Review your condition notes on the Conditions page — know your diagnoses, dates, and symptoms cold.
• Write down your top 3-5 symptoms for each condition being examined. Don't rely on memory under stress.
• Bring your symptom journal if you keep one (migraines, sleep, pain, anxiety) — concrete dates and frequencies are powerful.
• Know your functional impact — be ready to describe exactly how the condition affects your work, daily life, and relationships.
• Don't minimize. Describe your worst days, not your best. If you say "it's not that bad," the examiner will document minimal impairment.
• During ROM exams, stop at the point of pain. Do not push through — the measurement at the pain point is what counts.
• Be honest but thorough. Don't exaggerate, but don't under-report either. Report every symptom you actually have.
• Bring a copy of your medical records and any imaging/lab reports relevant to the condition.
• Bring a list of all medications and note any side effects you experience.
• Bring a buddy or spouse if possible — they can remind you of symptoms you forget and corroborate functional impact.
• After the exam, request a copy of the examiner's report and check it for accuracy. Errors are common and fixable.

The bilateral factor adds 10% to the combined rating of paired extremities (both arms, both legs) before they're combined with the rest of your body. This accounts for the compounding effect of having disability in both sides of a limb pair.

How it works:

1. Combine all bilateral extremity ratings using the VA "remaining efficiency" method (largest first, each subtracts from what's left).
2. Add 10% of that subtotal as the bilateral factor.
3. Combine the result with all non-bilateral conditions.

Example: Left knee 10% + Right knee 10% + Left hip 10% + Right foot 10%.

Many veterans under-claim by describing only their mildest symptoms or by not knowing the full rating criteria. The VA rates based on the evidence in your file — if your records only show mild symptoms, you get a mild rating, even if your real condition is more severe.

• Read the rating criteria for your condition in 38 CFR Part 4 (linked on the Resources page). Know exactly what symptoms and findings correspond to each rating level.
• Document toward the level you actually are, not the level you hope for or the level you're currently rated. If your migraines are prostrating and frequent, document prostrating and frequent — don't just say "headaches."
• Get the objective measurements raters need: ROM for joints, FEV-1 for asthma, audiogram for hearing, sleep study for apnea, BP logs for hypertension. Without objective data, you get the lowest defensible rating.
• Claim every symptom, not just the main one. A knee condition may have pain, instability, AND radiculopathy — each can be rated separately if separately diagnosable.
• Ask your provider to document severity in the terms the rating schedule uses. "Can you note that my migraines are prostrating and force me to lie down?" "Can you document that my knee gives out on stairs?"

• Minimizing symptoms. Saying "it's not that bad" or "I'm fine" during appointments. Your record reflects what you say — if you minimize, you get a minimal rating. Describe your worst days honestly.
• Not documenting functional impact. Raters need to know how the condition affects your life and work. "I can't [activity] because of [condition]" is the formula. Without functional impact, you get a low rating even with a solid diagnosis.
• Pushing through pain during ROM exams. The examiner measures at the point you stop. If you push through pain, you get a higher ROM measurement and a lower rating. Stop at pain.
• Not claiming secondaries. If a primary condition causes or worsens another condition, the secondary is separately ratable. Missing secondaries is the single biggest source of under-rating.
• Not getting objective evidence. Pain alone is ratable but at a low level. ROM measurements, imaging, sleep studies, audiograms, and lab results support higher ratings.
• Not checking your records for accuracy. Provider notes often under-document what you actually reported. Read every note after every visit and request corrections.
• Missing the BDD window. Filing after discharge means a longer wait and potentially a later effective date. The BDD program (180-90 days before discharge) is the fastest path.
• Not submitting an Intent to File. VA Form 21-0966 preserves your effective date for up to a year while you gather evidence. Skip this and you may lose months of back pay.

Use this template as a starting point for your VA Form 21-4142 personal statement. Edit it with your specific details, then print or copy it to submit with your claim. Keep it under 2 pages.

These strategies apply to every VA exam, regardless of condition. Master these and you'll maximize your chances of an accurate rating.

• Describe your WORST days, not your best days. The VA rates based on severity. If some days you can barely walk, describe those days in detail — not the days you feel okay.
• Be uncomfortably vulnerable. Veterans often downplay symptoms out of pride. Don't hold back. If anxiety makes you avoid social situations entirely, say so.
• Use frequency, severity, and duration. Instead of "I get migraines," say: "I have flare-ups [N] times per week, lasting [X] hours, pain [N/10], requiring a dark quiet room." Specific numbers carry weight.
• Explain functional impact. "I've missed [N] days of work this year," "My spouse has to help me with [activity]," "I can't [perform specific duty] anymore." The VA needs to know how this affects your daily life and work.
• Don't say: "I'm fine," "It's not that bad," "The medication fixes everything," "I never have problems" (absolutes aren't believable), "It's probably just..." (don't self-diagnose).
• The examiner is NOT your friend. Be polite, but remember they're evaluating you. Your exam starts in the parking lot — don't walk briskly if you claimed mobility issues.
• Bring hard-copy documents: Medication list with dosages, symptom diary with dates/frequencies, and any relevant DBQ forms.
• Don't push through pain during ROM measurements. Stop at the point where pain begins — that's your true limitation. Pushing through gives an inaccurate measurement.

• ☐ Review your condition notes on the Conditions page — know your diagnoses, dates, symptoms, and rating goals.
• ☐ Write down your top 3 symptoms to discuss — don't rely on memory.
• ☐ Note any changes since your last visit — new symptoms, worsening, new triggers, medication changes, side effects.
• ☐ Bring your medication list — dosages, frequency, start/stop dates, side effects.
• ☐ Plan to ask for specific documentation — e.g., "Please document that my knee gives out on stairs."
• ☐ Bring your symptom journal — migraines, sleep, pain, anxiety. Concrete dates carry weight.
• ☐ Get copies of your notes after the visit — check MHS Genesis / VA portal within 48 hours. Verify accuracy. Request corrections if needed.
• ☐ Follow up on referrals within 2 weeks — don't let consults expire.