### Section K. Other Compensation Considerations

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  66           Compensation for Disabilities Involving        2-K-2
               Certain Service-Connected                      
               (SC)/Nonservice-Connected (NSC) Paired Organs  
               or Extremities Under 38 CFR 3.383              

  67           Disability or Death From Use of Alcohol        2-K-5

  68           Disability or Death From Use of Drugs          2-K-9

  69           Disability or Death From Use of Tobacco        2-K-11
               Products                                       
  ------------ ---------------------------------------------- ------------

#### 66. Compensation for Disabilities Involving Certain Service-Connected (SC)/Nonservice-Connected (NSC)Paired Organs or Extremities Under 38 CFR 3.383

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on compensation for   |
| troduction | > disabilities involving certain paired organs or       |
|            | > extremities, only one of which is service-connected   |
|            | > (SC), under 38 CFR 3.383. It includes information on  |
|            | > the                                                   |
|            |                                                         |
|            | -   basis for awarding compensation for certain paired  |
|            |     organs or extremities under 38 CFR 3.383            |
|            |                                                         |
|            | -   criteria for establishing entitlement, and          |
|            |                                                         |
|            | -   effective dates for provisions of the law.          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. B | > Compensation is payable under 38 CFR 3.383 for        |
| asis for A | > disabilities involving certain paired organs or       |
| warding Co | > extremities, one SC and the other                     |
| mpensation | > nonservice-connected (NSC), provided the NSC          |
|  for Certa | > disability is not the result of the veteran's own     |
| in Paired  | > willful misconduct.                                   |
| Organs or  | >                                                       |
| Extremitie | > ***Reference***: For information on prohibitions      |
| s Under 38 | > against duplication of benefits, see M21-1MR, Part    |
|  CFR 3.383 | > IV, Subpart ii, 3.C.9.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > The following combinations of paired organs or        |
| b. Criteri | > extremities give rise to special consideration under  |
| a for Esta | > 38 CFR 3.383:                                         |
| blishing E |                                                         |
| ntitlement | -   blindness in one eye as a result of SC disability   |
|            |     and blindness in the other eye as a result of NSC   |
|            |     disability                                          |
|            |                                                         |
|            | -   loss, or loss of use (L/LOU), of one kidney as a    |
|            |     result of SC disability and involvement of the      |
|            |     other kidney as a result of NSC disability          |
|            |                                                         |
|            | -   deafness compensable to a degree of 10 percent or   |
|            |     more in one ear due to SC disability, and deafness  |
|            |     that meets the provisions of 38 CFR 3.385 in the    |
|            |     other ear due to NSC disability                     |
|            |                                                         |
|            | -   L/LOU of one hand or one foot as a result of SC     |
|            |     disability and L/LOU of the other hand or foot as a |
|            |     result of NSC disability, and                       |
|            |                                                         |
|            | -   permanent SC disability of one lung rated 50        |
|            |     percent or more disabling, in combination with NSC  |
|            |     disability of the other lung.                       |
+------------+---------------------------------------------------------+

Continued on next page

66\. Compensation for Disabilities Involving Certain Service-Connected
(SC)/Nonservice-Connected (NSC)Paired Organs or Extremities Under 38 CFR
3.383, Continued

+------------+---------------------------------------------------------+
| ##### c. E | > Use the table below to determine effective dates for  |
| ffective D | > the provisions of law that established the criteria   |
| ates for P | > establishing entitlement to compensation under 38 CFR |
| rovisions  | > 3.383.                                                |
| of the Law |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------------------+----------------------------+
| The criteria for establishing           | Became effective ...       |
| entitlement based on ...                |                            |
+-----------------------------------------+----------------------------+
| -   blindness in one eye due to SC      | August 28, 1962.           |
|     disability, and                     |                            |
|                                         |                            |
| -   blindness in the other eye due to   |                            |
|     NSC disability                      |                            |
+-----------------------------------------+----------------------------+
| -   L/LOU of one kidney due to a SC     | -   August 28, 1962, for   |
|     disability, and                     |     severe involvement of  |
|                                         |     an NSC kidney, and     |
| -   involvement of the other kidney due |                            |
|     to NSC disability                   | -   October 28, 1986, for  |
|                                         |     any involvement of an  |
|                                         |     NSC kidney.            |
+-----------------------------------------+----------------------------+
| -   total deafness in one ear due to SC | December 1, 1965.          |
|     disability, and                     |                            |
|                                         |                            |
| -   total deafness in the other ear due |                            |
|     to NSC disability                   |                            |
+-----------------------------------------+----------------------------+
| -   deafness compensable to a degree of | December 6, 2002.          |
|     10 percent or more in one ear as a  |                            |
|     result of SC disability, and        |                            |
|                                         |                            |
| -   deafness in the other ear that      |                            |
|     meets the provisions of 38 CFR      |                            |
|     3.385 as a result of NSC disability |                            |
+-----------------------------------------+----------------------------+
| -   L/LOU of one hand or foot due to SC | October 28, 1986.          |
|     disability, and                     |                            |
|                                         | ***Note***: Entitlement to |
| -   L/LOU of the other hand or foot due | Special Monthly            |
|     to NSC disability                   | Compensation (SMC) for     |
|                                         | these disabilities under   |
|                                         | 38 U.S.C. 1114(t) was      |
|                                         | effective October 1, 1978, |
|                                         | through October 27, 1986.  |
+-----------------------------------------+----------------------------+

Continued on next page

66\. Compensation for Disabilities Involving Certain Service-Connected
(SC)/Nonservice-Connected (NSC)Paired Organs or Extremities Under 38 CFR
3.383, Continued

  -----------------------------------------------------------------------
  c\. Effective Dates for Provisions of the Law (continued)

  -----------------------------------------------------------------------

+-----------------------------------------+----------------------------+
| The criteria for establishing           | Became effective ...       |
| entitlement based on ...                |                            |
+-----------------------------------------+----------------------------+
| -   a permanent SC disability of one    | October 28, 1986.          |
|     lung, rated 50 percent or more      |                            |
|     disabling, and                      |                            |
|                                         |                            |
| -   NSC disability of the other lung    |                            |
+-----------------------------------------+----------------------------+

+-----------------------------------------------------------------------+
| > ***Reference***: For more information on the history of SMC for     |
| > certain paired organs, see M21-1MR, Part IV, Subpart ii, 2.I.       |
+-----------------------------------------------------------------------+

#### 67. Disability or Death From Use of Alcohol

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on disability or      |
| troduction | > death from use of alcohol, including information on   |
|            |                                                         |
|            | -   willful misconduct                                  |
|            |                                                         |
|            | -   alcoholism as a primary disability                  |
|            |                                                         |
|            | -   alcoholism secondary to an SC disability            |
|            |                                                         |
|            | -   alcoholism due to personality disorders             |
|            |                                                         |
|            | -   claims filed before August 13, 1964, involving the  |
|            |     secondary effects of alcohol                        |
|            |                                                         |
|            | -   claims filed between August 13, 1964, and October   |
|            |     31, 1990, involving the secondary effects of        |
|            |     alcohol                                             |
|            |                                                         |
|            | -   claims filed after October 31, 1990, involving the  |
|            |     secondary effects of alcohol                        |
|            |                                                         |
|            | -   Dependency and Indemnity Compensation (DIC) based   |
|            |     on death resulting from an alcohol-related disease  |
|            |     or disability, and                                  |
|            |                                                         |
|            | -   resolving reasonable doubt.                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a    | > A disability or death sustained as a direct result of |
| . Willful  | > drunkenness is generally considered as being due to   |
| Misconduct | > willful misconduct.                                   |
|            | >                                                       |
|            | > When an individual willingly achieves a drunken state |
|            | > and undertakes tasks for which the drunken state      |
|            | > renders him/her physically and mentally unqualified,  |
|            | > the individual acts with wanton and reckless          |
|            | > disregard of the probable consequences of drinking.   |
|            | > Consider the resulting injury or death due to willful |
|            | > misconduct.                                           |
|            | >                                                       |
|            | > ***Reference***: For more information on willful      |
|            | > misconduct, see M21-1MR, Part III, Subpart v, D (TBD) |
|            | > or M21-1, Part IV, 11.04.                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Alcoholism as a primary disability is *not* a basis   |
| ## b. Alco | > for granting entitlement to or increasing             |
| holism as  | > compensation or pension under the laws administered   |
| a Primary  | > by the Department of Veterans Affairs (VA).           |
| Disability |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

67\. Disability or Death From Use of Alcohol, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > Establish service connection under 38 CFR 3.310(a)    |
| Alcoholism | > for any diseases or disabilities resulting from       |
|  Secondary | > alcohol abuse, if alcoholism is determined to be      |
|  to an SC  | > secondary to an SC disability.                        |
| Disability | >                                                       |
|            | > ***Note***: Alcohol abuse may also be considered a    |
|            | > symptom of an SC disability.                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > Do not consider personality disorders characterized   |
|  Alcoholis | > by developmental defects or pathological trends in    |
| m Due to P | > the personality structure as underlying psychiatric   |
| ersonality | > diseases for the purpose of secondary service         |
|  Disorders | > connection in compensation claims.                    |
|            | >                                                       |
|            | > Alcoholism due to personality disorders               |
|            |                                                         |
|            | -   may not be the basis for granting or increasing     |
|            |     disability compensation, and                        |
|            |                                                         |
|            | -   may be the basis for a rating of incompetency.      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e.   | > The secondary effects of alcohol were considered of   |
|  Claims Fi | > willful misconduct origin before August 13, 1964.     |
| led Before | >                                                       |
|  August 13 | > Do not award benefits under 38 CFR 3.114(a) prior to  |
| , 1964, In | > August 13, 1964, for the secondary effects of         |
| volving th | > alcohol.                                              |
| e Secondar |                                                         |
| y Effects  |                                                         |
| of Alcohol |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Organic diseases shown by substantiating evidence as  |
| #### f. Cl | > a secondary result of the use of alcohol as a         |
| aims Filed | > beverage, whether out of compulsion or otherwise,     |
|  Between A | > were not considered to have been the result of        |
| ugust 13,  | > willful misconduct in claims filed between August 13, |
| 1964, and  | > 1964, and October 31, 1990.                           |
| October 31 | >                                                       |
| , 1990, In | > ***Note***: Secondary results, such as cirrhosis of   |
| volving th | > the liver, gastric ulcer, peripheral neuropathy, or   |
| e Secondar | > chronic brain syndrome                                |
| y Effects  |                                                         |
| of Alcohol | -   sometimes appear because of indulgence in alcohol,  |
|            |     and                                                 |
|            |                                                         |
|            | -   may have been the basis for payment of compensation |
|            |     or pension, whether attributable to the chronic use |
|            |     of alcohol or other causes, under regulations then  |
|            |     in effect.                                          |
+------------+---------------------------------------------------------+

Continued on next page

67\. Disability or Death From Use of Alcohol, Continued

+------------+---------------------------------------------------------+
| ##### g.   | > The granting of service connection for secondary      |
|  Claims Fi | > disabilities or death resulting from the abuse of     |
| led After  | > alcohol is prohibited effective November 1, 1990,     |
| October 31 | > under the provisions of *Public Law (PL) 101-508*.    |
| , 1990, In | >                                                       |
| volving th | > Do *not* consider disabilities or death that results  |
| e Secondar | > from the abuse of alcohol to have been incurred in    |
| y Effects  | > the line of duty.                                     |
| of Alcohol | >                                                       |
|            | > ***Important***: Do *not*                             |
|            |                                                         |
|            | -   sever service connection that was properly          |
|            |     established under regulations previously in effect, |
|            |     or                                                  |
|            |                                                         |
|            | -   award an increase in compensation for the secondary |
|            |     effects of alcohol based on any claim received      |
|            |     after October 31, 1990, including a claim           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   for an increased evaluation, or                     |
|            |                                                         |
|            | -   to add a dependent.                                 |
|            |                                                         |
|            | > ***Note***: Cost-of-living increases, for which no    |
|            | > claim is required, may be paid.                       |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   line of duty and alcohol abuse, see 38 CFR          |
|            |     3.301(d), and                                       |
|            |                                                         |
|            | -   the prohibition against increasing compensation for |
|            |     disabilities resulting from the abuse of alcohol,   |
|            |     see VAOPGCPREC 02-98.                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Dependency and Indemnity Compensation (DIC) may not   |
| ## h. DIC  | > be granted based on death in service if the           |
| Based on D |                                                         |
| eath Resul | -   death resulted from an alcohol-related disease or   |
| ting From  |     disability, and                                     |
| an Alcohol |                                                         |
| -Related D | -   original or reopened claim is received after        |
| isease or  |     October 31, 1990.                                   |
| Disability |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

67\. Disability or Death From Use of Alcohol, Continued

+------------+---------------------------------------------------------+
| #####      | > Disabilities generally attributable to alcohol abuse  |
|  i. Resolv | > may be due to other causes.                           |
| ing Reason | >                                                       |
| able Doubt | > Do not deny a claim for service connection for any    |
|            | > disability generally attributable to alcohol abuse    |
|            | > unless the evidence clearly shows such a causal       |
|            | > relationship exists.                                  |
|            | >                                                       |
|            | > Resolve reasonable doubt in favor of the claimant.    |
|            | >                                                       |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   It is not always possible to determine the cause of |
|            |     a disease or disability.                            |
|            |                                                         |
|            | -   Any indication that a condition is the result of    |
|            |     alcohol abuse may be rebutted by evidence showing   |
|            |     some other cause.                                   |
|            |                                                         |
|            | > ***Reference***: For more information on application  |
|            | > of the benefit-of-the-doubt rule in compensation      |
|            | > cases, see M21-1MR, Part III, Subpart iv, 5.12.d.     |
+------------+---------------------------------------------------------+

#### 68. Disability or Death From Use of Drugs

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on disability or      |
| troduction | > death from use of drugs, including information on     |
|            |                                                         |
|            | -   willful misconduct                                  |
|            |                                                         |
|            | -   willful misconduct and the secondary effects of     |
|            |     drug usage prior to November 1, 1990                |
|            |                                                         |
|            | -   claims for service connection for the secondary     |
|            |     effects of drug usage filed after October 31, 1990, |
|            |     and                                                 |
|            |                                                         |
|            | -   drug usage for therapeutic purposes secondary to SC |
|            |     disability.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Consider disability or death the result of willful    |
|  Willful M | > misconduct when the evidence shows                    |
| isconduct  |                                                         |
|            | -   drugs were used to enjoy or experience their        |
|            |     effects, and                                        |
|            |                                                         |
|            | -   drug usage resulted proximately and immediately in  |
|            |     disability or death.                                |
|            |                                                         |
|            | > The progressive and frequent use of drugs, other than |
|            | > for a recognized therapeutic purpose, which results   |
|            | > in addiction, is considered willful misconduct.       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Organic diseases and disabilities shown by            |
| ## b. Will | > substantiating evidence as a secondary result of the  |
| ful Miscon | > chronic use of drugs, or infections coinciding with   |
| duct and t | > the injection of drugs, were not considered to have   |
| he Seconda | > been the result of willful misconduct in claims filed |
| ry Effects | > prior to November 1, 1990.                            |
|  of Drug U |                                                         |
| sage Prior |                                                         |
|  to Novemb |                                                         |
| er 1, 1990 |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

68\. Disability or Death From Use of Drugs, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > The grant of service connection for secondary         |
| Service Co | > disabilities or death that results from the abuse of  |
| nnection f | > drugs is prohibited effective November 1, 1990, under |
| or Seconda | > the provisions of *Public Law (PL) 101-508*.          |
| ry Effects | >                                                       |
|  for Claim | > Do *not* consider disabilities or death resulting     |
| s Filed Af | > from the abuse of drugs to have been incurred in the  |
| ter Octobe | > line of duty.                                         |
| r 31, 1990 | >                                                       |
|            | > ***Important***: Do *not*                             |
|            |                                                         |
|            | -   sever service connection that was properly          |
|            |     established under regulations previously in effect, |
|            |     or                                                  |
|            |                                                         |
|            | -   award an increase in compensation for the secondary |
|            |     effects of drug use based on any claim received     |
|            |     after October 31, 1990, including a claim           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   for an increased evaluation, or                     |
|            |                                                         |
|            | -   to add a dependent.                                 |
|            |                                                         |
|            | > ***Note***: Cost-of-living increases, for which no    |
|            | > claim is required, may be paid.                       |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   line of duty and drug abuse, see 38 CFR 3.301(d),   |
|            |     and                                                 |
|            |                                                         |
|            | -   the prohibition against increasing compensation for |
|            |     disabilities resulting from drug usage, see         |
|            |     VAOPGCPREC 02-98.                                   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Do not consider drug use or addiction to be of        |
| #### d. Dr | > misconduct origin or a bar to the awarding or         |
| ug Usage f | > increasing of monetary benefits where the use of      |
| or Therape | > drugs or drug addiction is shown by substantiating    |
| utic Purpo | > evidence as                                           |
| ses Second |                                                         |
| ary to SC  | -   arising out of use for recognized therapeutic       |
| Disability |     purposes, or                                        |
|            |                                                         |
|            | -   secondary to, or resulting from, an SC disability.  |
+------------+---------------------------------------------------------+

#### 69. Disability or Death From Use of Tobacco Products 

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on disability or      |
| troduction | > death from use of tobacco products, including         |
|            | > information on                                        |
|            |                                                         |
|            | -   the prohibition against direct service connection   |
|            |                                                         |
|            | -   disability secondary to a tobacco-related SC        |
|            |     disability                                          |
|            |                                                         |
|            | -   an example of a claim for a disability secondary to |
|            |     a tobacco-related SC disability                     |
|            |                                                         |
|            | -   secondary service connection for disability or      |
|            |     death related to tobacco use after service          |
|            |                                                         |
|            | -   considering claims for secondary service            |
|            |     connection, and                                     |
|            |                                                         |
|            | -   an example of a claim for secondary service         |
|            |     connection for a disability related to tobacco use  |
|            |     after service.                                      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Effective June 9, 1998, the granting of service       |
| # a. Prohi | > connection for a disability or death that results     |
| bition Aga | > from the veteran's use of tobacco products in service |
| inst Direc | > is prohibited.                                        |
| t Service  | >                                                       |
| Connection | > ***Reference***: For more information, see 38 CFR     |
|            | > 3.300(a).                                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Under 38 CFR 3.300(c), the establishment of service   |
| # b. Disab | > connection for a disability that develops as a result |
| ility Seco | > of a tobacco-related disability, for which service    |
| ndary to a | > connection was previously granted based on the        |
|  Tobacco-R | > veteran's use of tobacco products during service, is  |
| elated SC  | > prohibited, if such a claim for service connection is |
| Disability | > received on or after June 9, 1998.                    |
+------------+---------------------------------------------------------+

Continued on next page

69\. Disability or Death From Use of Tobacco Products, Continued

+------------+---------------------------------------------------------+
| ###        | > ***Facts***: Service connection for nicotine          |
| ## c. Exam | > dependence resulting from tobacco use that began      |
| ple: Disab | > during service was established in 1997. In April      |
| ility Seco | > 2003, the veteran claimed that his chronic            |
| ndary to a | > obstructive pulmonary disease was secondary to SC     |
|  Tobacco-R | > nicotine dependence.                                  |
| elated SC  | >                                                       |
| Disability | > ***Result***: Deny service connection for chronic     |
|            | > obstructive pulmonary disease.                        |
|            | >                                                       |
|            | > ***Rationale***: Although service connection was      |
|            | > previously established for nicotine dependence, under |
|            | > 38 CFR 3.300(c) the establishment of service          |
|            | > connection for a disability that is secondary to a    |
|            | > tobacco-related SC disability is prohibited, because  |
|            | > the claim was filed after June 9, 1998.               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > In VAOPGCPREC 6-2003, General Counsel (GC) held that  |
|  Secondary | > secondary service connection may be established for   |
|  Service C | > disability or death related to tobacco use after      |
| onnection  | > service that is the result of or aggravated by an SC  |
| for Disabi | > disability unrelated to tobacco use.                  |
| lity or De |                                                         |
| ath Relate |                                                         |
| d to Tobac |                                                         |
| co Use Aft |                                                         |
| er Service |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e. C | > The table below shows the steps involved in           |
| onsidering | > considering claims for secondary service connection   |
|  Claims fo | > for disability or death related to tobacco use after  |
| r Secondar | > service.                                              |
| y Service  |                                                         |
| Connection |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Did an SC disability cause the veteran to use tobacco        |
|       | products after service?                                      |
|       |                                                              |
|       | -   If ***yes***, go to step 2.                              |
|       |                                                              |
|       | -   If ***no***, deny the claim.                             |
+-------+--------------------------------------------------------------+

Continued on next page

69\. Disability or Death From Use of Tobacco Products, Continued

  -----------------------------------------------------------------------
  e\. Considering Claims for Secondary Service Connection (continued)

  -----------------------------------------------------------------------

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 2     | Was the use of tobacco products after service a substantial  |
|       | factor in causing or aggravating the disability claimed as   |
|       | secondary or in causing or contributing to death?            |
|       |                                                              |
|       | -   If ***yes***, go to step 3.                              |
|       |                                                              |
|       | -   If ***no***, deny the claim.                             |
+-------+--------------------------------------------------------------+
| 3     | Would the additional disability or death have been prevented |
|       | but for the use of tobacco products caused by the SC         |
|       | disability?                                                  |
|       |                                                              |
|       | -   If ***yes***, grant service connection for the secondary |
|       |     disability or death.                                     |
|       |                                                              |
|       | -   If ***no***, deny the claim.                             |
+-------+--------------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > ***Facts***: A veteran with an SC evaluation for      |
| #### f. Ex | > posttraumatic stress disorder (PTSD) claims secondary |
| ample: Sec | > service connection for tobacco-related emphysema. He  |
| ondary Ser | > states that he started smoking cigarettes after       |
| vice Conne | > service because of anxiety related to PTSD.           |
| ction for  | >                                                       |
| a Disabili | > ***Result***: Grant service connection for emphysema  |
| ty Related | > on a secondary basis if it is shown that              |
|  to Tobacc |                                                         |
| o Use Afte | -   symptoms of PTSD resulted in the veteran's use of   |
| r Service  |     cigarettes                                          |
|            |                                                         |
|            | -   cigarette smoking caused by PTSD was a substantial  |
|            |     factor in causing (or aggravating) emphysema, and   |
|            |                                                         |
|            | -   emphysema (or an increase in its severity) would    |
|            |     not have occurred if the veteran had not smoked     |
|            |     cigarettes.                                         |
|            |                                                         |
|            | > ***Rationale***: Per VAOPGCPREC 6-2003, secondary     |
|            | > service connection may be established for disability  |
|            | > related to tobacco use after service that is the      |
|            | > result of or aggravated by an SC disability unrelated |
|            | > to tobacco use.                                       |
+------------+---------------------------------------------------------+