Lateral Epicondylitis Secondary to Shoulder Injury: VA Rating Guide 2026

What Is Secondary Service Connection?

Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that lateral epicondylitis was directly caused by your military service — only that it was caused or worsened by your service-connected Shoulder Injury. This is one of the most powerful and underused tools in the VA claims system.

The Medical Nexus: Shoulder Injury → Lateral Epicondylitis

Compensatory movements from shoulder injuries transfer stress to the elbow joint.

To establish secondary service connection for lateral epicondylitis, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your lateral epicondylitis was caused or aggravated by your service-connected Shoulder Injury. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

How to File for Lateral Epicondylitis Secondary to Shoulder Injury

1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Shoulder Injury and lateral epicondylitis.
2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
3. List lateral epicondylitis as a secondary condition on your claim form, citing your service-connected Shoulder Injury as the cause.
4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

VA Rating for Lateral Epicondylitis: What to Expect

If your secondary claim is granted, VA will rate your lateral epicondylitis under the appropriate diagnostic code, typically at 10% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Shoulder Injury and receive a 10% rating for lateral epicondylitis, your combined rating would be approximately 73% (not 80%).

Nexus Letter Requirements for Lateral Epicondylitis Secondary to Shoulder Injury

A strong nexus letter for this claim should include:

• The physician’s credentials and familiarity with VA claims
• A review of your medical history showing the timeline (service-connected Shoulder Injury predates lateral epicondylitis diagnosis)
• A citation to medical literature supporting the causal relationship
• The “at least as likely as not” opinion stated explicitly
• A statement that the opinion is based on a review of the claims file and examination of the veteran

Common C&P Exam Questions for This Claim

At your C&P exam for lateral epicondylitis secondary to Shoulder Injury, the examiner will likely ask:

• When did your lateral epicondylitis symptoms begin relative to your Shoulder Injury diagnosis?
• Has your lateral epicondylitis worsened since your Shoulder Injury was diagnosed?
• What treatments have you received for lateral epicondylitis?
• How does lateral epicondylitis affect your daily functioning and ability to work?

Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your lateral epicondylitis.