Spicer v. McDonough: Secondary Claims & the But-For Standard (2026)

If you follow VA claim news in 2026, you have probably seen headlines about Spicer v. McDonough and a May M21-1 update. Some posts sound like secondary claims vanished. Others sound like every denial is suddenly winnable. Neither extreme is useful.

Here is the practical version for Veterans: Spicer is about how causation works for secondary-type disabilities—especially when a service-connected condition makes another problem worse today, including by getting in the way of treatment. The May 1, 2026 M21-1 update tells raters how to apply that framework. Educational only—not legal advice.

What Spicer actually held

In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the Federal Circuit interpreted 38 U.S.C. § 1110—compensation for disability “resulting from” service-connected injury or disease. The court treated present-day functional impairment as the disability, and agreed that “resulting from” requires but-for causation.

In plain language: ask whether the claimed impairment would be less severe today but for the service-connected disability (including multi-step chains when the medical evidence supports them). The case facts involved service-connected leukemia treatment interfering with care for a knee problem—so the knee impairment could still be tied to the service-connected disease under a but-for analysis.

The May 1, 2026 M21-1 update

On May 1, 2026, VA updated M21-1 adjudication guidance on secondary service connection / aggravation (commonly discussed as Part V, Subpart ii, Chapter 2, Section D). Public commentary from advocates and claim educators notes that the manual now emphasizes but-for analysis and recognizes pathways that include treatment interference—where a service-connected disability delayed, prevented, or interfered with treatment for another condition.

Manual language can be nuanced, and commentary online disagrees about how “tight” or “broad” some passages read in practice. Your takeaway as a Veteran: secondary claims were not cancelled. How you argue and prove causation may need to match current M21-1 + Spicer framing. When in doubt, read the current M21-1 section and work with an accredited representative.

Three pathways Veterans should understand

Not every claim uses all three. Pick the pathway that matches your records. A sleep-apnea-secondary-to-PTSD claim may still be a classic secondary chain. A knee that could not be operated on because of SC cancer treatment may be a Spicer-style interference story.

What to ask your clinician to address

Strong opinions after Spicer / the 2026 M21-1 update usually do more than say “related to service.” Where the facts support it, ask the clinician to address:

1. Current diagnosis and functional impairment.
2. Whether it is at least as likely as not that the impairment would be less severe today but for the service-connected disability (or its treatment).
3. Direct causation and/or aggravation, with rationale and records cited.
4. Treatment interference explicitly, if SC care delayed, blocked, or complicated treatment for the claimed condition.
5. Why alternative explanations are less persuasive (when relevant).

If you were denied before

A prior denial under an older proximate-cause framing does not automatically flip to a grant. But a supplemental claim with new and relevant evidence—such as a nexus opinion written to the but-for / treatment-interference analysis—may open the door. Read what to do after a denial and the appeals process guide.

Where this shows up in real claims

• Classic secondaries (e.g., conditions linked to PTSD secondary lists) still need medical rationale—now framed carefully under but-for where appropriate.
• Multi-step chains (SC condition → intermediate problem → claimed condition) may be viable when each link is medically supported.
• Treatment-interference fact patterns: SC medication, hospitalization, or contraindications that blocked surgery or rehab for another disability.

Action checklist

1. List the SC condition and the claimed secondary / aggravated condition.
2. Write down whether your story is cause, aggravation, interference—or a mix.
3. Gather treatment records that show delayed or blocked care (if interference applies).
4. Update or obtain a nexus opinion that uses but-for language and cites your records.
5. File or supplement via Step 6; track status with claim status / VERA.
6. Get free help if needed: VA Claim Help.

Sources for education: Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023); 38 U.S.C. § 1110; VA M21-1 updates discussed publicly as of May 1, 2026. Manual text changes—verify current M21-1 language on VA systems. This article is educational and not legal, medical, or claims-representation advice. No outcome is guaranteed.

Frequently Asked Questions

What is Spicer v. McDonough?

A 2023 Federal Circuit decision holding that § 1110’s “resulting from” language requires but-for causation for compensable disability, with a fact pattern involving treatment interference between a service-connected disease and another impairment.

Did VA eliminate secondary claims in 2026?

No. Secondary claims remain. The 2026 M21-1 update implements Spicer-aligned but-for / related guidance. Evidence still decides outcomes.

What is treatment interference?

When a service-connected condition or its treatment delayed, prevented, or interfered with care for another disability so that condition is worse today but for that interference.

Do I need a new nexus letter after Spicer?

Often helpful after an older nexus denial—especially if the new opinion addresses but-for causation and treatment interference with citations to your records. Not a guarantee.

Is “at least as likely as not” still the proof standard?

Yes for typical medical nexus questions. Spicer reframes causation analysis; it does not erase the approximate-balance standard clinicians usually use.