We need to be careful about jumping to conclusions based on YouTube videos. It seems like it has been happening a lot lately. However, don’t accept everything I say as gospel either.
I am not an attorney or a VA official. I’m a psychologist. I also don’t think we can actually say that but for causation and proximate causation are always dramatically different. However, based on recent changes from the VA, the VA also views but for causation as a less strict test than proximate causation. It is based on a court case that was also telling the VA that their approach was essentially too strict. Based on the M21-1, Part V, Subpart ii, May 1, 2026 key changes document, the Veterans Benefits Administration noted:
In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the U.S. Court of Appeals for the Federal Circuit held that the language “resulting from” in 38 U.S.C. 1110 requires a standard of “but-for causation” and that a stricter proximate causation standard is inconsistent with the statute. In accordance with the Spicer holding, the Department of Veterans Affairs (VA) will apply the broader but-for standard and will no longer consider natural progress of the NSC disability when deciding a claim based on aggravation of an NSC disability by an SC disability.
Less strict and no longer considering the natural progress of the disability (such as C&P examiners using the risk factor of “age” in their argument, for example?) only spells doom and gloom if you are a YouTuber or someone else who tries to conflate this as replacing the burden of proof/standard of evidence of “at least as likely as not (a 50 percent chance or greater).” Personally, I am not an attorney or VA official, but I think it isn’t correct to think that.
For a non-aggravation related secondary claim here is the major change: The word proximately due to) was replaced with language that technically is quite similar to what we were already using for obesity as an intermediate step anyway.
Here is that directly from the VA’s change document:
disabilities that are proximately due to, or the result of, or would not have occurred but for, a service-connected (SC) condition disability
Instead of “proximately due to” we have “the result of, or would not have occurred but for.”
Nothing in this says 100% certainty of causation or sole causation is required, nor does it replace at least as likely as not as a burden of proof from my view as a psychologist who is not an attorney.
Nothing in this makes the erroneous two-sentence C&P opinions related to causation sufficient. C&P opinions that simply state some evidence relates to an “association” or a correlation and not causation is still not a sufficient rationale in my opinion as a psychologist who is not an attorney. The Veteran’s burden of proof is still not 100% certainty of causation (or the 95% confidence/probability often used in research studies), it is at least as likely as not (again, in my opinion as a psychologist not an attorney or VA official). If a C&P examiner says research points to an “association” but not causation (essentially using scientific research evidence that required 95% confidence or higher rather than at least as likely as not), this still isn’t a sufficient rationale in my humble opinion as a psychologist. I still believe that rationales must relate to an analysis in the context of at least as likely as not in order to be sufficient, not a requirement of closer to 95% to 100% certainty of causation.
The typical language we often use may still be fine in many cases, but it certainly doesn’t hurt to demonstrate that we’ve addressed it as “the result of” or “would not have occurred but for” (though admittedly C&P examiners and other professionals were rarely specifically stating “proximately due to” in their opinions, and the questions C&P examiners were getting from VBA didn’t always use this language either).
As always, I am happy to answer questions in my role as a psychologist (not an attorney or VA official), and will keep following any updates related to VA changes.