Veterans who have been diagnosed with mental health conditions such as PTSD, depression, or anxiety are often aware that they can receive VA disability compensation for these primary conditions. However, many veterans may not know that they can also be compensated for conditions caused or aggravated by these service-connected mental disorders. This is known as secondary service connection, and it can play a significant role in increasing a veteran’s monthly compensation.
This article explores what secondary service connection is, common disabilities caused by mental health disorders, and how to combine multiple disability ratings using VA math.
What Is Secondary Service Connection?
Secondary service connection is when a disability is not directly caused by military service but is instead caused or aggravated by a service-connected condition. For example, if a veteran is service-connected for PTSD, and the symptoms or medications associated with PTSD cause another condition, such as sleep apnea, that secondary condition can also be claimed for VA compensation.
“Secondary service connection is a critical avenue for veterans to access additional benefits they may not be aware of. It’s essential to understand how your mental health condition may lead to other health issues and seek compensation for them,” says Jane Miller, a VA claims expert and advocate.
To successfully file for secondary service connection, veterans must provide medical evidence showing it is “at least as likely as not” (50 percent or greater probability) that the service-connected condition caused or worsened the secondary disability.
Overview: Common Secondary Conditions Linked to Mental Health Disorders
| Secondary Condition | Common Causes | Key Evidence | VA Ratings |
|---|---|---|---|
| Sleep Disorders (e.g., Sleep Apnea) | PTSD or other mental health disorders | Sleep study results, CPAP compliance, nexus letter | 0% to 100%, based on severity |
| Cardiovascular Conditions (e.g., Hypertension) | Anxiety, depression, chronic stress | Blood pressure logs, cardiology records, EKGs | 10% to 60%, can be higher for severe conditions |
| Headache Disorders (e.g., Migraines) | PTSD, stress, anxiety | Headache diaries, neurology evaluations, nexus letters | 0% to 50%, depending on frequency |
| Gastrointestinal Conditions (e.g., IBS, GERD) | PTSD, anxiety, stress | GI specialist notes, endoscopy results | 10% to 30%, depending on severity |
| Sexual Dysfunction (e.g., Erectile Dysfunction) | Depression, anxiety, psychiatric medications | Urology evaluations, medical records, nexus opinions | 0% to 10%, with possible SMC qualification |
| TMJ and Bruxism (Jaw Clenching) | Stress, anxiety, PTSD | Dental records, oral surgeon evaluations, sleep studies | Based on pain severity and range of motion |
| Metabolic Conditions (e.g., Diabetes, Metabolic Syndrome) | PTSD, psychiatric medications | Endocrinology notes, HbA1c levels, medication side effects | 10% to 100%, based on severity |
| Substance Use Disorders | PTSD, depression, anxiety | Addiction treatment records, liver function tests | Varies, depending on complications like liver disease |
| Cardiovascular Events (e.g., Heart Disease, Stroke) | Chronic stress, hypertension | Cardiology records, stress test results, nexus letters | 10% to 100%, depending on severity |
Common Secondary Conditions to Mental Health Disorders
1. Sleep Disorders (e.g., Sleep Apnea) Secondary to PTSD or Other Mental Health Conditions
Many veterans experience sleep disorders like obstructive sleep apnea due to PTSD. The symptoms of PTSD, such as nightmares and anxiety, can disrupt sleep, and psychiatric medications often contribute to weight gain or muscle relaxation, which can worsen sleep apnea.
Key Evidence: Sleep study results, CPAP compliance records, and a nexus letter from your doctor.
VA Ratings: From 0% (asymptomatic, but requiring CPAP) up to 100% (requiring tracheostomy).
2. Cardiovascular Conditions (e.g., Hypertension) Secondary to Anxiety, Depression, or Other Mental Disorders
Anxiety and depression can significantly increase stress levels, contributing to hypertension and other cardiovascular diseases. Additionally, medications used to treat these conditions can also have cardiovascular side effects.
Key Evidence: Blood pressure logs, cardiology records, EKGs, and medical opinions linking the condition to mental health.
VA Ratings: 10% to 60%, with more severe cardiovascular conditions rated higher.
3. Headache Disorders (e.g., Migraines) Secondary to PTSD or Other Mental Health Conditions
Veterans with PTSD may experience frequent migraines or tension headaches, often triggered by stress or disrupted sleep. Some psychiatric medications can also cause headaches as a side effect.
Key Evidence: Headache diaries, neurology evaluations, and nexus letters.
VA Ratings: 0% to 50%, depending on the frequency and severity of attacks.
4. Gastrointestinal Conditions Secondary to PTSD or Other Mental Health Disorders
Conditions like Irritable Bowel Syndrome (IBS) or GERD (Gastroesophageal Reflux Disease) are frequently seen in veterans with mental health conditions like PTSD. Stress and anxiety often exacerbate digestive issues, and certain medications may cause or worsen these conditions.
Key Evidence: GI specialist notes, endoscopy results, and documentation of frequency and severity.
VA Ratings: Typically 10–30%, depending on severity.
5. Sexual Dysfunction (e.g., Erectile Dysfunction) Secondary to Mental Health Disorders
Erectile dysfunction (ED) is commonly reported as a side effect of antidepressants and anti-anxiety medications. Veterans with PTSD, anxiety, or depression may experience sexual dysfunction as a result of these medications or mental health symptoms.
Key Evidence: Urology evaluations, medical records showing side effects, and nexus opinions.
VA Ratings: Usually 0–10%, but ED may also qualify for Special Monthly Compensation (SMC) in certain cases.
6. TMJ and Bruxism (Jaw Clenching and Teeth Grinding) Secondary to Mental Health Disorders
Stress and anxiety can lead to bruxism (teeth grinding) and TMJ (temporomandibular joint) disorders, causing jaw pain and dental issues.
Key Evidence: Dental records, oral surgeon evaluations, and sleep studies.
VA Ratings: Based on range of motion and pain severity.
7. Metabolic Conditions (e.g., Diabetes) Secondary to PTSD or Other Mental Health Disorders
Certain psychiatric medications, especially those used to treat PTSD, can cause weight gain and insulin resistance, contributing to metabolic conditions like diabetes. Stress itself can also affect glucose metabolism.
Key Evidence: Endocrinology notes, HbA1c levels, and documentation of medication side effects.
VA Ratings: 10% to 100%, depending on severity and complications.
8. Substance Use Disorders and Complications Secondary to Mental Health Disorders
While alcohol and drug use disorders cannot be directly service connected, they may be secondary to mental health conditions like PTSD. Complications arising from substance abuse, such as liver disease, may be compensable.
Key Evidence: Addiction treatment records, liver function tests, and medical nexus opinions.
VA Ratings: Vary based on complications, e.g., liver disease: 10% to 100%.
9. Cardiovascular Events (e.g., Heart Disease, Stroke) Secondary to Mental Health Disorders
Chronic stress and hypertension often increase the risk of heart disease and other serious cardiovascular events. Veterans suffering from mental health conditions are more likely to experience these issues later in life.
Key Evidence: Cardiology records, stress test results, and nexus letters.
VA Ratings: 10% to 100%, depending on severity and functional impact.
How to Do VA Math and Combine Ratings?
When applying for VA disability compensation for multiple conditions, veterans will need to calculate their overall disability rating using a process known as “VA math.” Instead of simply adding up the individual percentages, VA disability ratings are calculated using a formula that reduces the impact of each new disability.
Example:
A veteran with a 70% disability rating for PTSD and a 30% rating for sleep apnea will not have a combined rating of 100%. Instead, the VA formula is applied:
- 70% for PTSD + (30% of the remaining 30% for sleep apnea) = 79%, rounded to 80%.
“The concept of VA math is crucial for veterans to understand. While the combined disability rating doesn’t simply add up, each new condition has a tangible impact on their total compensation. A veteran’s efficiency is factored in, reducing the impact of additional disabilities,” says Mark Thompson, a VA claims consultant.
FAQs
What is secondary service connection?
Secondary service connection is when a disability is caused or aggravated by an already service-connected condition. For example, PTSD can lead to sleep apnea, which can be claimed as a secondary condition.
Can I get VA compensation for a condition caused by my PTSD?
Yes, if your PTSD or other mental health condition causes or worsens another condition, you may be eligible for VA compensation for that secondary disability.
What are some common secondary conditions related to PTSD?
Common secondary conditions include sleep disorders, hypertension, headaches, gastrointestinal issues, erectile dysfunction, and metabolic conditions like diabetes.
How is my combined disability rating calculated?
VA uses a formula known as “VA math” to combine ratings. It’s not a simple sum, but rather a calculation based on your overall efficiency.
How can I prove my secondary condition is related to my mental health disorder?
You will need medical evidence, including specialist reports, nexus letters, and detailed records that show how your primary mental health condition caused or aggravated the secondary condition.
