Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, such as combat, accidents, or violence.
Veterans often receive VA disability benefits for PTSD when the condition is linked to their military service.
However, PTSD frequently leads to other health problems, known as “secondary conditions,” which are directly caused or aggravated by the primary service-connected PTSD.
When applying for VA disability benefits, it is crucial to identify and include any secondary conditions, as they can impact your overall disability rating and compensation.
Table of Contents
Summary of Key Points
- PTSD and Its Impact on Veterans: Post-Traumatic Stress Disorder (PTSD) is a mental health condition that veterans can develop due to traumatic events experienced during service, such as combat or accidents. It is recognized as a service-connected condition eligible for VA disability benefits.
- Secondary Conditions Linked to PTSD: PTSD often leads to additional health issues, known as secondary conditions. These secondary disabilities can develop as a direct result of PTSD or be aggravated by it, and they can significantly impact a veteran’s overall disability rating and compensation.
- VA Rating Criteria for PTSD: The VA uses the General Rating Formula for Mental Disorders under 38 CFR § 4.130 to assign disability ratings for PTSD. The ratings range from 0% to 100%, based on the severity of symptoms and the degree to which PTSD affects the veteran’s ability to function in daily life, work, and social settings.
- Establishing Secondary Service Connection: To obtain VA disability benefits for secondary conditions, veterans must show that the condition is caused or worsened by their service-connected PTSD. This requires a current diagnosis, evidence of a service-connected primary condition (PTSD), and medical nexus evidence linking the secondary condition to PTSD.
How the VA Rates PTSD for Disability Benefits
The VA uses the General Rating Formula for Mental Disorders under 38 CFR § 4.130 to evaluate PTSD claims, basing the rating on the severity of symptoms and their impact on a veteran’s ability to function in daily life, work, and social settings.
PTSD VA ratings are as follows from 0% to 100% with breaks at 10%, 30%, 50%, and 70%:
- 0% Rating: PTSD symptoms are present but do not significantly impair daily life or work. The symptoms may be well-controlled by continuous medication or not severe enough to interfere with occupational and social functioning.
- 10% Rating: PTSD causes mild or transient symptoms that decrease work efficiency only during periods of significant stress, or the symptoms are controlled by continuous medication. The veteran is generally able to perform occupational tasks under normal circumstances.
- 30% Rating: PTSD results in occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks, though the veteran can generally function satisfactorily. Symptoms at this level may include anxiety, depressed mood, chronic sleep impairment, mild memory loss (such as forgetting names or recent events), suspiciousness, and occasional panic attacks.
- 50% Rating: There is reduced reliability and productivity in the workplace, with more frequent difficulties in social situations. Symptoms at this level can include impaired memory, flattened affect, difficulty understanding complex commands, panic attacks more than once a week, disturbances in motivation and mood, impaired judgment, and challenges in maintaining relationships.
- 70% Rating: PTSD causes significant occupational and social impairment, with symptoms affecting most areas such as work, school, family, judgment, and mood. This can involve suicidal ideation, near-continuous panic or depression, impaired impulse control, difficulty adapting to stressful situations, obsessional rituals, or an inability to maintain effective relationships.
- 100% Rating: PTSD results in total occupational and social impairment. Symptoms can include persistent delusions or hallucinations, gross impairment in communication or thought processes, grossly inappropriate behavior, a persistent danger of harming oneself or others, disorientation to time or place, and significant memory loss (e.g., forgetting close relatives’ names or one’s own name).
These ratings reflect the extent of functional impairment caused by PTSD symptoms and help determine the appropriate level of compensation for veterans based on the severity of their condition.
How to Service-Connect Secondary Claims to PTSD
To establish secondary service connection for a condition linked to PTSD, you need to show that your new disability is proximately due to, caused, or aggravated by your service-connected PTSD.
According to VA regulations in 38 CFR § 3.310, if a current disability is connected to an already service-connected condition (like PTSD), it can also be considered for VA benefits.
Here’s what you need to prove for a secondary service connection:
- Diagnosis of the Secondary Condition: You must have a current medical diagnosis of the condition you’re trying to connect to PTSD (such as migraines, sleep apnea, GERD, IBS, or erectile dysfunction).
- Service-Connected Primary Condition: You must already have a VA rating for PTSD, even if it’s as low as 0%.
- Medical Nexus Evidence: There needs to be a clear link, or “nexus,” showing that the secondary condition is either caused by or aggravated by your PTSD. This connection is often established with a Nexus Letter from a qualified healthcare provider, who explains how your PTSD impacts the secondary condition.
To support your claim, use any medical records that show the diagnosis and connection between your PTSD and the secondary condition.
A strong Nexus Letter for a secondary condition is often the key to proving that link.
10 Most Common VA Secondary Conditions to PTSD
Here’s a detailed list of the top 10 secondary conditions linked to PTSD for VA disability benefits, with explanations on how each condition is connected to PTSD:
#1. Migraines Secondary to PTSD
Migraines and chronic headaches are commonly associated with PTSD due to the heightened levels of stress and anxiety veterans experience. Research indicates that individuals with PTSD are more likely to suffer from migraines because chronic stress can act as a trigger for headache disorders. Additionally, medications used to treat PTSD, such as antidepressants, may have side effects that include headaches. Veterans experiencing migraines may report symptoms like throbbing pain, nausea, or light sensitivity, which can severely impact their daily life. Establishing a secondary service connection for migraines requires demonstrating that they are either caused or aggravated by PTSD.
#2. Sleep Apnea Secondary to PTSD
Veterans with PTSD are at a higher risk of developing sleep apnea, a disorder characterized by repeated interruptions in breathing during sleep. PTSD symptoms, such as hyperarousal, stress, and sleep disturbances, can contribute to or worsen sleep apnea. Obstructive sleep apnea is the most common form linked to PTSD and may require the use of a CPAP machine. Research shows that as the severity of PTSD symptoms increases, so does the likelihood of sleep apnea, making a strong case for secondary service connection when supported by medical evidence.
#3. Gastroesophageal Reflux Disease (GERD) Secondary to PTSD
GERD, commonly known as acid reflux, often co-occurs with PTSD. The relationship is typically related to the stress and anxiety associated with PTSD, which can increase stomach acid production and exacerbate digestive symptoms. Additionally, some medications used to manage PTSD symptoms can contribute to acid reflux. Veterans may experience heartburn, regurgitation, or chest pain, and if these symptoms are linked to their PTSD, they may qualify for secondary service connection. GERD is usually rated under the VA’s rating criteria for hiatal hernia.
#4. Irritable Bowel Syndrome (IBS) Secondary to PTSD
PTSD’s impact on the body’s stress response can significantly affect gastrointestinal functioning, leading to IBS. Veterans with PTSD may experience symptoms like abdominal pain, bloating, diarrhea, and constipation. The body’s “fight or flight” response, which is commonly activated in PTSD, can disrupt normal digestion and bowel movements. Establishing a secondary service connection for IBS involves showing that the condition is aggravated or caused by PTSD.
#5. Erectile Dysfunction (ED) Secondary to PTSD
PTSD can lead to sexual dysfunction, including ED, due to psychological factors such as anxiety, depression, and stress. In some cases, medications for PTSD can also contribute to ED. Research shows that veterans with PTSD have a significantly higher rate of sexual dysfunction compared to the general population. While ED often receives a 0% rating, veterans may still be eligible for Special Monthly Compensation for loss of use of a creative organ.
#6. Hypertension Secondary to PTSD
The chronic stress associated with PTSD can lead to hypertension (high blood pressure). This is because PTSD triggers the body’s stress response, which increases heart rate and blood pressure. Hypertension is a risk factor for more serious cardiovascular conditions, making it important for veterans to seek a secondary service connection if their high blood pressure is linked to PTSD. Medical evidence must show that PTSD either caused or aggravated the hypertension for a successful claim.
#7. Chronic Pain Secondary to PTSD
Chronic pain conditions, such as fibromyalgia or musculoskeletal pain, can be aggravated by PTSD. Veterans may experience increased sensitivity to pain due to the altered stress response from PTSD, which can heighten the perception of pain. Establishing a secondary service connection for chronic pain may involve showing that PTSD contributes to the severity of pain symptoms or worsens an existing pain condition.
#8. Temporomandibular Joint Disorder (TMJ) Secondary to PTSD
Temporomandibular Joint Disorder (TMJ) is a condition that affects the jaw joint and surrounding muscles, often causing pain, discomfort, and difficulty with jaw movement. Veterans with PTSD may experience TMJ due to stress-related behaviors such as jaw clenching or teeth grinding (bruxism), which are known to aggravate the condition. Additionally, muscle tension associated with anxiety and stress can contribute to jaw pain, further worsening TMJ symptoms. Establishing a secondary service connection for TMJ involves demonstrating that PTSD-related stress has either caused or exacerbated the condition.
#9. Cardiovascular Disease Secondary to PTSD
Veterans with PTSD have a higher risk of developing cardiovascular conditions such as coronary artery disease due to the continuous stress and anxiety associated with PTSD. The body’s ongoing stress response can result in inflammation and damage to the cardiovascular system, leading to heart conditions over time. Establishing a secondary service connection requires demonstrating that PTSD has negatively impacted the veteran’s cardiovascular health.
#10. Diabetes Secondary to PTSD
PTSD may contribute to the development or worsening of Type 2 diabetes by affecting the body’s regulation of blood sugar levels. Stress hormones, like cortisol, can increase blood sugar and insulin resistance, creating a higher risk for diabetes. Veterans can seek a secondary service connection for diabetes if medical evidence supports that PTSD plays a role in its development or aggravation.
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About the Author
Brian Reese
Brian Reese is a world-renowned VA disability benefits expert and the #1 bestselling author of VA Claim Secrets and You Deserve It. Motivated by his own frustration with the VA claim process, Brian founded VA Claims Insider to help disabled veterans secure their VA disability compensation faster, regardless of their past struggles with the VA. Since 2013, he has positively impacted the lives of over 10 million military, veterans, and their families.
A former active-duty Air Force officer, Brian has extensive experience leading diverse teams in challenging international environments, including a combat tour in Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy and earned his MBA from Oklahoma State University’s Spears School of Business, where he was a National Honor Scholar, ranking in the top 1% of his class.
