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Navigating the VA claims process for secondary service connection can be frustrating, confusing, and full of red tape.
But what if there was a proven strategy that could boost your chances of getting your secondary VA claim approved?
Fellow Veterans—meet your SECRET WEAPON for secondary claims: The DBQ + Nexus Letter Combo.
This approach is one of the most effective ways to prove service-connection for any secondary condition, especially for a high-value VA claims.
Whether you’re trying to service-connect Sleep Apnea secondary to PTSD, Migraines secondary to Tinnitus, GERD secondary to Anxiety, or Radiculopathy secondary to Back Pain, among others, this new article from VA disability expert Brian Reese is your playbook to succeed.
Let’s begin!
Summary of Key Points
- Secondary Service Connection Made Simple: If your new disability was caused or aggravated by an already service-connected condition, you can file a secondary VA claim under 38 CFR § 3.310.
- The SECRET WEAPON Strategy: Use the DBQ + Nexus Letter Combo—the most effective way to deliver clear, credible medical evidence and make your secondary claim “decision ready.”
- Causation or Aggravation: You don’t have to prove that your primary condition caused the secondary one—only that it aggravated it. That’s a legal path to victory.
- Common High-Value Secondary Claims: Examples include Sleep Apnea secondary to PTSD, Migraines secondary to Tinnitus, GERD secondary to Anxiety, and Radiculopathy secondary to Back Pain.
Table of Contents
What is Secondary Service Connection for VA Disability?
According to 38 CFR 3.310(a) and (b), service-connection can be granted for disabilities that are either directly caused by or aggravated by a service-connected condition.
This includes:
- Secondary Causation: Where the new secondary disability is “proximately due to” or “the result of” a current a service-connected condition rated at 0% or more.
- Aggravation: When a non-service-connected disability is aggravated (e.g., made worse) by a service-connected disability. It’s important to note that this does not require the aggravation to be permanent.
What is a Secondary VA Disability Condition?
A secondary VA condition means your new disability was either caused or aggravated by another condition that is already service-connected at 0% or higher.
The VA allows veterans to file claims for these additional disabilities because they can directly result from or be worsened by your primary condition.
List of Common Secondary VA Claims
- Migraines (Headaches) secondary to Tinnitus
- Sleep Apnea secondary to PTSD or Other Mental Health Condition
- GERD secondary to Anxiety or Depression
- Radiculopathy secondary to Back Pain
- ED secondary to PTSD or Medication Side Effects
- Depression secondary to Chronic Pain
>> Click HERE to see the Top 100+ VA Claims for Secondary Service Connection
3 Keys to Proving Secondary VA Claims for Secondary Service Connection
#1. Current Medical Diagnosis
You should have a recent diagnosis of the secondary condition (within the last 12 months).
This typically comes from VA or private healthcare providers.
#2. Service-Connected Primary Disability
The condition you claim as the cause should already be service-connected at 0% or higher.
This could be physical (e.g., back pain) or mental (e.g., PTSD).
#3. Nexus (Link or Connection) Between #1 and #2 Above
You need competent medical evidence showing that your secondary condition was “at least as likely as not” caused or aggravated by the primary disability.
That’s where the Nexus Letter for a secondary condition comes in.
SECRET WEAPON: The DBQ + Nexus Letter Combo
This strategy works because it delivers exactly what the VA needs to approve a secondary claim—clear, concise, and credible medical evidence that makes your claim “decision ready.”
What is a DBQ?
A Disability Benefits Questionnaire (DBQ) is a standardized form used by the VA to review and rate disabilities.
It allows a private provider to present your diagnosis, symptoms, and limitations in a format the VA understands.
Example: A veteran filing for Radiculopathy secondary to Back Pain submits a DBQ completed by a private neurologist showing how the pain radiates to the legs and impairs function. This gives the VA everything they need to approve your claim.
What Is a Nexus Letter?
A Nexus Letter is an independent medical opinion written by a qualified provider that helps to explain, with supporting evidence-based rationale, how your primary condition has caused or aggravated your secondary condition.
Example: A psychologist writes a Nexus Letter explaining how a veteran’s PTSD leads to chronic sleep disturbances and weight gain, which in turn caused Obstructive Sleep Apnea.
Together, these two forms—the DBQ + Nexus Letter Combo—are the knockout punch.
They make your claim “Decision Ready,” and might even help you avoid a C&P exam.
Pro Tip: Emphasize Aggravation, Not Just Causation
Many VA denials for secondary conditions happen because veterans only try to prove causation (that one condition caused the other).
But the law allows for service-connection if the primary condition aggravates (worsens) the secondary condition.
If your doctor can write that your secondary condition was made worse (aggravated) by your service-connected disability, that’s enough to win your claim, assuming it’s convincing evidence-based rationale backed up by your medical records.
And this strategy is especially helpful when causation is less clear.
Example: PTSD may not cause GERD—but PTSD could worsen symptoms like stress-induced acid reflux, justifying secondary service-connection on an “at least as likely as not” basis.
What to Do If Your Secondary VA Claim Was Denied
You’re never out of options unless you quit!
Here’s how to fight back legally and ethically:
- File a Higher-Level Review (HLR): If the VA ignored your Nexus Letter or didn’t consider aggravation. This option allows your denial to be reviewed by a more senior level claims adjudicator.
- Submit a Supplemental Claim: Add new and relevant evidence not previously considered, especially a DBQ or Nexus Letter if you didn’t have one at claim submission.
- Get a Rebuttal Letter: Ask the private provider who provided your DBQ or Nexus Letter to write a Rebuttal Letter to counter the VA’s denial. This can then be uploaded to support your Supplemental Claim.
Conclusion & Wrap-Up
Secondary VA claims can be confusing and frustrating—but they don’t have to be.
The DBQ + Nexus Letter Combo is a proven strategy to win service connection for high-value secondary conditions like Sleep Apnea, Migraines, GERD, Radiculopathy, ED, and Depression.
This approach works because it gives the VA exactly what they need: clear, credible medical evidence.
If your claim was denied, don’t give up.
File a Higher-Level Review or a Supplemental Claim with new and relevant evidence.
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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.
