Today I’m explaining the Top 5 Secondary Conditions to PTSD for VA disability benefits utilizing the legal and medical requirements for secondary service connection.
This is the ultimate guide for veterans searching for VA secondary conditions to PTSD!
According to the 2019-2020 Veterans Benefits Administration (VBA) report to congress, Post Traumatic Stress Disorder (PTSD) is the #4 most claimed VA disability with 1,118,041 disabled veterans with a service-connected PTSD rating.
While the average VA rating for PTSD is 70%, making it a high-value VA claim, did you know there are five OTHER high-value VA disability claims (rated at 30% or above) that can be medically linked through “aggravation” and claimed secondary to your service-connected PTSD?
In our experience, many veterans don’t even realize they qualify for a variety of additional VA disability benefits due to their current service-connected PTSD.
Why?
Because veterans aren’t medical experts (nor should they be), and yet, VA disability claims depend almost entirely upon MEDICAL EVIDENCE!
PTSD can have significant debilitating effects on veterans, especially due to the side effects of medications taken to manage your PTSD symptoms, often leading to a variety of other disabling conditions in veterans such as Sleep Apnea, Headaches, GERD, IBS, Erectile Dysfunction, and Female Sexual Arousal Disorder.
Okay, it’s time to jump into the main disability conditions causally linked to be proximately due to or aggravated by service-connected PTSD.
You might also like the following blog posts:
- The Definitive Guide to VA Ratings for Migraines
- VA Ratings for GERD – The Expert’s Guide
- How to Get a VA Disability Rating for IBS
How to Establish Service Connection Secondary to PTSD
In accordance with 38 CFR § 3.310 disabilities that are proximately due to, or aggravated by, service-connected disease or injury, a current disability condition, which is proximately due to or the result of a service-connected disease or injury shall be service connected.
Service connection on a secondary basis requires a showing of causation.
A showing of causation requires that the secondary disability claim be shown to be “proximately due to” or “aggravated by” another service-connected disability.
There are three evidentiary elements that must be satisfied for secondary conditions to PTSD to prove service connection under the law:
- A medical diagnosis of the secondary disability condition you’re attempting to link to PTSD AND
- A current service-connected primary disability (e.g., your current VA PTSD rating) AND
- Medical nexus evidence establishing a connection between the service-connected PTSD and the current disability you’re trying to connect (e.g., Migraines, Sleep Apnea, GERD, IBS, Erectile Disfunction / Female Sexual Arousal Disorder)
The first part can be satisfied with any existing medical evidence in service treatment records, VA medical records, or any private medical records.
The second part can be satisfied with a veteran’s existing service-connected disability rated at 0 percent or higher, which in this case, is PTSD.
The third part, and often the missing link needed to establish secondary service connection, can be satisfied with a credible Medical Nexus Letter (Independent Medical Opinion) from a qualified medical provider.
>> Wondering how to find doctors who write credible medical nexus letters for veterans?
Did you know there are five primary high-value VA disability conditions that can be medically linked to your current VA PTSD claim?
Truth bomb here veterans…
You could be missing out on thousands of dollars of tax-free disability benefits you deserve by law, and not even realize that your current VA disability might be caused or aggravated by your service-connected PTSD.
Need an Independent Medical Opinion (IMO) to help establish secondary service connection?
Click HERE now to join VA Claims Insider Elite, our premier education-based membership program, which also gets you discounted access to independent medical providers in our referral network for medical examinations, VA disability evaluations, and Medical Nexus Letters for a wide range of conditions!
List of the Top 5 Secondary Conditions to PTSD
- #1: Migraine Headaches secondary to PTSD
- #2: Sleep Apnea secondary to PTSD
- #3: GERD secondary to PTSD
- #4: IBS secondary to PTSD
- #5: ED secondary to PTSD
#1: Migraine (Headaches) Secondary to PTSD
Migraine Headaches, Tension Headaches, and Post Traumatic Headaches are the most common types of headaches in veterans although there are many others, too.
Medical research suggests a connection between Headaches and PTSD, and the symptoms go hand in hand with many types of headaches, including migraines and hypertension.
One study found that 32% of OEF/OIF veterans with PTSD say that they have problems with headaches.
A growing body of epidemiological literature supports an association between migraine and PTSD.
PTSD prevalence rates have been demonstrated to be increased in those with migraine in multiple different cohorts, including tertiary pain and headache clinics, veteran cohorts, and general population surveys.
In the tertiary clinic-based studies, approximately 22–30% of headache sufferers fulfilled PTSD criteria.
In a veteran cohort survey, the prevalence of PTSD was even greater than found in the tertiary care clinics, with almost 50% of those with migraine fulfilling criteria for PTSD.
Migraine headaches is one of the most common secondary conditions to PTSD.
Thus, there is some medical etiology to suggest that Migraines, and many different types of Headaches, can be proximately due to or aggravated by PTSD.
Furthermore, headaches are a common side effect of Selective Serotonin Reuptake Inhibitors (SSRIs) such as Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and Sertraline (Zoloft).
If you’re taking medications to try to manage your PTSD symptoms, but those medications cause side effects, you might be able to get service-connected secondary to PTSD due to the side effects of medications and how the “cause” or “aggravate” headaches.
>> Click HERE to read my Top 6 Tips for Your VA Claim for Migraines.
You’ll likely need a Nexus Letter from an independent medical professional to establish service connection for migraines secondary to PTSD.
Speaking of headaches, did you know there are more than 150 different types of headaches eligible for VA disability benefits under the law?
While the Schedule for Rating Disabilities only lists “Migraines,” ANY type of headache can be service connected and compensated under the law if the veteran has current symptoms of headaches that interfere with work, life, and social functioning.
CFR 38, Part 4, the Schedule for Rating Disabilities, lists Migraines under code 8100.
The Migraine Headaches secondary to PTSD VA rating scale consists of four possible ratings: 0%, 10%, 30%, and 50%.
The symptoms become markedly more severe between at the 30% and 50% rating levels, as evidenced by the rating criteria below:
| Migraines Secondary to PTSD VA Rating Scale: | VA Rating |
| Migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability | 50% |
| Migraines with characteristic prostrating attacks occurring on an average once a month over last several months | 30% |
| Migraines with characteristic prostrating attacks averaging one in 2 months over last several months | 10% |
| Migraines with less frequent attacks | 0% |
#2: Sleep Apnea Secondary to PTSD
Did you know veterans are almost four times as likely to have or develop Obstructive Sleep Apnea compared to the general population?
Sleep apnea is one of the most common secondary conditions to PTSD.
And numerous medical research studies point to the prevalence of Obstructive Sleep Apnea in veterans with PTSD.
For example, a study of U.S. veterans found that the probability of having Obstructive Sleep Apnea increased with increasing severity of PTSD symptoms.
According to Sonya Norman, PhD, director of the PTSD Consultation Program at the National Center for PTSD, and an associate professor of psychiatry at the University of California San Diego School of Medicine: “Sleep apnea is a risk factor for a long list of health problems such as hypertension, cardiovascular disease and diabetes, and psychological problems including depression, worsening PTSD and anxiety.”
Medical research supports causal linkages of Obstructive Sleep Apnea in veterans’ due to changes in physical structure or other medical conditions.
These include conditions such as: Obesity, large tonsils, endocrine disorders, neuromuscular disorders, heart or kidney failure, certain genetic syndromes, and premature birth.
In our experience, it is common for a veteran’s PTSD to aggravate his/her Sleep Apnea due to Obesity as an interim link for secondary service connection.
The #1 recommendation for veterans attempting to service connect sleep apnea as a secondary condition is to GET A CREDIBLE MEDICAL NEXUS LETTER!
VA claims for Sleep Apnea secondary to PTSD can be rated at 0%, 10%, 30%, or 50% depending upon the severity of your sleep apnea, and how your symptoms affect your work, life, and social functioning.
For example, a veteran may have a 70% rating for PTSD and then get service connected at 50% of sleep apnea with CPAP secondary to PTSD.
| Sleep Apnea Secondary to PTSD VA Rating Scale: | VA Rating |
| Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or requires tracheostomy | 100% |
| Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine | 50% |
| Persistent daytime hypersomnolence (daytime tiredness) | 30% |
| Asymptomatic but with documented sleep disorder breathing | 0% |
#3: GERD Secondary to PTSD
Medical research supports a connection between GERD and PTSD.
Both veteran and non-veteran studies have reported high rates of comorbidity between PTSD, Depression, and Gastrointestinal (GI) symptoms.
A 2013 study of veterans who deployed to Iraq and Afghanistan found that nearly 45% of patients screened positive for PTSD and 23% screened positive for depression symptoms.
While only 11% of patients reported GI symptoms, 73.4% of these patients had a positive screen for PTSD, indicative of a significant relationship.
Many veterans with GERD or acid reflux, especially those who were diagnosed long after leaving the military are eligible under the law for GERD secondary to PTSD.
For example, if veterans are taking SSRIs to help manage their PTSD symptoms, perhaps you’re suffering from side effects of those SSRI medications, which can lead to digestive system issues.
Thus, veterans can connect GERD as a secondary condition to PTSD.
Service connection on a secondary basis requires a showing of causation.
A showing of causation requires that the secondary disability be shown to be “proximately due to” or “proximately aggravated by” another service-connected disability.
By law, there are three evidentiary elements that must be satisfied for GERD secondary to PTSD to prove secondary service connection:
- A medical diagnosis of GERD in VA medical records or private records (unless you already have a diagnosis of GERD in your service treatment records)
- Evidence of a service-connected primary disability (such as PTSD, depression, anxiety, migraines, IBS), AND
- Medical nexus evidence establishing a connection between the service-connected disability (PTSD) and the current disability (GERD)
The first part can be satisfied with any existing medical evidence in service treatment records, VA medical records, or any private medical records.
The second part can be satisfied with a veteran’s existing service-connected disability rated at 0 percent or higher.
The third part can be satisfied with a medical nexus letter from a qualified medical professional.
GERD secondary to PTSD is a VA disability and can be rated at 10%, 30%, or 60%, depending upon the severity of your symptoms.
GERD is typically rated analogous to Hiatal Hernia under CFR 38, Part 4, VA Schedule of Ratings, Diagnostic Code 7346, Hernia Hiatal.
| GERD Secondary to PTSD VA Rating Scale: | VA Rating |
| Symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health | 60% |
| Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health | 30% |
| With two or more of the symptoms for the 30 percent evaluation of less severity | 10% |
#4: IBS Secondary to PTSD
Medical research points to a connection between IBS and PTSD.
One study identified patients with irritable bowel syndrome (IBS) have been found to have high rates of psychological trauma history (44%) and PTSD (36%).
In the same study, individuals with PTSD have been reported to experience rates of IBS at 35% and non-ulcer dyspepsia at 41%, indicating a correlation between the two conditions.
Many veterans with IBS, especially those who were diagnosed long after leaving the military are eligible under the law for IBS secondary to PTSD.
Service connection on a secondary basis requires a “showing of causation.”
A showing of causation requires that the secondary disability be “proximately due to” or “the result of” another service-connected disability.
By law, there are three evidentiary elements that must be satisfied for IBS secondary to PTSD to prove secondary service connection:
- A medical diagnosis of IBS in VA medical records or private records (unless you already have a diagnosis of IBS in your service treatment records)
- Evidence of a service-connected primary disability (such as PTSD, depression, anxiety, migraines, GERD), AND
- Medical nexus evidence establishing a connection between the service-connected disability (PTSD) and the current disability (IBS)
The first part can be satisfied with any existing medical evidence in service treatment records, VA medical records, or any private medical records.
The second part can be satisfied with a veteran’s existing service-connected disability rated at 0 percent or higher.
The third part can be satisfied with a medical nexus letter from a qualified medical professional.
Veterans should read this BVA case decision from 2016, where a veteran was granted secondary service connection for IBS, which was proximately due to or the result of medication side effects taken to manage symptoms of other service-connected disabilities:
“There is an approximate balance of favorable and unfavorable evidence as to whether the Veteran has irritable bowel syndrome proximately due to or the result of pain medications from his service-connected hiatal hernia, thoracolumbar spine, cervical spine, migraine headache, bilateral hip, bilateral shoulder, and bilateral knee disabilities. Resolving all reasonable doubt in his favor (aka, Benefit of the Doubt Doctrine “Tie goes to the runner,”) the Veteran has irritable bowel syndrome secondary to medication from his service-connected disabilities. 38 U.S.C.A. 1110, 5103, 5103A, 5107 (West 2014); 38 CFR 3.102, 3.159, and 3.310.” – BVA Case Decision DOCKET NO. 06-05 255
In 2022, IBS secondary to PTSD can be rated at 0%, 10%, or 30%.
IBS is a digestive system issue and is most often rated under CFR 38, Part 4, VA Schedule of Ratings, Diagnostic Code 7319, Irritable Colon Syndrome.
| IBS Secondary to PTSD VA Rating Scale: | VA Rating |
| Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress | 30% |
| Moderate; frequent episodes of bowel disturbance with abdominal distress | 10% |
| Mild; disturbances of bowel function with occasional episodes of abdominal distress | 0% |
#5: ED Secondary to PTSD
According to the VA’s Office of Research and Development, when compared with the general population, veterans with PTSD are at an increased risk of sexual dysfunction, such as Erectile Dysfunction (ED).
A review study published online in the Journal of Sexual Medicine found that male veterans with PTSD were significantly more likely than the civilian population to report ED or other sexual problems.
For example, one study of male combat veterans diagnosed with PTSD—a shocking 85% reported ED, compared with a 22% rate among male combat veterans without any mental health diagnosis.
A second study of 90 male combat veterans with PTSD found more than 80% were experiencing sexual dysfunction.
The researchers point out that while psychiatric medicines can play a role in sexual dysfunction, veterans who were not prescribed medication still experience problems, according to the literature.
Most veterans will receive a 0% non-compensable rating for ED secondary to PTSD.
However, service connection for ED secondary to PTSD makes veterans eligible for Special Monthly Compensation (SMC) for loss of use of a creative organ.
The current SMC-K rate for 2022 is $118.33 per month, which is paid in addition to a veteran’s regular (schedular) service connected disability compensation.
About The Author
Brian Reese
Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).
Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start.
As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.
He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).
