Secondary VA Conditions Complete Guide: Boost Your Rating with Secondary Service Connection

Secondary service connection is one of the most powerful — and most overlooked — tools for increasing your VA disability rating. If you already have a service-connected condition, any new disability caused or aggravated by that condition can also be service-connected. This guide covers exactly how secondary VA conditions work, the most common secondary claims, and how to build a winning case.

What Is Secondary Service Connection?

Under 38 CFR § 3.310, the VA grants service connection for a disability that is proximately due to or the result of an already service-connected condition. This is called secondary service connection.

There are two ways a condition can be secondarily service-connected:

1. Causation

Your service-connected condition directly caused a new condition. For example, a service-connected knee injury causes you to walk with an altered gait, which leads to chronic hip pain. The hip condition is secondary to the knee injury.

2. Aggravation

Your service-connected condition made a pre-existing condition worse. For example, you had mild anxiety before service, but your service-connected PTSD significantly worsened it. The aggravation of anxiety beyond its natural progression is secondarily service-connected.

Most Common Secondary Conditions

Here are the secondary VA conditions that veterans successfully claim most often, organized by primary service-connected condition.

Sleep Apnea Secondary to PTSD

This is one of the most commonly claimed secondary conditions. The medical literature supports a strong connection between PTSD and obstructive sleep apnea (OSA):

• PTSD causes hyperarousal and fragmented sleep patterns
• Chronic stress from PTSD leads to weight gain, a major risk factor for OSA
• PTSD medications (especially sedatives and antidepressants) can cause upper airway relaxation
• Studies show veterans with PTSD are diagnosed with sleep apnea at significantly higher rates than the general population

Rating value: Sleep apnea is rated at 0%, 30%, 50%, or 100%. With a CPAP machine (most common treatment), the rating is 50% — one of the highest individual ratings available.

Migraines Secondary to Tinnitus

Tinnitus (ringing in the ears) is the most common service-connected disability. Chronic tinnitus frequently leads to migraines through:

• Auditory stress — Constant noise creates neurological strain
• Sleep disruption — Tinnitus interferes with falling and staying asleep, a known migraine trigger
• Anxiety and tension — The frustration of persistent tinnitus causes muscle tension headaches that evolve into migraines

Rating value: Migraines are rated at 0%, 10%, 30%, or 50%. Veterans with prostrating attacks occurring once a month on average receive 30%, and very frequent completely prostrating attacks receive 50%.

Depression Secondary to Chronic Pain

Chronic pain from any service-connected musculoskeletal condition (back injuries, knee injuries, shoulder injuries) frequently leads to depression:

• Chronic pain limits activities and social engagement, leading to isolation
• Persistent pain causes sleep disturbance, which worsens mood
• Loss of physical ability leads to feelings of hopelessness and worthlessness
• Medical literature consistently shows a strong bidirectional relationship between chronic pain and major depressive disorder

Rating value: Depression is rated at 0%, 10%, 30%, 50%, 70%, or 100%. Many veterans with depression secondary to chronic pain receive 50% or 70%.

Radiculopathy Secondary to Back Conditions

If you have a service-connected back condition (degenerative disc disease, lumbar strain, herniated disc), nerve damage radiating into your legs is a common secondary condition:

• Disc degeneration causes nerve root compression
• Herniated discs press on spinal nerves causing pain, numbness, and weakness in the extremities
• Each affected extremity is rated separately — bilateral radiculopathy means two additional ratings

Rating value: Radiculopathy is rated at 20%, 40%, or 60% per extremity for the sciatic nerve. Having both legs affected adds two separate ratings to your combined total.

GERD Secondary to PTSD Medications

Gastroesophageal reflux disease (GERD) is commonly claimed as secondary to PTSD — specifically, secondary to the medications used to treat PTSD:

• NSAIDs prescribed for pain damage the stomach lining
• SSRIs and SNRIs (antidepressants) can increase stomach acid production
• Anti-anxiety medications affect gastrointestinal motility
• Chronic stress from PTSD independently increases acid production

Rating value: GERD is rated at 10% or 30%. While not a high individual rating, it adds to your combined rating and is relatively easy to establish with medication records.

Erectile Dysfunction Secondary to Medications

Many VA-prescribed medications for PTSD, depression, and pain cause erectile dysfunction (ED) as a side effect:

• SSRIs (sertraline, fluoxetine) — sexual dysfunction is a documented side effect in 30-70% of users
• Antihypertensives — blood pressure medications reduce blood flow
• Opioids — suppress testosterone production
• Beta-blockers — affect sexual function

Rating value: ED is typically rated at 0% but qualifies for Special Monthly Compensation (SMC-K) — an additional $139.87/month (2026 rate) on top of your regular compensation. SMC-K is awarded for loss of use of a creative organ.

Evidence Requirements for Secondary Claims

To win a secondary service connection claim, you need three things:

1. An Already Service-Connected Primary Condition

You must have a condition that the VA has already rated as service-connected. This is your starting point.

2. A Current Diagnosis of the Secondary Condition

A licensed medical professional must diagnose the secondary condition. VA medical records, private treatment records, or a Disability Benefits Questionnaire (DBQ) can establish this.

3. A Medical Nexus Linking the Two Conditions

This is the critical piece. You need a nexus letter from a medical professional stating that your secondary condition is "at least as likely as not" (≥ 50% probability) caused or aggravated by your service-connected condition.

What Makes a Strong Secondary Nexus Letter

A winning nexus letter for secondary conditions should include:

• Clear identification of both the primary and secondary conditions
• Medical explanation of how the primary condition causes or worsens the secondary condition
• Citation of medical literature supporting the connection
• Review of your specific records showing the timeline and progression
• The magic language: "It is at least as likely as not that [secondary condition] is proximately due to or the result of [service-connected condition]"

How Secondary Conditions Affect Your Combined Rating

The VA uses combined ratings math (often called "VA math") to calculate your total disability rating — and it doesn't work like regular addition.

VA Math Explained

Instead of adding ratings together, the VA applies each rating to the remaining percentage of your "whole" body. Here's an example:

• PTSD: 70% → You're 70% disabled, 30% "whole"
• Sleep apnea (secondary): 50% of the remaining 30% = 15% → Combined: 85%
• Migraines (secondary): 30% of the remaining 15% = 4.5% → Combined: 89.5%
• Rounded: 90%

Without the secondary conditions, you'd be at 70%. With them, you're at 90% — a difference of over $550/month in compensation (2026 rates).

Rating Thresholds That Unlock Major Benefits

Certain rating thresholds unlock significant additional benefits:

Secondary conditions are often the difference between being stuck at a lower rating tier and reaching the next threshold.

Step-by-Step: Filing a Secondary Condition Claim

1. Identify potential secondary conditions — Review your medications' side effects, symptoms caused by your service-connected conditions, and conditions your doctors have linked to your primary disabilities
2. Get diagnosed — See a doctor (VA or private) and get a formal diagnosis for each secondary condition
3. Obtain a nexus letter — Have a medical professional write a nexus opinion linking the secondary condition to your service-connected disability
4. File VA Form 21-526EZ — Select "new claim" and indicate the condition is secondary to an existing service-connected disability
5. Submit evidence — Upload your nexus letter, medical records, and any supporting documentation
6. Attend C&P exam — The VA will likely order an exam; be prepared to explain how your primary condition caused the secondary one
7. Review decision and appeal if needed — If denied, a Supplemental Claim with a stronger nexus letter is often the best path forward

Using the Benefits Finder at Higher Ratings

Every increase in your combined disability rating unlocks new benefits. Use the Veterans Benefits Finder to see exactly which federal and state benefits become available as your rating increases from adding secondary conditions.

Enter your current rating and your expected rating after secondary claims, and compare the results. Many veterans are surprised to discover that going from 60% to 80% unlocks property tax exemptions, additional education benefits, and thousands more in annual compensation.