Mental Health Caused by Your Service-Connected Conditions

Step 6 of the method is one many veterans never think to file for. Depression and anxiety that grow out of any service-connected condition are real disabilities, and the VA rates them. In the Board of Veterans' Appeals decisions we have indexed, the cause named most often is a bad back. Next come a bad knee, then tinnitus and hearing loss. This article uses chronic pain as the example. The same rule covers tinnitus, sleep apnea, a brain injury, hearing loss, a disfiguring scar, or sexual dysfunction. A mental health rating can be a big part of a combined rating, and it can reach 100 percent on its own.

New here? The free page on depression and anxiety shows what the Board granted, denied and sent back, and links the decisions themselves. Nothing to sign up for.

What is secondary service connection?

The rule says a disability "which is proximately due to or the result of a service-connected disease or injury shall be service connected." It then counts as part of the original condition. Nothing in the rule limits the secondary condition to physical problems. Depression that results from living with a service-connected knee is a disability caused by that knee. The depression itself does not need any connection to your time in service.

The rule also covers a condition made worse. If a service-connected condition worsens one that is not service connected, the increase is service connected. Worsening that is just that condition's natural progress does not count. The VA also needs medical evidence of how bad the condition was before the worsening began. If none exists, the earliest medical evidence after it began, and before the evidence of how bad it is now, can serve.

How the rating works

Mental health conditions have their own rating formula, from 0 to 100 percent. It asks how much your symptoms get in the way of work and relationships. Your pain is rated with the physical condition. The depression is a separate disability with its own symptoms. Once it is service connected, it is rated on its own. How the VA Rates Depression and Anxiety quotes the formula and explains what happens if you cannot work.

Why veterans miss this claim

• Veterans think mental health claims are for combat trauma. Post-traumatic stress disorder (PTSD) is one code among many in the same formula.
• Veterans do not connect the dots. You stopped sleeping because of the pain in your back. You stopped going out. You snap at your kids. You never called that depression, so you never told a doctor.
• Do not count on anyone at the VA to suggest it. The VA has a duty to tell you what evidence a claim needs and to help gather records. But the claim you file is what gets decided.

The conditions it gets claimed with

Fifteen conditions have been claimed this way often enough to read. That is more than any other condition on this site. Each links to its own page of counts.

• A lower back condition: 2,056 issues, 51 percent granted of the ones decided.
• A knee condition: 1,031 issues, 49 percent.
• Tinnitus: 760 issues, 51 percent.
• Hearing loss: 618 issues, 42 percent.
• Migraines and headaches: 458 issues, 47 percent.
• PTSD: 442 issues, 55 percent.
• A traumatic brain injury: 441 issues, 45 percent.
• A foot condition: 434 issues, 44 percent.
• Diabetes: 396 issues, 41 percent.
• Cancer: 394 issues, 43 percent.
• Arthritis: 351 issues, 60 percent.
• A skin condition: 297 issues, 45 percent.

granted more oftengranted less often thicker means claimed more oftenpairing not involving tinnitus

Tap a line to read what that pairing has to show.

Two things those counts are not. Every decision counted here is an appeal, so the regional office decided the claim first and the veteran disagreed. These are not the odds on a first claim. And past decisions don't predict yours. A Board decision binds only the case it decided.

Read the spread rather than any one number. These sit between 41 and 60 percent granted of the ones decided, which is high for secondary claims. Joint claims argued the other way round, one joint leading to another, mostly sit in the twenties. That does not tell you what will happen in your claim. It does tell you the Board takes this route seriously when a doctor explains it.

The claims that run the other way

Six conditions are claimed as secondary to depression and anxiety, rather than the other way round: sleep apnea (2,078 issues, 53 percent granted of the ones decided), high blood pressure (1,710, 34 percent), erectile dysfunction (731, 53 percent), migraines (684, 70 percent), heart disease (488, 39 percent) and reflux (467, 29 percent).

Those are the same six the Board sees claimed with PTSD, and the arguments are the same. Conditions claimed as secondary to PTSD goes through what the rating schedule asks for each one.

What the Board actually does with these claims

Each decision below is linked at va.gov. Three from 1993 show the whole picture.

In 93-14591, a roofer with a service-connected gunshot wound to the right hand claimed a psychiatric disorder secondary to it. He could not grip a hammer. An outside doctor gave him a psychiatric exam, paid for by the VA. It tied his depression to the pain and to what the hand did to his work. Lay statements backed up what the hand did to his work. A Board medical adviser wrote that a chronic psychiatric condition was probably present. It had "slowly evolved in response to the problems of living with a chronic, painful, physical handicap and meeting family responsibilities." The Board granted.

In 93-10278, a veteran with service-connected diabetes had years of records showing job loss from medical visits, then depression tied to that job loss. A VA examiner diagnosed recurrent depressions associated with chronic physical illness. Granted.

In 93-10940, a veteran with a 60 percent left knee claimed depression secondary to it. His wife testified he had gone from "happy-go-lucky" to unable to be around people. Denied. The examiners named other causes too, from conditions that were not service connected to money trouble and the recent death of a son. The Board found the service-connected knee was not "an essential cause" of the depression. The lay evidence was good. The medical opinion never separated out the service-connected condition.

That is the lesson. Winning claims have a clinician stating in writing that the service-connected condition caused or worsened the mental health condition. Losing claims have a clinician listing five causes and never sorting them.

In citation 1302500, from 2013, an examiner blamed "aging, medical issues, and increased dependency." The examiner never said if his service-connected conditions were among them. The VA had also never told the veteran what evidence his secondary claim needed. The Board sent the claim back, in part for those reasons. In the same decision it granted service connection for his knees and cold injuries. It told the examiner to answer directly whether those or his other service-connected conditions caused or worsened the psychiatric disorder. The examiner also had to discuss the lay evidence.

Want the whole picture for depression and anxiety? The Depression and Anxiety Pack puts the Board's counts, the rating criteria and the decisions to read in one file. No account and nothing to fill in.

What evidence supports the claim

1. A current diagnosis. It has to conform to the DSM-5, the manual used to diagnose mental disorders, and the exam findings have to support it. See a psychologist or psychiatrist, and tell them what the pain has done to your life.
2. A nexus opinion, a clinician's letter on whether the two conditions are linked. It should say whether it is at least as likely as not that the service-connected condition caused or worsened the mental health condition, and why. If you had depression before the back injury made it worse, the file has to show how bad it was before.
3. Treatment records showing the timeline. Pain first, then sleep loss, withdrawal, mood changes.
4. Lay statements. Lay evidence is competent when it comes from someone who knows the facts and describes what a layperson can observe. Your spouse can say you stopped sleeping. Your battle buddy can say you stopped answering the phone. Lay Evidence shows who can write one.
5. Your own statement. Describe a normal week, what the pain stops you from doing, and how that makes you feel.

What to do

If you already have a service-connected condition, send VA an intent to file now. It does not have to name a condition, so you do not need the diagnosis or the opinion to send it. If the complete claim reaches VA within a year of it, VA counts the claim as filed on the day the intent to file arrived. Then file the mental health claim as secondary to that condition, with the evidence attached, before that year runs out. An intent to file does not work for a supplemental claim, where you add evidence and ask VA to decide again.

If your primary claim is pending, file them together and state in writing that the mental health condition is claimed as secondary.

At the exam, be honest. Do not put on a show, and do not play it down either. If you have thought about hurting yourself, say so. If the examiner or the Board decides you exaggerated, your credibility takes a hit, and that carries over to the other issues in your file. Be Honest shows how to describe a bad day and a good day.

I'm not your representative. Read the rules, read the decisions, and file what is true.