Conditions Claimed as Secondary to PTSD

Step 3 of the method is secondary conditions. A secondary condition is one that grew out of a condition the VA already rates.

PTSD is rated on how much it gets in the way of work and relationships, and that rating has its own ceiling. What it carries with it is rated separately, and those conditions are the biggest group of secondary claims the Board sees.

Already rated for PTSD? Add it to the free Claim Map to see the conditions the Board has seen claimed with it.

What a secondary claim needs

Here's the rule on secondary conditions, starting in the middle of its first sentence.

… disability which is proximately due to or the result of a service-connected disease or injury shall be service connected.

Proximately due to means the first condition led to the second. Three things have to be in your file. A diagnosis of the second condition. PTSD that is already service connected. And a medical opinion tying the one to the other that says why.

A claim here needs a doctor to find that the PTSD led to or worsened the second condition. It isn't a finding of ours. Whether it's true for you is a question for your doctor.

The rule holds a second route, aggravation, for a condition you already had that the PTSD made worse. It needs a baseline, meaning medical evidence of how bad that condition was before the PTSD started making it worse.

What the Board has seen claimed with PTSD

Ten conditions carry enough decided claims to read. Each links to its own page of counts.

• Sleep apnea: 4,908 issues, 48 percent granted of the ones decided.
• High blood pressure: 4,750 issues, 33 percent.
• Heart disease: 1,359 issues, 35 percent.
• Erectile dysfunction: 1,201 issues, 50 percent.
• GERD and reflux: 1,038 issues, 30 percent.
• Migraines and headaches: 957 issues, 62 percent.
• Depression, anxiety and other mental health conditions: 442 issues, 55 percent.
• Irritable bowel syndrome: 355 issues, 27 percent.
• Diabetes: 330 issues, 31 percent.
• Stomach ulcers and gastritis: 306 issues, 36 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.

Four of them, and what the schedule asks

Migraines are rated on prostrating attacks, meaning attacks that stop you and send you to lie down. One every two months on average is 10. About one a month is 30. The top step, 50, asks for very frequent prolonged attacks that make it hard to keep work. A headache diary that records how often an attack stops you is the evidence that fits.

High blood pressure has a rule most veterans miss. The lowest step is 10. One way to reach it is a history of diastolic pressure predominantly 100 or more in someone who needs continuous medication. The code also asks for readings confirmed on at least three different days, so one high reading at one visit is not enough.

Erectile dysfunction is rated 0 under its own code unless there is deformity, which surprises people. The rating is not the whole story. The schedule points the rater to a separate payment, special monthly compensation, for loss of use of a creative organ. A 0 percent rating still puts the condition in your file and can open that door.

GERD is stricter than it used to be. The current code turns on a documented history of esophageal strictures causing trouble swallowing. It wants that shown by a barium swallow, a scan, or a scope. Daily heartburn on medication does not reach the bottom step by itself.

PTSD itself, and any depression or anxiety with it, run on one formula. How the VA rates depression and anxiety walks through its words at each step, and the VA cannot rate the same symptom twice.

The Claim Map shows each of these with its diagnostic code and rating steps.

The written playbook gives up to eight of your main conditions a chapter each. A chapter has the rating ladder and what the Board granted and denied in cases like yours. See what the playbook covers.

What our counts show

PTSD has its own page of Board counts, PTSD. Since 2019 veterans raised 74,459 issues about it, and the Board granted 47 percent of the ones it decided.

Sleep apnea claimed as secondary to PTSD is the largest pairing on this site. It has its own article.

What to do

1. Send VA an intent to file first. If your complete claim reaches VA within a year of it, VA counts the claim as filed on the day the intent to file arrived. It doesn't have to name a condition, so you don't need the diagnosis or the opinion to send it. It doesn't work for a supplemental claim, where you add evidence and ask VA to decide again.
2. Get the second condition diagnosed in writing, by name, with the test the schedule asks for. A sleep study for sleep apnea. Blood pressure readings on separate days. A scope or a barium swallow for reflux.
3. Name PTSD in the claim as the condition the second one is secondary to.
4. Ask your doctor for the reasoning, not only the conclusion. How it happened in you, and what in your records shows it. The phrase to ask for is at least as likely as not. Step 1 covers that letter.
5. Say what you've lost, not only what you feel. What you stopped doing, what you avoid now.
6. File the claim with all of it attached, within a year of your intent to file.

The nine steps lays out the rest. I'm not your representative.