VA Disability Benefits for Secondary Conditions to Depression
Depression is a mental health condition that can often manifest several secondary conditions. The combination of depression and secondary conditions can significantly impact a veteran’s well-being. Veterans who develop a condition that is secondary to their service-connected depression are eligible to receive VA disability benefits for their secondary condition.
What is Depression?
Depression, or major depressive disorder, is a serious medical condition that can interfere with necessary activities of life, such as eating, sleeping, and working. Depression can affect how a person feels and thinks. As such, depression often takes a significant mental, emotional, and physical toll on a person.
Symptoms of Depression
- Feelings of sadness, fatigue, worthlessness, guilt, or hopelessness
- Loss of interest or pleasure in usual activities
- Disturbances in sleep
- Anxiety or restlessness
- Difficulty concentrating or remembering things
- Loss of appetite and weight loss or increased appetite and weight gain
- Thoughts of death or suicide
What Causes Depression in Veterans?
Rates of depression are particularly high among servicemembers and veterans. A 2014 study found that nearly 1 in 4 active duty servicemembers showed signs of a mental health condition.
The Substance Abuse and Mental Health Services Administration also determined that approximately 18.5 percent of veterans returning from Iraq and Afghanistan have or have had PTSD or depression. Studies continue to be done to analyze the link between military service and depression, however, there are a variety of theories as to why so many service members and veterans experience depression.
The nature of service often causes a person to experience trauma. Trauma can have a lasting impact, long after a person’s experience is over. Depression can occur shortly after a person experiences trauma, or it may take years to manifest. Below are some examples of trauma that could lead a veteran to develop depression:
- Witnessing a fellow service member be injured or killed
- Experiencing an injury as the result of combat
- Experiencing an IED explosion
- Being part of a burial crew
- Living with the fear of hostile military or terrorist activity
- In-service assault or threat of assault
Female veterans are at significant risk for depression and are more than 250 percent more likely to commit suicide than their civilian counterparts. The rate of military sexual trauma female veterans face could be one of the potential reasons the rates of depression and suicide are so high among this population.
It is also important to know that veterans can still receive benefits for events that may not be linked to their service, but that occurred while the veteran was in service. An example of this may be if a veteran’s family member passes away while they are deployed.
Direct VA Service Connection for Depression
To establish direct service connection for depression, veterans will typically need three things:
- A current diagnosis of depression—The easiest way to show proof of a diagnosis for depression is through medical records. Importantly, the diagnosis must be current.
- An in-service event or stressor—To prove an in-service event, veterans might use service treatment records, as they will have documented any injury or illness, including depression, if it was treated during active duty. Unfortunately, not all veterans have this type of evidence available to them, as many service members do not seek treatment out of fear of stigma. In this case, lay statements from the veteran and/or their family members can be particularly effective. These statements can be used to describe both the onset and progression of the veteran’s depression, as well as how it relates to service.
- A medical nexus between the depression and the in-service event—A statement from a qualified healthcare professional affirming that they believe your condition was “at least as likely as not” caused by your military service can serve as a medical nexus.
VA Ratings for Depression
Mental health conditions can be rating anywhere from 0 percent to 100 percent. Specifically, major depressive disorder is rated under Diagnostic Code 9434. The rating given will be based on the level of social and occupational impairment a veteran experiences and the severity of symptoms.
- 100%–This rating is for veterans who experience “total occupational and social impairment.” Symptoms may include gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (such as minimal maintenance of personal hygiene), disorientation to time or place, memory loss for names of close relatives, occupation, or name.
- 70%–Veterans rated at 70 percent experience occupational and social impairment, with deficiencies in “most” areas. Symptoms may be similar to those listed above in the 100 percent criteria. Impairment may affect the veteran’s work, school, family relations, thinking or mood. Veterans rated at this level may also experience suicidal ideation.
- 50%–The 50 percent rating is given to veterans with occupational and social impairment, specifically with “reduced reliability and productivity.” Symptoms can include panic attacks more than once a week, difficulty understanding complex commands, loss of memory, impaired judgement, disturbances of mood, and difficulty establishing and maintaining effective work and social relationships.
- 30%–To secure the 30 percent rating, veterans will experience occupational and social impairment with “occasional decrease in work efficiency” and periods of inability to perform occupational tasks. Symptoms may include depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, and mild memory loss.
- 10% –10 percent ratings are given to veterans with occupational and social impairment from “mild or transient symptoms” that can decrease work efficiency or the ability to perform occupational tasks during periods of stress.
- 0%–The 0 percent rating is non-compensable, meaning that it is not associated with any financial compensation . However, this rating is still important because it establishes service connection for the condition and can potentially help the veteran receive an increased rating in the future. With the 0 percent rating, veterans have a diagnosis, but the symptoms may not be severe enough to interfere with occupational or social functioning.
Importantly, a veteran does not need to endorse all the symptoms listed in each rating criteria. A Court of Appeals for Veterans Claims case, Mauerhan v. Principi, established that the symptoms listed in Diagnostic Code 9411 (i.e. post-traumatic stress disorder) are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. The same case law applies when determining a disability rating for depression. Therefore, a veteran can have any number of symptoms listed in the rating criteria for depression and still meet that level of evaluation.
Secondary Service Connection and Depression
Once a veteran is service-connected for depression, they may seek secondary service connection for conditions connected to their depression. Veterans may also seek secondary service connection for depression itself, as may be the case if the veteran were to develop depression as the result of a service-connected orthopedic injury.
To establish secondary service connection for a condition that stems from the veteran’s depression, the veteran will usually need:
- A current diagnosis of a condition secondary to depression
- Medical evidence showing the relationship between their depression and the secondary condition
For example, many psychotropic medications that are prescribed to treat depression can result in significant weight gain. This weight gain could then cause or exacerbate an orthopedic condition. Thus, the orthopedic condition may warrant secondary service connection.
To obtain secondary service connection for this orthopedic condition, the veteran will need a diagnosis for their orthopedic condition and medical evidence indicating that the orthopedic condition was brought on or aggravated by their depression.
Common Conditions Secondary to Depression
Depression can be linked to a multitude of different conditions. The following list is composed of just some of the conditions which may occur as secondary to depression. Many of these conditions can occur in the reverse order, meaning that depression could be the secondary condition. However, for the purposes of this list, the following conditions are examples of conditions known to be caused or aggravated by depression.
- Post-Traumatic Stress Disorder
- Sleep Apnea
- Restless Leg Syndrome
- Erectile Dysfunction
- Gastrointestinal Conditions
- Liver Conditions that may be brought on by alcoholism as method of coping with depression
- Orthopedic Conditions
Some of the above conditions may be related directly to depression, while others, like seizures or gastrointestinal conditions, can be side effects of medications like anti-depressants. Veterans who develop conditions as a result of their depression medication are eligible for secondary service connection for those conditions.
VA Compensation and Pension (C&P) Exams for Secondary Conditions
The process for obtaining secondary service connection for conditions related to depression is comparable to that for direct service connection. This means that a compensation and pension exam (C&P) may be requested.
The C&P exam will be performed by a VA examiner or a VA-contracted examiner. They may physically examine the veteran, if applicable, or interview the veteran regarding the secondary condition. Since the condition is secondary to depression, the examiner may ask questions regarding the veteran’s mental health.
It is important to attend any C&P exams that VA requests, even if they request two exams: one for depression and one for the secondary condition. Though the exams may seem redundant, it is crucial that the veteran attends because VA may deny the claim if they do not. If the veteran must miss a C&P exam, they should contact VA as soon as possible to try to reschedule.
TDIU and Conditions Secondary to Depression
Secondary conditions can be very beneficial to help boost a veteran’s overall combined rating. Overall combined ratings can help a veteran achieve TDIU.
TDIU, or total disability based on individual unemployability, is a monthly VA benefit that compensates veterans at the 100 percent level if they are prevented from working because of their conditions.
In order to be eligible for Schedular TDIU, veterans must have one condition rated at 60 percent minimum OR two conditions that can be combined to reach 70 percent, where one condition is at minimum 40 percent. As such, secondary service connection can be extremely helpful in boosting veterans to the 70 percent minimum needed for multiple conditions to achieve TDIU. The criteria for schedular TDIU is outlined under 38 CFR § 4.16a.
Veterans who do not meet the necessary criteria for schedular TDIU may be eligible for extraschedular TDIU. For this form of TDIU, veterans must prove that their condition(s) uniquely hinder their ability to maintain substantially gainful employment. Extraschedular TDIU is rated under 38 CFR § 4.16b.
Resources for Veterans Experiencing a Mental Health Crisis
Veterans who experience depression, or have conditions stemming from their depression, may experience a mental health crisis or contemplate suicide. Importantly, veterans should know that help is available and they do not need to be alone if they are experiencing such a crisis.
The Veteran’s Crisis Hotline offers 24/7 assistance. It is confidential and anonymous, so veterans do not need to fear any stigma or retaliation for reaching out. This resource is available to veterans, even if they do not have VA health care or have not been service-connected for any VA benefits. The service is toll-free and veterans, as well as their family members and friends, can speak with a qualified, caring VA responder. Veterans may call the hotline at 1-800-273-8255 and press 1, or text 838255.
Veterans can also utilize a confidential online chat session at VeteransCrisisLine.net/Chat. Additionally, this site offers a self-check quiz for veterans to learn more about whether stress and depression may be affecting them.
To learn more about other resources available for veterans experiencing a mental health crisis, and what VA has done to respond to the veterans’ suicide epidemic, you can read our blog: What is VA Doing to Help the Veterans’ Suicide Epidemic.
Need Help with Your VA Disability Benefits for a Condition Secondary to Depression?
Claims for conditions secondary to depression can be complicated due to the nature of depression. Specifically, the stigma of mental health conditions may have prevented veterans from seeking treatment while still in service and, as such, a lack of in-service evidence may be an obstacle in the way of service connection for depression or secondary service connection.
If your claim for service connection for depression, or secondary service connection for a condition caused by your depression, has been denied, Chisholm Chisholm & Kilpatrick may be able to help. Our team has helped veterans with their appeals for service connection for depression, increased ratings for depression, and conditions secondary to depression. Contact us today for a free case review.
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