VA Disabilities Secondary to Mental Health Conditions: What Veterans Need to Know
CCK Law: Our Vital Role in Veterans Law
Many veterans know they can receive VA disability compensation for mental health conditions like PTSD, depression, or anxiety. But fewer realize that they can also be compensated for conditions caused or worsened by service-connected mental health disorders. This is called secondary service connection, and it can make a major difference in a veteran’s monthly compensation.
This article will explain:
- What secondary service connection is
- What disabilities are often caused by mental health disorders (i.e., “secondary conditions to mental health disorders”)
- How to calculate combined ratings (i.e., how to add your secondary and original ratings together using “VA math”)
What Is Secondary Service Connection?
Secondary service connection means that a disability is not directly caused by military service but is instead caused or aggravated by another condition that is already service connected.
For example, if you are service connected for PTSD and your PTSD medications or symptoms lead to obstructive sleep apnea, then sleep apnea can be claimed as a sleep disorder secondary to PTSD.
The legal standard is clear: you need medical evidence showing that it is “at least as likely as not” (50 percent or greater probability) that your service-connected mental health condition caused or aggravated the secondary disability.
Here are VA secondary conditions to mental health that we often see our clients needing to pursue.
1. Sleep Disorders (e.g., Sleep Apnea) Secondary to PTSD or Other Mental Health Conditions
- Example: Obstructive sleep apnea
- Why it happens: Many veterans suffer from sleep disorders secondary to PTSD, since PTSD symptoms often disrupt sleep. Additionally, many psychiatric medications cause weight gain and muscle relaxation that worsen apnea.
- Key evidence: Sleep study results, CPAP compliance records, and a nexus letter from your doctor.
- VA ratings: From 0 percent (asymptomatic but requiring CPAP) up to 100 percent (requiring tracheostomy).
2. Cardiovascular Conditions (e.g., Hypertension) Secondary to Anxiety, Depression, or Other Mental Disorders
- Examples: heart disease, hypertension
- Why it happens: Hypertension secondary to depression or anxiety is fairly common. Chronic stress and medications can also raise blood pressure and damage cardiovascular health, causing other heart conditions.
- Key evidence: Blood pressure logs, cardiology records, EKGs, and medical opinions linking the condition to your mental health.
- VA ratings: 10 percent to 60 percent, depending on the severity of hypertension; cardiovascular disease ratings can go higher.
3. Headache Disorders (e.g., Migraines) Secondary to PTSD or Other Mental Conditions
- Examples: tension headaches, migraines
- Why it happens: Migraines secondary to PTSD are common and are often triggered by stress or disrupted sleep. Separately, some psychiatric medications list headaches as side effects.
- Key evidence: Headache diaries, neurology evaluations, and nexus letters.
- VA ratings: 0 percent to 50 percent depending on the frequency and severity of attacks.
4. Gastrointestinal Conditions Secondary to PTSD or Other Mental Disorders
- Examples: IBS, Gastroesophageal Reflux Disease (GERD)
- Why it happens: Many veterans experience GERD secondary to PTSD or another mental health condition. The gut-brain connection is strong—stress and psychiatric medications frequently cause digestive problems like IBS or GERD to develop.
- Key evidence: GI specialist notes, endoscopy results, and documentation of frequency and severity.
- VA ratings: Typically 10–30 percent, depending on severity.
5. Sexual Dysfunction (e.g., E.D.) Secondary to Mental Health Disorders
- Example: erectile dysfunction
- Why it happens: Many antidepressants and anxiety medications cause erectile dysfunction and reduced libido.
- Key evidence: Urology evaluations, medical records showing side effects, and nexus opinions.
- VA ratings: Usually 0–10 percent, but may qualify for Special Monthly Compensation (SMC).
6. TMJ and Bruxism (Jaw Clenching and Teeth Grinding) Secondary to Mental Health Disorders
- Why it happens: VA mental health conditions like stress and anxiety can cause chronic jaw tension, tooth grinding, or conditions like TMJ to develop.
- Key evidence: Dental records, oral surgeon evaluations, and sleep studies.
- VA ratings: Based on range of motion and pain severity.
7. Metabolic Conditions (Metabolic Syndrome, Diabetes) Secondary to PTSD or Other Mental Disorders
- Why it happens: Veterans sometimes file for diabetes secondary to PTSD, since certain psychiatric medications used to treat PTSD and other disorders can cause weight gain and insulin resistance. Stress can also affect glucose metabolism.
- Key evidence: Endocrinology notes, HbA1c levels, and documentation of medication side effects.
- VA ratings: 10 percent to 100 percent, depending on severity and complications.
8. Substance Use Disorders and Complications Secondary to Mental Health Disorders
- Important legal note: Alcohol and drug use disorders cannot be directly service connected. But if the substance abuse is a secondary condition to a mental health disorder that is already service connected, complications (like liver disease) may qualify.
- Key evidence: Addiction treatment records, liver function tests, and medical nexus opinions.
- VA ratings: Vary based on specific complications (e.g., liver disease: 10–100 percent).
9. Cardiovascular Events (Coronary Artery Disease, Stroke) Secondary to Mental Health Disorders
- Why it happens: Chronic stress and hypertension increase the risk of serious cardiovascular events like stroke or heart disease.
- Key evidence: Cardiology records, stress test results, and nexus letters.
- VA ratings: 10 percent to 100 percent, depending on severity and functional impact.
How to Do VA Math and Combine Ratings
VA disability ratings for multiple disorders are not simply added together, and this applies to VA disability ratings for mental health conditions and their secondary disorders as well. Instead, VA uses a formula that reduces the rating of each new disability due to your lower “efficiency.”
Example:
- 70 percent PTSD + 30 percent Sleep Apnea does not equal 100 percent.
- Instead: 70 percent + (30 percent of the remaining 30 percent) = 79 percent, rounded to 80 percent.
Use the CCK Law 2025 VA Disability Calculator to learn more about VA math or do the calculations for you.
Parting Thoughts from CCK Law
If you have a service-connected mental health condition and are experiencing other health problems—such as sleep apnea, hypertension, migraines, or digestive issues—those conditions may also be eligible for VA compensation. Secondary conditions often develop and worsen over time, so it is highly recommended to file for service connection as soon as possible.
Don’t assume VA will make the connection for you. A well-prepared claim supported by strong medical evidence gives you the best chance of success.
- Specialist evaluations
- Documentation of symptoms
- Nexus letters linking the conditions
Not sure of what secondary conditions to mental health you may be eligible for? Identifying benefits that you have earned but have not considered is one of the most valuable services offered by an experienced, VA-accredited advocate. Please contact CCK Law at (800) 544-9144 or online for a free case evaluation.
