VA Disability for Medication Side Effects
What Are Medication Side Effects?
Generally speaking, side effects are unwanted symptoms caused by medical treatment and/or medications. In some cases, they are referred to as “adverse effects” or “adverse reactions.” Importantly, all types of medication can cause side effects, and symptoms tend to range from mild (e.g., drowsiness, nausea, dry mouth) to severe (e.g., blood clot, heart attack, stroke). Typically, the risk of experiencing negative side effects varies from person to person.
Each medication is distributed with a patient information leaflet (PIL), which lists potential side effects that a person may experience. To determine which side effects a medication may be associated with, individuals should read over the PIL very thoroughly. Furthermore, the PIL should show whether each side effect is:
- Very common – more than 1 in 10 people are affected
- Common – between 1 and 10 and 1 in 100 people are affected
- Uncommon – between 1 in 100 and 1 in 1,000 people are affected
- Rare – between 1 in 1,000 and 1 in 10,000 people are affected
- Very rare – fewer than 1 in 10,000 people are affected
Importantly, if veterans are experiencing side effects as a result of their medications, they may be eligible for disability benefits on a secondary basis.
What is Secondary Service Connection?
A secondary service-connected condition is one that resulted from a condition that is already service-connected. In claims for secondary service connection, proving a nexus is especially important. A nexus is a medical opinion that, in the case of secondary service connection, links a veteran’s secondary condition to their already service-connected condition. The nexus between their primary service-connected condition and their secondary condition must be clearly established in order for secondary service connection to be granted.
There are several ways that a primary service-connected condition can cause a secondary condition. As mentioned above, medication represents one potential cause. That is, if a veteran is taking medication for their service-connected condition and later develops a side effect (i.e., secondary condition) as a result of their medication, secondary service connection may be warranted.
Common Medication Side Effects Veterans Experience
Again, medications can cause a number of undesired and unpleasant side effects. In many cases, veterans experience the following side effects for which they may be eligible to receive secondary service connection:
Erectile dysfunction, or impotence, is the inability to establish and sustain an erection firm enough for sexual intercourse. Ongoing erectile dysfunction can cause stress, affect self-esteem, and contribute to relationship issues. Erectile dysfunction symptoms might include persistent trouble getting an erection, trouble keeping an erection, and reduced sexual desire. Erectile dysfunction is a very common side effect to psychotropic medications, which are commonly used to treat mental health conditions (e.g., PTSD, depression, anxiety). There are five major classes of psychotropic medications, including anti-anxiety agents, antidepressants, antipsychotics, mood stabilizers, and stimulants, all of which may contribute to erectile dysfunction.
Importantly, erectile dysfunction may also be caused by opioids or pain medications prescribed for orthopedic conditions (e.g., back pain). If a veteran can show that they are taking any of the medications described above for a service-connected condition, they may be eligible for secondary service connection should erectile dysfunction result.
Gastrointestinal (GI) conditions, such as GERD, IBS, and acid reflux, are extremely common in veterans who are taking certain medications. Again, psychotropic medications, particularly antidepressants and antipsychotics, are known to cause GI issues. In addition, medications to deal with high blood pressure (i.e., hypertension) are commonly associated with GI complaints. Veterans should discuss with their primary care providers whether their GI issues are permanent and/or reflective of a more serious GI condition. If so, they may be eligible for secondary service connection as described above.
Headaches and Dizziness
Headaches and dizziness are side effects of many medications, including those mentioned above. It may be difficult to establish secondary service connection for these conditions, but it is nonetheless possible. If veterans experience headaches and/or dizziness on a consistent basis due to the medication they take for a service-connected condition, they should apply for service connection on a secondary basis.
Importantly, benzodiazepines, which are often used to treat anxiety-related conditions can have severe side effects, including seizures. Benzodiazepines are known to be very addictive. As such, they are recommended to be used in limited and short-term circumstances. Nonetheless, if veterans become addicted to benzodiazepines and subsequently try to stop taking them, they may be at risk for withdrawal symptoms with seizures being the most severe.
Generally speaking, VA assigns disability ratings for seizures based on the number of seizures that took place in the past year. As such, it is possible to receive a disability rating based on secondary service connection for seizures; however, veterans must prove that their seizures are the result of their medication use, which was related to a primary service-connected condition.
Increased VA Disability Ratings for Medication Side Effects
In some cases, veterans may not be awarded service connection for their medication side effects. However, it is possible that their disability rating will increase as a result of their side effects. Specifically, if a veteran is taking a medication for a service-connected condition and that medication produces negative side effects, VA adjudicators should take these additional symptoms into account when rating the veteran’s overall level of disability.
Decreasing Disability Ratings due to Medication Management
Importantly, VA adjudicators cannot consider the positive effects of a veteran’s current medications when rating a disability if the applicable diagnostic code is silent with respect to medication. Under the case laws of Mingo v. Derwinski (1992) and Jones v. Shinseki (2012), the Court of Appeals for Veterans Claims (CAVC) held that veterans are entitled to disability ratings based on their unmedicated condition (i.e., the higher disability evaluation) if the effects of the medication are not explicitly mentioned in the rating schedule.
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