Post-Traumatic Stress Disorder (PTSD) is a mental health disorder that occurs when an individual experiences a traumatic event. It is a common diagnosis in veterans after the events they witness or experience during their time in the military.
PTSD is diagnosed by a mental health professional, whether it is a psychiatrist, therapist, or a primary care physician.
What is Secondary Service Connection?
A secondary service-connected condition refers to one that was a result of a separate condition, already service connected.
Veterans can receive disability benefits from a secondary service-connected disability, just the same way they receive benefits for primary service-connected disabilities.
In order to do this, they will need to prove their condition was developed or aggravated by an existing service-connected condition.
The “presumption of aggravation” definition.
Under 38 U.S.C. 1153 and 38 CFR 3.306
This refers to the pre-existing condition to have been aggravated by active military service when there is an increased disability during active military service, unless the evidence clearly and unmistakably shows the increase in disability is due to the natural progression of the injury or disease.
Common Secondary Conditions to PTSD
With PTSD, there are many different conditions that can occur as a side-effect or co-morbidity. These are a few different examples.
Depression Secondary to PTSD
Depression is a mental health condition that impacts an individual’s day-to-day functioning, the way they think, feel and act.
Symptoms vary but may include things such as:
- Persistent feelings of sadness or hopelessness
- Lack of motivation and drive
- Difficulty sleeping or sleeping too much
- Changes in appetite
- Irritability
- Fatigue
- Suicidal thoughts/ideations, or attempts
38 CFR § 4.130, VA’s General Rating Formula for Mental Health Disorders
Veterans can receive ratings of 0, 10, 30, 50, 70 or 100 percent for mental health conditions.
| 100% | Total Occupational and Social Impairment Symptoms may include: Persistent delusions or hallucinations, inappropriate behavior, persistent danger of hurting self or others, inability to perform daily-living activities, disorientation to time and place, memory loss |
| 70% | Occupational and Social Impairment, with deficiencies in most areas (work, school, family, etc.) Symptoms may include: Suicidal ideation, obsessive behaviors interfering with daily life, illogical or irrelevant speech, near-continuous panic and depression impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene, inability to maintain personal relationships |
| 50% | Occupational and Social Impairment with reduced reliability and productivity. Symptoms may include: Flattened effect (lack of emotional expression), stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory, impaired judgment and abstract thinking, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships |
| 30% | Occupational and Social Impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Symptoms may include: Depressed mood, anxiety, suspiciousness, panic attacks (less frequent), chronic sleep impairment, mild memory loss |
| 10% | Occupational and Social Impairment due to mild or transient symptoms which decrease work efficiency only in periods of significant stress and controlled by medication |
| 0% | Formally diagnosed mental condition but symptoms are not severe enough to interfere with occupational and social functioning. |
A veteran cannot receive separate ratings for multiple mental health conditions. This is called pyramiding.
Anxiety Secondary to PTSD
Anxiety is a mental health condition where individuals experience intense, excessive and persistent worry and fear about everyday situations.
There are several types of anxiety disorders including:
- Generalized anxiety disorder (DC 9400)
- Panic disorder (DC 9412)
- Phobia-related disorders (DC 9403)
- Obsessive-Compulsive Disorder (DC 9404)
Symptoms of anxiety disorders may include:
- Restlessness or jumpiness
- Difficulty concentrating
- Trembling or twitching
- Feeling nauseous or dizzy
- Experiencing rapid heartbeat (and arrhythmia)
- Shortness of breath
- Difficulty sleeping
- Excessive worrying
38 CFR § 4.130, VA’s General Rating Formula for Mental Health Disorders
Veterans can receive ratings of 0, 10, 30, 50, 70 or 100 percent for mental health conditions.
| 100% | Total Occupational and Social Impairment Symptoms may include: Persistent delusions or hallucinations, inappropriate behavior, persistent danger of hurting self or others, inability to perform daily-living activities, disorientation to time and place, memory loss |
| 70% | Occupational and Social Impairment, with deficiencies in most areas (work, school, family, etc.) Symptoms may include: Suicidal ideation, obsessive behaviors interfering with daily life, illogical or irrelevant speech, near-continuous panic and depression impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene, inability to maintain personal relationships |
| 50% | Occupational and Social Impairment with reduced reliability and productivity. Symptoms may include: Flattened effect (lack of emotional expression), stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory, impaired judgment and abstract thinking, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships |
| 30% | Occupational and Social Impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Symptoms may include: Depressed mood, anxiety, suspiciousness, panic attacks (less frequent), chronic sleep impairment, mild memory loss |
| 10% | Occupational and Social Impairment due to mild or transient symptoms which decrease work efficiency only in periods of significant stress and controlled by medication |
| 0% | Formally diagnosed mental condition but symptoms are not severe enough to interfere with occupational and social functioning. |
Sleep Apnea Secondary to PTSD
Sleep Apnea is a serious sleep disorder which causes an individual’s breathing to be interrupted constantly during the course of their sleep.
There are three types of sleep apnea:
- Obstructive Sleep Apnea: the most common type. It occurs when throat muscles relax and block the airway during sleep.
- Central Sleep Apnea: occurs when your brain doesn’t tell your muscles to work to breathe while you are sleeping
- Complex (Mixed) Sleep Apnea: occurs when someone has both of the above types
| 100% | Chronic respiratory failure with carbon dioxide retention, the need for a tracheostomy, or cor pulmonale (enlargement/failure of right side of heart) |
| 50% | Veteran requires the usage of a breathing assistance device, such as a CPAP machine |
| 30% | Veteran experiencing daytime hypersomnolence (chronic sleepiness) |
| 0% | Condition is asymptomatic but has documented sleep disorder |
Migraines Secondary to PTSD
Migraines are a severe form of headache that can last for many hours to days.
Symptoms of migraines include:
- Severe pain
- Nausea and vomiting
- Sensitivity to light and sound
- Lightheadedness
- Blurred vision
- Auras (visual disturbances)
38 CFR § 4.124a, Diagnostic Code 8100
Veterans can receive ratings for migraines at 50, 30, 10 and 0 percent, based on severity.
Prostrating means you need to lay down because of the migraine.
| 50% | Very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability |
| 30% | Prostrating attacks occurring on average once a month over the last several months |
| 10% | Prostrating attacks averaging one in two months over the last several months |
| 0% | Less frequent attacks than mentioned prior |
Hypertension Secondary to PTSD
Hypertension is also known as high blood pressure. Blood pressure is the pressure of blood against the walls of arteries, and is measured with two numbers:
- Systolic: pressure when your heart beats
- Diastolic: pressure when heart is resting
Hypertension is very common with PTSD symptoms because oftentimes it is aggravated by periods of high stress.
Normal blood pressure should be less than 120 systolic and 80 diastolic. High blood pressure is anything higher than 160 systolic and 90 diastolic.
38 CFR § 4.104 – Schedule of Ratings, Cardiovascular System, Diagnostic Code 7101
Veterans can receive a rating of 60, 40, 20 or 10 percent.
| 60% | Diastolic pressure predominantly 130 or more |
| 40% | Diastolic pressure predominantly 120 or more |
| 20% | Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more |
| 10% | Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control |
GERD Secondary to PTSD
Gastroesophageal Reflux Disease (GERD) is a digestive system disorder which causes stomach acid to flow backward up from the stomach and into the esophagus.This is typically caused by acid reflux.
38 CFR § 4.114 with Diagnostic Code 7346
Veterans can receive a rating of 60, 30 or 10 percent.
| 60% | Requires symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, resulting in a severe impairment of health |
| 30% | Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm and shoulder pain, and considerable impairment of health |
| 10% | Two or more symptoms of 30 percent evaluation of less severity |
Total Disability Rating Based on Individual Unemployability (TDIU) for PTSD and Secondary Conditions
If your PTSD and the related secondary conditions significantly influence your ability to work and maintain gainful employment, you may be eligible for TDIU.
TDIU allows veterans to receive compensation at the 100 percent rate, even if they aren’t rated at 100 percent, if their service-connected disabilities prevent them from remaining gainfully employed.
Under regulations 38 CFR § 4.16, the VA states the eligibility requirements for TDIU. In order to qualify, the veteran must have:
- One service-connected condition rated at 60 percent or higher, or
- Two or more service-connected conditions, one of which is rated at 40 percent or higher, with a combined rating of 70 percent or higher.
An important thing to note: If a veteran has a rating for PTSD, and a rating for a secondary condition, the secondary condition rating can contribute to the overall disability rating and make the veteran eligible for schedular TDIU.
Have Questions About Appealing Your Claim or Understanding How the Claims Process Works?
The attorneys at Hill & Ponton are here to support you with appealing a claim to get disability benefits for PTSD and secondary conditions associated with it.
If you get denied, you can always file again if you have the necessary medical documents and nexus that support your claims. Don’t lose hope–especially when it comes to fighting for the benefits you deserve!
If you are intending to appeal a denied claim, you can contact us for an evaluation and we can help you with this process.
However, if you are considering filing an initial claim, or even if you are interested in learning about the appeals process, we offer a free ebook to get you started on the right foot!
The Road to VA Compensation Benefits will help break down the claims process from start to finish. Click the link below to learn more.
