For military veterans, Post-Traumatic Stress Disorder (PTSD) is more than just a diagnosis; it’s a life-altering condition often stemming from exposure to traumatic events during service.
Beyond PTSD itself, there lies a web of secondary conditions, deeply connected and possibly intensifying the struggles veterans face daily.
Understanding this network and navigating the VA system to increase disability benefits can be complex.
Here’s a step-by-step guide to help.
Understanding Secondary Conditions and Their Link to PTSD
PTSD, while a significant concern in itself, can also be the root cause of various other conditions.
These conditions, arising due to or aggravated by PTSD, are termed ‘secondary conditions’.
Depression, Anxiety, Sleep Apnea, Migraines, Hypertension, and Gastroesophageal Reflux Disease (GERD) are just a few of the disorders that can manifest as a result of PTSD.
Why is this important?
For veterans, acknowledging and proving these secondary conditions can increase their VA disability rating.
This, in turn, results in higher disability benefits, thereby providing additional financial and medical support.
How to Make a Secondary Service Connection Claim
- Identify Your Secondary Conditions: Beyond PTSD, consider if you’ve experienced symptoms or have been diagnosed with any of the secondary conditions mentioned above.
- Get a Diagnosis: Engage a mental health professional or primary care physician to diagnose and document these secondary conditions.
- Draw a Connection: It’s not just about proving the existence of a secondary condition but also its connection to PTSD. Medical opinions, literature, or evidence that supports this link can be pivotal.
- Understand the VA’s Presumption of Aggravation: In accordance with 38 U.S.C. 1153 and 38 CFR 3.306, veterans need to demonstrate that the secondary condition was aggravated by or arose due to their service-connected PTSD. The VA presumes that if there’s an increase in disability during active military service, it’s due to aggravation from service, unless there’s clear evidence to the contrary.
What Happens if My Secondary Service Connection Claim is Denied?
Denials can be disheartening, but remember: you have options.
If your secondary service connection claim for PTSD or a condition related to it has been denied, you can file an appeal.
At Hill & Ponton, we specialize in assisting veterans with such appeals. Contact us and let our expertise guide you through the process.
Together, we can ensure you receive the benefits you rightfully deserve.
Exploring Common Secondary Conditions to PTSD
Now, as we delve further into this guide, let’s break down the intricacies of these secondary conditions.
By understanding the symptoms, VA ratings, and their connection to PTSD, veterans can better advocate for their health and disability benefits.
Note: The provided list is a brief overview. Each secondary condition has been elaborated in detail as the article progresses.
- Depression: Emotional and behavioral shifts such as persistent sadness, lack of motivation, and more.
- Anxiety: Characterized by excessive worry, trembling, restlessness, and difficulty sleeping.
- Sleep Apnea: A sleep disorder that disrupts breathing patterns.
- Migraines: Intense headaches triggered by stress and other factors.
- Hypertension: High blood pressure exacerbated by the stress inherent to PTSD.
- GERD: A digestive disorder that results in the backward flow of stomach acid.
Each of these conditions offers its own set of challenges. By recognizing them and their connection to PTSD, veterans are better equipped to seek proper care and claim deserved benefits.
Depression Secondary to PTSD
Depression stands as a prevalent mental health issue that significantly affects an individual’s everyday life, profoundly altering their thoughts, emotions, and actions.
This condition has frequently been found to coexist with Post-Traumatic Stress Disorder (PTSD) in veterans, taking a toll on their daily activities and overall well-being.
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 disorders, characterized by excessive worry and fear, often arise as secondary conditions to PTSD.
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
In the context of veterans with PTSD, anxiety could surface as a reaction to the intense stress experienced during service.
Diagnosis is typically conducted by a mental health professional, with severity ranging from mild, controlled by medication, to total occupational and social impairment.
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, a sleep disorder marked by interrupted breathing patterns, frequently accompanies PTSD as a secondary condition.
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
When linked to PTSD in veterans, the disturbance in sleep rhythm could be attributed to the heightened levels of stress and anxiety inherent to the disorder.
Veterans can receive ratings of 100, 50, 30 or 0% for sleep apnea conditions.
| 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, severe headaches are another secondary condition commonly associated with PTSD.
The connection is thought to be stress-related, where the chronic stress from PTSD triggers migraines.
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, or high blood pressure, is another health issue that frequently arises secondary to PTSD.
The high stress levels experienced by PTSD-afflicted veterans often aggravate hypertension.
It is measured with two numbers:
- Systolic: pressure when your heart beats
- Diastolic: pressure when heart is resting
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 for hypertension 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
GERD is a digestive disorder that results in the backward flow of stomach acid into the esophagus, commonly due to acid reflux.
It is often found as a secondary condition in veterans suffering from PTSD.
38 CFR § 4.114 with Diagnostic Code 7346
Veterans can receive a rating for GERD 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.
Read more about TDIU in our comprehensive guide below.
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.
