Military Disability Made Easy
Get Full Access
Search

Claiming Secondary Conditions for VA Disability

  • Last Updated: July 26, 2024
For a condition to be eligible for VA Disability, you must be able to prove that it is service-connected. The best way to do this is to provide medical records from your time on active duty showing thorough evidence of the condition, especially its original diagnosis. As long as a condition was first diagnosed and developed while on active duty, it is considered connected to service (the rules are a bit different for Reservists).
 
However, for any condition that develops more than a year after separation from the military, proving service-connection can be pretty difficult. Unless it is on the VA’s Presumptive List for things like Agent Orange exposure, etc., the only surefire way to ensure service-connection is to prove that the condition was caused by (“secondary to”) another service-connected condition.
 

What is a Secondary Condition?

 
A secondary condition is a condition that develops directly because of another condition, not just on its own. Arthritis, for example, can naturally develop on its own from overuse or misuse of a joint over time. It can also, however, develop as a secondary condition. For instance, a spinal injury can result in extra pressure being applied to the hip joints, which could result in arthritis that probably would not have occurred without the spinal injury. The hip arthritis would then be considered secondary to the spinal injury.
 
In this case, if the spinal injury occurred while on active duty (thus service-connected), and the hip arthritis developed over time and was diagnosed 6 years after service, it should still be considered service-connected since it was caused by a service-connected condition. Military service caused one, which caused the other, so the logic is that military service caused both, even though the secondary condition wasn’t diagnosed until after service.
 

How to Claim a Secondary Condition

 
To be able to successfully claim a secondary condition, you must prove that 1.) the original condition was service-connected and 2.) the secondary condition was definitely caused by the original service-connected condition.
 
If you are submitting a VA Disability Claim for both conditions for the first time, then you must provide proof that the original condition was diagnosed and significantly present while on active duty. Make sure to submit all service treatment records that show the diagnosis and treatment of the condition.
 
For the secondary condition, submit all records that demonstrate the development, diagnosis, and treatment of the condition and its relationship to the original condition. A Nexus Letter from your physician stating that the secondary condition was “more likely than not” caused by your original condition will also be very helpful to your case. A Nexus Letter is simply a letter from a qualified specialist that medically establishes a link between two conditions. If there is not enough evidence to clearly connect the two conditions, service-connection may be denied. It must be clear that the condition is unlikely to have developed without the original condition.
 
If you have already claimed the original condition and it was granted service-connection by the VA, then all you have to do is claim the secondary condition along with all of the evidence listed above for secondary conditions.
 

Rating Secondary Conditions

 
Once the VA grants service-connection for your secondary condition, it will be rated on the VASRD the same way every other condition is rated. In most cases, it will be assigned a code and given a rating based on the severity of its symptoms.
 
In some cases, however, the rules of the VASRD may limit a secondary condition’s ability to be rated separately. For example, nephrosclerosis is kidney disease caused by high blood pressure. Although blood pressure and kidneys are technically two separate body systems, the VASRD states that only one or the other can be rated, whichever gives the higher rating. This is because they are so closely connected and their rating requirements so similar, that rating both would violate the Pyramiding Principle.
 
Even in cases like this, it is undeniably worth it to claim the secondary condition. As long as it is granted service-connection, it qualifies for full medical coverage, it could increase the ratings for the original condition, it could eventually cause its own secondary conditions that would then qualify for their own ratings, etc. Ultimately, it never hurts to submit a claim for a secondary condition.  As long as you carefully construct your claim and provide sufficient evidence, you’ll ensure that you continue to receive the benefits you deserve as your conditions progress.

242 Comments

  • How does the system work for full time ANG technicians doing their military job during the week? I had to have back surgery for an injury suffered while working on jets.

  • I am service connected for sleep apnea. I believe I have a couple of conditions that are likely to be secondary to the sleep apnea as both occurred or started before I started using a CPAP. Are you familiar with this :

    https://www.va.gov/health/NewsFeatures/2013/July/VAs-Telesleep-a-Breath-of-Fresh-Air.asp

    It lists impotence and stroke as conditions that might have been avoided if I had been using a CPAP. I suffered a subarachnoid hemorrhagic stroke in 2009 and ED was first noted in my medical records in 2011 or 12. I finally went on a CPAP in 2015 and inadvertently discovered that sleep apnea could cause so many different conditions after doing a DBQ with a VA contract doctor. Basically he seemed more interested in the fact that I had a stroke than in the sleep apnea.

  • Yes, both ED and stroke have been significantly tied to sleep apnea. Depending on the exact circumstances of your case, the first diagnosis of sleep apnea, etc., it is possible that your conditions are connected and will also qualify for disability. Sounds like the physician correctly recorded the issues on the DBQ, so you should be good to go, depending on your medical evidence.

  • I was diagnosed with sleep apnea in 2005 and had the stroke in 2009,developed ED in 2010. When I had my DBQ exam for a rate increase in 2015 the doctor asked me about scars. When I told him i had one on top of my head where they drilled a hole to drain fluid due to my stroke he became excited and started putting info into the computer he was using. I was wondering why he got excited about that and went home and googled it. That's when I realized the stroke was probably caused by the sleep apnea. However when I requested a copy of the DBQ the question about scars was checked no and there was no supporting notes. When I asked my pulmonologist about sleep apnea causing strokes he didn't seem to think so. He also didn't seem to like that I was getting disability for the sleep apnea. Would you know any doctors in the Dallas, TX area that are familiar with VA disabilities? I would like to get an opinion statement and claim these as secondary conditions.

  • Can a claim be changed to a secondary condition after I have already filed, at the discretion of the VA?

    What if I am not sure if something is secondary to an already service connected condition? For example, if I have 10% patella femoral syndrome in one knee, and a secondary 10% sublaxation in the other knee–I am not sure if my low back pain and arthritis would be interpreted as connected to this?

    Lastly and somewhat unrelated, if I am filing for 8 separate conditions, it will be up to the VA to determine whether one is related to the other and essentially combine them correct?

    Thank you

  • Colonel,

    First of all, thanks so much for having this wonderful site!

    I was rated 20% for gout in both feet. In addition, I was rated 10% for degenerative arthritis with bone spurs on the spine. It’s been 6-years since I was rated by VA.

    Two years ago I had my right knee operated on for a torn meniscus. The Surgeon stated that I had severe arthritis and would eventually need a knee replacement (looks like within the next year or two). Every six months I receive a series of five Hyalgan Injections to help with the pain in the right knee. Recently my left knee began bothering me with pain and swelling as well. After my surgeon’s examination he stated that I had arthritis in my left knee too. My question: I’ve established gout & spine arthritis issues with the VA. Will the arthritis for both knees qualify for VA compensation (I left the service 11-years ago)? I have good motion with both knees. However, both swell frequently and are painful quite often (5-6 times monthly).

    V/R,
    Steve

  • We are a national site, and so can't give local recommendations, unfortunately.

    A second opinion is always a good idea, though, especially since you'll need the seizures directly tied to the sleep apnea in your case. They are not definitively connected, so depending on your evidence, it may not be enough to connect them.

    Scars are only ratable if they are significantly large, so yours is probably not, so I wouldn't be too concerned about that. As long as the VA has the record of that procedure, the scare is not important.

  • I am currently SC for Meniere's disease and I'm on the process to submit a claim for anxiety and Depression secondary to the Meniere's. Someone told me that you can only claim either anxiety or depression ( not both at once). Also, on my DBQ the ENT wrote Cervicalgia and shoulder pain (decreased range of motion and stiffness) as related to the Meniere's because they aggravate my condition and trigger my headaches and vertigo/dizziness. My question is… Do you think I have a case? Should I go ahead and submit my secondary condition claim. I am 30% for the Meniere's but I suffer of dizziness and vertigo almost every day. Is that something that justifies a request for increase in rating? Thank you.

  • Yes, the VA will look at all of your conditions and combine them as needed to rate them correctly. That's why it is better to list everything that has been diagnosed than to assume you know how to combine them and end up leaving something off.

    If you can prove service-connection for any condition without needing the secondary connection, then that is always the best. Secondary conditions are only important if they cannot be connected to military service by themselves. So if you have evidence of all of these conditions while in service, then it doesn't matter if they are secondary or not. Just list them all and then provide evidence of their diagnosis while in service, and you'll be good to go.

    However, if you do not have evidence of your back pain and arthritis in service, then you definitely need to establish them as secondary if the VA is going to consider them service-connected. You'll need sufficient medical records and probably a NEXUS letter to do this, because if you are unsure, the VA will be too. They won't consider them secondary unless you can show proof.

  • Hi Steve –

    Unfortunately, the knees won't qualify unless you can prove that they are the direct result of the feet/back issues that are service-connected. And that is going to be tricky at best. Unfortunately, in 11 years, that is plenty of time to knee issues to develop, so it'll be easy for the VA to say that they would have developed regardless. You'll need a strong NEXUS letter from a specialist if your claim is going to be successful.

  • You can list both anxiety and depression, but they are correct that you will only be given a single overall mental health rating. The VA will combine all of your symptoms and just give a single rating that covers everything.

    For your Meniere's, definitely submit for an increase. A 30% rating is only if there is dizziness less than once a month. Daily is 100% if it includes staggering while walking. At minimum, it sounds like you qualify for the 60%:

    http://www.militarydisabilitymadeeasy.com/theears.html#j

    It definitely does not hurt to submit for the cervicalgia and shoulder pain as secondary. Since they aren't caused by the condition, but instead just exacerbate it, they may not be ratable, but doesn't hurt to try.

  • Hello Doctor Johnston,
    Great site. I'm a retired veteran and from time to to I assist other veterans with their claims. Which brings me to this question. I have a veteran that's receiving a va rating of 30% for bronchitis with sarcoidosis (claimed as sarcoid). His records clearly show treatment for sarcoidosis throughout his military career yet his claim was denied for sarcoidosis. Should he submit sarcoidosis as a secondary to bronchitis? He's also being treated for sinusitis, sleep apnea, and thromboid veins which are not service connected.

    Thanks,

  • I have a few questions, in 2010 I was diagnosis with prostate cancer due to being sprayed with agent Orange while in Vietnam. Surgery was done 09/2011 for removal of the prostate, I developed incontinence and ED, but as you may know VA rated me at a temporary 100%. But since the surgery I applied for a rating for the residuals already mention, after years of fighting VA for the claim on the residuals Incontinence and ED , I was awarded 40% and 20% for the cancer. if the residuals are from the surgery and I had to make a claim for them, am I entitled to additional compensation for the residuals, even if I'm already 100% total and permanent? I had applied for the residuals before they made me total and permanent, I wear and average of 7 depends a day, make 5 to 6 trips to urinate at night, have to have a bed pad incase I urinate before I can get up. I have type two diabetes I stay thirsty all the time and I'm on 15 different medications for other service connected issues. does VA owe me compensation for those residuals, and by the way they gave me service connected for ED, but because the penis is not deformed I do not get compensated . VA had me go to four C&Ps and each have given the same outcome, all were do to the Cancer and the surgery, even the Chief of surgery (urology) supported my claim.

  • What if a total combined rating equate to more than 100%, how are the conditions "lowered" to equate to 100%? Are some given 0% service connected?

  • Since he is already receiving a rating for bronchitis, he cannot receive a second rating for sarcoidosis. Because of the Pyramiding Principle, only a single lung rating can be given at a time, even if multiple lung conditions are present. Since "bronchitis with sarcoidosis" is already rated 30%, both conditions are being covered by that rating.

    So even if you submit sarcoidosis as secondary to bronchitis, the VA won't give him a second rating. They will rate only one or the other, whichever gives the higher rating.

    And they already have it on the claim if they are recognizing the "bronchitis with sarcoid".

    What you should do is check the ratings for Sarcoidosis and see if his test results would qualify him for a higher rating than 30%. If so, then submit for an "increased evaluation" for the bronchitis with sarcoidosis.

    If the sarcoidosis ratings do not qualify him for a higher rating, then just leave as is.

    http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#w

  • So the cancer is rated 100% temporarily after the surgery is over, then it is rated on residuals. You said you were rated 40% and 20%. What were those for? There isn't a rating for "the cancer" anymore, just the residuals. So if those ratings were for the cancer, then those are for the residuals.

    I'm assuming (maybe incorrectly), that the 40% is for your incontinence. A 40% is given if you have to urinate more than every hour during the day.

    http://www.militarydisabilitymadeeasy.com/thegenitourinarysystem.html#urinary

    As for ED, there isn't a rating for ED at all, so that is correctly rated 0%. However, it does qualify for special monthly compensation K for loss of use of a creative organ.

    http://www.militarydisabilitymadeeasy.com/specialmonthlycompensation.html#k

    Since I'm not sure exactly what your rating breakdown is, so I'm not sure what the 40% and 20% and your P&T 100% are for, but hopefully what I've said applies to your case. If not, please clarify.

  • No. Each condition is still rated as is. The total combined is just capped at 100%. You can't receive more than 100% of benefits, but individual condition ratings could qualify you for additional benefits, like special monthly compensation, CRDP, etc. So those remain in case they help you qualify for those other benefits, but you only receive 100% compensation.

  • I have a right elbow injury that limits the range of motion. The limited range of motion caused my right arm to become shorter and I can not reach as far. This condition has caused my right shoulder to drop causing my back to be out of alignment resulting in lower back pain and pain down my leg. would this shoulder and back trouble be considered a secondary condition?

  • You've likely heard this a million times but I need advice on how to approach my claims based on the following. I entered the service in 1979, commissioned a 2LT. Throughout my career, I was told by leaders at all levels that I should never give appearance to the troops that I was 'riding sick-call'. Subsequently, many things that have followed me throughout my career are a chronic problem to me, but because of the culture I served in, most of the problems I have are not captured in my records. Do you have advice on how to make legitimate claims for conditions that originated while I was in the military, but cannot claim because they are not in my records? Thanks for the great forum.

  • Yes, you are definitely not alone in this very large problem. Luckily, that culture has started to change, but not until it left too many veterans in a rut.

    The VA legally must have proof that conditions are service-connected before they can grant disability benefits. There are a few different ways to do this. Thoroughly check our Service-Connected page and our VA Presumptive List page:

    http://www.militarydisabilitymadeeasy.com/service-connected.html
    http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html

    If you can show proof that your conditions meet any of these circumstances, then the VA will grant service-connection. If not, then there unfortunately, isn't much that can be done.

  • I filed a claim in March 2017, but I was homeless at the time & VA had no way to get in touch w/ me. Since then thanks to the homeless vets program I'm now in a home & filed a new claim w/ the same stuff. My question is can I somehow get retro pay back to my original claim?

  • Hi Nimitz –

    It's just now coming up on a year since you first applied, so you could be able to complete that original claim. Did you find out if they ever processed the claim and made a decision? If that claim was never officially closed out, then it is still active and your application date will still be considered for the start of your benefits.

    If it was closed since they couldn't contact you, then it was technically not their fault that they couldn't process the claim, and so your start date for benefits will be from the submission of the new claim.

  • I am rated for PTSD/Insomnia/Depression at the 70%. I finally got a sleep study done through the VA in 2017 (I left service in 2010 (active) and reserves in 2013). I was told I have sleep apena. I submitted a claim for secondary and it was denied. What can I do to show the link?

  • This is my second submission of this question, because I'm not sure the first one was published. I have been fighting
    ITP since 2014. The first time I was hospitalized for this problem, my platelet count was undetectable. Since then I have had my spleen removed, but it has not stabilized my problem, it has only made it manageable. My count is like a yoyo, up and down, but never stable. I have filed a disability claim with the VA, because I believe my disease is cause by exposure to Agent Orange in Vietnam from Nov. 1968 to Jan. 1970. Does the VA know that Agent Orange can disrupt the function of the immune system and cause ITP?

  • Sorry we didn't respond to the first. We've been having issues with comments not showing up, so glad you re-posted.

    ITP is not currently included on the VA's Presumptive List for Agent Orange exposure.

    http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#herbicide

    Basically, they do not currently automatically consider it connected. You can submit for it, but since it is non-cancerous it isn't covered by any of the conditions that are on the list. However, if you can supply enough proof with your claim, the VA may still grant service-connection.

  • My spouse has service connected atrial fibrillation. He went for a sleep study through the VA many years after retiring from the military. He had been snoring/gasping for breath many years before retirement, but back then, nobody ever heard of sleep apnea. After his sleep study, he was diagnosed with severe sleep apnea. We were advised to claim sleep apnea as secondary to atrial fibrillation (as there are many well-accepted medical reports linking them). The examiner at my spouse's C&P exam did not conclude one was linked to the other. Is this something we should argue?

  • Thanks for your prompt response to my March 7th question. It was not what I was hoping to hear, but you didn't tell me that I didn't have a chance either. I have submitted a fair amount of evidence
    to support my claim. Probably the best piece I have is a Korean study that shows, that with higher
    exposure to Agent Orange, the number of cases increased.

    I noticed that ITP has a diagnosis code of 7705. It also has four disability ratings starting at
    100% and going down to 0%. Based on the descriptions for 100% disability, I would most closely fit that category.

    Based on the fact that the VA has four levels of disability for ITP, they must have accepted responsibility in a few cases. Can you shed any light on that?

    Gene Blomberg

  • I filed a claim for my left shoulder, left bicep tear & rt shoulder for over-use. I found out later that I also have cervical stenosis. Can I get service connection for that (cervical stenosis) due to over-usage also or would it be a secondary condition for my shoulders? Also I'm register gulf war vet how is Degenerative disc disease rated & how can I prove service connection?

  • ITP is not only caused by Agent Orange exposure, so the VA can cover any case that can prove service connection. Thus, the majority of cases that are covered are ones that can prove service-connection in other ways, not by connection to Agent Orange.

  • Your advice was correct: the best way to get compensation for the sleep apnea would be as secondary to atrial fibrillation. It is unfortunate that the examiner didn't connect them. I'm assuming that you got the VA's decision back and they denied it? If so, then you can submit an appeal. Make sure, however, to include a NEXUS letter from a physician clearly drawing the connection between the two conditions. This will give your case a higher chance of success.

  • Anxiety and depression can make sleep apnea worse, but there is no solid evidence that they cause sleep apnea. Because of this, it will be difficult, if not impossible, to claim sleep apnea as secondary to anxiety and depression. If you can get a Nexus letter from a physician, however, it may still be worth submitting a claim.

  • For all of these conditions to be granted, you'll need to prove service-connection. Anything diagnosed on active duty will be considered service-connected, but things diagnosed after may not be. You can claim things as secondary to conditions that the VA considers service-connected, so if they have granted service-connection for your shoulders, you can then submit your cervical stenosis as secondary to your shoulders. The same goes for your DDD, if it was diagnosed after separation, you have to prove that it is secondary or qualifies for service-connection in another way. DDD is not on the presumptive list for Gulf War vets.

    http://www.militarydisabilitymadeeasy.com/service-connected.html
    http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#gulf

    If service-connected, DDD is rated as intervertebral disc syndrome:

    http://www.militarydisabilitymadeeasy.com/thespine.html#inter

  • Your March 21 response to my question about ITP is very intriguing. I do not need to win this disability claim because of exposure to Agent Orange, I just need help in establishing that ITP can be service related. Now I have to say that the only thing that I know I was exposed to in the service was Agent Orange. Do you have a list of other causes for ITP? I will eagerly await your response. Thank you for continuing to provide me with information.

    Sincerely,
    Gene R. Blomberg

  • Thanks so much for your reply! We are working with our VSO and he is preparing a NOD. We will include a NEXUS letter from my husband's cardiologist with the NOD. Next week, we will meet with our VSO and he can show us in VBMS what the examiner said in her report. Thanks so much for your blog and great assistance you provide to so many people.

  • Thanks Dr. Johnson,

    I was exposed to Agent Orange for 14 months. That's still the best I can come up with, but I'll
    keep watching for other possible secondary causes.

    I threw quite a few things in with my initial claim, I'll see how that does. Mean while, if anyone else
    has any info that would help, they can send it to you and if you think it has merit, I will hope to see it in this blog.

    If I lose, I do plan to appeal if I find an attorney that will take the case. I don't give up easily! If I didn't believe that Agent Orange was the root of my problem, I wouldn't be pursuing this case with such determination.

    Thanks for all your help!

    Gene R. Blomberg

  • I have hearing loss and tinitis whitch I believe accured during my time in Vietnam. I was attached to a huey outfit and also spent time at an airbase with f-104, & f-111 aircraft taking off and landing at all hours. jet engines can produce db levels up to 150.
    how do I fill out a claim and what proof do I need?
    thank you for helping

  • Both hearing loss and tinnitus are automatically service-connected if your MOS is on the Noise Exposure Listing.

    http://www.militarydisabilitymadeeasy.com/theears.html#noise

    If it is on the list, then just submit proof of your MOS and all medical records tied to your hearing loss and tinnitus.

    If it isn't, then you need to show further proof that you worked in the circumstances noted that exposed you to high levels of noise. A letter from your commander would be beneficial.

    Then just follow the instructions on how to submit a claim and include this evidence.

    http://www.militarydisabilitymadeeasy.com/vadisabilityclaim.html

  • My husband and I were both denied service connected tinnitus. Our MOS is on the NEL. I find your comment about being automatically connected interesting.

  • Hi, thank you for your time. I am 73 And served in the Army 63 to 66 in Germany as a switchboard operator Mos 724. I filed for compensation for hearing loss and Tinnitus in 2013. Received SC 50% for hearing loss and 10% for Tinnitus. Over the last 2 years I have developed and been diagnosed Meniere by doctor and would like to file for the Meniere but have seen that it’s not possible to have Meniere secondary to hearing loss. I was wondering that i developed at so late in life if I would be able to prove it.

  • It's definitely possible. Conditions that affect the way you stand and walk can lead to pain in various joints. As long as you have a physician write a NEXUS for your conditions, you should be able to get these as secondary unless there is clear evidence of a different cause.

  • Hi Rodnek –

    You're correct that there is no evidence to support that Meniere's can be caused by hearing loss. It is usually the other way around. Since it has been so long since your service, there is really very little to no evidence that it was caused by your service.

    You can always try to apply for it, but the likelihood of proving it effectively is slim. If you try and it doesn't work, then the next option would be to just apply for an increase in your hearing loss rating if your hearing loss is worse. They still won't rate the Meniere's, but they can increase your hearing loss rating if it is worse.

  • Dr. Johnson,

    I had issues noted on exit medical exam (ankle & lungs), considered and noted at C&P exam, but denied (Feb 2018) due to no diagnosis. After separation I moved overseas for work and will be submitting Notice of Disagreement (NOD).

    Question: With the NOD, should I included the additional information (some or all) – tests, diagnosis, and Nexus LTRs supporting or wait until contact from Decision Review Officer?

    Any insight appreciated. Thanks.

  • Dr. Johnson
    I was diagnosed with breast cancer (L) and as a result now have Lymphedema, pleural thickening and chronic neuropathy. I'm told that these are all considered secondary to the breast cancer but can't seem to find any information nor rating for those diagnosis.

  • Definitely go ahead and submit any and all additional evidence you have with your NOD. They need proof that your conditions were officially diagnosed, so anything you can give them that shows and official diagnosis is essential right away.

  • Since they are secondary, they will definitely be rated. The VA will rate them on the the closest codes that best cover the symptoms.

    Pleural thickening will probably be rated on code 6825 since diffuse interstitial fibrosis also causes scar tissue in the lungs.

    http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#x

    The Neuropathy will be rated on the main nerves affected (arms, legs, etc.)

    http://www.militarydisabilitymadeeasy.com/lowernerves.html

    Lymphedema is rated under code 7121 as a post-phlebitic syndrome.

    http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#j

  • Greetings,

    I wanted to asked can you received a separate rating for medical collateral Ligament laxity and Lateral collateral ligament laxity under code 5257?

  • Dr. 2 questions, I was retired 10 years before I filed my claims,awarded 10% for multiple level buldging discs (L2-S1)with stenosis with 20% for sciatic radiculopathy, filed a claim for hip arthritis but came back not service connected. After discussing conditions with a few friends, they say I should refile the hip arthritis as a secondary due to it is the same hip that has the sciatica and radiculopathy, so with a nexus written from an orthopedic doctor or rheumatologist, it has a good chance of being awarded. Second question deals with presuptive of IBS, had some symptoms a few years after returning from Desert Sheld / Storm, but never really said what it was, fast forward to last 3 years and have been diagnosed by my gastrointologist of IBS of both types, with a clear colonoscopy
    What's the best way to approach this since I read the date to claim it has been extended, is a Nexus better to get , but as I've read presumptive mean just that, but I did also read that about 85% of IBS claims are being denied.

  • Yes, claiming the arthritis as secondary with a nexus letter is definitely the way to go.

    You can claim IBS as the presumptive list has been extended to 2021. However, IBS is an official diagnosis. The presumptive list is for Gulf War Syndrome, which is a collection of conditions with no official diagnosis. This is why the majority of these claims are denied. You can still apply, but just know that it may be denied since it is an official diagnosis.

    http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#gulf

  • Ben
    Doctor, I just got service connection for my right hip that I had a hair I fracture on the femoral neck back in 1996. I originally put both hips left and right hip along with my right knee and ankle because they have been in a lot of pain since 2001. The original claim was denied so I appealed because I had to prove service connection to the right hip first. Now, that the right hip is proven to be service connected. Can I place another claim with a Nexus letter from my doctor and ex rays that show the damage to those joints. The claim would be filed as a secondary service connection.

  • I am service connected for left shoulder. Because my left shoulder was frozen I had to overuse my right shoulder. I started feeling a lot of pain and stiffness in my right shoulder for the past couple of months. I went to the VA and I had a MRI done. I was diagnosed with shoulder impingement and a partial tear of my rotator cuff. I asked if the doctor there could write me a nexus and he said no. I was wondering what would be the chances of it being approved for secondary disability and what would be the best way to strengthen my case.

  • Hi Antonio –

    The issue you are facing is the diagnosis in the right shoulder. Both shoulder impingement and rotator cuff tear aren't conditions usually seen from overuse of the shoulder as a result of overcompensating for the other shoulder. They are more usually the result of an injury or repetitive over-the-shoulder movements. These types of movements aren't typically done in compensation for the other shoulder.

    This is probably why the physician didn't feel comfortable writing a Nexus.

    You could always get a second opinion from a civilian physician. If you can find a doc who feels that they are connected and will write a Nexus, that would be the best way to strengthen your case.

  • I have a service connected disability for chronic pelvic pain/endometriosis and hysterectomy. Unfortunately my pain has not gotten better and I am required to have surgery every 2-3 years to remove painful peritoneal adhesion's. In 2010 I was diagnosed with a frozen pelvis.
    Should I claim adhesion's as a secondary disability?
    Should or will these be rated separately from my endometriosis?

  • Dr. Johnson,

    I'm looking for a VASRD code for pseudotumor cerebri also written in my records as idiopathic intracranial hypertension. Currently they group it with hypertension code 7101 and since I don't have High Blood Pressure they rated me at 0%. No one seems to be able to point me in the right direction in finding the correct labeling/grouping of my conditions. I also have headaches and papilledema, but since they aren't my "unfitting" condition they weren't considered. Thank you in advance.

  • Hi Nadine –

    It depends on what your main symptoms are. If pain is the only symptom, then that is already covered by your endometriosis rating. However, it sounds like your condition causes more than just pain, so those additional symptoms could probably be rated separately.

    Also, you would qualify for a 100% rating during your recovery period for each of those surgeries:

    http://www.militarydisabilitymadeeasy.com/vasrdprinciples.html#hospital

    Although some symptoms are already covered by endometriosis, others may qualify for separate rating, so I definitely recommend applying and giving it a shot.

  • Hi Karol –

    Thanks for your inquiry. The DoD will only rate conditions that make you unfitting, but the VA will rate every service-connected condition, including your headaches.

    Since this is such a rare condition, there isn't a "correct" code. The VA can choose whichever code they feel best represents your overall symptoms. I agree, however, that hypertension isn't necessarily the best since your main symptoms are headaches and papilledema.

    If there is any decreased vision, then you should be rated for that probably under code 6026 for optic neuropathy.

    http://www.militarydisabilitymadeeasy.com/theeyes.html#optic

    This doesn't cover headaches, though, so that should receive a second rating under code 8100.

    http://www.militarydisabilitymadeeasy.com/centralnervoussystem.html#headaches

    The VA is supposed to choose the codes that best rate the main symptoms, so if I had done the rating, these are probably the codes I would have chosen.

    I suggest appealing that their rating choice didn't cover the symptoms of the condition.

  • do you know where I could possible find more information about injuries caused for overcompensation of one shoulder. I've been trying to find information but I can't.

  • I had submitted a claim and it was denies in 1999 for chronic bronchitis. Now I have been Diagnosed with Bronchiectasis. I deployed to Saudi Arabia in 1996-1997 though not considered a burn pit area. However I did not work exclusively on the main base due to my job in munitions. Is there any likelihood that the bronchiectasis diagnosis could be considered service connected. all of the testing/labs I have had done has shown no known etiology.
    Thank you

  • Dr. Johnson,

    I was diagnosed with IBS when I left the army in 2006 and received an increase last year from 10 to 30%. I was diagnosed with anxiety and MDD due to my IBS. Both the psychiatrist and psychologist both wrote that diagnosis in the notes and I’m taking meds for both. Do you think I have a good claim to claim anxiety and depression as secondary to my IBS? It’s been bad lately but have only seen the psych for a few months. Would I need a nexus letter?

    Thanks for any input doctor!!

  • There is definitely less evidence out there since shoulders are non-weight bearing. For legs, if one doesn't work as well, there is a clear load being put on the other, often leading to arthritis, etc. For the shoulders, this is less the case. If you happen to be in an occupation that requires a lot of lifting, and you have to do it all one-armed, then there could be a case for arthritis or other shoulder issues. But this will be based on the movements/requirements of those motions, not necessarily compensation for the other arm.

    Ultimately, it's tricky, and the connection is inherently weak, but not nonexistent, depending on your particular circumstances.

  • Unfortunately, it doesn't sound like you have a strong case for service-connection. Without your bronchitis being service-connected, they aren't going to service-connect your bronchiectasis. If you had treatment records of bronchitis while in service or something similar, there would be a higher chance, but without those and no other solid evidence linking the bronchiectasis, it is very unlikely to be service-connected.

  • Hi Janet –

    Yes, you can apply for your mental health conditions as secondary to your IBS. Make sure to definitely have a nexus letter clearly connecting the conditions. If your evidence is strong enough it should be granted. This is a unique connection, however, so without fairly strong evidence, it could be denied.

  • Hello. I submitted a claim for Sjogren's, with some of the supporting evidence being my eye problems with MGD, blepharitis, and dry eye.

    I did NOT claim my eye conditions as secondary to Sjogren's and I see now that I may qualify under Code 6025 Lacrimal Apparatus??

    Is this something that the VA could add to my claim even though I did not claim it separately? Or do I need to add it myself? If the latter, is it too late now that I have submitted my FDC?

    THANK YOU!!

  • Sir, I served six years in the Army Reserves, honorably discharged. In 1973, I fractured the 2nd metatarsal shaft, right foot while taking basic training. Through the years I've dealt with pain in this foot especially when barefooted or standing for long periods of time. Talked with my doctor about it and he feels arteritis has developed. I have my Army medical records to support the claim fracture happened while I was undergoing training. Would I be justified in filing a claim with the VA? Thanks

  • The VA will never add a condition for you. They will rate whatever you include on a claim. So if you want something rated, you need to include it.

    However, dry eye is a symptom of Sjogren's, not a separate condition. So the VA will consider it when rating Sjogren's. If you are diagnosed with a separate lacrimal apparatus condition, then you will need to submit that separately, but since this a symptom of Sjorgren's, you do not.

  • Yes, since the initial injury occurred directly in the line of duty, the VA will consider it service-connected. As long as you get a letter from your physician stating that they believe the condition is "more likely than not" caused by that injury, your claim has a high chance of being successful.

  • Hi Thomas –

    Tricky situation. The bladder cancer is not on the Presumptive List, so they correctly denied that. But prostate cancer is. The basic rule they follow when rating prostate cancer is to rate whatever conditions it clearly causes separately. Since it is going to be difficult to prove how much of the incontinence is due to the prostate cancer, they may deny that. But they will rate other things. Ultimately, you can definitely include urinary incontinence if you end up needing to apply for prostate cancer, and they might just rate it.

  • Sir,
    I'm already getting compensation for my back and radiculopathy for my right side lower extremeties. But not for my left side, I am planning on submitting a new claim for left side but not sure if I should go with a secondary or service connected. When I first did my claim I mentioned my left leg but I was neither denied nor given a 0% rating. It's been over a year now and my pain and symptoms have gotten worse. I reviewed my c file and the evidence is there plus I have new evidence to confirm my syptomns. My question is, how should I go about in submitting this claim?

    Thank you

  • Either claim should be successful, but I suggest submitting the one you have the most evidence of. So if you have plenty of in-service evidence of left radiculopathy, then just submit a new claim. If you have some, but not a ton, then maybe a secondary claim would be stronger as long as you can show full proof that the radiculopathy is directly caused by your spine condition. Go with whichever case is most solid.

  • Dr. Johnson

    I will file a claim entitlement to migraines, vertigo, and tinnitus, secondary to sinusitis (30%), allergic rhinitis (0%), and sinus headaches (0%). I separate the nexus letter in two parts.

    First, I discussed the entitlement to migraines, secondary to sinusitis, allergic rhinitis, and sinus headaches.

    Secondly, I discussed the entitlement to tinnitus and vertigo, secondary to sinusitis, allergic rhinitis, and sinus headaches.

    I will submit the following medical literature:
    a. WebMD, Migraine or Sinus Headache b. Mayo Clinic, Diseases and Conditions, Sinus Headaches c. American Migraine Association d. Medscape Medical News from the American Headache Society (AHS) e. Vertigo, Silverstein Institute, Is There a Link Between Your Allergies? f. Vertigo, Boots WebMD Partners in Health g. Vertigo, Healthline Newsletter, Allergies and Dizziness: The Cause and the Treatment h. Vertigo, New York Sinus Center i. Can a Sinus Infection Cause Tinnitus? South Florida ENT Associates and the American Tinnitus Association

    Do you think I have a chance of these secondary conditions approved by VA?

    Thanks,

    LEG

  • Thank you for the quick response. I'm going to go with the service connected route, since I have more evidence in my military records with new evidence to support the claim.

  • A NEXUS letter can't be written by you. It must be written by a doctor with the right specialties to have a viable opinion on your case. You can still submit your letter along with the evidence, but in order to make your case stronger, you'll need a NEXUS from a physician.

  • Dr. Johnson,

    I was rated 70% for PTSD. I suffer from many other issues such as Migraines, Hypertension, Sleep Apnea, Diabetes and IBS. The psychiatrist suggested these are all secondary conditions of the PTSD diagnosis. No told me to claim them as secondary to PTSD. Should I file for a secondary for each one and file them all together at the same time? Thank you for your BLOG and help…

  • On my final physical before retirement, as a Marine for 27 years, One of the questions was: do you have numbness and tingling in your extremities? My answer was "yes, I have numbness and tingling in my hands and feet, and when I sit down for a while, my left leg goes numb, and I cannot feel it. I listed this on my original claim as "Numbness and Tingling upper extremities" and "Numbness and Tingling Lower Extremities". I received a rating decision about 6 months later, which was a denial for service connection because they said I had "No diagnosis while in service for this condition". My question is: 1) How much weight is the VA supposed to give for the Final Physical, and if I reported the problem before exiting the service, how can it be denied? 2) Also, I am service connected for Degenerative disk disease at 10% for cervical and thoracolumbar spine. Is this enough by itself to get service connected for upper and lower radiculopathy or do I have to provide a medical opinion letter?

    Thank You sir

  • Hi Doctor
    I am having trouble getting statements from my husbands doctor he passed away but I have been told to link the right knee service connection to the left knee conditions he was having. Although he did not have a diagnosis of left knee injury in the military he was diagnosed with the left knee arthritis in fact its listed as more on the left side on some of the paperwork and some says bilateral but he was only rated for the right. How do I do handle that.

  • Yes, you can submit a single claim for all the conditions. Make sure to include that they are secondary to PTSD, all the evidence to support this claim, and a NEXUS letter from your physicians (ideally from both the psychiatrist and those treating your other conditions).

  • Tricky situation. They basically just needed the radiculopathy to be officially diagnosed, not just listed on your exam as numbness and tingling. The final physical is not really a diagnostic exam.

    When did you have it officially diagnosed? If it was within the first year, you should be able to get that decision overturned with an appeal. Just submit evidence of the official diagnosis, and you should be good.

    If it was diagnosed after the year mark, then you can still get it added now as secondary to your DDD. A NEXUS letter will definitely strengthen your case.

  • I had it officially diagnosed on 05-09-2018, which is when I had the electrophysiological study with a Neurologist. I'm not real sure if I have a diagnosis or not though because of the way it is written. It states "No definite evidence for widespread polyneuropathy affecting the lower extremities. There is a possible right lateral planar neuropathy, with no potential elicited in the right lateral planar nerve. The remaining plantar nerves are normal bilaterally. The upper nerve study says "This electrophysiological study shows mild decrease ulnar nerve amplitude bilaterally, but no evidence for ulnar nerve denervation on the EMG study of the left upper extremity. The median nerves are normal bilaterally. Then she states on another page "Neurologic exam is nonfocal. Definite evidence for neuropathy found on nerve conduction studies of the lower extremities, but this does not definitely rule out a small fiber neuropathy". Can you decipher this and let me know if I have a diagnosis of Neuropathy or radiculopathy? Thank You!

  • I can't give you a full medical opinion as I'm not a neurologist, though she does say that there is evidence of neuropathy (basically the same as radiculopathy), so I personally say that was a diagnosis. If the VA won't accept this, then what you need is a statement from her or a medical record basically stating: "Diagnosis of peripheral neuropathy of the lower extremities caused by lumbar DDD."

  • Yes sir. Thank you very much. I did get a copy of my C & P exam, and I also saw the medical opinion that the C & P examiner had to provide to the VA. The C & P examiner stated "It is at least as likely as not 50/50 that the Veterans neuropathy is caused due to military service because it is a valid secondary condition caused by degenerative disk disease, which the Veteran is service connected for". I'm hoping this will suffice to the VA Rater who will be deciding my claim. Do you think I have a pretty good chance for success?

    Thank You

  • Hi Dr. I have CAD as service connected at 30%. I filed a claim for Coronary bypass surgery and the VA denied it. I now understand it was because of pyramiding (I think); but they then downgraded my CAD rating to 10% without any medical information given by me. The VA Dr. talked to me for several minutes and then typed on his computer for 90% of the time. How do I handle this. Thanks for your time.

  • Hi Doctor, I have a VA disability rating 50% for hearing loss and 10% for Tinnitus. I was thinking about filling for compensation for unemployability. Do you think I could qualify for it. I also have Ménière’s syndrome. Thank you for your time

  • I have already been rated for several items. One of these is sleep apnea at 50%. If I do a secondary (1) ED to sleep apnea, (2) Hypertension to sleep apnea, (3) Diabetes Mellitus to sleep apnea and (4) Vascular issues (atherosclerosis and abdominal aortic aneurysm) secondary to the hypertension…do I have to a new DBQ for each of these? I have already been diagnosed by the VA for these conditions, but I have never filed them as secondary conditions.

  • Hi Doc,
    I am service-connected patellar femoral pain syndrome, I submitted a claim for metatarsalgia; secondary to PFPS. Is it true that a knee problem can't "cause" a foot problem? I was told by the C&P examiner that only a foot problem can cause a knee problem, not the other way around. Although, he did briefly mention that my knee problem could "aggravate" my metatarsalgia. Your thoughts?

  • That depends on the condition. If the knee condition clearly causes you to walk abnormally on the foot, it potentially could cause a problem. However, this is rare. Even if you limp or walk oddly, knee conditions usually still allow normal motion of the foot. Ultimately, it depends on your exact symptoms and how the foot is being used.

  • Dr. Johnson,
    I'm about to file a VA disability claim for a nose deformation, a painful scar due to an ingrown toenail and Tinnitus. I am reasonably confident that I should be awarded these disabilities.
    In my research I've begun to wonder if my other "issues" may be service connected as well due to my two 6 month tours in the Persian Gulf. (Southwest Asia)
    In the last 3 years I've been diagnosed with Spherocytosis, Cirrhosis of the liver (i don't drink or do drugs) and diabetes. Due to the Spherocytosis my RBC's are on the low end of the range. Dips below once in awhile. My platelets are steadily dropping…currently at 45,000. I had to have my gall bladder removed. I still create stones that get lodged in my bile duct. I've had 4 trips to the ER due to stones and had to have (2) ERCP's to remove the stones.
    White WBC's are down to 2.1 as well.
    None of my doctors can pinpoint why I've come down with these ailments. Spherocytosis can be hereditary in 75% of cases but i have a twin brother who was checked and is clear so it would seem i'm in the 25% category. Not sure what could have caused this to manifest.
    There is no clear evidence that these issues were caused in my civilian life.
    I find it "interesting" that all of these issues have manifested themselves all within a short period of time. I've been out of the military for 20 years.
    My question to you is how should I file for these conditions? I've read that you need to be careful on how you file based off of the diagnosed illness or the subsequent symptoms.
    I've noticed that the Gallbladder, Cirrhosis, Diabetes & Thrombocytopenia are on the VA presumptive list. I can't guarantee that I was at 10% within the first year after discharge since I never had any symptoms till my gall bladder had to come out. I very well could of been at 10% for the cirrhosis and the spherocytosis w/o knowing it. Gulf War Syndrome states that you may not have any symptoms until 2021 and still qualify for benefits. Could these fall under the Gulf War Syndrome umbrella?

  • The key to a successful claim is to claim them in a way that clearly demonstrates that they meet the requirements on the Presumptive List.

    http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#gulf

    You have to show that you meet the requirements for deployment/exposure as well as the requirements for diagnosis or non-diagnosis (in the case of Gulf War Syndrome).

    http://www.militarydisabilitymadeeasy.com/gulfwarsyndrome.html

    Remember, Gulf War Syndrome is a group of unrelated symptoms with no diagnosed caused. Conditions with clear diagnoses will not be considered here.

  • Thanks Doc.
    I've read both of those links many times before my initial post.
    I understand the reasoning and clearly see the "catch 22" in determining a diagnosed illness vs and a non-diagnosed illness. Explains why the VA can deny 80% of these claims.

    So that being said….
    Can I consider my Cirrhosis and my low platelet count as being non-diagnosed illness's? Neither one of these issues have any symptoms that I can readily see or feel at this point. They were discovered while investigating my Spherocytosis issue. My Cirrhosis will eventually lead to a liver transplant and could eventually kill me. The low platelet count (45K) could kill me as well due to possible internal bleeding. Especially if I need to have ERCP's done every couple of years. Both of these issues are also on the Chronic disease list of the VA Presumption List so they're obviously known issues for vets. My doctors don't know what the cause is for either of these issues. So I would consider these unrelated symptoms with no diagnosed cause.

    Just curious how you see these issues in your professional opinion. I fully understand the uphill challenge and intend to get a lawyer involved but at least want to start off on the right foot and file the initial paperwork correctly.

    Thanks for your time!

  • I had an x-ray that diagnosed me with cervical arthritis in September 1993; 12 years prior to my retirement. I had another x-ray done in 2018 which also showed arthritis of the cervical spine and I continue to have neck pain and stiffness. Can I claim that and would it be considered service connected?

  • There is some potential with these two conditions, however, most symptoms labeled as Gulf War Syndrome are fairly superficial: high blood pressure, nightmares, anxiety, stomach cramps, headaches, etc.

    Since yours are very significant and serious conditions, they are more likely to have a definitive cause that has just not been found as yet. You can attempt to apply for them as Gulf War Syndrome, but you'll want a physician backing you up, which may be hard.

  • Hey doc,
    Have you heard about the Saunders v. Wilkie ruling from April 2018? According, to that ruling, chronic pain can now be considered a disabilty. What's your interpretation of this ruling?

  • So far, the ruling hasn't made a real difference to VA ratings yet. The VA has always rated pain with motion with most musculoskeletal conditions, however, this may eventually encourage them to change their policy to extend minimum pain ratings to all conditions. Again, nothing has been officially changed from what they already do, but this could be a precedent for future adjustments.

  • I am service connected for stage IV non-Hodgkin’s lymphoma cancer and a brain tumor. I’ve since been diagnosed with chronic fatigue, chronic pain, fibromyalgia, neuropathy (service connected), IBS (service connected), hyperhydrosis in hands and feet (service connected), migraines (service connected), PTSD (service connected) and newly diagnosed Osteoarthritis in my left hip (possibly from steroids used with chemotherapy medicine and triggger point injections while on active duty or low back back that I’m still trying to get service connected) since being medically retired. My cancer was treated in Alabama while stationed in Florida and I was never told what to expect once I reached remission. Since then I’ve moved and only been followed by oncology in Louisiana (civilian) and now Texas (VA). I’ve found literature that states that chronic fatigue, chronic pain and fibromyalgia are all long term/late affects of having chemotherapy. Plus I researched several support groups thru the American Cancer Society who all report the same side effects post chemotherapy in different stages of remission. How can I get these late/long term effects rated as secondary Conditions to the chemotherapy without having to pay a medical professional for their opinion? Every doctor states that chemotherapy really does a number on the body but here in Texas I have a VA oncologist and a DOD oncologist (tricare). Should I contact the oncologist that treated me who is now in Jacksonville Florida for a nexus letter or go to my VA oncologist with VHA Directive 1134 and my civilian and military records to get the nexus letter?

  • For any secondary condition, it needs to be officially diagnosed. If your depression has been officially diagnosed by a psychologist and you are receiving treatment, etc., for it, then submit those medical records. The cause of the depression in the medical records needs to clearly be ED.

  • How would one address the issue of a Denied claim where the VA says that service treatment records are silent for complaints, treatment or a diagnosis? This claim was for Chronic Fatigue issues and complaints were documented during Military Service in physical therapy records for a service connected back injury. Would I need to submit a secondary claim with a copy of the treatment record? It seems to me these records have been sorely overlooked.

  • The VA needs to see treatment records that show the original diagnosis and continued treatment for each condition claimed. If the physical therapy was for a back injury, then that is not an official diagnosis or treatment of chronic fatigue syndrome. If you have records that officially diagnose and show the treatment of chronic fatigue syndrome, then that is the evidence the VA needs. You can submit an appeal and include these records.

  • I understand. The problem is that there were complaints made but the military side of treatment would never address the issue, so no diagnosis was ever made. Thanks

  • If there was no in-service diagnosis of CFS. Direct-Service connection can not be granted.
    A secondary-service connection argument can be made. If you meet this criteria:
    #1. Have a service-connected disability
    #2. Current diagnosis for Chronic Fatigue Syndrome
    #3. Obtain a medical nexus of opinion stating "at least as likely as not" that #1 and #2 are linked. Furthermore, a clear and concise rationale must be included in the nexus of opinion.

    In addition, your SC back problem may cause or aggravate other secondary conditions.

    Hope this helps.

  • Also I have sleep apnea diagnosed about 10 years after separation but didn't mention sleeping problems when active. I did have severe motion sickness and slept a lot while flying. Should I put in a claim?

  • If you are service-connected for a mental health condition,such as PTSD,Depression,Anxiety; you can secondary-service connect sleep apnea.

    If you are service connected for COPD or other serious respiratory conditions you can secondary service connect sleep apnea.

    Here is the criteria for secondary-connection that must be met for a favorable decision:

    #1. Must have a Service-Connected Disability
    #2. Must have a current diagnosis of secondary condition claimed.
    #3. Nexus of opinion stating that "at least as likely as not" #1 and #2 are linked.

    On the denied claim for Tinnitus, that's a subjective condition that is more likely than not;a granted claim, if you were on a flight line,around live firing of weapons,machinery,etc.

    You will need to appeal to the DRO first if it's an initial claim. Appeal to traditional appellate review if it was denied again by DRO review.

    Hope this info helps.

  • Jet – Did you submit evidence of your MOS when you claimed tinnitus? If so, and they still denied you, try submitting evidence of flight time or other evidence of time spent in high-noise areas along with your appeal, and it should be successful.

  • Gene I was also diagnosed with ITP while in service in the VA rated me with 0% and I had to have my spleen removed also and was rated at 20%. I am currently awaiting to see what they rated my Arthritis claim I hurt and Injured my left knee in Basic and hope they do not deny my claim for that. I had an X-RAY by VA and outside sources and both showed Arthritis

  • Any chance you submitted a sleep study; current diagnosis with your claim for secondary OSA to PTSD??

    I may have an answer to your question. I was denied twice even though I had a sleep study done after service that confirmed an OSA diagnosis for "Sleep Apnea as secondary to PTSD" because I didn't have new and material evidence. Meaning I didn't have a Disability Benefits Questionnaire(DBQ) or a Nexus of opinion linking the Sleep Apnea to PTSD. I was able to obtain a filled out Sleep Apnea DBQ from my pulmonologist, and submitted that to re-open my OSA claim. I was then scheduled for a C&P exam and the examiner provided the proper nexus of "at least as likely as not" Sleep Apnea is linked to PTSD and the rationale was a study that was done in 2005 by the VA doctors, Baylor doctors, and other researchers.

    https://www.researchgate.net/publication/7434993_Association_of_Psychiatric_Disorders_and_Sleep_Apnea_in_a_Large_Cohort

    [Copy and paste the link to your address bar; print it out and present it with a copy of a sleep apnea DBQ to your pulmonologist to fill out]

    https://www.vba.va.gov/pubs/forms/VBA-21-0960L-2-ARE.pdf

    If the Dr. refuses to fill out the DBQ. Request to speak to a patient advocate and explain the circumstances. Also VA Directive 1134 outlines that VA doctors can fill out DBQs and provide Nexus of opinions. A VSO can also make the request on your behalf.

    If and when you're able to obtain the DBQ or nexus of opinion.

    Submit the filled out DBQ or nexus of opinion, sleep study confirming the diagnosis of OSA, a copy of the above Sleep Apnea study to re-open your denied claim. IF for some reason you are past the 1-year appeal time limit that decision becomes final, BUT you can always re-open a finalized decision with new and material evidence. Which you will have if you obtain (say it with me) a filled out Sleep Apnea DBQ or Nexus of opinion from a pulmonologist or your primary care dr.

    Best wishes.

  • Hello, I have 2 separate issues I'm concerned with:

    1. What if a service connected knee contributes to falling down some stairs and injuring a shoulder? Would the shoulder be covered as being caused by the other already service connected knee condition?

    2. Also, I was a USMC pilot and feel like I have tinnitus. It wasn't as aggravating when I first left service but has become quite annoying. Can I apply to have that added to my disability rating?

    Thank you

  • #1. Yes, it would. You're knee's instability would cause you to lose your balance, resulting in an awkward fall. If you fell directly on your shoulder or had to put your arm out to try to lessen the fall and your hands, elbow, or shoulder resulted in injury. Your shoulder injury can be claimed, as secondary to your service-connected knee condition.It has been awarded before in appealed cases.

    #2. Since your MOS was as a pilot, you were exposed to a loud-noise environment. In most cases, tinnitus is granted. But, yes, there's a but.Recently, the VA ratings schedulers have been denying tinnitus claims to Flight crew members, Engine room personnel aboard naval ships, artillery personnel, etc. It would be a good idea to get a private audiogram to see if you have hearing loss also.

    Tinnitus is a subjective condition, meaning you are the only one who can hear it. I've seen in some appealed claims, that a Ratings Scheduler will say that tinnitus is objective, which would be nearly physically impossible because another person has to hear the ringing coming from your ear(it is rare)!

    It would be a good idea to get a nexus of opinion from a private audiologist stating "at least as likely as not" the veteran's tinnitus is due to military service.

    Veteran was a pilot in the United States Marine Corps. His military occupation consisted of daily high-levels of noise exposure. The veteran's military occupation specialty is listed in the VA fast-letter 10-35 as High Probability for Noise-Level Exposure.

    Copy and past this link into your address bar-

    http://3e3wit1jv3691nltvx1r85n3-wpengine.netdna-ssl.com/wp-content/uploads/2015/02/Duty-MOS-Hearing-Loss-Probability-Chart-VA-Fast-Letter-10-35.pdf

    Hope this helps.

  • Hello,
    Can you please assist in answering this question for me? While in the military I was always at sick-call for painful periods and have gotten shots for it as well. This problem persisted long after I got out of the miliary eventually lead my doctor to diagnosis me with Endometriosis and as well as fibroids. I then had surgery but a part of my ovaries and bladder was removed in the procedure. I now have issues holding my bladder on a daily basis. I have been seen by Incontinence clinic because it has been so debiliating for me. Am I eligible for compensation for this issue? Thanks!

  • If your symptoms in-service are consistent with your current Endometriosis symptoms, it may be related to military service. You'll need to look over your service medical record to see if there ever was a documented diagnosis for Endometriosis or other female reproductive condition.
    But, only a dr. can determine if your current diagnosis is due to military service via a nexus of opinion. Prior to service were you experiencing mensturation problems? Or did it occur during service?

    FYI, the nexus of opinion, must state the minimium threshold of "at least as likely as not" your condition is due to military service.

    I hope this provides some insight for you.

  • Leroy,
    Thank you for your advice. That really helps a lot. I will definitely need to go over my records with my doctor. Hopefully, she can see the connection as I didn't have these problems prior to joining the service.

  • Be sure to obtain a copy of your Service Medical Record first,if you do not have a copy already; before reviewing your civilian medical records with your Dr.

    Here is why:
    You'll need to connect the dots for the VA Ratings Scheduler assigned to your claim. Starting with your MEPS entrance physical. Then all your sick-call visits pertaining to your menstrual problems in-service until you left military service. Then, continuity of symptoms after service;in the form of lay statements from friends and family. Civilian dr. records until you were diagnosed with Endometriosis and the continuity of symptoms.

    A diagnosis alone doesn't always guarantee a granted claim. A diagnosis with continued symptoms that effects you earning an income is compensable.I can only imagine how debilitating this condition has been for you.

    Take your time gathering all the medical evidence pertaining to the condition you want to claim. Although, the VA has a Duty to Assist, the Ratings schedulers dont always follow this.

    Best wishes.

    Unfortunately, we as veterans carry the burden to prove and substantiate our own claims.

  • I recently submitted a claim for depression secondary to ED. The VA acknowledged my depression DX, but replaced it with a preexisting condition already rated at 30%.This is how they worded it (unspecified depressive disorder (previously diagnosed as primary insomnia). I've had insomnia since deployment in 2008, my ED began in 2011 which led to my depression. One thing has nothing to do with the other. What can I do about this?

  • Thanks for the helpful information Mr Alaniz. I take it you work with Dr Johnson to help people with their concerns. I'll utilize the info you provided. Thanks for the assistance.

  • I am not affiliated with Dr.Johnson or his website,but I have acquired experience with va disability claims. Dr.Johnson has years of medical experience and VA disabilty claims experience. His advice supercedes mine.I'm just sharing valuable information that I've learned over the past 5 years with my disability claims.

  • Dave, the shoulder should be considered service-connected, but there is a key to what you said. You said it contributed to the fall, but did not directly cause the fall. That suggests that your knee has not been diagnosed with instability and Leroy stated.

    The VA likes to be sticklers in situations like this. They will need proof that your knee condition caused the fall. If it did, then, yes, your shoulder will qualify as service-connected secondary to your knee condition.

  • Hi Tina –

    Sorry to hear about your case.

    If you weren't diagnosed with Endometriosis until more than year after separation, you are in for a tough battle. Painful periods aren't always enough to denote Endometriosis, even though yours were significant while in service. Did the doctor ever perform tests to discover the cause of the painful periods? If so, and no evidence of endometriosis was found, this could further weaken your case.

    I am not trying to dissuade you from pursuing a claim, but to prepare you for how the VA will approach it. It is definitely worth submitting a claim, but be prepared for the difficult battle. A NEXUS letter from your OB-GYN and showing continuity of symptomatology and care since separation will definitely be helpful, but ultimately, the more in-service evidence you can provide that supports the Endometriosis diagnosis the better.

  • I definitely understand why you are confused. What you are seeing is the Pyramiding Principle at play. Because of this principle, the VA can only legally give a single mental health rating. Insomnia, although technically a sleep condition, is rated as a mental health condition. Thus, the VA has to combine all mental health conditions and give only a single rating, regardless of the cause.

    Basically, what they do is combine all the symptoms from both conditions and use them all to assign a rating based on the Psychological Rating System. If they didn't increase your rating, they are stating that your depression and insomnia symptoms together were not severe enough to justify a higher rating. You can compare your symptoms combined to the rating system to see if this is correct. If you find that you do actually qualify for a higher rating, then you have grounds for an appeal.

    http://www.militarydisabilitymadeeasy.com/mentaldisorders.html#system

  • Prior to going to Vietnam, I had no problem sleeping. According to my Spouse (of 50 years) after returning from Vietnam she observed that I would stop breathing when I slept. To be honest, neither of us had ever heard of Sleep Apnea we only knew that I would stop breathing. This first occurred in 1972 or 1973. I suffered with being exhausted every morning and not knowing why. There were times where I would fall asleep during the work day. After I retired in 1988, I still suffered until in 2001 I spoke to my Doctor. She had me complete a Sleep Study which resulted in my first CPAP machine. In 2011 my same Doctor sent me for a second Sleep Study and again I had OSA and they prescribed a new CPAP. I believe I did not have sleep apnea prior to going to Vietnam. I guess my question is, can I file a VA Claim for sleep apnea as result of me being in country. Like others, we took incoming rockets often, and after transferring to the Delta we were evacuated when our ammo dump was hit by the VC.

  • Dr.Johnson, thanks for your valuable insight. If I read your post correctly, my hip replacement surgery (right side) may be secondary to my service connected Lumbar/right side sciatica (bulged & prolapsed disc) rated at 40%. Hard to get a Dr to write nexus..Thanks Dennis

  • Unfortunately, sleep apnea is not a condition on the Presumptive List for exposure to Agent Orange or service in Vietnam.

    http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#herbicide

    In order for it to qualify for disability, it would have to have been diagnosed while on duty, meet another requirement of service-connection, or be caused by another service-connected condition.

    http://www.militarydisabilitymadeeasy.com/service-connected.html

  • You're right, it could be. Often spine conditions can lead to arthritis in the hip. If that is what lead to the hip replacement, then it is plausible. You will have to ask around until you can find a doc able and willing to write a letter. Usually the best option is the doc most familiar with your case and qualified to comment on the condition.

  • If steelrig is service-connected with a mental health condition, respiratory, or a heart condition could Sleep Apnea be co-morbid and OSA be claimed on a secondary basis?

  • Dr. Johnson, do you do a nexus letter? I developed obstructive sleep apnea with CPAP after I was diagnosed with GERD while I was in the Army. If not, can you suggest a doctor who does a nexus letter. Thank you.

  • Unfortunately, no. Simply too many vets to do them for everyone. And as we are a national site, we can't provide individual recommendations. However, there are some that you may be able to find if you google.

    Regardless, in all cases the best physician to do your NEXUS is the one who knows you and your conditions the best and is most qualified to speak to their origins.

  • Thanks for reply Dr Johnson. The knee is rated at 10% but I don't know if that automatically equals instability. Is instability separate from the basic % rating…or does the knee need to be rated at a certain % to be considered unstable?

  • Instability is a separate condition entirely and should be independently diagnosed. It is the only other knee condition that can qualify for its own rating (Code 5257) in addition to another knee rating.

    http://www.militarydisabilitymadeeasy.com/kneeandleg.html#too

    The knee would have to give out regularly in order for instability to be diagnosed. However, even without a diagnosis of instability, if your knee is the cause of the fall, then you may still qualify.

  • I am taking prednisone for my skin rush and my pain in joints because I have polyathalgias since1998.I had a kidney transplant in2009.They gave me my pills and they include prednisone and i told them that I been talking prednisone long time ago.They told me very good.Now I would like to know if I can qualify for SYSTEMIC THERAPY.

  • Prednisone is a type of systemic therapy, so if the codes the VA has chosen to rate your conditions have systemic therapies for rating options, then yes, you can be rated accordingly.

    Most joint ratings do not include systemic therapy as an option. Some skin conditions do, but not the basic skin rash. A kidney transplant also does not consider systemic therapy in its ratings.

  • Hello Doc, my situation is I'm service connected for Afib (1987) 30%. I've had many episodes of Afib over the years and had Cardio Ablation in 2016. In 2017 I had an extreme episode of Afib which required Cardioversion, and was noted I had an apneic episode during my hospital stay. I was referred out and diagnosed with Obstructive Sleep Apnea and put on a CPAP unit. Would it be worth applying for OSA secondary condition to the Afib I have?

  • I was recently given a 10% increase for thoracolumbar degenerative joint disease. In the medical records sent to the VA for evaluation showed scoliosis. Can I file a claim for scoliosis?

  • Yes, there is some evidence that cardiovascular conditions can result in sleep apnea. In order to ensure your case, a NEXUS letter from your specialist establishing a solid link between your conditions will be essential. The VA will need more than a loose connection to be able to firmly grant that your OSA was definitely caused by your heart history, and this letter should enable you to solidify your case.

  • I have a 10 percent tinnitus rating, I believe this causes my my headaches and depression/anger issues. Can I claim these as secondary off the tinnitus. Also I have a s/c of 0 percent for deveated septum, ever since the break I snore terribly and am always tired. Can I file secondary for sleep apnea. What r my chances

  • Tinnitus can cause Depression on a secondary basis. For some, not all veterans, it can be bad enough to the point it is difficult for a veteran to hear anything else. A veteran will begin to isolate, avoid people, and do not engage in activities that were once part of their life. Resulting in becoming Depressed. You will need to have at least 1-2 years of medical evidence to substantiate a claim for Depression,as secondary to Tinnitus.

    On your question of secondary sleep apnea:

    A 0% rating for your deviated septum may not be considered to be enough to substantiate a secondary sleep apnea claim. Do you believe your deviated septum issue has worsened? Build medical evidence to request an increase.

    In addition, there is another option to secondary connect Sleep Apnea via Depression if you can get it granted first.

    To get secondary connect Sleep Apnea you must meet this criteria:

    #1.Current Diagnosis
    #2.Current service connected disability
    #3.Medical nexus of opinion linking #1 & #2. A rationale must also be provided.

    Furthermore, you will require:
    1. A sleep study administered to confirm you actually have Sleep Apnea.
    2. The sleep study report or Dr. note must state "medically necessary cpap"
    3. Sleep Apnea must be diagnosed.

    If you can do all of the above you will increase your chances of secondary connecting Sleep Apnea. Can't go just claiming sleep apnea if you think or believe you have it.

    The VA ratings scheduler will deny your claim if the evidence and criteria are not met.

    Doc your thoughts?

  • Are you officially diagnosed with and being treated for depression? If so, and your mental health provider agrees that it is the result of your tinnitus, then, yes, it can be claimed as secondary.

    The headaches are harder to prove. There is far more medical evidence stating that headaches cause tinnitus, not that tinnitus causes headaches. Again, with proper medical support and physicians opinions, this could be a potential.

    For sleep apnea, you would have to have an official sleep apnea diagnosis (shown to have been the result of the deviated septum) in order to be successful. Snoring because of the deviation is not necessarily sleep apnea and the two are not automatically connected.

    The chances are always based on the strength of your evidence. You must show a definite diagnosis with continued and current treatments of the condition. You must also show medical evidence of the connection between the secondary and primary conditions, including NEXUS letters from your physicians detailing the connection. As long as you are able to submit strong evidence, you have a strong chance.

  • I had a knee replacement in February of 2018 and was given a nerve block. I now have numbness in my interior heel of my foot, the doctor said the nerve may be permanently damaged. Can I file for a secondary condition for my foot?

  • Yes, as long as the knee replacement is service-connected, the nerve damage would be considered secondary. Make sure to include evidence of the surgery and treatment that led to the damage. A NEXUS letter from your physician detailing the connection will also strengthen your claim.

  • Hey there doc,

    Hope you’re still available for questions,

    Here goes: did 10 years Navy, was an air traffic controller for the first 6, re-enlisted and wentvto BUD/S. Within two years I finally washed out of three classes (tore right Achilles-service connected;lis-franc fracture right foot a year later which ultimately led to medical discharge as I was told I wouldn’t be able to perform anymore). Fast forward to today, I’ve had countless documentation’s at the VA of secondary conditions, my leg and back from over compensation. On top of that, I have been clinically diagnosed with depression and anxiety for the last 6 years as well. I can’t excercise, work physically, because I’m in pain and constantly just depressed. All been documented. In short:going for my exam this month, not trying to get 100, but being unable to work/do the things I could prior to my injury, will the va take that into consideration when applying for depression? A nexus letter has already been written. Any feedback is totally appreciated. Cheers

  • Hi Mike –

    Sorry to hear about your situation. Yes, the ratings for conditions like depression definitely take into account your daily functioning, including the ability to work. In addition to the evidence they record at your exam, it will be vital to also submit all of your mental health records for your treatment of depression over the years. The VA will need to see that it is an ongoing condition. Your medical records from your mental health provider should also include the important details they'll need to rate the condition, including employment status over time, long term symptoms, etc. This information will be vital to your case. It's great that you already have a NEXUS letter. All additional proof you can submit as well will be helpful.

  • m getting ready to submit my FDC. I keep reading conflicting advice about whether to file a secondary condition at the same time as my initial claim, or wait. My main claim is PTSD due to MST, but I also want to claim secondary Sleep Apnea (aggravated by the PTSD symptoms)
    I’ve heard that if I file them both on the initial claim, the sleep apnea would be considered a separate, main disability. But if I wait to be rated for the PTSD, and claim sleep apnea later, it would be a secondary? Is that correct? Are secondary conditions subject to the “combined rating scale”? Or is that just for separate, main disabilities? I’m not sure I could get sleep apnea service connected on its own without the PTSD. Which path is better? Or am I mistaken about all of this?
    Thanks so much for any help!
    Aurora

  • You can submit for all of your conditions at the same time. Just make sure that your conditions are very clearly listed:

    PTSD caused by MST
    Sleep Apnea secondary to PTSD

    Sleep apnea and PTSD are two separate conditions and as long as your proof of service-connection (and secondary-connection) is solid enough, the conditions will be each rated separately. The VA only combines ratings for conditions that affect the same body systems and do not have clearly separate symptoms. PTSD and sleep apnea cause separate distinct symptoms and so can be rated separately as long as both separately qualify for a rating under their rating requirements.

    http://www.militarydisabilitymadeeasy.com/mentaldisorders.html#ptsd

    http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#sleep

  • Thanks for replying. Last question: do I personally need to compile the mental health records and upload them somehow. The mental health provider is in the Manhattan VA, so it should all be documented in the system right? My VSR is horrible, and I just want to make sure I have everything ready before next week. Buddy statements from my partner, my former boss, nexus from mental health doc at the va etc… Anything I’m missing you think would help I’d truly appreciate. Thanks again for what you do. This forum has been a tremendous resource for so many. Tip of the hat, sir.

  • It's always best to have your own copies of everything to ensure that it is all submitted correctly every time. You should be able to check and see what evidence the VA has attached to your claim in the eBenefits portal. You can also upload additional evidence there. Just to ensure that everything is submitted, we also recommend compiling and uploading it yourself. Once you've put it in the eBenefits system, you know they definitely have it.

  • A friend has a 10% disability (prostate cancer related to Agent Orange). He was recently diagnosed with skin cancer in several areas of his body. Is this something that might qualify him for secondary disability?

  • Often arthritis can be caused by having to compensate for another condition, so it is highly likely that the VA will grant you connection for the hip. The spinal stenosis could be connected, depending on the exact cause of the stenosis. Ultimately, in order to win a secondary claim, it is always best to get a NEXUS letter. If your physician writes a letter connecting both the spine and hip to your knee, then it will have a stronger chance of being approved by the VA.

  • There are some rare occurrences of prostate cancer spreading to the skin, however, your friend would have to show proof that his skin cancer is undeniably the spreading of his prostate cancer and not some other unrelated cancer, which is more likely.

  • I have service connected PTSD and I had a panic attack at work which caused me to take a risk at work that I shouldn't have. When I feel like I am failing, I feel like someone is going to die. That's why I took the unnecessary risk. Anyway, I tried to slow down a fly wheel with my foot by applying pressure to it. At the time I didn't know what a flywheel was, but nonetheless, the flywheel caught the tread of my shoe and pulled my foot up into a fixed metal object and broke my talus bone (ankle) in three places. I had surgery and now have six screws permanently in my ankle. I have daily pain with my ankle, limp, and do not have full range of motion in it. Do you think this would be a good case for a secondary rating?

  • Sorry to hear about the incident.

    If you can get a few things in support of your claim, you definitely have a chance.

    First, you need a letter from your mental health practitioner claiming a connection between your action, the panic attack, and your PTSD. A NEXUS letter from the physician clearly showing the link between the injury and your PTSD will help.

    Second, a buddy statement from someone who witnessed the event and can testify to your panic attack and the situation that was occurring before and during the injury would also help. The idea is to clearly show the string of events as directly caused by your PTSD.

    If your evidence is strong enough, the VA could grant secondary connection for the injury.

  • I was notified I was pre diabetic within the first year of medical board, 8 years later I was diagnosed with type 2 diabetes. Can I claim diabetes as a secondary disability because a 30% shoulder injury and 30% depression and anxiety disability? Thanks you in andvance, this blog has been very informative along with the Q&A

  • You can claim secondary disability only if you can provide evidence that your diabetes is a direct result of your service-connected conditions, and no other cause. A NEXUS letter from your physician detailing this connection would greatly strengthen your claim.

    While diabetes is on the Presumptive List, it would have had to be ratable at 10% during that first year, not just pre-diabetes, in order to qualify using that route.

    http://www.militarydisabilitymadeeasy.com/vapresumptivelist.html#chronic

  • Quote "Unfortunately, in 11 years, that is plenty of time to knee issues develop"……keep in mind the level of proof is "at least as likely as not" or "more likely than not" that it COULD be from your service connected disability. A nexus letter will support that. Doesn't even have to be a "strong" one.

  • True, but common VA practice shows evidence that weak claims can still be denied with such a large time gap. The stronger the connection, the better. Always. Apply regardless, but it is always good practice to ensure the strength of your claims to the best of your ability.

  • I have been rated 30% for Asthma and I put in a claim for sleep apnea but was denied. I have read from reliable resources that asthma can be linked to sleep apnea ie. American Thoracic Society, Mayo Clinic and WebMD. What would I need to do to get the sleep apnea as secondary to asthma to raise my rate to 60%?

  • I have spinal stenosis accepted of the c-3 through c-7, because of this I have developed sleep apnea, I have found several studies but I was wondering if you have any insight or know of other studies I can present, I have my 2 buddies letters and I have 2 sleep studies, I am being sent by LHI to a NP to have her do a DBQ on behalf of the VA, thanks

  • Sir,
    I was in the military from 1975 to 1997. I was diagnosed with TMJ but did not file with the VA until after retirement. TMJ was sufficiently documented in my military medical and dental records. I am currently receiving a disability for TMJ. I also have sleep apnea diagnosed by sleep study in 2004. My VA advocate stated that I should get a doctor to connect my sleep apnea, secondary to TMJ. My wife can attest to my snoring and stopping breathing for the past 30 years. My challenge is finding a doctor willing to complete a DBQ or work with the VA. I also have tinnitus and I receive VA disability for it. I also have PTSD as diagnosed by the VA. Any recommendations or help would be appreciated.
    Gunner

  • There are some loose studies out there suggesting that OSA could be caused by TMJ, but none prove this. There are studies suggesting the opposite as well. Because there isn't a ton of concrete evidence to support this claim, you would need a NEXUS letter from your physician clearly stating that your OSA is directly caused by your TMJ.

  • Thank you for the quick response. Because my physician is not familiar with the VA process, are there examples of Nexus letters anywhere that would be accessable?

  • There isn't a database or system for finding doctors that are familiar with writing NEXUS letters. However, any doctor can do it, and if you prepare the letter as much as possible for them before hand, it will save them time if they only have to fill in the details.

  • I am new to this blog and have a question regarding secondary ratings. I currently have a 10% rating for my left knee. I am submitting a secondary claim for my right knee. I have a nexus letter from the doctor saying the right knee problem is more than likely caused by the service connected left knee. If approved does the right knee only get a maximum 10% rating like the left knee, or can the right knee get a higher rating? Thanks for the help! Gary

  • The secondary status has nothing to do with the rating, but the condition itself. If the VA approves and decides there is sufficient proof that the right knee is secondary, then they will look at the right knee condition overall and determine the best rating for that condition based on the severity of its symptoms.

  • Wow, thanks for the quick reply…I'm new to the VA claims filing process and appreciate the information. I have a couple more questions. Do you recommend completing the VA FORM 21-4138, "STATEMENT IN SUPPORT OF CLAIM"? I have three claims that are recently open with the VA and I'm wondering if I should complete this form for each claim to tell my story? Also, when I go to eBenefits they show that they have had my claims since 24 September and are collecting additional information, etc. How long does it take for them to show the actual individual claims on eBenefits? Thanks again for the help and whatever information and advice you can offer. Gary

  • It never hurts to submit VA Form 21-4138, but in all honesty, these aren't as effective as pure evidence that directly supports your claim (medical records, commander statements, etc.). It all depends on the strongest evidence you can possibly give to prove your case. Your personal testimony is always going to rank fairly low in comparison to official documents and notes from specialists that are qualified to speak to the case at hand, etc. Again, though, shouldn't hurt your case.

    As for the timeline, it all depends. There is no definite answer. However, since they are collecting additional evidence, that means that you did not submit enough evidence to support your claims. It is ultimately your responsibility to ensure that they have the evidence needed to correctly rate your conditions, so you can help expedite this process by proactively collecting the additional evidence and submitting it yourself. They won't be able to process the claims until sufficient evidence is received or until it is clear that there isn't sufficient evidence, whereupon they will deny the claim.

  • I won my appeal on 10/16/19, the judge said everything being equal they sided with me. Final, now have to wait for back pay from 2012, this will bring me up to 70%, thank you for your answer

  • Greetings!I recently developed plantar F on both of my feet. I had a knee replacement (SVC connected at 30%)just over a year ago. Would it be better to go to a podiatrist or my ortho DR to get a nexus statement? Can this be rated as a secondary condition? Thanks for your help.

  • I recently was seen for my diagnosis of Fibromyalgia which is a presumptive illness for Gulf Era. However, during my VA doctor acknowledged my Irritable Bowel Syndrome, Chronic Fatigue and a couple other things that are typically rated as secondary claims. Will the VA rate them during my decision or will I need to file another claim and just use the same evidence?

  • service connected for bi lateral hearing loss and tinnitus can insomnia be secondary to tinnitus and then be linked to sleep apnea I had a va sleep study and was told I have sleep apnea and was givin a machine and mask I feel that years of bad sleep trying to fall asleep waking up constantly has caused sleep apnea ever hear of this link thank you

  • Since the secondary condition is a foot condition, your podiatrist is better able to speak to its cause and so would have a more powerful NEXUS. It isn't an undeniable connection since plantar fasciitis can be caused by just wearing bad shoes. Your NEXUS letter will have to solidly draw a connection to make it clear that the strain on your feet from the knee replacement is the definite cause.

  • The connection between tinnitus and insomnia is still weak based on medical evidence. There is more evidence that tinnitus can cause mood disorders (depression, etc.) and that mood disorders can cause insomnia. If you have a mood disorder as well, then that could bridge the gap between the conditions. As for the connection between insomnia and sleep apnea, this is also tricky. There is evidence of that sleep apnea is the cause of many insomnia cases, but less that insomnia actually causes the sleep apnea.

    Ultimately, you have a very tricky case to prove. The more official studies that can connect your conditions, the better. Strong NEXUS letters connecting your conditions is also going to be essential.

  • I have a bit of a situation and would like to get some insight. I am currently rated 60% for my right shoulder, lower back, knees, tinnitus and left ankle. I would like to file for secondary conditions for scoliosis, hip pain/arthritis in the hip, left shoulder pain, anxiety, and migraines. I have VA records and X-rays showing anxiety, scoliosis, and degenerative change in the hip.

    My dilemma is, in April I was involved in a car accident, which I mentioned to my primary VA physician. What are my chances of being granted increases and secondary conditions with this information being disclosed? Am I able to submit the X-rays and other physical therapy findings as evidence, without it being linked to the accident?

  • That is tricky. You will need to show definite proof that your secondary conditions existed prior to the accident and were severe enough to justify a rating before they were aggravated by the accident. If you can submit enough proof that clearly separates them from the accident and strongly connects them to your service-connected conditions, you'll have a strong chance of a successful claim.

  • Thank you so much for your response. I honestly don't know where to begin trying to show this proof. I've been to the VA a couple times prior to the accident for my shoulder and back pain, but I don't know if that would be enough evidence.

  • The unfortunately reality is that you may not have enough. But it's worth a shot to try. If the records from before show a severe enough disability or at least one consistent with the current, then that supports that the accident wasn't the cause of the exacerbation. If it does not, then it will be difficult, if not impossible to prove. Always worth a shot, though.

  • I have sleep apena, hypothyoidism , high cholesterol , gout, carry a epipen hypertion, type 2 diabetes hearing loss,tinnitus macula degeneration . The only ratings of 10% each are tinnitus , type 2 diabetes (10 and 10) total of 30%. I filed for aggervated hypertension after being diagnosed with type 2 diabetes . As a short time after the diagnosis of type 2, the va Dr doubled my hypertension meds from 5th to 10mg. Va denied claim, that type 2 didn't impact the hypertension . So why did they double my meds? If I hadn't got type 2 they would have kept at 5 MG correct?

  • Hello, what if a service connected ankle injury caused one to fall and accidentally injure the left shoulder, can that be file as secondary injury? I think the chance is slim but better to find out for sure. Thanks.

  • In order for the VA to recognize aggravation, the condition must be aggravated to a compensable degree. The increase of medications alone does not qualify hypertension for a higher rating and so does not count as aggravation. If the diastolic pressure increased enough to qualify for a higher rating post-diabetes as it did pre-diabetes, then the VA would more likely consider it aggravated.

    http://www.militarydisabilitymadeeasy.com/thearteriesandveins.html#high

  • Dr. I was treated for arthritis of the thoracic spine while stationed
    in Germany in 66-67 and was given injections in the back along with therapy that did not help at all so the doctors shut me down completely
    with no prolong standing, no prolong walking, no extra duty at all, They basically disabled me for the rest of my time until discharged.
    the problem still exist and now it's causing problems with cervical
    spine with stiff neck ad headaches, I have X-Rays showing all of this
    and I am now waiting to receive my outpatient records. I filed less than a year ago and was denied because I did show that the problem was still there. I just need my in-service outpatient records of which I am waiting for and when they arrive should I refile with a secondary claim for the cervical spine problem also?

  • Yes, once you can show proof that your lumbar issues started while in service and have required regular medical care over the years, they should grant your claim for the lumbar condition. As for the cervical, yes, you can apply for these as secondary to the service-connected lumbar condition. Make sure to include a NEXUS letter from your physician detailing that the cervical spine issues are the result of the lumbar spine condition.

  • Hearing loss cannot physiologically cause low back problems, so a claim to make that secondary is highly unlikely to be successful. Sinusitis can cause tinnitus symptoms but they are rarely chronic without severe chronic sinusitis, but tinnitus cannot cause sinusitis.

  • I was drafted in 1970 and joined the Army that same year. I am a situs inversus (internal organs in opposite positions – noted in my army medical records) yet I passed the physical. I served in Korea from Jun 1971 to Jul 72. I came to find out lately that I have and had Kartagener's syndrome because of my situs inversus. This means that I have been open to develop Bronchiectasis since birth, which is exacerbated by exposure to environmental toxins. I had a terrible health history in Korea with hives, welts and breathing issues, but the Army would not address them as there was no CT scan tests for Bronchiectasis at the time. I have come to find out that agent Orange was being used at my camp during my tour of duty in Korea. I have a boatload of nodules in my lungs due to infections brought on by my Bronchiectasis through exposure to agent orange and tear gas. I should have never been drafted, I should not have passed the physical, and I have just suffered a heart attack, yet I don't smoke, I don't drink, and I am not overweight or obese. Both Bronchiectasis and Heart attacks are presumptive for agent orange exposure. I have always held a white-collar office job, so I have never been exposed to chemical pollutants outside of my Army service. Should I file a VA disability claim?

  • Dear Sir I'm a 50% service connected vet. 20 % left ankle 20% lower back and 10% combined hearing loss and tinnitus. I have been diagnosed with unspecified depression. The local dad. Vet rep filed a claim for depression due to chronic pain in left ankle and lower back. I was denied my claim for depression. But found my favorable for unspecified depression. My first c&p exam the psychiatrist said I had anxiety,depression, and PTSD. That was her diagnosis. Then va sent me to another c&p exam and this psychiatrist said my depression was unspecified. VA threw out the first one as misdiagnosed and denied my claim for depression. What should my next steps be as far as my claim. I also have right knee problems. My back pain is worse. I have stenosis in my neck joint. Please help in any way possible. And I thank you for all the help you provide us veterans.

  • In order to get the depression connected, it needs to be officially diagnosed and regularly being treated by a mental health professional. In their clinical notes, they also need to note that the depression is directly connected to your service-connected medical conditions. If there is enough evidence that you clearly have depression severe enough to require regular treatment and that it is the result of your conditions, then it is more likely to be successful.

    You can apply for an increased evaluation for you lumbar spine. Just check the box on the claim form. Do note that they do not rate on level of pain, so it will only qualify for an increased rate if your range of motion is more limited.

    For additional conditions, you can claim them as secondary, but will need to provide NEXUS letters and further evidence of their relation to at least one of your other conditions.

  • I was turned down already but found me favorable for unspecified depression but not depression for service connected. Feel like I should maybe should have filed it depression secondary to me pain in left ankle and lower back pain since they're service connected. I don't know what they meant by unfavorable for depression but favorable for unspecified depression. Can you help me out that way

  • If they are not rating your depression because it is not service-connected, then yes, your main focus needs to be establishing service-connection. In order to get it connected as secondary to your ankle and back issues, then it will have to be very clear in your mental health records that those physical issues ARE the stressors causing the depression. A NEXUS letter from your mental health provider clearly stating this connection will help. It will also have to be logical in the progression of your conditions, i.e. the depression developed in an appropriate timeline for it to have been the result of your back/ankle.

  • Hi, I retired 1 Mar 2009 and was diagnosed with diabetes 4 Mar 2010 with a HB A1c of 12.4. Prior to this, the only HB A1C test was 2008 with was 5.8 ( pre-diabets) and fasting blood test of 324 Feb 2009. I was denied service connection because I wasn't officially diagnosed until 4 days outside the one year window. That was over 10 years ago and I am thinking of reopening the claim because diabetes manifested within a year of discharge. What are my chances of getting this service connected? should I open the old case from 2010 or start a new claim? Also, I am service connected for Hypothyroidism. Perhaps I can diabetes secondary to hypothyroidism. Your thoughts.

  • They really got you on a technicality. The VA did have the right to deny your claim since the diabetes isn't proven to have manifested enough within that 1-year mark since the diagnosis is just shy. You have a case, however, in that diabetes is a slow-onset condition, so with only a 4-day window, you clearly had it during the 1-year period.

    Since it has been more than a year since your first claim, it's too late to appeal the original decision, so you will need to submit a new claim for the same condition (this will effectively reopen the original claim).

    You have 3 different options for claiming diabetes:

    – fight for service-connection on its own using the slow-onset factor as proof that it was present during the 1-year period. Your claim will probably be denied in the first round out of technicalities, but an appeal could definitely be successful with a strong letter from your physician clearly detailing that the condition was sufficiently present during the applicable time.
    – claim as secondary to hypothyroidism. There is a strong connection between diabetes and hypothyroidism, so with a solid NEXUS letter, this has a strong chance of success.
    – do both. Officially claim your diabetes as secondary to hypothyroidism and submit a NEXUS letter, but also include a statement and doctor's note that details that the diabetes was manifested to 10% within the 1-year mark due to its slow-onset nature and thus meets the requirements for the Presumptive List.

    https://militarydisabilitymadeeasy.com/vapresumptivelist.html#chronic

  • In 2016 DAV “helped” me file service connected claim for ED and I was denied. I didn’t know at the time it should have been filed secondary due to anti anxiety medications for PTSD.
    I recently submitted a new Secondary claim for ED, but the VA sent me a letter stating I was previously denied and I need to submit VA form 20-0995 (review request: supplemental claim).
    Since I started taking anti-anxiety medications, I have complaints of ED in my records and have medications prescribed for years now.

    Should I fill out VA Form 20-0995 stating the claim should have been submitted as a secondary claim and not as a service connected disability?
    Or is there different route I should take?
    Please help me this issue, thank you for all that you guys do for vets.

  • Yes, From 20-0995 is the correct way to go. You need to submit ample evidence of the secondary status of the condition and "new and relevant evidence," including full evidence of your PTSD, the prescribed medications, and the subsequent development of ED. You'll also want to submit a NEXUS letter from your physician stating that your ED is the result of the medications.

  • There are some cases where sleep apnea secondary to a musculoskeletal condition has been successful. You will definitely need a strong NEXUS letter from your physician clearly showing how your knees resulted in your sleep apnea. Here are a few cases that have been successful:

    https://www.va.gov/vetapp14/Files4/1424567.txt (considered aggravated instead of secondary)

    https://www.va.gov/vetapp14/Files5/1435836.txt (to low back, but could have similarities)

  • Hey all, veteran wife here!
    I have been helping my husband file his VA claim. I am very knowledgeable in the medical field and prepared his entire medical record myself to submit to the VA. I have one question. In 2014 he submitted a claim trying to link Dizziness to a service connection disability that was later denied. When he filed a new claim this year he field another dizziness claim to different service connection (tinnitus) but I was removed from the claim stating it was previously denied in 2014. 1. This is for a totally different service connection(prior to 2014) already established, and I have all the records linking vertigo(dizziness) to tinnitus. Any idea why the would remove the secondary condition from the claim? What do I do now? How do I get it back on the claim?

  • Was tinnitus on the original claim in 2014? If so, then the VA is denying the dizziness because there is no new evidence to prove service-connection. Even though it was claimed as secondary to a different condition, the VA reviews it in view of all of the claimed conditions. They basically considered it in light of the tinnitus and decided there was not enough proof of secondary connection there either.

    The best way to fix this is to provide NEW evidence regarding the dizziness. A NEXUS letter from his ENT clearly stating that the dizziness is directly caused by the tinnitus could help. Any other additional new evidence that links the conditions together will help strengthen his case.

    It's also important to note that the VA will only rate dizziness if it is officially diagnosed as a peripheral vestibular disorder. As only a condition of tinnitus, it won't qualify for an additional rating.

    https://militarydisabilitymadeeasy.com/earratings.html#balance

  • I too have ITP diagnosed Dec 2019. I am trying to connect it to jp4 exposure as there is a Citation where and Airman won. Let me know how you faired in your endeavor as I am struggling.

  • I to have ITP and am working to connect it to JP4 exposure. I was wondering if you had any luck. I have much to say as there is a Citation where and airman won his appeal on this. Please get back to me.

  • i have a va rated disability for my left knee, after multiple surgeries were unsuccessfull it dislocates on a regular bases. this causes me to fall and have to put it back in before i can stand again. saying this i was on my roof doing an emergency repair when knee dislocated causing me to fall and injure my neck pretty severely, it also dislocated on another occassion causing me to fall and fracture my hip which still hasnt healed after 3 years. i have been treated by va and they want to do fusion and replacement surgeries. can i file for secondary to my knee since it caused falls causing injuries? there were multiple witnesses on both of these occasions. if so i dont know where to begin and would like help

  • Yes, absolutely! As long as you provide evidence that the knee instability is the cause of the falls, any resulting injuries can be granted secondary service-connection and rated. Hopefully the medical records following the falls document the cause, but you can also submit letters from the witnesses noting the knee instability as the cause.

Leave a Reply

Member Help

Served With Honor

About Us

Legal

Scroll to Top