Claiming Secondary Conditions for VA Disability

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 to claim the secondary condition is submit VA-Form 21-526b along with all 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.


  • 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 :

    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.