Secondary service connection
Major depressive disorder secondary to a back condition: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided major depressive disorder claimed as secondary to a back condition in 855 decisions. It granted the issue in 49.2% of them, above the 35.3% grant rate for all major depressive disorder issues, denied it in 15.9%, and remanded it in 33.1%. Counting only decisions on the merits, 75.6% were granted.
Decisions
855
2017–2026
Granted
49.2%
All major depressive disorder: 35.3%
Granted on the merits
75.6%
Granted ÷ (granted + denied)
Remanded
33.1%
Denied: 15.9%
See all major depressive disorder decisions, direct and secondary.
Major depressive disorder secondary to a back condition: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 89 | 31.5% | 30.3% | 32.6% | 5.6% |
| 2018 | 147 | 47.6% | 17.7% | 29.3% | 5.4% |
| 2019 | 134 | 50.7% | 11.2% | 33.6% | 4.5% |
| 2020 | 97 | 48.5% | 13.4% | 36.1% | 2.1% |
| 2021 | 77 | 45.5% | 18.2% | 36.4% | 0.0% |
| 2022 | 71 | 42.3% | 15.5% | 39.4% | 2.8% |
| 2023 | 76 | 55.3% | 11.8% | 32.9% | 0.0% |
| 2024 | 86 | 55.8% | 11.6% | 32.6% | 0.0% |
| 2025 | 67 | 56.7% | 16.4% | 26.9% | 0.0% |
| 2026 | 21 | 76.2% | 0.0% | 19.0% | 4.8% |
Each row counts issues (each condition the Board decided), so the shares add up to 100%. Other: dismissed, withdrawn or no clear outcome. Years with fewer than 20 issues are left out.
Evidence in granted and denied major depressive disorder decisions
For each kind of supporting evidence: how often the Board granted the major depressive disorder issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 411 | 93.1% | 45.9% | +47.2 pts |
| Private medical opinion | 488 | 84.0% | 58.5% | +25.5 pts |
| Favorable VA exam | 176 | 88.8% | 70.3% | +18.5 pts |
| Treating physician opinion | 85 | 87.0% | 74.0% | +13.0 pts |
| Lay statement | 708 | 73.6% | 88.2% | −14.6 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 74.1% of the decisions that granted major depressive disorder.
- The Board found the veteran's statements credible in 24.7% of grants and 10.3% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often major depressive disorder was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Unfavorable VA exam | 663 | 74.4% | 80.2% | −5.7 pts |
| Negative nexus opinion | 533 | 70.8% | 83.8% | −13.0 pts |
How these claims are argued
A secondary claim says a back condition caused major depressive disorder or made it worse, and names how. Below: whether the Board's decision discussed aggravation, and the medical link each decision names, with how often those issues were granted.
Aggravation discussed
made worse by the disability, 3.310(b)
37.4%
granted, of 206 issues (23.8% of all)
Causation only
caused by the disability, 3.310(a)
52.4%
granted, of 659 issues (76.2% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Chronic pain Granted “The Board found persuasive evidence linking the psychiatric disorder to the functional impairments and pain caused by these service-connected conditions.” 26001071 (2026) Denied “VA psychiatric opinions found disorders most consistent with recent life events and chronic pain, not service.” 24021729 (2024) | 161 | 83.9% |
Nerve involvement Granted “Service connection for depressive disorder due to another medical condition is granted, found to be secondary to the service-connected lumbar spine condition and bilateral lower extremity radiculopathy.” A26001877 (2026) Denied “The veteran claimed service connection for depressive disorder secondary to service-connected right lower radial nerve and lumbar degenerative disease.” A25104968 (2025) | 70 | 67.1% |
Stress Granted “The Board found a private medical opinion probative, linking the Veteran's stress, anxiety, and depressed mood to chronic pain from these service-connected conditions.” A25061319 (2025) Denied “The Board also denied direct service connection for these psychiatric disorders, finding the medical evidence did not establish a causal link to in-service stressors.” 24021729 (2024) | 43 | 25.6% |
Sleep disruption Granted “Service connection for a psychiatric disorder, including diagnosed depressive and insomnia disorders, was granted as secondary to the Veteran's service-connected degenerative arthritis of the lumbar spine, chronic fatigue, and IBS.” 26001071 (2026) Denied “Evidence weighed against direct service connection for depression and sleep disturbance..” A24037701 (2024) | 31 | 61.3% |
Reduced activity or mobility Granted “Private medical opinion linked mental health to physical limitations” A26001877 (2026) Denied “The VA examiner noted frustration due to physical limitations but no diagnosed mental health condition or symptoms.” A25033153 (2025) | 13 | 69.2% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 32.0% of the 865 issues name at least one medical link; the rest only say “secondary to” the disability. One issue can name several links. Granted is the share of those issues granted (remands count as not granted). A link named in a denial was often the argument the Board rejected.
Why the Board granted or denied major depressive disorder
Most common reasons in grants
- Caused by the service-connected disability112
- Current diagnosis established38
- Service connection established38
- Aggravated by the service-connected disability23
- Criteria for service connection met7
- New and material evidence submitted5
- VA examiner: less likely than not related to service4
- Criteria for secondary service connection met3
Most common reasons in denials
- VA examiner: less likely than not related to service16
- Preponderance of the evidence against the claim14
- Service records negative or silent11
- No current diagnosis10
- No in-service complaints, treatment or diagnosis7
- Service connection established4
- Aggravated by the service-connected disability3
- Current diagnosis established3
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent major depressive disorder decisions
Granted
Private physician opinion found condition more likely than not secondary to service-connected injuries.; Evidence found to be in equipoise regarding nexus.; Benefit of the doubt resolved in Veteran's favor.
Private psychiatric opinion found depressive disorder caused/aggravated by chronic pain from service-connected conditions.; Private opinion cited medical literature and applied it to veteran's symptoms.; VA examiners' opinions were less favorable or speculative.; Presumption of sound mind at entry to service applied due to lack of pre-service psychiatric disorders.
Secondary service connection granted; Private medical opinion found persuasive; Benefit of the doubt applied
Denied
Private opinion inadequate due to inconsistencies with VA treatment records; Lack of clear rationale or review of medical history in private opinion; Veteran's assertions on etiology deemed incompetent
No current diagnosis during appeal period; Service treatment records negative; Post-service treatment records negative
Competent medical opinions indicated multiple etiologies unrelated to low back disability.; Weight of the evidence was against service connection.; Benefit of the doubt doctrine not applicable as evidence weighed against claim.
What VA needs to grant a secondary claim
Secondary service connection means VA disability benefits for a condition caused or made worse by a disability that is already service connected (38 CFR 3.310). The claim needs three things:
- A current diagnosis of major depressive disorder.
- A back condition is already service connected.
- Medical evidence linking them (a nexus opinion): major depressive disorder was caused by a back condition (3.310(a)), or was made worse beyond its natural progress by it (aggravation, 3.310(b)).
VA's procedures for these claims are in M21-1 V.ii.2.D. When the evidence for and against is about even, VA must decide in the veteran's favor (38 CFR 3.102).
Other conditions secondary to a back condition
- Paralysis of sciatic nerve secondary to a back condition325 decisions · 57.8% granted
- Radiculopathy secondary to a back condition1,181 decisions · 49.9% granted
- Paralysis of sciatic nerve or external popliteal nerve secondary to a back condition2,436 decisions · 38.7% granted
- Sleep apnea secondary to a back condition1,166 decisions · 38.2% granted
- Ulnar nerve paralysis secondary to a back condition628 decisions · 34.6% granted
- Peripheral nerve conditions secondary to a back condition307 decisions · 32.2% granted
- Peripheral nerve disorders secondary to a back condition1,204 decisions · 27.8% granted
- Erectile dysfunction secondary to a back condition619 decisions · 27.6% granted
- Degenerative arthritis of the spine secondary to a back condition679 decisions · 23.7% granted
- Urinary incontinence secondary to a back condition408 decisions · 22.8% granted
- Hypertension secondary to a back condition330 decisions · 20.0% granted
- Migraine secondary to a back condition347 decisions · 18.7% granted
- Hip impairment secondary to a back condition1,856 decisions · 13.6% granted
- Knee conditions secondary to a back condition2,083 decisions · 12.3% granted
- Ankle impairment secondary to a back condition322 decisions · 11.2% granted
- Cervical spine limitation of motion secondary to a back condition1,553 decisions · 8.8% granted
- Shoulder impairment secondary to a back condition647 decisions · 7.3% granted
- Foot impairment secondary to a back condition354 decisions · 6.2% granted
Major depressive disorder secondary to other conditions
See all conditions secondary to a back condition or psychiatric disorders as a primary or secondary condition.
Rules that apply to secondary major depressive disorder claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer
Research your major depressive disorder case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a major depressive disorder issue claimed as secondary to a back condition, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.