Secondary service connection
Major depressive disorder secondary to PTSD: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided major depressive disorder claimed as secondary to PTSD in 305 decisions. It granted the issue in 62.0% of them, above the 35.3% grant rate for all major depressive disorder issues, denied it in 9.2%, and remanded it in 26.6%. Counting only decisions on the merits, 87.1% were granted.
Decisions
305
2017–2026
Granted
62.0%
All major depressive disorder: 35.3%
Granted on the merits
87.1%
Granted ÷ (granted + denied)
Remanded
26.6%
Denied: 9.2%
See all major depressive disorder decisions, direct and secondary.
Major depressive disorder secondary to PTSD: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 26 | 61.5% | 7.7% | 23.1% | 7.7% |
| 2018 | 38 | 68.4% | 5.3% | 18.4% | 7.9% |
| 2019 | 41 | 51.2% | 7.3% | 41.5% | 0.0% |
| 2020 | 39 | 56.4% | 7.7% | 35.9% | 0.0% |
| 2021 | 35 | 57.1% | 14.3% | 28.6% | 0.0% |
| 2022 | 22 | 54.5% | 13.6% | 27.3% | 4.5% |
| 2023 | 29 | 65.5% | 10.3% | 20.7% | 3.4% |
| 2024 | 32 | 68.8% | 6.3% | 25.0% | 0.0% |
| 2025 | 26 | 80.8% | 7.7% | 11.5% | 0.0% |
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 Other: dismissed, withdrawn or no clear outcome.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 | 154 | 97.0% | 71.1% | +25.9 pts |
| Favorable VA exam | 113 | 96.1% | 79.1% | +16.9 pts |
| Combat service | 64 | 92.5% | 85.4% | +7.1 pts |
| Treating physician opinion | 47 | 92.5% | 85.9% | +6.6 pts |
| Private medical opinion | 125 | 90.0% | 84.6% | +5.4 pts |
| Lay statement | 262 | 86.2% | 95.5% | −9.3 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 71.4% of the decisions that granted major depressive disorder.
- The Board found the veteran's statements credible in 47.6% of grants and 17.9% 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 |
|---|---|---|---|---|
| Negative nexus opinion | 141 | 81.2% | 92.2% | −11.1 pts |
| Unfavorable VA exam | 206 | 82.8% | 97.0% | −14.2 pts |
How these claims are argued
A secondary claim says PTSD 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)
48.5%
granted, of 33 issues (10.8% of all)
Causation only
caused by the disability, 3.310(a)
63.6%
granted, of 272 issues (89.2% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Stress Granted “Same in-service stressors applied to PTSD and major depression.” A26006754 (2026) Denied “Major depressive disorder diagnosis not based on verified in-service stressor.” 23019570 (2023) | 26 | 42.3% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 11.8% of the 305 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 disability38
- Current diagnosis established29
- Service connection established12
- Aggravated by the service-connected disability4
- Secondary to PTSD3
- PTSD is service-connected3
- Service connection criteria met3
- Intertwined with service-connected PTSD2
Most common reasons in denials
- No current diagnosis4
- Current diagnosis established3
- Preponderance of the evidence against the claim2
- Service records negative or silent2
- No causal or etiological relationship to service shown1
- No basis for separate compensable evaluations1
- Diagnosis of psychiatric conditions requires medical expertise and clinical testing1
- Medical opinions attributed depression to post-service back injury and economic factors1
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
Depression symptoms could not be disassociated from PTSD; Symptom overlap between PTSD and depression noted; Service connection warranted as a manifestation of PTSD
Current diagnosis of MDD established.; PTSD is service-connected.; Private medical opinion linked MDD to PTSD with favorable nexus.
VA examiner found MDD met DSM-5 criteria; Examiner opined MDD caused by inability to cope with PTSD symptoms; Examiner provided positive nexus to service
Denied
No current diagnosis of Major Depressive Disorder (MDD) found.; Evidence shows depressed mood, but not MDD.; Symptoms responsive to therapy and coping skills.
PDD considered subsumed by PTSD; No separate service connection warranted
Symptoms subsumed by PTSD diagnosis; Anti-pyramiding rule (38 C.F.R. § 4.14); No distinct symptoms shown
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.
- PTSD is already service connected.
- Medical evidence linking them (a nexus opinion): major depressive disorder was caused by PTSD (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 PTSD
- Migraine secondary to PTSD1,732 decisions · 37.1% granted
- Sleep apnea secondary to PTSD11,479 decisions · 31.7% granted
- Erectile dysfunction secondary to PTSD1,645 decisions · 30.3% granted
- Gastroesophageal reflux disease (GERD) secondary to PTSD1,237 decisions · 25.3% granted
- Irritable colon syndrome (spastic colitis mucous colitis) secondary to PTSD380 decisions · 24.2% granted
- Diabetes mellitus secondary to PTSD551 decisions · 20.3% granted
- Hypertension secondary to PTSD3,194 decisions · 16.5% granted
Major depressive disorder secondary to other conditions
See all conditions secondary to PTSD 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 PTSD, 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.