Secondary service connection
Conditions secondary to PTSD
Veterans with service-connected PTSD often claim other conditions as caused or worsened by it. This page lists those conditions, what VA needs to grant them, and how they fared when veterans appealed to the Board of Veterans' Appeals.
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 the secondary condition.
- PTSD is already service connected.
- Medical evidence linking them (a nexus opinion): the secondary condition 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).
Conditions claimed secondary to PTSD
Conditions the Board decided at least 300 times as secondary to this disability, highest appeal grant rate first. Open one for the evidence and reasons behind the decisions.
- Major depressive disorder secondary to PTSD305 decisions · 62.0% granted
- 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
How VA rates PTSD
Once service connection is granted, VA assigns a disability rating from the rating schedule, 38 CFR 4.130. Posttraumatic stress disorder (diagnostic code 9411) is rated under the General Rating Formula for Mental Disorders, the same scale as every other mental disorder code. The rating is the same whether the condition is service connected directly or as secondary to another disability.
| Rating | Criteria |
|---|---|
| 100% | Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. |
| 70% | Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. |
| 50% | Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. |
| 30% | Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). |
| 10% | Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. |
| 0% | A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. |
Common conditions rated under the same formula
- Schizophrenia DC 9201
- Generalized anxiety disorder DC 9400
- Unspecified anxiety disorder DC 9413
- Bipolar disorder DC 9432
- Major depressive disorder DC 9434
- Unspecified depressive disorder DC 9435
- Chronic adjustment disorder DC 9440
All 23 other codes under the General Rating Formula for Mental Disorders
Delusional disorder (9208), Other specified and unspecified schizophrenia spectrum and other psychotic disorders (9210), Schizoaffective disorder (9211), Delirium (9300), Major or mild neurocognitive disorder due to HIV or other infections (9301), Major or mild neurocognitive disorder due to traumatic brain injury (9304), Major or mild vascular neurocognitive disorder (9305), Unspecified neurocognitive disorder (9310), Major or mild neurocognitive disorder due to Alzheimer's disease (9312), Major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder (9326), Specific phobia; social anxiety disorder (social phobia) (9403), Obsessive compulsive disorder (9404), Other specified anxiety disorder (9410), Panic disorder and/or agoraphobia (9412), Dissociative amnesia; dissociative identity disorder (9416), Depersonalization/Derealization disorder (9417), Somatic symptom disorder (9421), Other specified somatic symptom and related disorder (9422), Unspecified somatic symptom and related disorder (9423), Conversion disorder (functional neurological symptom disorder) (9424), Illness anxiety disorder (9425), Cyclothymic disorder (9431), Persistent depressive disorder (dysthymia) (9433).
Text of 38 CFR 4.130 as of Feb 27, 2026. Confirm the current text at the source before relying on it.
All Board decisions on PTSD, direct and secondary: PTSD grant rates.
Rules that apply to secondary 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 - 38 CFR 4.130 · DC 9411
Schedule of ratings: mental disorders
Read it in VA Law Explorer - 38 CFR 3.304(f)
Service connection for PTSD
Read it in VA Law Explorer - M21-1 V.iii.13
Mental disorders: scope of the claim, change of diagnosis, reductions
Read it in VA Law Explorer - M21-1 IV.i.3.B.1.d
Reviewing a mental health examination report
Read it in VA Law Explorer
Research your secondary case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
Where this data comes from
- Claim
- Regional office decides
- Veteran appeals
- Board decides
- Granted · Denied · Remanded: back to the regional office
Board of Veterans' Appeals decisions show how VA's highest review body applies 38 CFR and weighs evidence on contested claims.
Each one is an appeal: a regional office decided the claim first, and the veteran appealed. So these rates describe the Board, not a veteran's odds at the regional office, where most claims are decided and whose decisions are not public.
More on what Board decisions can and cannot tell you