Combat veterans and PTSD: a claim map

The claim map

A claim map follows one veteran's route: how they served, the condition the law makes easier to prove for that service, and the conditions that follow from it. Each box shows how the Board ruled at that step.

How they served

Combat service

The veteran engaged in combat with the enemy, shown by the records or by a combat decoration

33,560 Board decisions that record combat service

stressor eased by law38 CFR 3.304(f)(2)

Step 1 · stressor eased by law

PTSD

46.4% granted

2,170 of 4,673 veterans · all PTSD claims 27.1%

secondary38 CFR 3.310(a)

Step 2 · claimed secondary to PTSD

60.6%granted when the same decision granted the PTSD

4.5%granted when it did not

Step 2 depends on step 1: a secondary claim needs a service-connected condition to attach to.

• Sleep apnea DC 6847

  32.2% · 188 of 584

  all veterans 32.8%

• Hypertension DC 7101

  19.9% · 28 of 141

  all veterans 18.2%

• Erectile dysfunction DC 7522

  36.1% · 26 of 72

  all veterans 33.0%→ may open special monthly compensation

• Migraine / headaches DC 8100

  43.7% · 31 of 71

  all veterans 35.6%

• Acid reflux (GERD) DC 7206

  19.6% · 10 of 51

  all veterans 27.9%

• Depression DC 9434

  77.3% · 17 of 22

  all veterans 65.2%

• COPD DC 6604

  28.6% · 6 of 21

  all veterans 14.3%

• Irritable bowel syndrome DC 7319

  50.0% · 10 of 20

  all veterans 30.8%

• Anxiety DC 9400

  68.4% · 13 of 19

  all veterans 39.4%

• Neurocognitive disorder DC 9326

  75.0% · 12 of 16

  all veterans 56.1%

Bar: share granted in Board decisions that record combat service (one count per veteran; a remand counts as not granted). Red mark: all veterans with the same claim. Step 2 counts claims decided in the same decision; conditions with at least 15 veterans.

Does combat make a PTSD claim easier to prove?

Yes, for the stressor. Under 38 U.S.C. 1154(b) and 38 CFR 3.304(f)(2), if the evidence shows the veteran engaged in combat and the stressor is related to that combat, the veteran's own testimony can establish that it happened, unless clear and convincing evidence shows otherwise. In decisions that record combat service, the Board granted 46.4% of PTSD claims, against 27.1% for all veterans.

33,560 Board decisions from 2020 to 2025 record combat service. This page counts the PTSD claims in them, rated under DC 9411. Whether a decision records combat service was read by AI from the decision; the limits are below.

What does a combat veteran still have to prove?

A diagnosis of PTSD that meets the criteria in 38 CFR 4.125(a), and medical evidence that links the current symptoms to the stressor (38 CFR 3.304(f)). For 682 denials, the Board's note named the diagnosis in 76.8% of them, the link in 46.2% and the stressor in 40.8%.

The combat rule answers only one question: did the stressor happen? A veteran with a confirmed combat stressor can still be denied when the examiner does not diagnose PTSD, or diagnoses a different condition, or does not link the symptoms to the stressor.

How does VA decide whether a veteran engaged in combat?

From the evidence as a whole; there is no limit on the kind of evidence that can show it (M21-1 VIII.iv.1.D). Some decorations, such as the Combat Infantryman Badge, the Combat Action Ribbon and the Purple Heart, make VA presume combat unless clear and convincing evidence shows otherwise (M21-1 VIII.iv.1.A.3.h).

The second step: conditions claimed secondary to PTSD

What conditions can be claimed secondary to PTSD?

Sleep apnea was the most common: granted for 188 of 584 combat veterans (32.2%) in the same decisions, against 32.8% for all veterans. Migraine was granted 43.7%, erectile dysfunction 36.1%, hypertension 19.9% and acid reflux 19.6%.

Claimed secondary to PTSD	Combat veterans	All veterans
Sleep apnea	32.2% (188 of 584)	32.8%
Hypertension	19.9% (28 of 141)	18.2%
Erectile dysfunction	36.1% (26 of 72)	33.0%
Migraine or headaches	43.7% (31 of 71)	35.6%
Acid reflux (GERD)	19.6% (10 of 51)	27.9%

The combat rule helps prove the stressor, not the link between PTSD and another condition. That link rests on medical evidence. For the most common secondary claims, sleep apnea, hypertension and erectile dysfunction, combat veterans came out close to all veterans. Some smaller ones did better, such as depression and anxiety, and acid reflux did worse, all on small numbers.

Does the second step depend on the first?

Yes. When the same decision granted the PTSD, the conditions claimed secondary to it were granted 60.6% of the time (63 of 104). When it did not, 3 of 66 were granted.

Most secondary claims came where the PTSD was not on appeal, usually because it was already service connected: 1,116 veterans, 29.7% granted. Those claims stood on a medical opinion about the link.

Read the decisions

Recent decisions, with the Board's reasoning as summarized by AI:

• A25111116, December 2025: PTSD granted on conceded combat stressors in Southwest Asia and a VA mental health assessment that diagnosed PTSD consistent with them.
• A25109434, December 2025: obstructive sleep apnea granted secondary to service-connected PTSD, on a private medical opinion.
• A25110053, December 2025: PTSD claimed from mortar and rocket attacks in Iraq, denied; several VA exams found no PTSD diagnosis that met the diagnostic criteria.

What the data cannot tell you

Combat service is an AI-extracted finding for the whole decision, and it is often part of how the Board explains a PTSD grant, so the gap at the first step shows what the decisions contained, not what caused the result. Service-connection claims only; rating appeals are left out. The second step counts only claims decided in the same decision. Denial notes are AI-extracted. These are historical outcomes, not predictions.

For representatives

• Show the combat first: decorations, unit records, and the veteran's account of the event.
• Get a diagnosis that meets the criteria and an opinion that ties the symptoms to the combat stressor.
• After the grant, screen for the conditions that follow: sleep apnea, migraine, hypertension, erectile dysfunction and acid reflux, each with its own medical opinion.