Secondary Service Connection For PTSD

Post-traumatic stress disorder (PTSD) is a trauma and stressor-related disorder that has received widespread attention since the wars in Iraq and Afghanistan began. Common symptoms of PTSD include, but are not limited to, depression, anxiety, and sleep issues.

The symptoms of PTSD are typically divided into four primary categories:

  • Avoidance: PTSD can cause a person to be easily triggered by any factors that remind them of their trauma. If you have PTSD, you may find yourself avoiding certain places, people, activities, and anything else that brings back unpleasant memories of your traumatic experiences. This avoidance can lead to isolation and often makes it difficult for Veterans with PTSD to maintain their jobs.
  • Reliving: Veterans with PTSD often relive their traumatic experiences in the form of nightmares, flashbacks, and other forms of disturbing recollections. In addition, many sufferers of PTSD struggle to sleep due to these recollections, and some even develop insomnia. The intense flashbacks and nightmares caused by PTSD can make it difficult to function during the day and to get enough rest at night.
  • Negative Thoughts and Feelings: For some Veterans with PTSD, the disorder is a source of intense guilt and shame. Some Veterans who suffer from the disorder may feel that it is their fault that they endured traumatic experiences. This idea is perpetuated by the toxic “blame the victim” mentality pervading many aspects of American society. However, it’s important to note that PTSD is not a weakness, nor is it the sufferer’s fault that they deal with the effects of their traumatic experiences.
  • Arousal: Many people with PTSD experience heightened anxiety and increased sensitivity to external stimuli. Veterans with PTSD may feel like they are constantly “switched on,” even if there is nothing in their environment that seems to be wrong. Potential triggers of this aroused state can include factors that serve as reminders of a Veteran’s traumatic experiences.

How PTSD Can Lead To Other Disabilities

PTSD will often cause other conditions or disabilities. If you’ve been diagnosed with PTSD, chances are you suffer from what is known as secondary conditions. Some examples of conditions secondary to PTSD are sleep apnea, gastroesophageal reflux disease (GERD), hypertension, migraines, and erectile dysfunction.

You can receive additional VA disability compensation for each of these conditions if you show they are related to your service-connected PTSD. The first step is recognizing the symptoms of these conditions.

Sleep Apnea 

Sleep apnea is typically diagnosed via sleep study, where professionals determine whether your breathing during sleep is stopping momentarily. Obstructive sleep apnea occurs when the upper airway becomes blocked during sleep, reducing or stopping airflow. Symptoms of sleep apnea include:

  • Snoring
  • Waking up gasping for air
  • Daytime fatigue

If you experience some or all of these symptoms, it may be worthwhile to do a sleep study.

Breathing devices such as CPAP machines and lifestyle changes are common changes. Undiagnosed or untreated sleep apnea can lead to serious complications, such as:

  • Glaucoma
  • Diabetes
  • Behavioral disorders
  • Heart attack
  • Cancer

If you receive service connection for sleep apnea after being diagnosed with service-connected PTSD, your sleep apnea will be considered a secondary condition. This means your military service did not directly cause the disability – instead, PTSD, your service-connected disability, led to the development of sleep apnea. If you can verify that PTSD caused you to develop sleep apnea through medical records and other evidence, the VA will likely recognize your sleep apnea as a secondary condition.


GERD occurs when stomach acid flows into your esophagus, irritating its lining. GERD symptoms depend on the severity of the condition. Mild symptoms include heartburn and belching. More severe symptoms include regurgitation of food, difficulty swallowing, and substernal arm or shoulder pain. Some people wake up choking on acid or food that has regurgitated while they are sleeping. If you experience any of these symptoms, you may want to consider an examination for possible GERD.

Depending on the severity of your GERD symptoms, you may be able to qualify for significant disability benefits for the condition. However, milder symptoms may also be considered not disabling enough to warrant an increased disability rating. If you attempt to file for GERD as a secondary condition, make sure that your symptoms are severe enough to affect your life significantly. If the VA considers your GERD to be less than 10% disabling, you will not be able to qualify for an increased disability rating.


Hypertension, also known as high blood pressure, occurs when the blood force on the artery walls is too high. Recent research shows that hypertension may be aggravated by stress and anxiety, which are very common PTSD symptoms.

It’s important to note that high blood pressure can put you at risk of other serious health problems. Make sure to seek medical treatment for hypertension, even if you cannot get service connection for the condition.

If you are struggling to convince the VA that your hypertension was caused or worsened by PTSD, consider getting an independent medical examination (IME) from a private doctor. You can then present your IME results to the VA as part of an appeal, which can potentially change the outcome of your disability claim.

Migraines and Headaches 

A migraine is a headache of varying intensity that is sometimes associated with nausea and lightheadedness. Several studies correlate the severity of PTSD with the severity of migraine and other types of headaches.

If you are suffering from frequent and severe headaches, you may qualify for increased disability benefits. If you can determine that your headaches are caused or exacerbated by your PTSD symptoms, the VA will most likely raise your disability rating. However, the VA may re-examine your condition in the years that follow your increased rating to determine whether you are still dealing with the same severity of symptoms. 

Erectile Dysfunction 

While having erection trouble from time to time isn’t necessarily a cause for concern, it could be diagnosed as erectile dysfunction if it becomes an ongoing issue. On top of occasionally making sex more difficult, it can cause stress, affect self-confidence, and even contribute to relationship problems. Some people experience this as a side effect of the medications they are taking.

PTSD medication and erectile dysfunction may be linked in some cases. If you are dealing with chronic problems with getting an erection and are a disabled Veteran who has PTSD, you may qualify for increased disability benefits. 

It’s also important to note that you should never stop taking your PTSD medication in an attempt to treat erectile dysfunction. Make sure to stick with your normal medication regimen unless your doctor instructs you to do otherwise.

Secondary Service Connection 

If you receive a diagnosis for any of the above conditions, you may be able to get a secondary service connection related to PTSD. You must already have PTSD service-connected to receive secondary service connection based on PTSD.

Once you have established a service connection for PTSD, you can build a case for secondary service connection. For sleep apnea, GERD, or erectile dysfunction, you must have a diagnosis and provide evidence that your condition stems from PTSD or from the medication you take for PTSD. The most substantial evidence in secondary service connection cases comes in the form of medical opinions.

For example, if you want to get service connection for sleep apnea secondary to PTSD, you would want to obtain a medical opinion from a psychiatrist, psychologist or pulmonologist indicating that it is likely your sleep apnea is related to your PTSD. The medical professional would provide supporting rationale for his or her opinion.

Understanding Your Condition 

While those studies are not necessarily definitive in and of themselves, they do provide a basis for asking your doctor or other medical professionals for an opinion on whether your PTSD may have caused or aggravated these common secondary conditions. Each person’s situation is different, and your doctor or medical professional is best suited to determine whether your conditions are related.

Veterans Serving Veterans 

Berry Law was founded by Vietnam War Veteran and legendary trial lawyer John Stevens Berry Sr. We are proud to have many military Veterans among our attorneys and staff who understand what it means to serve and know firsthand the struggles many of our clients face every day.

If your secondary service connection claim for PTSD has been denied, Berry Law may be able to help. We have been successfully representing Veterans for decades. Contact us today for a free evaluation.