Nexus Letters

Secondary Conditions and VA Disability Claims

A secondary condition is one the VA connects to a disability it has already service-connected, rather than to your service directly. You do not have to show it started in service. You have to show it was caused or made worse by something the VA has already accepted.

The difference

Primary and secondary, in plain terms

A primary claim

Links a current condition to something that happened during service — an injury, an illness, an exposure, or the conditions of the work itself. The evidence has to reach back to your time in uniform.

A secondary claim

Links a current condition to a disability the VA has already service-connected. The evidence has to reach back only as far as that condition — and to show it caused the new one, or made it worse.

The medical question is the same in both cases: is it at least as likely as not that one thing led to the other? That is the question a nexus letter answers, and it is why a secondary claim usually needs one — the link between two conditions is rarely written down anywhere in your file.

Examples

The secondary connections we are asked about most

These are examples, not a list of what qualifies. Whether any of them applies to you is a question about your records.

Sleep apnea secondary to PTSD

Sleep apnea claimed as caused or worsened by service-connected PTSD.

Sleep apnea secondary to rhinitis and sinusitis

Sleep apnea claimed as caused or worsened by a service-connected upper-airway condition.

GERD and IBS secondary to PTSD

Gastrointestinal conditions claimed as caused or worsened by service-connected PTSD, including through the medication used to treat it.

Back conditions secondary to orthopedic conditions

A spine condition claimed as caused or worsened by another service-connected joint or limb condition, through the altered gait and loading it produces.

Mental health secondary to pain conditions

Depression or anxiety claimed as caused or worsened by a service-connected physical condition and the chronic pain that comes with it.

What a secondary claim needs

Three things, and the third is usually the gap

A service-connected condition already granted. The claim is built on it, so it has to be there first.
A current diagnosis of the new condition. Documented by a clinician, not self-reported.
A medical opinion connecting the two. Explaining how the first condition caused or aggravated the second, and why that is at least as likely as not.

The first two are usually already in your file. The third is what a nexus letter is for.

Start here

Not sure whether your condition is secondary to something already granted?

Send us your records and we will tell you what the evidence supports, including if we do not think a medical opinion would help your claim.

This page is general information, not individualized medical or legal advice.