Secondary Conditions to PTSD: Complete List for 2026

If you're service-connected for PTSD, you may be entitled to additional compensation for conditions caused or aggravated by your PTSD. These "secondary conditions" can significantly increase your combined rating. This guide covers the most commonly approved PTSD secondary claims.

Secondary service connection: Under 38 CFR § 3.310, you can get service connection for any disability that is "proximately due to or the result of" an already service-connected condition—or is "aggravated" by it.

Most Common PTSD Secondary Conditions

1. Sleep Apnea (Rated 0-100%)

The connection: PTSD causes hyperarousal, chronic stress, and weight gain (from medications and reduced activity)—all risk factors for obstructive sleep apnea.

Multiple studies link PTSD to increased sleep apnea risk
50% rating if using CPAP machine
Requires sleep study diagnosis and nexus letter

2. Migraines/Headaches (Rated 0-50%)

The connection: Chronic stress, sleep deprivation, and hypervigilance from PTSD commonly trigger or worsen migraines.

50% rating for prostrating attacks occurring more frequently than once a month with severe economic inadaptability
Keep a headache diary documenting frequency and severity

3. Hypertension (Rated 0-60%)

The connection: PTSD's chronic stress response elevates blood pressure over time. The "fight or flight" system stays activated, putting strain on the cardiovascular system.

Well-documented medical literature supporting connection
Need diagnosis + nexus letter
10% rating for diastolic 100-109 or systolic 160-199

4. GERD/Acid Reflux (Rated 0-60%)

The connection: Stress increases stomach acid production. PTSD medications (SSRIs, SNRIs) can also cause or worsen GERD.

30% rating for persistently recurrent symptoms with substernal pain, regurgitation
Document medication side effects

5. IBS/Digestive Issues (Rated 0-30%)

The connection: The gut-brain connection is well established. Chronic stress directly affects digestive function.

30% for severe IBS with constant abdominal distress
Also a Gulf War presumptive (separate claim path)

6. Erectile Dysfunction (Special Monthly Compensation)

The connection: PTSD causes anxiety, depression, and relationship issues that affect sexual function. PTSD medications (especially SSRIs) commonly cause ED as a side effect.

0% rating for loss of erectile power
Qualifies for Special Monthly Compensation (SMC-K): additional ~$131/month
Easy to prove with medication documentation

7. Peripheral Neuropathy (Rated 0-40% per extremity)

The connection: If PTSD leads to diabetes (through weight gain, inactivity, medication side effects), neuropathy can develop as a secondary-to-secondary condition.

8. Bruxism/TMJ (Temporomandibular Joint Disorder)

The connection: Stress and hypervigilance cause jaw clenching and teeth grinding, leading to TMJ disorder.

Rated under dental/oral conditions
Get dental records documenting grinding/clenching

9. Chronic Fatigue (Rated 0-100%)

The connection: PTSD disrupts sleep, causes hyperarousal, and depletes energy—all contributing to chronic fatigue.

10. Substance Use Disorder

The connection: Self-medication is common with PTSD. While substance abuse itself isn't directly ratable, conditions caused by the substance use (liver disease, heart conditions) may be claimed as secondary.

How to Prove Secondary Connection

Evidence That Wins

✓Nexus letter from doctor specifically stating condition is 'at least as likely as not' caused/aggravated by PTSD
✓Medical literature/studies supporting the connection
✓Timeline showing condition developed after PTSD symptoms began
✓Treatment records mentioning PTSD when discussing secondary condition
✓Documentation of PTSD medication side effects

Evidence That Loses

✗No nexus letter connecting conditions
✗Secondary condition existed before PTSD diagnosis
✗No current diagnosis of the secondary condition
✗Doctor opinion states conditions are 'unrelated'

Sample Nexus Letter Language

A strong nexus letter should include:

"It is my medical opinion that [Veteran's] sleep apnea is at least as likely as not (50% or greater probability) caused by his service-connected PTSD. The medical literature demonstrates a clear connection between PTSD and obstructive sleep apnea, as PTSD causes chronic hyperarousal, disrupted sleep architecture, and often weight gain—all significant risk factors for OSA development."

Strategic Approach to Secondary Claims

List all health issues you've developed since PTSD diagnosis
Research connections using medical literature (PubMed, VA studies)
Get current diagnoses for each potential secondary condition
Obtain nexus letters from qualified medical professionals
Document medication side effects—many secondaries stem from PTSD treatment
File claims strategically—some veterans file secondaries after primary is established

Aggravation claims: Even if a condition existed before service or before PTSD, you can claim it as secondary if PTSD made it worse. The rating is based on the degree of aggravation.

Don't forget: Each secondary condition gets its OWN rating that combines with your existing rating using VA math. Five conditions rated at 10% each can significantly boost your overall rating.