What You’ll Learn

• What is a secondary condition?
• Why secondary claims get denied
• Step-by-step filing process
• Evidence you need to win
• How to get a strong nexus letter
• Special cases and examples
• What to do if denied
• Complete filing checklist

What Is a Secondary Condition?

A secondary condition is a new health problem caused by a disability you already get VA benefits for.

The VA law (38 CFR 3.310) says you can get benefits for both conditions if:

• You already get VA benefits for one condition (called the “primary condition”)
• That condition causes or makes another condition worse (the “secondary condition”)
• You have medical proof connecting the two conditions

Simple Examples:

Why This Matters:

If the VA approves your secondary condition, you get:

• A separate disability rating for the secondary condition
• More monthly compensation
• A higher combined disability rating
• Possible path to 100% total disability

Why Secondary Claims Get Denied (And How to Avoid It)

Understanding why the VA denies secondary claims helps you build a stronger case. Here are the most common problems and how to fix them:

Common Problem	What the VA Says	How to Fix It
No nexus letter	“No medical evidence linking the conditions”	Get a medical opinion letter that says “at least as likely as not” your secondary condition is caused by your primary condition
No formal diagnosis	“Condition not confirmed by medical evidence”	Get a proper diagnosis from a qualified doctor with medical records and test results
Weak medical records	“Insufficient evidence of current disability”	Gather complete medical records showing ongoing treatment and symptoms
Missing the connection	“No clear relationship between conditions”	Get a detailed nexus letter explaining exactly how one condition causes the other
Wrong claim type	“Claim not properly filed”	Use VA Form 21-526EZ and clearly mark it as a secondary condition claim

Step-by-Step: How to File Your Secondary Claim

Follow these steps in order to give yourself the best chance of approval:

Step 1: Identify Your Primary Condition

Find the service-connected disability that is causing your new problem. For example:

• “My service-connected back injury is causing hip pain”
• “My PTSD is causing sleep problems”
• “My knee injury is causing me to walk differently, which hurts my ankle”

Step 2: Get Diagnosed

You need a formal diagnosis of your secondary condition from a qualified doctor. This means:

• See a doctor (VA or private)
• Get medical tests if needed (X-rays, blood work, etc.)
• Make sure the diagnosis is in your medical records
• Get copies of all medical records

Step 3: Get a Nexus Letter

This is the most important step. A nexus letter is a medical opinion that connects your two conditions. The doctor must:

• Review your medical records
• Examine you or review your current condition
• Write a letter saying “it is at least as likely as not” that your secondary condition is caused by your primary condition
• Explain exactly how one condition causes the other

Step 4: Gather Supporting Evidence

Collect all evidence that supports your claim:

• All medical records for both conditions
• Your nexus letter
• Personal statements describing your symptoms
• Statements from family or friends who see how the conditions affect you
• Any disability benefits questionnaires (DBQs) if available

Step 5: File Your Claim

Submit your claim using:

• Online: Go to VA.gov and file electronically
• By mail: Use VA Form 21-526EZ
• In person: Visit your local VA regional office

Make sure to:

• Clearly identify your primary service-connected condition
• Clearly identify your claimed secondary condition
• Include all your supporting evidence
• Keep copies of everything

Step 6: Respond to VA Requests

After you file:

• The VA may schedule you for a compensation and pension (C&P) exam
• They may request additional evidence
• Respond quickly to all requests
• Keep track of all deadlines

Evidence You Need to Win

Strong evidence is the key to winning your secondary claim. Here’s what you need:

Medical Records

• Primary condition records: Proof of your service-connected disability
• Secondary condition records: Diagnosis and treatment records for your new condition
• Treatment history: Show ongoing medical care for both conditions
• Test results: X-rays, MRIs, blood work, etc.

Nexus Letter (Most Important)

This medical opinion letter must include:

• Doctor’s credentials: Medical license, specialty, experience
• Record review: “I have reviewed the veteran’s complete medical records”
• Medical opinion: “It is at least as likely as not that [secondary condition] is caused by [primary condition]”
• Medical explanation: How one condition causes the other
• Timeline: When symptoms started and how they progressed
• Rule out other causes: Why other possible causes are less likely

Personal Statements

Your own written statement should describe:

• When you first noticed symptoms of the secondary condition
• How the primary condition affects your daily life
• How you believe one condition caused the other
• Specific examples of how both conditions limit you

Lay Statements

Written statements from family, friends, or coworkers who can describe:

• Changes they’ve seen in your health
• How your conditions affect your daily activities
• Their observations about your symptoms

How to Get a Strong Nexus Letter

A nexus letter is a medical opinion that connects your secondary condition to your primary condition. Here’s how to get one that the VA will accept:

Who Can Write a Nexus Letter?

• Medical doctors (MD)
• Doctors of osteopathy (DO)
• Specialists relevant to your conditions
• VA doctors (if they agree to write one)
• Private doctors

What Makes a Strong Nexus Letter?

1. Doctor’s Qualifications

The letter should start with the doctor’s credentials:

• Medical license and specialty
• Years of experience
• Relevant training or certifications

2. Record Review

The doctor must review your complete medical history:

• Service treatment records
• VA medical records
• Private medical records
• Previous VA decisions

3. Medical Opinion Using the Right Language

The doctor must use the “at least as likely as not” standard. This means there’s a 50% or greater chance your secondary condition is caused by your primary condition.

4. Medical Rationale

The doctor must explain exactly how your primary condition causes your secondary condition:

• Biological or mechanical process
• Timeline of symptom development
• Medical literature supporting the connection
• Clinical findings from examination

Where to Get a Nexus Letter

VA Doctors

• Pros: Free, familiar with VA system
• Cons: May be reluctant to write favorable letters

Private Doctors

• Pros: More likely to write favorable letters
• Cons: Can be expensive ($500-$2,000)

Independent Medical Examination Services

• Pros: Specialize in veteran claims, experienced with VA requirements
• Cons: Most expensive option

Special Cases and Common Examples

Some secondary conditions are more common than others. Here are the most frequently filed secondary claims with tips for each:

PTSD Secondary Conditions

PTSD commonly causes several secondary conditions:

Sleep Disorders

• Connection: PTSD causes nightmares, anxiety, hypervigilance
• Evidence needed: Sleep study results, medication records
• Nexus focus: How PTSD symptoms directly interfere with sleep

Depression

• Connection: PTSD and depression often occur together
• Evidence needed: Mental health treatment records, medication history
• Nexus focus: Neurochemical changes from PTSD leading to depression

Migraines

• Connection: Stress and tension from PTSD trigger headaches
• Evidence needed: Headache diary, treatment records
• Nexus focus: Stress response and muscle tension

Irritable Bowel Syndrome (IBS)

• Connection: Stress affects digestive system
• Evidence needed: GI specialist records, test results
• Nexus focus: Gut-brain connection and stress response

Orthopedic Secondary Conditions

Knee Injury → Hip/Back Problems

• Connection: Altered gait and compensation patterns
• Evidence needed: Gait analysis, imaging studies
• Nexus focus: Biomechanical stress and altered movement patterns

Back Injury → Leg Problems

• Connection: Nerve compression or radiculopathy
• Evidence needed: MRI, nerve conduction studies
• Nexus focus: Anatomical relationship between spine and legs

Diabetes Secondary Conditions

Neuropathy (Nerve Damage)

• Connection: High blood sugar damages nerves
• Evidence needed: Nerve conduction studies, blood sugar logs
• Nexus focus: Diabetic complications and blood sugar control

Kidney Disease

• Connection: Diabetes is leading cause of kidney disease
• Evidence needed: Kidney function tests, blood work
• Nexus focus: Progressive kidney damage from diabetes

Medication-Induced Secondary Conditions

Sometimes medications for your primary condition cause secondary problems:

Weight Gain → Sleep Apnea

• Connection: Psychiatric medications cause weight gain
• Evidence needed: Weight records, sleep study, medication history
• Nexus focus: Timeline of weight gain after starting medication

What to Do If Your Claim Is Denied

Don’t give up if your secondary claim is denied. You have several options to get the decision reversed:

1. Review the Denial Letter Carefully

The VA must tell you why they denied your claim. Common reasons include:

• No nexus opinion linking the conditions
• Insufficient medical evidence
• No current diagnosis of secondary condition
• Alternative causes more likely

2. Choose Your Appeal Option

Supplemental Claim (Most Common)

• When to use: You have new evidence to submit
• Examples: New nexus letter, additional medical records, stronger medical evidence
• Timeline: Can file anytime, no deadline
• Form: VA Form 20-0995

Higher-Level Review

• When to use: You think the VA made an error with existing evidence
• Examples: VA didn’t consider all your evidence, made legal error
• Timeline: Must file within 1 year of decision
• Form: VA Form 20-0996

Board Appeal

• When to use: You want a Veterans Law Judge to review your case
• Timeline: Must file within 1 year of decision
• Form: VA Form 10182

3. Strengthen Your Evidence

Get a Better Nexus Letter

• Find a doctor who specializes in your conditions
• Make sure they review ALL your medical records
• Ask for a more detailed medical explanation
• Address any weaknesses the VA identified

Gather More Medical Evidence

• Get additional diagnostic tests
• Obtain specialist consultations
• Document ongoing treatment
• Get updated medical records

Address Alternative Causes

• If the VA says another cause is more likely, get medical evidence showing why your service-connected condition is the primary cause
• Have your doctor specifically address and rule out other potential causes

4. Consider Getting Help

If your case is complex, consider getting assistance from:

• Veterans Service Organizations (VSOs): Free help from accredited representatives
• VA-accredited attorneys: Can handle complex cases, usually work on contingency
• VA-accredited claims agents: Professional help for a fee

Complete Filing Checklist

Use this checklist to make sure you have everything you need before filing your secondary claim:

Take Action Now

Don’t wait to file your secondary claim. The sooner you file, the sooner you can start receiving the benefits you’ve earned.

Need more help? Check out these additional resources:

• Battle-Tested Disability Guide – Detailed condition information
• Hidden Connections Guide – Find more secondary conditions
• VA Disability Calculator – Calculate your potential rating
• BDD Process FAQ – Filing timeline questions