The Playbook › Step 7 of 7: Raise and protect your rating
A secondary condition is a disability that did not start in service, but was caused or made worse by a condition that is already service connected. VA compensates secondary conditions the same way as any other. Each one gets its own rating, and those ratings combine with the rest.
For many veterans, secondary claims are the most realistic way to reach a higher combined rating.
The short version
- You need three things: a current diagnosis, an existing service-connected condition, and a medical opinion linking the two.
- The link can be causation or aggravation.
- Side effects of medication for a service-connected condition count.
- A nexus letter is nearly always required.
- File on VA Form 21-526EZ and name the primary condition.
On this page
Two kinds of secondary connection
Caused by. The service-connected condition directly led to the new one. A veteran with a service-connected right knee favors that leg for years and develops a left hip problem.
Aggravated by. The new condition has another cause, but the service-connected condition made it permanently worse than it would otherwise be. VA compensates the degree of worsening. This requires medical evidence of how severe the condition was before the aggravation, which can be hard to establish.
Common pairings
These are examples that come up often. None is automatic. Each needs medical evidence in your own case.
| Primary service-connected condition | Possible secondary conditions |
|---|---|
| Knee, ankle, or foot conditions | Opposite-side joints, hip and low back problems from altered gait |
| Back conditions | Radiculopathy (nerve pain in the legs), depression |
| PTSD and other mental health conditions | Sleep apnea, migraines, GERD, hypertension, erectile dysfunction, substance use disorders caused by the condition |
| Chronic pain of any kind | Depression, anxiety, insomnia |
| Diabetes | Peripheral neuropathy, kidney disease, eye conditions, erectile dysfunction, heart disease |
| Tinnitus | Migraines, anxiety, depression, insomnia |
| Traumatic brain injury | Migraines, depression, cognitive disorders, certain conditions VA presumes |
| Hypertension | Heart disease, kidney disease, stroke |
| Medications for any service-connected condition | GERD and stomach problems from anti-inflammatories, weight gain, erectile dysfunction, liver or kidney effects |
Our condition guides cover several of these in detail: tinnitus, migraines, sleep apnea, depression and anxiety, GERD and IBS, hypertension, radiculopathy, and foot conditions.
Radiculopathy deserves a mention
Nerve pain, numbness, or tingling running down the legs from a back condition is rated separately for each leg, in addition to the back rating. If the examiner did not test for it and you have these symptoms, raise it. See back ratings.
What you must prove
- A current diagnosis of the secondary condition.
- A service-connected primary condition. It can be rated at 0%. It only needs to be service connected.
- A medical link. A medical professional states it is at least as likely as not that the primary condition caused or aggravated the secondary one, and explains why.
The third element is where these claims are won or lost. VA examiners frequently give negative opinions on secondary claims with little explanation. A reasoned private opinion that cites your records and the medical literature is the best counter.
Building a strong secondary claim
- Timeline. Show the secondary condition appeared after the primary one.
- Treatment notes that mention the link. If your doctor has written “depression related to chronic pain,” that is valuable.
- Medical literature. A good nexus letter cites studies supporting the connection.
- Rule out other causes, or address them. If you have other risk factors, the opinion should explain why the service-connected condition is still at least an equal cause.
- Your statement. Describe how one condition leads to the other in your daily life.
A note on obesity
VA does not treat obesity as a disability in its own right. But it can act as a middle step. If a service-connected condition caused weight gain, for example by preventing exercise, and the weight gain was a substantial factor in causing another condition such as sleep apnea, the chain can support a secondary claim. This needs a careful medical opinion addressing each step.
How to file
- Submit an Intent to File if your evidence is not ready.
- File VA Form 21-526EZ. Add the condition as new and state what it is secondary to, for example “GERD, secondary to medication for service-connected lumbar strain.”
- Upload the diagnosis and the nexus opinion.
- Attend the exam.
The effective date is generally the date VA receives the secondary claim. It does not go back to the date of the primary condition.
Why secondary claims matter for your combined rating
Because of the way ratings combine, adding a new rated condition often moves your combined rating more than a small increase on an existing one. Run the numbers in the calculator and see VA math.
Secondary conditions also count toward the thresholds for TDIU.
Common mistakes
- Filing with no medical opinion
- Claiming a condition as secondary when it is really a symptom already covered by the primary rating. VA will not rate the same symptom twice.
- Not naming the primary condition on the form
- Giving up after a negative C&P opinion. See what to do after a denial.
Free printable checklist. Everything to gather before you file, what to bring to your C&P exam, and what to check in your decision, on two pages.
Last reviewed October 2026. This guide is general educational information, not legal or medical advice, and this site is not affiliated with the Department of Veterans Affairs. Rules and rates change. Confirm details on VA.gov or with an accredited representative. See our disclaimer and editorial policy.