VA Ratings Guide

Author: Col. James R. Whitfield (Ret.)

  • Depression Secondary to Tbi: VA Rating Guide 2026

    Depression Secondary to Tbi: Key Facts

    Typical VA Rating 50% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Tbi rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that depression was directly caused by your military service — only that it was caused or worsened by your service-connected Tbi. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Tbi → Depression

    Neurological damage from TBI alters mood regulation pathways. Depression secondary to TBI is well-established in VA case law.

    To establish secondary service connection for depression, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your depression was caused or aggravated by your service-connected Tbi. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Depression Secondary to Tbi

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Tbi and depression.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List depression as a secondary condition on your claim form, citing your service-connected Tbi as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Depression: What to Expect

    If your secondary claim is granted, VA will rate your depression under the appropriate diagnostic code, typically at 50% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Tbi and receive a 50% rating for depression, your combined rating would be approximately 85% (not 120%).

    Nexus Letter Requirements for Depression Secondary to Tbi

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Tbi predates depression diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for depression secondary to Tbi, the examiner will likely ask:

    • When did your depression symptoms begin relative to your Tbi diagnosis?
    • Has your depression worsened since your Tbi was diagnosed?
    • What treatments have you received for depression?
    • How does depression affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your depression.

  • Sleep Apnea Secondary to Tbi: VA Rating Guide 2026

    Sleep Apnea Secondary to Tbi: Key Facts

    Typical VA Rating 50% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Tbi rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that sleep apnea was directly caused by your military service — only that it was caused or worsened by your service-connected Tbi. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Tbi → Sleep Apnea

    TBI damages the brainstem and hypothalamus, disrupting respiratory control during sleep. Strong nexus for secondary service connection.

    To establish secondary service connection for sleep apnea, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your sleep apnea was caused or aggravated by your service-connected Tbi. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Sleep Apnea Secondary to Tbi

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Tbi and sleep apnea.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List sleep apnea as a secondary condition on your claim form, citing your service-connected Tbi as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Sleep Apnea: What to Expect

    If your secondary claim is granted, VA will rate your sleep apnea under the appropriate diagnostic code, typically at 50% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Tbi and receive a 50% rating for sleep apnea, your combined rating would be approximately 85% (not 120%).

    Nexus Letter Requirements for Sleep Apnea Secondary to Tbi

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Tbi predates sleep apnea diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for sleep apnea secondary to Tbi, the examiner will likely ask:

    • When did your sleep apnea symptoms begin relative to your Tbi diagnosis?
    • Has your sleep apnea worsened since your Tbi was diagnosed?
    • What treatments have you received for sleep apnea?
    • How does sleep apnea affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your sleep apnea.

  • Ptsd Secondary to Tbi: VA Rating Guide 2026

    Ptsd Secondary to Tbi: Key Facts

    Typical VA Rating 50% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Tbi rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that PTSD was directly caused by your military service — only that it was caused or worsened by your service-connected Tbi. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Tbi → Ptsd

    TBI and PTSD frequently co-occur after combat or blast exposure. VA rates them separately under different diagnostic codes.

    To establish secondary service connection for PTSD, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your PTSD was caused or aggravated by your service-connected Tbi. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Ptsd Secondary to Tbi

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Tbi and PTSD.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List PTSD as a secondary condition on your claim form, citing your service-connected Tbi as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Ptsd: What to Expect

    If your secondary claim is granted, VA will rate your PTSD under the appropriate diagnostic code, typically at 50% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Tbi and receive a 50% rating for PTSD, your combined rating would be approximately 85% (not 120%).

    Nexus Letter Requirements for Ptsd Secondary to Tbi

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Tbi predates PTSD diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for PTSD secondary to Tbi, the examiner will likely ask:

    • When did your PTSD symptoms begin relative to your Tbi diagnosis?
    • Has your PTSD worsened since your Tbi was diagnosed?
    • What treatments have you received for PTSD?
    • How does PTSD affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your PTSD.

  • Migraines Secondary to Tbi: VA Rating Guide 2026

    Migraines Secondary to Tbi: Key Facts

    Typical VA Rating 30% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Tbi rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that migraines was directly caused by your military service — only that it was caused or worsened by your service-connected Tbi. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Tbi → Migraines

    Post-traumatic headaches are among the most common TBI sequelae. VA rates migraines secondary to TBI based on frequency and prostrating attacks.

    To establish secondary service connection for migraines, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your migraines was caused or aggravated by your service-connected Tbi. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Migraines Secondary to Tbi

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Tbi and migraines.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List migraines as a secondary condition on your claim form, citing your service-connected Tbi as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Migraines: What to Expect

    If your secondary claim is granted, VA will rate your migraines under the appropriate diagnostic code, typically at 30% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Tbi and receive a 30% rating for migraines, your combined rating would be approximately 79% (not 100%).

    Nexus Letter Requirements for Migraines Secondary to Tbi

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Tbi predates migraines diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for migraines secondary to Tbi, the examiner will likely ask:

    • When did your migraines symptoms begin relative to your Tbi diagnosis?
    • Has your migraines worsened since your Tbi was diagnosed?
    • What treatments have you received for migraines?
    • How does migraines affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your migraines.

  • Tinnitus Secondary to Ptsd: VA Rating Guide 2026

    Tinnitus Secondary to Ptsd: Key Facts

    Typical VA Rating 10% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Ptsd rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that tinnitus was directly caused by your military service — only that it was caused or worsened by your service-connected Ptsd. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Ptsd → Tinnitus

    Hypervigilance from PTSD amplifies perception of tinnitus. Rated separately from any noise-induced tinnitus.

    To establish secondary service connection for tinnitus, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your tinnitus was caused or aggravated by your service-connected Ptsd. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Tinnitus Secondary to Ptsd

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Ptsd and tinnitus.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List tinnitus as a secondary condition on your claim form, citing your service-connected Ptsd as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Tinnitus: What to Expect

    If your secondary claim is granted, VA will rate your tinnitus under the appropriate diagnostic code, typically at 10% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Ptsd and receive a 10% rating for tinnitus, your combined rating would be approximately 73% (not 80%).

    Nexus Letter Requirements for Tinnitus Secondary to Ptsd

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Ptsd predates tinnitus diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for tinnitus secondary to Ptsd, the examiner will likely ask:

    • When did your tinnitus symptoms begin relative to your Ptsd diagnosis?
    • Has your tinnitus worsened since your Ptsd was diagnosed?
    • What treatments have you received for tinnitus?
    • How does tinnitus affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your tinnitus.

  • Erectile Dysfunction Secondary to Ptsd: VA Rating Guide 2026

    Erectile Dysfunction Secondary to Ptsd: Key Facts

    Typical VA Rating 0% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Ptsd rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that erectile dysfunction was directly caused by your military service — only that it was caused or worsened by your service-connected Ptsd. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Ptsd → Erectile Dysfunction

    PTSD medications (SSRIs) commonly cause erectile dysfunction. VA rates ED as secondary to PTSD medication side effects.

    To establish secondary service connection for erectile dysfunction, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your erectile dysfunction was caused or aggravated by your service-connected Ptsd. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Erectile Dysfunction Secondary to Ptsd

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Ptsd and erectile dysfunction.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List erectile dysfunction as a secondary condition on your claim form, citing your service-connected Ptsd as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Erectile Dysfunction: What to Expect

    If your secondary claim is granted, VA will rate your erectile dysfunction under the appropriate diagnostic code, typically at 0% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Ptsd and receive a 0% rating for erectile dysfunction, your combined rating would be approximately 70% (not 70%).

    Nexus Letter Requirements for Erectile Dysfunction Secondary to Ptsd

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Ptsd predates erectile dysfunction diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for erectile dysfunction secondary to Ptsd, the examiner will likely ask:

    • When did your erectile dysfunction symptoms begin relative to your Ptsd diagnosis?
    • Has your erectile dysfunction worsened since your Ptsd was diagnosed?
    • What treatments have you received for erectile dysfunction?
    • How does erectile dysfunction affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your erectile dysfunction.

  • Gerd/Acid Reflux Secondary to Ptsd: VA Rating Guide 2026

    Gerd/Acid Reflux Secondary to Ptsd: Key Facts

    Typical VA Rating 10% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Ptsd rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that GERD/acid reflux was directly caused by your military service — only that it was caused or worsened by your service-connected Ptsd. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Ptsd → Gerd/Acid Reflux

    PTSD increases gut motility dysfunction. VA recognizes GERD as secondary to PTSD when the PTSD predates the digestive symptoms.

    To establish secondary service connection for GERD/acid reflux, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your GERD/acid reflux was caused or aggravated by your service-connected Ptsd. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Gerd/Acid Reflux Secondary to Ptsd

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Ptsd and GERD/acid reflux.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List GERD/acid reflux as a secondary condition on your claim form, citing your service-connected Ptsd as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Gerd/Acid Reflux: What to Expect

    If your secondary claim is granted, VA will rate your GERD/acid reflux under the appropriate diagnostic code, typically at 10% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Ptsd and receive a 10% rating for GERD/acid reflux, your combined rating would be approximately 73% (not 80%).

    Nexus Letter Requirements for Gerd/Acid Reflux Secondary to Ptsd

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Ptsd predates GERD/acid reflux diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for GERD/acid reflux secondary to Ptsd, the examiner will likely ask:

    • When did your GERD/acid reflux symptoms begin relative to your Ptsd diagnosis?
    • Has your GERD/acid reflux worsened since your Ptsd was diagnosed?
    • What treatments have you received for GERD/acid reflux?
    • How does GERD/acid reflux affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your GERD/acid reflux.

  • Hypertension Secondary to Ptsd: VA Rating Guide 2026

    Hypertension Secondary to Ptsd: Key Facts

    Typical VA Rating 10% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Ptsd rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that hypertension was directly caused by your military service — only that it was caused or worsened by your service-connected Ptsd. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Ptsd → Hypertension

    PTSD-related chronic stress elevates cortisol and adrenaline, directly contributing to sustained high blood pressure.

    To establish secondary service connection for hypertension, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your hypertension was caused or aggravated by your service-connected Ptsd. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Hypertension Secondary to Ptsd

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Ptsd and hypertension.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List hypertension as a secondary condition on your claim form, citing your service-connected Ptsd as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Hypertension: What to Expect

    If your secondary claim is granted, VA will rate your hypertension under the appropriate diagnostic code, typically at 10% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Ptsd and receive a 10% rating for hypertension, your combined rating would be approximately 73% (not 80%).

    Nexus Letter Requirements for Hypertension Secondary to Ptsd

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Ptsd predates hypertension diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for hypertension secondary to Ptsd, the examiner will likely ask:

    • When did your hypertension symptoms begin relative to your Ptsd diagnosis?
    • Has your hypertension worsened since your Ptsd was diagnosed?
    • What treatments have you received for hypertension?
    • How does hypertension affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your hypertension.

  • Migraines Secondary to Ptsd: VA Rating Guide 2026

    Migraines Secondary to Ptsd: Key Facts

    Typical VA Rating 30% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Ptsd rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that migraines was directly caused by your military service — only that it was caused or worsened by your service-connected Ptsd. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Ptsd → Migraines

    Chronic stress and hyperarousal from PTSD trigger migraine episodes. Studies show veterans with PTSD have 3x higher migraine rates.

    To establish secondary service connection for migraines, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your migraines was caused or aggravated by your service-connected Ptsd. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Migraines Secondary to Ptsd

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Ptsd and migraines.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List migraines as a secondary condition on your claim form, citing your service-connected Ptsd as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Migraines: What to Expect

    If your secondary claim is granted, VA will rate your migraines under the appropriate diagnostic code, typically at 30% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Ptsd and receive a 30% rating for migraines, your combined rating would be approximately 79% (not 100%).

    Nexus Letter Requirements for Migraines Secondary to Ptsd

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Ptsd predates migraines diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for migraines secondary to Ptsd, the examiner will likely ask:

    • When did your migraines symptoms begin relative to your Ptsd diagnosis?
    • Has your migraines worsened since your Ptsd was diagnosed?
    • What treatments have you received for migraines?
    • How does migraines affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your migraines.

  • Major Depressive Disorder Secondary to Ptsd: VA Rating Guide 2026

    Major Depressive Disorder Secondary to Ptsd: Key Facts

    Typical VA Rating 50% (varies by severity)
    Legal Basis 38 CFR 3.310 — Secondary Service Connection
    What You Need Nexus letter from physician + medical records showing the connection
    BVA Grant Rate ~62% when supported by a nexus letter
    Combined Rating Impact Added to your existing Ptsd rating using VA combined ratings formula

    What Is Secondary Service Connection?

    Secondary service connection under 38 CFR 3.310 allows VA to compensate a disability that was caused or aggravated by an already service-connected condition. You do not need to show that major depressive disorder was directly caused by your military service — only that it was caused or worsened by your service-connected Ptsd. This is one of the most powerful and underused tools in the VA claims system.

    The Medical Nexus: Ptsd → Major Depressive Disorder

    PTSD and depression are highly comorbid. VA rates them separately if they have distinct symptom clusters, or as a combined rating if symptoms overlap.

    To establish secondary service connection for major depressive disorder, your nexus letter must state, at minimum, that it is “at least as likely as not” (50% or greater probability) that your major depressive disorder was caused or aggravated by your service-connected Ptsd. The VA uses this “at least as likely as not” standard — it does not need to be certain, just probable.

    How to File for Major Depressive Disorder Secondary to Ptsd

    1. Get a nexus letter from your treating physician or a private independent medical opinion (IMO) provider. The letter must explicitly state the causal connection between your Ptsd and major depressive disorder.
    2. File VA Form 21-526EZ (if you haven’t already) or a supplemental claim if you’ve been previously denied.
    3. List major depressive disorder as a secondary condition on your claim form, citing your service-connected Ptsd as the cause.
    4. Attend your C&P exam — the examiner will evaluate the nexus. If the examiner provides a negative nexus opinion, you can rebut it with your private nexus letter.
    5. If denied, file a supplemental claim with new and relevant evidence (your nexus letter) or appeal to the Board of Veterans’ Appeals.

    VA Rating for Major Depressive Disorder: What to Expect

    If your secondary claim is granted, VA will rate your major depressive disorder under the appropriate diagnostic code, typically at 50% for moderate severity. The rating is then combined with your existing ratings using the VA combined ratings formula — it does not simply add to your current percentage. For example, if you are currently rated 70% for Ptsd and receive a 50% rating for major depressive disorder, your combined rating would be approximately 85% (not 120%).

    Nexus Letter Requirements for Major Depressive Disorder Secondary to Ptsd

    A strong nexus letter for this claim should include:

    • The physician’s credentials and familiarity with VA claims
    • A review of your medical history showing the timeline (service-connected Ptsd predates major depressive disorder diagnosis)
    • A citation to medical literature supporting the causal relationship
    • The “at least as likely as not” opinion stated explicitly
    • A statement that the opinion is based on a review of the claims file and examination of the veteran

    Common C&P Exam Questions for This Claim

    At your C&P exam for major depressive disorder secondary to Ptsd, the examiner will likely ask:

    • When did your major depressive disorder symptoms begin relative to your Ptsd diagnosis?
    • Has your major depressive disorder worsened since your Ptsd was diagnosed?
    • What treatments have you received for major depressive disorder?
    • How does major depressive disorder affect your daily functioning and ability to work?

    Answer these questions honestly and specifically. Describe your worst days, not your average days. The examiner is evaluating both the nexus and the severity of your major depressive disorder.