VA Disability Compensation

Secondary Conditions

A disability you already have a rating for can cause a new one, or make an old one worse. VA can pay for that too. Here is the rule, the evidence, and the traps.

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Veterans Crisis Line — dial 988, then press 1. Text 838255. Chat at veteranscrisisline.net. TTY 711 then 988, or 1-800-799-4889. 24 hours a day, 7 days a week. You do not have to be enrolled in VA benefits or health care to connect.
What a secondary claim is. A secondary service-connected disability is a condition caused by — or made worse by — a disability VA has already service connected for you. You file it the same way you filed the first one, and it gets its own rating. The rule is 38 CFR 3.310, titled "Disabilities that are proximately due to, or aggravated by, service-connected disease or injury." Nothing here is automatic. VA publishes no list of approved secondary conditions. Every claim stands on its own evidence. If you are a Soldier still in uniform, read this before you out-process — the records you build now are the evidence you will need later.
Flowchart

A secondary claim, start to finish

Six steps, in order. The rule behind each one is on this page.

  1. Start with a condition VA has already grantedYour primary condition has to be one VA has already service connected and rated. That is your starting point. 38 CFR 3.310
  2. Find the condition it caused or made worseThe new condition has to be "proximately due to or the result of" the service-connected one, or made worse by it. VA publishes no list of approved pairs; every claim stands on its own evidence.
    Examples veterans claim, none automatic:Knee → back or hipTinnitus → anxiety or migrainesPTSD → sleep apneaMedication → the condition it caused
    Made worse: VA needs a baseline, see Aggravated Conditions. Claim the condition, not the "side effect."
  3. Get it diagnosedA provider has to name the new condition in your records. A symptom alone is not a claim.
  4. Get the link in writingVA calls this the nexus: a medical opinion tying the new condition to the service-connected one.
    Who can write it
    • VA doctor
    • Private doctor
    • Specialist (sleep, ortho, mental health)
    • VA C&P examiner, when VA asks for the opinion at your exam
    What it should say
    • The condition is "at least as likely as not" caused or aggravated by the service-connected one
    • The reasons why
    • The records, treatment history or medical literature it relies on
    A paid nexus letter is not always required: see The Nexus Letter. Obesity counts only as a middle step: see Mental Health Secondaries.
  5. Protect your date, then fileFile the intent to file (VA Form 21-0966) first. Then file VA Form 21-526EZ within one year: online, by mail, or with an accredited representative. Make sure it names the service-connected condition the new one comes from, and send your evidence with it.
    Service treatment recordsCurrent medical recordsNexus opinionLay statements (VA Form 21-10210)Medical literature
    38 CFR 3.155(b)
  6. VA reviews and decidesYou get a written decision with the rating and effective date. If it is denied, you have three review lanes: see Appeal a VA decision.
    Evidence reviewC&P exam, if VA needs oneGrant or denyWritten notice
The test every secondary claim has to pass: the new condition was caused or made worse by the service-connected one, and competent medical evidence says so.
Start here

There are two routes, not one

Most people only ever hear about the first one. The second one is real money.

  • Route one — causation. 38 CFR 3.310(a). A condition that is "proximately due to or the result of" a service-connected disability. Your rated knee changes how you walk; the changed walk wears out your hip; you claim the hip.
  • Route two — aggravation. 38 CFR 3.310(b). You had a condition that is not service connected, and your service-connected disability made it worse. VA pays for the increase — the amount it got worse — as long as the worsening is not just the natural progress of that disease.
On route two, do not let anybody tell you that you need records from before it got worse. The regulation gives you two ways to set the baseline: medical evidence created before the aggravation started, or "the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity." If you have no old records, the earliest records made after the worsening began can still carry the claim. File it.
One narrow exception written into 3.310(a) itself: if the original disability was service connected because of your tobacco use in service, a condition secondary to it is not granted under 3.310(a) (38 CFR 3.300(c)). That is the only carve-out in the paragraph.
★ Caused it, or made it worse. Both count.
The link

What VA actually needs from you

The word for the connection between the old condition and the new one is nexus.

  • A current diagnosed condition — a doctor has named it in your records.
  • An already service-connected disability.
  • Evidence of a link between the two.
VA's own words on that link: "Usually we need medical records or medical opinions from health care providers to support this link. In certain circumstances, we may also accept lay evidence, like a buddy statement (VA Form 21-10210)." Read that twice. It says usually — not always. If no doctor will write you an opinion, that is not the end of the claim. A lay or witness statement from your spouse, a Family member, a battle buddy, or anyone who has watched the change in you is accepted evidence in certain circumstances. File it and let VA weigh it.
You do not always have to buy a nexus letter. Where the record shows a current diagnosis, an established service-connected disability, and an indication the two may be related, VA must provide a medical examination or obtain a medical opinion at no cost to you when one is needed to decide the claim — 38 CFR 3.159(c)(4). Go to the C&P exam VA schedules. Missing it can lose the claim.
★ Usually medical. Not only medical.
Free money

The two things VA presumes

In these two places only, you do not have to prove the link at all.

1. Cardiovascular disease after a leg amputation — 38 CFR 3.310(c). This one is narrow. It applies only if you are service connected for amputation of one lower extremity at or above the knee, or amputations of both lower extremities at or above the ankles. Then ischemic heart disease or other cardiovascular disease "shall be held to be the proximate result of the service-connected amputation." Note the difference: one leg has to be at or above the knee; both legs qualify at or above the ankles. It is not a general heart-disease presumption and it does not reach any other amputation.
2. After a service-connected traumatic brain injury — 38 CFR 3.310(d). If you are service connected for TBI, these are held to be the result of it, absent clear evidence to the contrary:
  • Parkinsonism, including Parkinson's disease — after moderate or severe TBI
  • Unprovoked seizures — after moderate or severe TBI
  • Presenile dementia of the Alzheimer type, frontotemporal dementia, or dementia with Lewy bodies — within 15 years of moderate or severe TBI
  • Depression — within 3 years of a moderate or severe TBI, or within 12 months of a mild TBI
  • Diseases of hormone deficiency resulting from hypothalamo-pituitary changes — within 12 months of moderate or severe TBI
Depression is the only one on that list reachable after a mild TBI. The regulation carries its own severity table — structural imaging, loss of consciousness, alteration of consciousness, post-traumatic amnesia, Glasgow Coma Scale — and whether your TBI is graded mild or moderate-to-severe is what decides which of these you get.
Missing the time window is not a denial. 38 CFR 3.310(d)(2) says these rules "shall not preclude a finding of service connection" based on evidence of proximate causation outside those parameters. Outside the window you are back to route one with a nexus opinion — which is still a live claim.
★ Two presumptions. Both narrow. Both real.
The trap

Pyramiding — the rule that denies claims

38 CFR 4.14. You cannot be paid twice for the same thing.

The regulation: "the evaluation of the same disability under various diagnoses is to be avoided," and "the evaluation of the same manifestation under different diagnoses are to be avoided." It names "dyspnea, tachycardia, nervousness, fatigability" as examples of manifestations that "may result from many causes" and must not be double-counted. It also warns that disability from injuries to the muscles, nerves and joints of an extremity "may overlap to a great extent."
  • If a symptom is already written into the rating formula for a condition you have, claiming it again as a separate condition gets denied.
  • The move is not to file a second claim. The move is to document that symptom and ask for an increase on the rating you already hold.
  • Stacking five overlapping claims in the same arm or leg can end with fewer ratings, not more.
★ Same symptom, one payment.
Know the difference

A symptom is not a claim

VA rates diagnosed disabilities. It does not rate complaints.

  • Get it diagnosed and named. VA eligibility runs on "a current illness or injury (known as a condition)." Filing for "knee pain," "hip pain" or "neck pain" with nothing diagnosed behind it draws a denial. Get it examined and get a name in the record.
  • Fatigue, altered gait, mobility impairment, secondary joint pain, balance problems — filed as conditions, these lose. Filed as evidence, they raise a rating or lead you to the diagnosis that pays.
  • "Falls" is an event, not a disability. Claim the injury from the fall — the fractured wrist, the head injury.
  • "Medication side effects" is not a rateable thing. Name the condition the medication caused, and claim that.
★ Name the diagnosis. Then file.
Mental health

All of it is one rating — file it anyway

This is where I see the most wasted filings, and the most bad advice.

A diagnosed mental health condition can be granted as secondary, but VA normally pays one evaluation for all of your service-connected mental disorders. How to file it, what the one rating covers, and TDIU are on our page Mental health secondaries.

Two more things from the same part of the regulation. 38 CFR 4.126(b): VA "shall not assign an evaluation solely on the basis of social impairment" — so social isolation on its own pays nothing. 38 CFR 4.126(c): a neurocognitive disorder is rated on the mental-disorder formula, but "neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined." For a veteran with TBI, that is separate money most people never ask for.
★ One rating. Still claim the diagnosis.
Spine and nerves

What is inside the back rating, and what is not

The spine codes cover more than most veterans realize — and less.

  • Inside it already: limited range of motion and muscle spasm. The General Rating Formula for Diseases and Injuries of the Spine (DC 5235-5243, which includes 5237, lumbosacral or cervical strain) rates by measured forward flexion and ankylosis, "with or without symptoms such as pain (whether or not it radiates), stiffness, or aching." Claiming those separately is pyramiding. Document them for an increase.
  • Headache from the neck. A separately diagnosed headache disorder secondary to a service-connected cervical strain is a legitimate claim under 3.310(a), rated by analogy. Headache is not one of the symptoms the spine formula lists, so it is not barred as pyramiding.
Nerve damage running down an arm or a leg is rated separately from the spine. Which nerve, which code and the bilateral factor are on our page Lumbar spine secondaries.
Muscle weakness in the affected leg is already inside the nerve rating. Balance is not — the sciatic nerve criteria are written in terms of muscle function and foot drop, not balance. A diagnosed vestibular or balance disorder has its own code and can be claimed.
★ One nerve, one rating. Two nerves, two.
Feet, ankles, legs

The chain reaction claim

This is the most common secondary claim I help people see, and VA uses it as its own example.

  • An altered gait, favoring one side, or a changed posture from a service-connected injury puts extra stress on the feet, ankles, knees, hips, back and neck. Chronic conditions that develop from that stress may be granted as secondary.
  • VA's own illustration is exactly this shape: a service-connected knee injury causes a limp, and the limp causes arthritis in the hip.
  • Still not automatic. You need the diagnosis and the link — usually a medical opinion describing the mechanism, the altered gait or the changed load.
Some of these conditions are not named in the rating schedule at all. Heel spurs and shin splints are examples. That does not mean they cannot be rated — 38 CFR 4.20 allows rating an unlisted condition "under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous." Do not let anyone tell you there is no code, so there is no claim.
★ Follow the limp. It goes somewhere.
Special rules

Two claims that need to be filed differently

Weight gain and obesity. Obesity by itself cannot be service connected. VA General Counsel precedent opinion VAOPGCPREC 1-2017 holds that "obesity per se is not a 'disability' for purposes of 38 C.F.R. 3.310." The way it still helps you: obesity can be an intermediate step in a chain. If a service-connected condition caused the weight gain, and the weight gain was a substantial factor in causing a further condition, and that further condition would not have happened without it, the further condition can be granted as secondary. Claim the downstream condition, not the weight.
Alcohol and substance use. 38 U.S.C. 1110 and 1131 both say "no compensation shall be paid if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs," and 38 CFR 3.301(a) bars direct service connection for it. The doors that are still open: under Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001), an alcohol or substance use disorder can be service connected as secondary to an already service-connected disability, with clear medical evidence that the service-connected condition caused the abuse. Separately, 38 CFR 3.301(c)(2) provides that "organic diseases and disabilities which are a secondary result of the chronic use of alcohol as a beverage, whether out of compulsion or otherwise, will not be considered of willful misconduct origin," and 3.301(c)(3) says the same for chronic drug use and adds "infections coinciding with the injection of drugs." The organ damage is a different and often better path than the use disorder. Ask an accredited representative which one fits you.
And remember the mental-health rule above: drinking that is a symptom of a mental disorder you are already rated for is paid inside that rating, not as a new claim.
★ Closed door, open window.
Other doors

Two things that are not secondary claims

Dental damage. Under 38 CFR 3.381(b), treatable carious teeth, replaceable missing teeth, dental and alveolar abscesses and periodontal disease are noncompensable — they are service connected for outpatient dental treatment purposes only. 38 CFR 4.150 rates loss of teeth only where it comes from loss of substance of the body of the maxilla or mandible, and only "where the lost masticatory surface cannot be restored by suitable prosthesis"; those ratings "apply only to bone loss through trauma or disease such as osteomyelitis." Acid erosion from reflux does not meet that. Where to go instead: VA dental care eligibility under 38 CFR 17.161. Ask VA dental about Class VI — a dental condition clinically determined to be complicating a medical condition currently under treatment. Class II(a) covers a noncompensable dental condition resulting from combat wounds or service trauma; Class IV covers veterans rated 100 percent schedular or paid at the 100 percent rate for unemployability.
If VA care itself caused the new disability. That is not a 3.310 secondary claim — it is a 38 U.S.C. 1151 claim. It compensates additional disability or death caused by VA "hospital care, medical or surgical treatment, or examination" where there was "carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault," or "an event not reasonably foreseeable." It is paid as if the disability were service connected. Different claim, same paperwork trail — raise it with a representative.
★ Wrong claim type is still a denial.
How to file

Four steps, and one to do first

Do this before anything else: file an intent to file. VA Form 21-0966 tells VA you are coming, and VA says it "can secure the earliest possible effective date for any retroactive payments you may be eligible to receive." If you apply online instead, VA says "your effective date gets set automatically when you start filling out the form online — before you submit it." The intent to file expires. Under 38 CFR 3.155(b), your completed application has to reach VA within one year of the intent to file for that earlier date to hold. Miss the year and it is gone.
  1. Get diagnosed. The new condition has to be named by a provider in your records.
  2. Get the link. A medical opinion saying the condition is "at least as likely as not" caused or aggravated by your service-connected disability — or lay and buddy statements where medical evidence is not available (VA Form 21-10210).
  3. File VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits — the same form as an original claim. Online at va.gov/disability/how-to-file-claim is the faster route and sets your effective date as you start.
  4. Send the evidence. Records, imaging, treatment notes, the nexus opinion if you have one. Keep records that show the change over time — the gait, the balance, the mobility, the pain.
There is no deadline to file a secondary claim. You can file any time after the primary condition is service connected — five years later, twenty years later. But your effective date is tied to when VA hears from you, not to when the condition started. That is the whole reason to put the intent to file in first and build the evidence after. Waiting does not buy you a better date.
★ Protect the date. Then build the file.
Do not quit

If it comes back denied

Denial is a normal first outcome on secondary claims. It is not the end.

The three review lanes, their forms and their clocks, including the contested-claim rule, are on our page Appeal a VA decision. The Supplemental Claim effective-date trap (38 CFR 3.2500) is on Help your own claim. Official pages: Higher-Level Review, Board Appeal, Supplemental Claim.

★ A denial is a step, not a verdict.
Your money

Who can help you, and what they may charge

VA accredits three kinds of representative, not one.

  • An accredited Veterans Service Organization representative
  • An accredited attorney
  • An accredited claims agent
VA's own words: "the services an accredited VSO representative provides on your VA benefit claims are always free. But an accredited attorney or claims agent can charge you fees." 38 CFR 14.636 puts it squarely: "Recognized organizations (including their accredited representatives when acting as such) and individuals recognized under § 14.630 of this part are not permitted to receive fees." A VSO representative cannot charge you. Full stop. Find one at va.gov/get-help-from-accredited-representative.
If you do hire an attorney or agent, they may charge only after VA's initial decision on the claim. The fee rules are on our page Help your own claim.
★ Free help exists. Use it first.
Do not give up on it

Two things people quit over too early

A 0 percent rating is still a win. A secondary granted at 0 percent pays nothing today, but it establishes service connection for that condition. That opens VA treatment for it and it is the foundation for an increase later when the condition gets worse. Veterans see the zero and stop pursuing. Do not.
Travel pay does not start at 30 percent. VA lists as its own separate qualifier: "You're traveling for treatment of a service-connected condition, even if your VA disability rating is less than 30%." If you are driving to VA for care on a condition VA has service connected, check va.gov/health-care/get-reimbursed-for-travel-pay whatever your percentage is.
And when you file the secondary, look at the primary at the same time. If the condition you are already rated for has gotten worse, claim the increase alongside it instead of leaving it on the table.
★ Zero percent is a foot in the door.
Ratings and chains

Rating facts that decide what you file

Every one of these is in VA's own rating schedule. Each new condition is rated on its own code.

  • Tinnitus (DC 6260) is rated 10 percent, one rating no matter whether you hear it in one ear, both ears or your head. 38 CFR 4.87 says a separate tinnitus rating "may be combined with an evaluation under diagnostic codes 6100, 6200, 6204, or other diagnostic code, except when tinnitus supports an evaluation under one of those diagnostic codes." If you have hearing loss or a head injury on file, tinnitus is its own claim. Heads up: in February 2022 VA proposed deleting DC 6260 and compensating tinnitus only through related codes such as 6100, 6204 and 8045, depending on its cause (Federal Register proposed rule, 15 Feb 2022). As of September 2026 I found no final rule from VA. Check the Federal Register before you rely on the 10 percent.
  • Dizziness and balance (DC 6204, peripheral vestibular disorders) pays 10 percent for occasional dizziness and 30 percent for dizziness with occasional staggering. The regulation requires "objective findings supporting the diagnosis of vestibular disequilibrium" before any compensable rating, so get the balance testing done, not only a note that you feel dizzy.
  • Migraine (DC 8100) is rated by prostrating attacks: less frequent attacks 0 percent, about one every two months 10 percent, about once a month 30 percent, very frequent completely prostrating and prolonged attacks 50 percent. Keep a log of every attack and how long it kept you down.
  • Jaw (TMJ) problems (DC 9905, 38 CFR 4.150) are rated from 10 percent up to 50 percent, based on how far the mouth opens, side-to-side jaw movement and diet limits. Ratings for limited opening and limited side-to-side movement are not combined.
  • Sciatic nerve (DC 8520) pays 10 percent (mild incomplete), 20 (moderate), 40 (moderately severe), 60 (severe with marked muscle wasting) and 80 percent (complete paralysis).
  • PTSD and other mental disorders (DC 9411 and the General Rating Formula, 38 CFR 4.130) run 0, 10, 30, 50, 70 and 100 percent. The top level is 100, so do not assume 70 is the ceiling.
  • Back (DC 5237 and the spine formula) also goes to 100 percent, for unfavorable ankylosis of the entire spine. It is not capped at 40.
If your service-connected condition is a traumatic brain injury. 38 CFR 4.124a, DC 8045, rates the residuals in three areas: cognitive impairment, emotional and behavioral problems, and physical or neurological problems. It also says to "separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease." Migraines, vertigo or a balance disorder and a seizure disorder after a TBI are therefore claimed and rated on their own codes, not folded into one number. Each still needs its own diagnosis and a medical link.
★ Find the code. Then file the condition.

Migraine (DC 8100)

Page reviewed September 2026.less frequent attacks0 percentabout one every two months10 percentabout once a month30 percentvery frequent completely prostrating50 percent
Migraine (DC 8100) is rated by prostrating attacks: less frequent attacks 0 percent, about one every two months 10 percent, about once a month 30 percent, very frequent completely prostrating and prolonged attacks 50 percent.VA's own rating schedule
Diabetes

Three ways diabetes gets connected

  • Secondary. Under 38 CFR 3.310 diabetes can be claimed if a condition VA already service connected caused it or made it worse. If you take medication or treatment for a service-connected condition and your doctor ties the diabetes to it, the claim is the diabetes, with the medical opinion linking them. It is not automatic.
  • Obesity as a middle step. The same chain rule from the "Special rules" section applies. Obesity itself is not a disability, but if a service-connected condition caused weight gain and the weight gain was a substantial factor in causing the diabetes, the diabetes can be claimed as the downstream condition.
  • Presumptive. Type 2 diabetes is on the herbicide list in 38 CFR 3.309(e) for veterans exposed to herbicide agents. Diabetes mellitus is also a chronic disease under 38 CFR 3.309(a); 38 CFR 3.307(a)(3) presumes it if it "became manifest to a degree of 10 percent or more" within one year after separation, for veterans with qualifying wartime or post-1946 service. No link needs proving in either case.
  • Complications of diabetes you already have connected. Kidney disease, nerve damage and similar conditions that come from service-connected diabetes are claimed as secondary. VA rates them under the diabetes rule, 38 CFR 4.119, Diagnostic Code 7913, Note (1): compensable complications are evaluated separately, and noncompensable ones are "considered part of the diabetic process." A complication that rates 0% is folded into the diabetes rating instead of getting its own. For the diabetes, thyroid and adrenal rating levels, see Diabetes, Thyroid and Adrenal VA Ratings.
Diabetes comes with its own complications claims. DC 7913 is rated 10, 20, 40, 60 or 100 percent by treatment (diet only, oral medication, insulin, regulation of activities). Under the rating note, compensable complications of diabetes are rated separately unless they support the 100 percent level, and non-compensable ones are part of the diabetes rating. Diabetic nerve damage in the hands and feet is the common one. Get it diagnosed, then file it.
★ Three doors. Check all three.
Get help now

Where to call and where to go

★ Call. Ask. Write down who you talked to.
Sources

Where these facts come from

Next step: Plan Your VA Claim walks you through a claim in six steps. Prepare Your VA Claim is a printable checklist.