If you already have a VA disability rating, you may have another potential path to service connection that you haven’t considered: secondary conditions.

A secondary condition is a disability that was caused or aggravated by another condition that is already service connected.

For example, a veteran may have a service-connected knee condition that eventually contributes to a back condition because of altered gait. Or a veteran with service-connected tinnitus may also develop migraines that are related to the tinnitus.

The important point is that your secondary condition does not necessarily have to have started while you were on active duty.

If you can establish the required connection between your current disability and an existing service-connected condition, the secondary condition may qualify for VA disability compensation.

This guide explains how VA secondary conditions work and provides a comprehensive list of potential secondary conditions to investigate.

Important: A condition appearing on this list does not automatically mean VA will grant service connection. You generally need medical evidence establishing the required relationship between the primary service-connected condition and the secondary condition.

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What Is a VA Secondary Condition?

A secondary condition is a disability that is connected to a condition that VA has already recognized as service connected.

The basic concept is:

Service-connected condition → causes or aggravates → another disability

The second disability may then potentially be service connected on a secondary basis.

For example:

Service-connected knee condition → altered gait → back condition

Or:

Service-connected tinnitus → migraines

The second condition is not being claimed because it happened during military service.

Instead, the argument is that the second condition exists because of, or has been aggravated by, an already service-connected disability.

Secondary service connection is addressed under 38 CFR § 3.310.

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How Secondary VA Disability Claims Work

There are generally three important things to establish.

1. You have a current disability

You need evidence that the secondary condition actually exists.

This could include:

• Medical records
• A diagnosis from a physician
• Imaging
• Laboratory testing
• Specialist records
• Treatment records
• Other competent medical evidence

Simply experiencing symptoms may not always be enough to establish a compensable disability.

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2. You have a service-connected primary condition

The condition you believe caused or aggravated the secondary disability generally needs to already be service connected.

For example, if your knee condition is service connected, you could potentially investigate whether another condition developed because of that knee disability.

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3. There is a connection between the two

This is often the most important part of the claim.

You need evidence supporting the relationship between the service-connected condition and the claimed secondary condition.

This is where medical evidence can become extremely important.

A doctor may need to explain why the primary condition caused or aggravated the secondary condition.

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VA Secondary Conditions List

The following are examples of secondary-condition relationships veterans may want to investigate.

This is not an automatic list of VA-approved combinations. The relationship still has to be established in your individual case.

Secondary Conditions Related to Back Conditions

A service-connected back condition may potentially be associated with:

• Radiculopathy
• Sciatica
• Nerve conditions
• Hip problems
• Knee problems
• Foot problems
• Altered gait
• Depression or anxiety related to chronic pain
• Sleep problems
• Erectile dysfunction in certain circumstances
• Other musculoskeletal conditions

One particularly important area is radiculopathy.

A back condition involving nerve-root problems can produce symptoms such as pain, numbness, tingling, or weakness in the lower extremities.

Veterans should also pay attention to whether chronic pain or altered movement has contributed to additional orthopedic problems. Click here for more information about additional common secondary conditions related to back conditions.

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Secondary Conditions Related to Knee Conditions

Knee conditions can affect the way a person walks, stands, and distributes weight.

Potential secondary conditions may include:

• Back conditions
• Hip conditions
• Other knee conditions
• Ankle conditions
• Foot conditions
• Plantar fasciitis
• Arthritis in other joints
• Chronic pain-related mental health conditions

For example, a veteran with a severely painful service-connected knee may begin favoring one side of the body.

Over time, changes in gait and biomechanics may contribute to problems elsewhere.

That does not mean every back or hip condition automatically qualifies as secondary.

The medical evidence needs to establish the relationship. Click here for more potential secondary conditions related to knee pain.

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Secondary Conditions Related to Hip Conditions

Potential secondary conditions associated with hip problems may include:

• Back conditions
• Knee conditions
• Ankle conditions
• Foot conditions
• Altered gait
• Other joint conditions
• Chronic pain-related mental health conditions

The key question is often whether the hip condition changed the veteran’s biomechanics enough to cause or aggravate another condition.

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Secondary Conditions Related to Foot Conditions

Service-connected foot conditions can potentially affect the entire lower extremity.

Potential secondary conditions include:

• Knee problems
• Hip problems
• Back problems
• Ankle problems
• Plantar fasciitis
• Other foot conditions
• Altered gait
• Chronic pain-related mental health conditions

A veteran should not assume that a condition affecting a different body part is unrelated simply because the symptoms occur somewhere else.

The important issue is whether there is a medically supported connection.

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Secondary Conditions Related to Plantar Fasciitis

Plantar fasciitis and other chronic foot conditions can affect gait and weight distribution.

Potential secondary conditions may include:

• Knee conditions
• Hip conditions
• Back conditions
• Ankle conditions
• Other foot conditions

The strongest claims generally focus on the specific medical mechanism connecting the conditions rather than simply stating that one condition caused another.

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Secondary Conditions Related to PTSD

PTSD is one of the most important conditions to investigate for potential secondary relationships.

Depending on the veteran’s individual circumstances, potential secondary conditions may include:

• Sleep apnea
• Migraines
• Gastroesophageal reflux disease (GERD)
• Erectile dysfunction
• Hypertension
• Sleep disorders
• Substance-use disorders in certain circumstances
• Other physical or psychological conditions

However, veterans should be particularly careful with claims involving PTSD.

Simply having PTSD and another diagnosis does not establish secondary service connection.

There needs to be evidence explaining the relationship.

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Secondary Conditions Related to Sleep Apnea

Sleep apnea can potentially be associated with other disabilities, including:

• Hypertension
• Heart conditions
• GERD
• Depression
• Anxiety
• Certain cardiovascular complications

However, the direction of causation matters.

For example, saying that sleep apnea caused hypertension is different from saying hypertension caused sleep apnea.

The medical evidence needs to address the specific relationship being claimed.

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Secondary Conditions Related to Tinnitus

Tinnitus is another condition that veterans frequently investigate for secondary relationships.

Potential secondary conditions may include:

• Migraines
• Headaches
• Anxiety
• Depression
• Sleep problems

Again, these relationships are not automatic.

A veteran pursuing a secondary claim needs evidence supporting the specific connection.

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Secondary Conditions Related to Hearing Loss

Potential secondary conditions associated with hearing loss may include:

• Tinnitus
• Balance problems
• Certain psychological conditions
• Communication-related functional impairment

Hearing loss and tinnitus frequently occur together, but each condition still needs to be evaluated under the applicable VA rules.

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Secondary Conditions Related to Migraines

Potential secondary conditions associated with migraines may include:

• Depression
• Anxiety
• Sleep problems
• Certain medication-related complications
• Other conditions related to the underlying cause of the migraines

The relationship needs to be established based on the veteran’s medical circumstances.

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Secondary Conditions Related to GERD

Potential secondary conditions associated with GERD may include:

• Sleep problems
• Certain respiratory complications
• Dental problems
• Esophageal complications
• Mental health effects associated with chronic symptoms

Some veterans may also be investigating GERD as a secondary condition to another service-connected disability.

The direction of the claim is critical.

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Secondary Conditions Related to Diabetes

Diabetes can be associated with numerous complications.

Potential secondary conditions include:

• Peripheral neuropathy
• Kidney disease
• Eye conditions
• Erectile dysfunction
• Cardiovascular conditions
• Hypertension
• Foot problems
• Other diabetic complications

This is an especially important area because diabetes can affect multiple body systems.

Veterans with service-connected diabetes should discuss potential complications with their healthcare providers and make sure their medical records accurately reflect diagnosed complications.

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Secondary Conditions Related to Hypertension

Potential secondary conditions associated with hypertension may include:

• Heart disease
• Kidney disease
• Certain cardiovascular complications
• Erectile dysfunction in some circumstances

Hypertension can also potentially be the secondary condition rather than the primary condition, depending on the evidence.

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Secondary Conditions Related to Medication

One area veterans sometimes overlook is treatment-related complications.

A medication prescribed for a service-connected condition may produce side effects or complications.

Depending on the circumstances, those complications may potentially become part of a secondary-service-connection argument.

Examples could include:

• Gastrointestinal problems
• Sexual dysfunction
• Sleep problems
• Other documented medication side effects

The medical records should clearly identify the medication, the underlying condition for which it was prescribed, the resulting complication, and the medical relationship between them.

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Secondary Conditions Related to Chronic Pain

Chronic pain is another major area veterans should consider.

A long-term service-connected condition may affect:

• Sleep
• Mood
• Mobility
• Physical activity
• Relationships
• Employment
• Quality of life

Potential secondary conditions may include:

• Depression
• Anxiety
• Sleep disorders
• Certain sexual dysfunction
• Other physical conditions caused or aggravated by altered movement

The specific diagnosis and medical evidence matter.

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Can One VA Disability Have Multiple Secondary Conditions?

Yes.

A single service-connected disability can potentially be associated with more than one secondary condition.

For example:

Service-connected knee condition

→ altered gait
→ back condition
→ hip condition
→ ankle condition

At the same time:

Chronic pain from the knee condition

→ sleep problems
→ depression

This is why veterans should think about their disabilities as a connected system, rather than looking at each diagnosis in isolation.

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Can a Secondary Condition Have Its Own Secondary Conditions?

Potentially, yes.

This is sometimes referred to as a secondary-to-secondary relationship.

For example, consider a hypothetical chain:

Service-connected knee condition

→ causes back condition

Then:

Back condition

→ causes radiculopathy

The veteran may need to establish each link in the chain.

The existence of a service-connected knee disability does not automatically make every condition later diagnosed service connected.

Each connection must be supported.

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Aggravation: The Part Many Veterans Miss

Secondary service connection is not limited to conditions that were directly caused by a service-connected disability.

VA regulations also recognize situations where a service-connected disability aggravates another condition.

That distinction can be extremely important.

For example, a veteran may already have a back condition.

Later, a service-connected knee condition could make the back condition worse because of altered gait or other biomechanical effects.

The argument may therefore be:

The service-connected condition aggravated the non-service-connected condition.

That is different from saying:

The service-connected condition originally caused the condition.

When evaluating a potential secondary claim, veterans should ask both questions:

Did my service-connected disability cause this condition?

and

Did my service-connected disability make this condition worse?

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What Evidence Do You Need for a Secondary VA Claim?

Evidence will vary depending on the claim, but useful evidence may include:

Medical diagnosis

You need evidence establishing the claimed condition.

Treatment records

Medical records can demonstrate symptoms, treatment, progression, and chronicity.

Medical opinion

A medical professional may be able to explain the relationship between the service-connected condition and the secondary disability.

Medical literature

In appropriate circumstances, medical research can help explain the medical mechanism connecting two conditions.

However, general medical literature usually does not replace an individualized medical opinion.

Lay statements

Your own statements and statements from people who know you can help document symptoms and changes over time.

For example, a spouse might describe changes in sleep, mobility, mood, or behavior.

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Do You Need a Nexus Letter for a Secondary Claim?

Not necessarily.

There is no universal rule that every secondary VA claim requires a document called a “nexus letter.“

What matters is whether the evidence establishes the required connection.

A medical opinion may be especially useful when the relationship between the two conditions is not obvious or when the VA does not already have sufficient medical evidence.

A strong medical opinion should explain why the conditions are related.

Simply stating:

“Condition A is related to Condition B.”

is generally much less persuasive than an opinion that explains the medical reasoning behind the conclusion.

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How to Find Your Own Secondary Conditions

One of the easiest ways to uncover potential secondary claims is to start with every condition that VA has already service connected.

Then ask yourself:

Question 1: Has this condition caused problems somewhere else?

Think about:

• Pain
• Altered gait
• Nerve problems
• Limited mobility
• Sleep disruption
• Medication side effects
• Mental health effects

Question 2: Has this condition made another condition worse?

Don’t only look for conditions that were completely caused by the service-connected disability.

Consider aggravation as well.

Question 3: Have I developed new diagnoses since my original VA claim?

Look through your medical records.

You may find diagnoses that you never considered when filing your original claim.

Question 4: Have my doctors documented a relationship?

Look for statements in your medical records connecting one condition to another.

Question 5: Are there conditions I simply assumed were unrelated?

This is where many veterans overlook potential secondary claims.

A condition affecting your foot may eventually affect your knee.

A knee condition may affect your back.

Chronic pain may affect your mental health or sleep.

The important thing is to investigate the medical connection rather than assume there isn’t one.

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The VA Secondary Condition “Chain”

Think of your VA disabilities as a chain.

For example:

Service-connected foot condition

↓

Altered gait

↓

Knee condition

↓

Back condition

↓

Radiculopathy

There may be multiple potential claims within that chain.

But there is an important warning:

You cannot simply create a chain of disabilities and assume VA will grant every condition.

Each link needs to be supported by evidence.

The stronger your medical documentation is, the easier it becomes to understand whether a legitimate connection exists.

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Common Mistakes Veterans Make With Secondary Claims

Mistake #1: Assuming a diagnosis automatically qualifies

Having two conditions does not automatically establish a secondary relationship.

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Mistake #2: Ignoring aggravation

Veterans often ask:

“Did my service-connected condition cause this?”

They should also ask:

“Did my service-connected condition make this worse?”

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Mistake #3: Filing without understanding the medical connection

Before filing, understand the argument you’re making.

What caused the condition?

What medical mechanism connects the conditions?

What evidence supports that relationship?

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Mistake #4: Assuming you need a nexus letter in every case

A nexus letter can be useful, but it is not automatically required for every secondary claim.

The goal is sufficient competent evidence—not simply obtaining a particular document.

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Mistake #5: Forgetting about new diagnoses

Your VA claim may have been filed years ago.

Your medical situation may look completely different today.

Review your current medical records for new diagnoses and complications.

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VA Secondary Conditions Checklist

Before pursuing a secondary claim, ask:

• Do I have a current diagnosis?
• Is my primary condition service connected?
• Can I explain how the two conditions are connected?
• Do my medical records support the relationship?
• Could the primary condition have aggravated the secondary condition?
• Have I discussed the relationship with my doctor?
• Do I have evidence documenting my symptoms?
• Do I have relevant medical opinions or treatment records?
• Have I identified any additional conditions that may be related?

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The Most Important Question: What Has Changed Since Your Original Claim?

This may be the most useful way to think about secondary conditions.

Don’t just look at your original VA claim.

Look at your current medical picture.

Ask:

What conditions do I have today that I didn’t have when I originally filed?

Then ask:

Could any of those conditions be related to something VA has already service connected?

That is where secondary claims can become extremely valuable.

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Frequently Asked Questions

What is the most common secondary VA claim?

There isn’t one universal secondary claim that is guaranteed to be the most common or successful.

However, veterans frequently investigate relationships involving musculoskeletal conditions, mental health, sleep apnea, migraines, tinnitus, neuropathy, and complications of diabetes.

The evidence in the individual veteran’s case matters more than the popularity of a particular claim.

Can I claim multiple secondary conditions?

Yes. A veteran may potentially claim multiple disabilities that are caused or aggravated by a service-connected condition, provided each claim is supported by the required evidence.

Can I claim a condition that developed years after service?

Potentially, yes.

A secondary condition does not necessarily need to have developed during active duty.

The important question is whether it can be connected to an existing service-connected disability.

Can I file a secondary claim without a nexus letter?

Yes.

A separate nexus letter is not automatically required for every secondary claim.

The evidence as a whole must establish the required relationship.

Can VA deny a secondary condition?

Yes.

VA may deny a secondary claim if it determines that the evidence does not establish the required relationship, if there is no current disability, or for other reasons related to the claim.

A denial does not necessarily mean the condition can never be service connected.

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Final Thoughts

Secondary conditions can be one of the most overlooked parts of a veteran’s overall VA disability strategy.

If you already have service-connected disabilities, don’t stop at the conditions listed on your original award.

Look at what those disabilities have caused, what they have aggravated, and how your medical situation has changed over time.

A useful starting point is:

Service-connected condition → What has it affected?

Then investigate the medical evidence.

Remember, the goal isn’t to find as many conditions as possible to claim.

The goal is to identify legitimate disabilities that are medically connected to your service-connected conditions and supported by evidence.

Explore More VA Secondary Condition Guides

Continue exploring the Informed Veteran secondary-condition guides:

• VA Secondary Conditions to Back Pain
• VA Secondary Conditions to Knee Conditions
• VA Secondary Conditions to Tinnitus (Coming soon)
• VA Secondary Conditions to Sleep Apnea (Coming soon)
• VA Secondary Conditions to Plantar Fasciitis (Coming soon)
• VA Secondary Conditions to Migraines (Coming soon)
• VA Secondary Conditions to Diabetes (Coming soon)
• VA Secondary Conditions to Hip Conditions (Coming soon)
• VA Secondary Conditions to Foot Conditions (Coming soon)

Related: Learn more about how VA secondary claims work, how to establish a nexus, and what to do if your VA claim is denied.

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Medical & Legal Disclaimer

This article is for educational and informational purposes only. It is not legal, medical, or financial advice and does not create an attorney-client or doctor-patient relationship. VA disability claims are evaluated based on the facts and evidence of each individual case. Always consider consulting an accredited VA representative, attorney, claims agent, or qualified medical professional regarding your specific circumstances.