Filing a Claim for Common Secondary Conditions

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This is general education, not legal or claims advice, and not guidance for your specific claim. It cannot promise you a rating or an outcome, and no one can. For help with your own claim, see a free accredited representative (see Get free, accredited help below). Nothing here creates a representative relationship.

Current as of October 2026. Rules, forms, and figures change. Check current details at va.gov.

The best way to use this guide

The strongest position is to be your own informed advocate and to work with a free accredited representative. An accredited Veterans Service Organization, such as the DAV, VFW, American Legion, or a county or state veterans office, helps at no charge. Accredited claims agents and attorneys can help too. They can't charge for work done before VA issues its initial decision on your claim, and after that they may charge a fee within the limits of 38 CFR 14.636. This guide is here so you understand your own situation and can work with them as a full partner instead of handing it over blind. If you'd rather handle this yourself, and you're comfortable doing that, the guide walks you through every step. Either way, you stay in control.

What you'll get done

The outcome: By the end of this guide you'll identify your likely secondary conditions by body system and file complete secondary service-connection claims on VA Form 21-526EZ under 38 CFR 3.310.

This guide prepares you for the task. It doesn't and can't promise a rating, a percentage, or an outcome. The evidence in your file decides the result.

What you need before you start

• Internet access for VA.gov, or the VA hotline at 1-800-827-1000.
• A list of your service-connected conditions and their diagnostic codes.
• Current diagnoses for the secondary conditions you plan to claim.
• A medical opinion for each secondary that names the primary condition, if you have one. VA can also get one at an exam.
• The names, cities, and treatment dates of the facilities that hold your records.
• Your VA file number, if you have one.

When to start: Whenever you have a service-connected condition and a new problem that grew out of it. An Intent to File (online at VA.gov, by phone at 1-800-827-1000, or on VA Form 21-0966) protects your potential effective date for one year while you gather evidence. One Intent to File holds the date only for the first complete compensation claim you file after it, so put every secondary on that same claim.

Start here: the basics

A secondary condition is one that's caused or made worse by a condition VA has already service connected. A secondary claim rests on three things: a service-connected primary condition, a current diagnosis of the secondary, and medical evidence linking the two. That evidence can be your own provider's opinion or an opinion VA gets at a C&P exam. Secondaries often cluster by body system, for example mental health conditions that follow chronic pain, sleep apnea linked to PTSD, radiculopathy from a back condition, or reflux from medications. These are examples only, not a promise about your case. This guide doesn't print rating percentages; look up how each condition is evaluated at va.gov.

One rule to know before you list mental health secondaries. VA gives one mental health rating for all of your service-connected mental health diagnoses. If you already have one, like PTSD, a new one such as depression secondary to chronic pain adds its symptoms to that one rating instead of getting its own.

Where this is written down: 38 CFR § 3.310; 38 CFR § 3.159(c)(4); 38 CFR § 4.14; 38 CFR § 4.130.

The steps

Step 1. List your service-connected conditions and their diagnostic codes.

How. Write down every condition the VA has already service-connected and the diagnostic code for each. This is the foundation: a secondary claim always attaches to a primary condition that's already service-connected.

Done when you have a written list of your service-connected conditions and their diagnostic codes.

Step 2. Identify likely secondaries by body system.

How. Match your service-connected conditions to the conditions they commonly cause or worsen. Common patterns, as examples only and not a promise for your case: mental health conditions secondary to chronic pain or tinnitus; sleep apnea secondary to PTSD or to weight gain from a service-connected condition; radiculopathy secondary to a service-connected back condition; gastroesophageal reflux (GERD) secondary to medications; migraines secondary to a traumatic brain injury; erectile dysfunction secondary to PTSD or its medications; and hypertension secondary to PTSD or diabetes.

Do not claim a secondary you haven't actually been diagnosed with. A hunch isn't a claim; you need a real diagnosis (Step 3).

Done when you have listed the specific secondary conditions you may have, each tied to a named primary.

Step 3. Get a current diagnosis of each secondary condition.

How. See the right provider and get the secondary condition diagnosed and documented in your medical records. VA needs a current disability to grant a claim.

Done when each secondary condition you plan to claim has a current, documented diagnosis.

Step 4. Get a nexus opinion tying each secondary to the named primary.

How. Ask a provider to state whether the secondary condition is "at least as likely as not caused or aggravated by" your named service-connected primary, and why. A useful opinion names the primary condition and explains the link, not just that the two are "related." If you can't get one, VA gets an exam or opinion when the record needs one to decide the claim.

Where this is written down: 38 CFR § 3.102; 38 CFR § 3.159(c)(4).

Done when you hold a written opinion for each secondary that names the primary, or you know VA will get one.

Step 5. Sort caused-by from aggravation.

How. A secondary condition can be caused by the primary, or it can be a nonservice-connected condition that the primary made worse beyond its natural progress. The evidence differs.

If the secondary is entirely new and grew out of the primary, then claim straight secondary service connection. If the condition was already there and the primary made it worse, then claim aggravation. VA needs medical records showing how bad it was before it got worse (the baseline), and it pays only for the worsening above that level. Have the opinion describe the baseline and the worsening.

Where this is written down: 38 CFR § 3.310(a) and (b).

Done when you know, for each secondary, whether you're claiming it was caused by or aggravated by the primary.

Step 6. Complete VA Form 21-526EZ and name the link.

How. In Section V, Item 16, list each secondary condition and name its primary by condition and diagnostic code, for example "major depressive disorder, secondary to service-connected chronic low back strain (DC 5237)." You can also add a statement on VA Form 21-4138 explaining the connection. Name each VA and private facility with city and treatment dates.

Do not write only the secondary condition and leave VA to guess the primary. Spell out the link.

Done when every secondary condition is named on the form with its primary and diagnostic code stated.

Step 7. Assemble one organized package, submit it, and save proof.

How. Put the 526EZ, any 21-4138 statement, the diagnoses, and the nexus opinions in one submission with a cover-letter index. File online and download the receipt, or mail it by certified mail to Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444, and keep the receipt.

Done when your package is one labeled, page-numbered file and you hold a dated confirmation receipt.

Step 8. Confirm receipt and know your options if denied.

How. About 10 days later, check VA.gov or call 1-800-827-1000 to confirm the claim shows as received and every document is in the file.

If a secondary is denied, then to keep your effective date, choose within one year of the decision notice: a Supplemental Claim (VA Form 20-0995), a Higher-Level Review (VA Form 20-0996), or a Board Appeal (VA Form 10182). Take the letter to a free accredited representative to weigh them.

Where this is written down: 38 CFR § 3.2500.

Done when you have confirmed your documents are on file.

Recap checklist

• Listed my service-connected conditions and their diagnostic codes.
• Identified likely secondaries by body system, each tied to a named primary.
• Got a current diagnosis for each secondary I plan to claim.
• Got a medical opinion naming the primary for each secondary, or know VA will get one.
• Sorted each secondary into caused-by or aggravation, with a baseline for aggravation.
• Completed the 526EZ, Item 16, naming each secondary and its primary and diagnostic code.
• Assembled one labeled, page-numbered package and submitted it.
• Checked about 10 days later that every document is in my file.

Reminder: rules and rates change. Check any current figure at va.gov. Help from an accredited Veterans Service Organization is free. Accredited claims agents and attorneys can't charge for work done before VA issues its initial decision on your claim. After that, they may charge a fee within the limits of 38 CFR 14.636. This guide prepared you for the task. The evidence in your file decides the result.

Go further

• The book: VA Secondary Claims Manual, the full guide this one comes from. Coming soon as a PDF on this site and in Kindle and paperback on Amazon.
• The workbook: The Master VA Claim Workbook, a fillable PDF. Coming soon.
• Free toolkit: the worksheets that go with VA Secondary Claims Manual. No signup.

Get free, accredited help

For anything about your own claim, talk to an accredited representative. Help from an accredited Veterans Service Organization is free. Accredited claims agents and attorneys can't charge for work done before VA issues its initial decision on your claim. After that, they may charge a fee within the limits of 38 CFR 14.636. Free help is available through Veterans Service Organizations such as the DAV, VFW, and American Legion, and through county and state veterans offices.

To find one near you, visit va.gov/get-help-from-accredited-representative. Representation begins only when you sign VA Form 21-22 (for a Veterans Service Organization) or 21-22a (for an individual agent or attorney). With one rare exception for a single unpaid case, only accredited people can represent you before the VA, and only an accredited agent or attorney can charge you a fee. Nothing in this guide creates that relationship.

A warning about claim sharks. Anyone who offers to file your initial claim for a fee, or who guarantees you a rating or a percentage, is selling something you shouldn't buy. Accredited Veterans Service Organizations help at no charge, and accredited claims agents and attorneys may charge only after VA issues its initial decision, within the limits of 38 CFR 14.636. Report predatory companies to the VA Office of Inspector General at 1-800-488-8244.

About this guide

This guide is education, not representation. It explains how part of the VA system works so you can handle your own business with confidence. It is not legal or claims advice, and reading it does not create any representative relationship between you and the author. The author is not affiliated with the Department of Veterans Affairs, and nothing here is endorsed by the VA.

This guide prints no live VA dollar figures and no rating percentages on purpose, because they change. Before you make a decision based on any number, check the current figure at va.gov. No book can promise you a rating; the evidence in your file decides the result. Help from an accredited Veterans Service Officer is always free.

Details

• PDF, US Letter, 8 pages including the cover
• 14 fillable checkboxes
• Current as of October 2026

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Never a cut of your claim.

About the author: J. Erickson is a service-disabled Air Force veteran. He served as a military firefighter and as a veteran service officer, where he spent years walking veterans through the same claims process he writes about now. He holds an MBA and writes plain-language guides for veterans who want to understand the system without a translator.