Secondary conditions: caused by, or made worse by
Some conditions start in service. Others start because of a condition the VA already connects to your service. The VA calls those secondary.
A nexus letter is a signed medical opinion that links a current condition to your service. On a secondary claim, the link runs through the condition you’re already rated for.
Two ways in
The rule is 38 CFR 3.310. It gives two paths.
Caused by
A condition that is “proximately due to or the result of” a service-connected one is service connected too.
Your PTSD led to weight gain. The weight gain led to sleep apnea.
Made worse by
A condition that wasn’t caused by service, but got worse because of a service-connected one. The VA calls this aggravation.
Your left knee was already sore. Favoring your service-connected right knee wore it down further.
On the “made worse” path, the VA pays only for the worsening. It needs medical records that show how bad the condition was before, so it can compare. It also takes out any worsening that would have happened anyway. Read 38 CFR 3.310 (opens in a new tab)
Why secondary claims get denied
- The VA exam asks only whether your rated condition caused the new one. It never asks whether it made it worse.
- The opinion says the two conditions often show up together, but never explains how one led to the other in you.
- The condition it runs through isn’t service connected yet. File both, or connect that one first.
- Nothing in the file shows how bad the condition was before it got worse.
“To be adequate, a VA opinion must provide separate rationales for both causation and aggravation.”
Board of Veterans’ Appeals, 2024, on a knee claimed as caused or made worse by the other knee. Read decision A24041087 on VA.gov (opens in a new tab)
In our study of 1,721 Board rulings, the Board credited a veteran’s private opinion on 215 secondary claims. 88 of those opinions (41%) took on the “made worse” question. How we counted
What a strong secondary letter does
- Names the service-connected condition it runs through, and where your file shows it.
- Answers both questions, each with its own reasons: did it cause it, and did it make it worse.
- Shows each step of the chain with your own records, like your weight at each visit.
- Points to the records that show how bad things were before they got worse.
- Cites medical studies and explains how they fit your case.
- Uses the VA’s standard, “at least as likely as not,” which means a 50 percent or better chance.
By condition
Each page shows real Board decisions, linked on VA.gov. Not sure why you were denied? Decode your letter
Sleep apnea and PTSD
Real appeals where a private medical opinion explained how PTSD, or another service-connected condition, led to obstructive sleep apnea.
What the Board looked forTinnitus
Real appeals where a private medical opinion tied ringing in the ears to noise in service, even when hearing tests looked normal.
What the Board looked forHearing loss
Real appeals where a private medical opinion tied hearing loss to noise in service, even with normal hearing tests at discharge.
What the Board looked forBack conditions
Real appeals on low back strain and degenerative disc disease where a private medical opinion carried the weight.
What the Board looked forRadiculopathy (nerve pain down the arms or legs)
Real appeals on nerve pain down the legs, claimed as caused by a service-connected back, where a private medical opinion carried the weight.
What the Board looked forKnee conditions
Real appeals on knee arthritis, kneecap pain, and meniscus tears where a private medical opinion carried the weight.
What the Board looked forShoulder conditions
Real appeals on rotator cuff tears, shoulder arthritis, and impingement where a private medical opinion carried the weight.
What the Board looked forPTSD and depression
Real appeals where a private mental health opinion carried more weight than the VA exam.
What the Board looked forMigraines and headaches
Real appeals where a private medical opinion tied headaches to service, to a head injury, or to another service-connected condition.
What the Board looked forHigh blood pressure (hypertension)
Real appeals where a private medical opinion tied high blood pressure to PTSD, to Agent Orange, or to Camp Lejeune water.
What the Board looked forBurn pit and airborne hazard exposure
Real appeals on sinusitis, asthma, and heart disease after burn pits and airborne hazards, where a private medical opinion carried the weight.
What the Board looked for
See what your records support
Our Nexus Check reads every page you send and cites the page for each finding, including pages that work against the claim. It’s free. If you request a letter, we draft it, and a licensed clinician reviews it, edits it and signs only what they support.
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Public Board of Veterans’ Appeals decisions. These veterans weren’t Anchorpoint clients. Every claim is decided on its own evidence.