Post-traumatic stress disorder (PTSD) is a debilitating condition that affects individuals who have experienced or witnessed traumatic events. Leah will explore the top secondary conditions she sees in veteran populations related to PTSD, examining the medical literature and research findings to understand the intricate connections between PTSD and these conditions. Also, learn how many veterans establish a secondary service connection related to PTSD, helping them obtain compensatory VA disability benefits.
PTSD and Secondary Conditions in Veterans
Post-traumatic stress disorder, a mental health disorder triggered by traumatic and intense events veterans encounter during military service, profoundly impacts their lives, with symptoms like flashbacks, anxiety, and depression. PTSD is evaluated using the General Rating Formula for Mental Disorders under 38 CFR § 4.130. Typically, the VA rates PTSD from 0% to 100% for disability benefits.
Beyond PTSD, veterans may even experience secondary conditions such as sleep apnea or GERD that may amplify their daily challenges. Hence, veterans may qualify for secondary service connections for conditions linked to PTSD by providing medical evidence and then receive VA disability benefits.
Understanding Secondary Conditions
Before delving into the specific conditions, it’s crucial to understand what “secondary conditions” mean in the context of PTSD. These are conditions caused by or aggravated by the primary service-connected disability, which, in this case, is PTSD. These secondary conditions can manifest in various ways and significantly impact the lives of individuals coping with PTSD.
1. Headaches: A Common Secondary Symptom
Headaches, whether tension headaches, migraines, or non-specific generalized headaches, are common secondary conditions among veterans with PTSD. Stress and anxiety from PTSD are key triggers for migraines, which can include chronic pain, nausea, sensitivity to light and sound, and auras. Veterans may experience an increase in the intensity and frequency of headaches after developing PTSD.
Leah Bucholz refers to an article titled “Migraine Maladaptive Brain Responses to Stress,” published in the Headache Journal. The study investigates how repeated stressors can alter normal physiological responses, leading to stress-related chronic headaches.
Migraines are rated under 38 C.F.R. 4.124a, Diagnostic Code 8100, with ratings from 0% to 50% based on severity and frequency of attacks.
2. Sexual Dysfunction: A Complex Interplay
Sexual dysfunction disorders, including erectile dysfunction and female sexual arousal disorders, are often linked to both the emotional components of PTSD and the medications prescribed to treat the condition. The use of serotonin selective reuptake inhibitors (SSRIs), such as Zoloft and Celexa, is common in PTSD treatment.
Additionally, female sexual arousal dysfunction and erectile dysfunction can be further intensified by secondary conditions such as anxiety, depression, and chronic stress linked with PTSD.
Leah Bucholz recommends an article titled “Sexual Dysfunction and Selective Serotonin Reuptake Inhibitors and Potential Solutions” from The Mental Health Clinician to explore the relationship between SSRIs and sexual dysfunction. The study found that the sexual side effects were highest with paroxetine, followed by fluvoxamine, sertraline, and fluoxetine.
While most veterans receive a 0% non-compensable rating for erectile dysfunction secondary to PTSD, this service connection qualifies them for Special Monthly Compensation (SMC) for loss of use of a creative organ, currently at $118.33 per month.
3. Gastrointestinal Disorders: Unraveling the Connection
Gastrointestinal disorders, particularly irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) are frequently associated with PTSD, depression, and anxiety disorders, which can heighten stomach acid production. GERD, or Gastroesophageal Reflux Disease, occurs when stomach acid flows back into the esophagus, causing symptoms like heartburn, regurgitation, and chest pain.
An article from the Journal of Neuroscience and Rural Practice in 2015 explores the connection between stress, the limbic system, and the enteric nervous system, leading to increased symptoms of IBS.
Medications for PTSD, such as SSRIs, can also worsen GERD symptoms. Veterans can receive a VA disability rating for GERD as a secondary condition to PTSD, with ratings at 10%, 30%, or 60%, depending on symptom severity.
- 10% Rating: Mild symptoms like heartburn, regurgitation, or difficulty swallowing that are present but less severe.
- 30% Rating: Recurrent and more severe symptoms, including heartburn, regurgitation, and chronic pain that impair health.
- 60% Rating: Severe symptoms such as pain, vomiting, significant weight loss, or bleeding that result in a severe impairment of health.
Veterans looking to establish a secondary service connection between PTSD and Gastroesophageal Reflux Disease can receive assistance with proper medical diagnosis, documentation, and an independent medical opinion.
4. Sleep Apnea: Controversies and Correlations
Sleep apnea is a contentious secondary condition related to PTSD. Often diagnosed via a sleep study, sleep apnea occurs when the airway becomes blocked during sleep, leading to symptoms like snoring, gasping for air, and daytime fatigue. Veterans with PTSD are at higher risk due to shared symptoms and stress, which can worsen sleep apnea. Many veterans are service-connected for sleep apnea, but proving the causation or aggravation can be challenging.
There are generally three types of sleep apnea: obstructive, central, and complex (involving the first two). The most common form of sleep apnea, obstructive sleep apnea, often increases stress levels, leading to PTSD. It is important to understand the fragmentation of sleep and abnormalities of rapid-eye movement (REM) in causing physiological obstructions leading to obstructive sleep apnea.
A study found that 69.2% of veterans with PTSD are at high risk for obstructive sleep apnea (OSA), compared to 43.4% without PTSD. This suggests a strong link between post-traumatic stress disorder and obstructive sleep apnea.
Disability ratings for sleep apnea range from 0% to 100%, depending on severity. A credible medical nexus letter is essential for veterans seeking service connection for sleep apnea secondary to PTSD.
5. Hypertension: A Common Cardiovascular Complication
Hypertension, or high blood pressure, is a common condition among veterans with PTSD, often aggravated by the high stress and anxiety associated with the disorder. Hypertension occurs when blood pressure consistently exceeds normal levels, with systolic pressure over 160 or diastolic pressure over 90 being considered high for VA rating purposes.
The study titled “Risk for Incident Hypertension Associated with PTSD in Military Veterans, and The Effect of PTSD Treatment” investigates the relationship between PTSD and the risk of developing high blood pressure in military veterans, using data from nearly 200,000 veterans. It found that untreated PTSD significantly increases the risk of hypertension, with the hazard ratio (HR) ranging from 1.24 to 1.46, depending on the event.
Veterans may receive a VA disability rating for hypertension secondary to PTSD under Diagnostic Code 7101, with ratings of 60%, 40%, 20%, or 10%, depending on the severity of diastolic or systolic pressure, or the need for continuous medication.
6. Weight Gain: An Intermediate—1 Step to Various Conditions
Weight gain as an intermediate step is a significant concern for individuals with PTSD. Veterans with a positive PTSD screen have reported quite higher emotional eating across various emotions, such as anxiety, sadness, and anger. Conditions like plantar fasciitis, coronary artery disease, hypertension, and diabetes can be linked to weight gain. There is a need to establish a direct connection between weight gain and service-connected disability.
Establishing Service Connection Secondary to PTSD
Remember, in most cases, a veteran cannot receive separate ratings for multiple mental health conditions, often termed pyramiding. To obtain additional guidance on these principles and how they may pertain to an individual case, it may be helpful to consult with an accredited legal professional. To establish a secondary service connection to PTSD, veterans must provide three key elements:
- A medical diagnosis of the secondary condition
- Proof of an existing service-connected condition (like PTSD)
- Medical evidence linking the secondary condition (like migraines, GERD, or sleep apnea) to the primary one
This often involves obtaining a Medical Nexus Letter from a qualified provider, which offers a medical opinion that connects the secondary condition to the service-connected primary condition. A medical opinion will also be provided at the VA C&P exam at no cost in applicable cases.
Veterans with significant disabilities linked to PTSD may qualify for Total Disability based on Individual Unemployability (TDIU), offering compensation at the 100% rate if employment is substantially impaired. If a secondary service connection claim is denied, veterans can appeal, using additional evidence like outside medical opinions or buddy statements.
Conclusion
Leah Bucholz provides valuable insights into the often-overlooked secondary conditions linked to PTSD. Understanding these connections is crucial for veterans seeking compensation and healthcare support. The mentioned articles and research findings offer a foundation for individuals and their healthcare providers to build a case for service connection when dealing with these secondary conditions. It is essential to recognize the complex interplay between PTSD and its secondary manifestations to ensure comprehensive care and support for those who have served their countries.
Also read: What to Expect in a TMJ Veterans Disability C&P Exam
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
Our purpose is to empower YOU, the veteran, to take charge of your medical evidence and provide you with valuable educational tools and research to guide you on your journey.
Understanding the unique challenges veterans face, our commitment lies in delivering exceptional service and support.
Leveraging an extensive network of licensed independent medical professionals, all well-versed in the medical professional aspects of the VA claims process, we review the necessary medical evidence to incorporate in our reports related to your VA Disability Claim.
Prestige Veteran Medical Consulting is not a law firm, accredited claims agent, or affiliated with the Veterans Administration or Veterans Services Organizations. However, we are happy to discuss your case with your accredited VA legal professional.
