One service-connected condition often leads to others. If you have one of the conditions below, look closely at the ones commonly associated with it. A Nexus Letter is what connects them with medical evidence.
Start My Free Readiness CheckThese are the VA's own rules. The medical evidence has to show the link — that is exactly what a Nexus Letter does.
A disability that is proximately due to or the result of a service-connected condition is itself service connected. 38 CFR § 3.310(a)
If a non-service-connected condition is aggravated by a service-connected one, the added disability can be service connected. 38 CFR § 3.310(b)
Obesity is not a disability by itself, but VA recognizes it can be the link — for example, a back condition limits activity, weight gain follows, and sleep apnea or hypertension develops. VA General Counsel Precedent Opinion 1-2017
After a service-connected TBI, VA presumes these are secondary when timing and severity criteria are met: Parkinsonism, unprovoked seizures, certain dementias, depression, and hormone deficiency diseases. 38 CFR § 3.310(d)
Consider:
Active-duty service members were diagnosed with osteoarthritis at 7.86 per 1,000 person-years, and service members 40 and older had 19 times the rate of those 20 and younger. Cameron et al., Arthritis & Rheumatism, 2011
Prolonged load carriage is linked to stress fractures, back strains, knee pain, metatarsalgia, and rucksack palsy. Knapik et al., Military Medicine, 2004
Veteran military parachutists showed more knee and ankle joint changes than comparison groups. Murray-Leslie et al., Annals of the Rheumatic Diseases, 1977
Consider:
69.2% of Iraq and Afghanistan veterans in a VA PTSD clinic screened high-risk for sleep apnea, and higher PTSD severity increased that risk. Colvonen et al., Journal of Clinical Sleep Medicine, 2015
PTSD raised the risk of sexual dysfunction more than threefold (adjusted RR 3.61), and 4.59 with psychiatric medication. Breyer et al., Journal of Sexual Medicine, 2014
A meta-analysis found PTSD is associated with an increased risk of coronary heart disease. Edmondson et al., American Heart Journal, 2013
Consider:
Neuropathy, retinopathy, and kidney disease are recognized diabetes complications that the American Diabetes Association directs clinicians to screen for routinely. ADA Standards of Care in Diabetes — 2025
Consider:
The presumptive condition gets you in the door; the complications are claimed as secondary. See our PACT Act page for the full presumptive list and qualifying locations.
Consider:
VA regulation presumes specific conditions are secondary to service-connected TBI, including depression within 3 years of a moderate or severe TBI or within 12 months of a mild TBI. 38 CFR § 3.310(d)
Consider:
Among U.S. veterans with tinnitus, 38% also had a depression diagnosis, and nearly 70% of people seeking tinnitus treatment report insomnia. Patil et al., Frontiers in Aging Neuroscience, 2023
Consider:
People with nighttime nasal symptoms five or more nights a month were 1.8 times more likely to have moderate-to-severe sleep-disordered breathing. Young et al., Journal of Allergy and Clinical Immunology, 1997
Consider:
VA allows obesity to be the intermediate step between a service-connected condition and a secondary one, when the medical evidence shows the chain. VA General Counsel Precedent Opinion 1-2017
Our free readiness check looks at your conditions and flags secondary connections worth a closer look.
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NEXUS