Veterans Disability Info Blog

How Veterans Get Secondary Service Connection for Anxiety

For veterans who experience anxiety disorders, the journey to securing an anxiety VA rating can be arduous. Veterans can pursue direct service connection for anxiety, but many veterans go the secondary service connection route, linking their anxiety disorder with an already service-connected condition. To learn more about anxiety VA ratings—including anxiety disability eligibility requirements, types of eligible anxiety disorders, and strategies to help increase your anxiety VA rating—read our free eBook, VA Disability Ratings for Anxiety: An Essential Guide for U.S. Veteran.

Anxiety: Direct Service Connection vs. Secondary Service Connection

Direct service connection for anxiety is established when a veteran can directly attribute their anxiety disorder to a specific event or series of events involving military service. Traumatic experiences like exposure to combat, witnessing tragic events, experiencing life-threatening situations, or struggling to adapt after military discharge can leave a lasting impact on a veteran’s mental well-being.

The constant state of hyper-vigilance, fear, and stress that often accompanies military service can cause anxiety disorders such as OCD, phobias, generalized anxiety disorder (GAD), or panic disorder. Cases like these may be relatively straightforward to prove, as they involve a clear cause-and-effect relationship that can be documented through medical records and service-related documentation.

However, not all veterans have medical records or service-related documentation showing anxiety symptoms, treatment, or in-service events. In fact, most don’t. Many service members quickly learn to mask symptoms of fear or anxiety and rarely report it or seek treatment. For these veterans, secondary service connection may be the most effective way to secure an anxiety VA rating.

Secondary service connection for anxiety is particularly relevant for veterans who develop anxiety disorders as a result of physical ailments or injuries incurred during their military service. Here, the veteran’s anxiety disorder can be linked to a service-related injury or illness, rather than linking the anxiety directly to an event or series of events involving military service.

Anxiety Secondary to Physical Health Conditions

Scientific research has linked numerous physical illnesses and injuries to the development of anxiety disorders. Chronic pain, biochemical alterations in the body and brain, mobility limitations, and medication side effects can trigger or exacerbate anxiety disorders.

Heart Disease

For example, individuals diagnosed with heart disease show a higher rate of anxiety disorders compared to the general population. Many veterans have service-connected heart disease, including cardiomyopathy, arrhythmias, heart valve disease, and peripheral artery disease. Coronary artery disease is a presumptive condition for Agent Orange exposure. The stress associated with managing a cardiovascular disease can lead to anxiety disorders.


Similarly, people with diabetes show a 36.2% prevalence of anxiety disorders compared to non-diabetics (14.4%). Diabetes is common among veterans and frequently service-connected due to Agent Orange exposure or the development of metabolic syndrome and obesity resulting from psychological trauma and exposure to toxins from burn pitsmilitary vaccineswater contamination, and others.

Constant monitoring of blood sugar levels, the potential for severe complications, and the lifestyle modifications required to manage the condition can all contribute to increased anxiety levels. While more research is needed to establish a definitive causal relationship, the existing evidence suggests a strong association between diabetes and anxiety disorders.

Thyroid Conditions

Veterans may develop hyperthyroidism (an overactive thyroid gland) due to exposure to polybrominated diphenyl ethers or other flame retardants, organochlorines, or Agent Orange. Scientific evidence has shown a clear association between hyperthyroidism and anxiety disorders. Thyroid hormone overproduction can lead to symptoms such as restlessness, irritability, and an increased heart rate, all of which are common symptoms of anxiety. The hormonal imbalance caused by hyperthyroidism may disrupt the brain’s chemistry, leading to the development of anxiety disorders in individuals with this condition.

Chronic Obstructive Pulmonary Disorder (COPD)

A high incidence of chronic obstructive pulmonary disorder (COPD) is seen in veterans due to prolonged exposure to dust, sand, fumes, smoke from burn pits, chemicals, air pollution, and tobacco use. Individuals with COPD have a higher chance of experiencing anxiety disorders. The constant struggle to breathe and the limitations imposed by the condition can cause significant distress, leading to the development of anxiety. Additionally, the reduced oxygen levels in the body can also contribute to anxiety and panic.


Likewise, asthma has been found to be associated with anxiety disorders. The chronic nature of asthma, coupled with the fear of asthma attacks, can lead to heightened levels of anxiety. Individuals with asthma may constantly worry about triggers and feel a sense of unease about their ability to breathe properly. This chronic state of apprehension can pave the way for the development of anxiety disorders.

Chronic Pain

Chronic pain is also linked to the development of anxiety disorders. Service-connected injuries and illness often come with chronic pain. Living with persistent pain can have a devastating impact on an individual’s quality of life, leading to feelings of frustration, helplessness, and anxiety. The constant discomfort can create a state of hyperarousal, where individuals are on high alert and constantly anticipating more pain. This heightened state of anxiety can have a significant impact on an individual’s mental health and well-being.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) can also play a role in the onset of anxiety disorders. IBS is a common disorder among veterans that affects the large intestine. Symptoms include abdominal pain, bloating, and changes in bowel movements.

Studies have found that people with IBS are more likely to show symptoms of anxiety compared to those without the condition. This suggests that there may be a bi-directional relationship between IBS and anxiety disorders, where one condition increases the risk of the other. The precise reason for this connection remains uncertain, but it is believed that factors such as chronic pain, discomfort, and the impact of IBS on daily life can contribute to the development of anxiety symptoms.

Certain medications can also cause the development of anxiety disorders. Corticosteroids can have anxiety-inducing effects. Hypnotics, sedatives, and opioids, commonly used to promote sleep or relieve pain, can disrupt the brain’s natural balance of chemicals, leading to heightened anxiety.

VA Claims for Anxiety Secondary to Other Physical Conditions 

To establish the secondary connection between a service-connected health condition and anxiety, veterans must supply medical evidence supporting the link between the two conditions.

For example, we had a client who was service-connected for hepatitis C but was claiming anxiety secondary to the hepatitis.  The VA denied the claim initially because they felt that his hepatitis was so mild as to not cause serious health problems.  As such, VA had difficulty believing the anxiety connection.  However, we won the claim by focusing on the anxiety the veteran experienced over fear that he would infect his family with the hepatitis.  The claim was based on an internal fear and not physical discomfort.  We engaged an expert psychiatrist to evaluate him, and the psychiatrist was able to establish the link between the hepatitis C and anxiety.  Other conditions that are similar would be anxiety secondary to a cancer diagnosis.  So, even if the cancer was in remission, there is the anxiety that it could return and cause death.  To prove secondary anxiety, a veteran must have:

  • Proof of diagnosis for anxiety, and
  • Medical evidence demonstrating how anxiety disorder is a direct result of their other service-connected condition.

The medical evidence is also referred to as a medical nexus letter. The medical nexus letter should be written by a trained physician who is experienced with anxiety disorders, the service-connected condition, and the VA claims process. A medical nexus letter will explain the scientific relationship between the two conditions and how they impact the veteran’s overall functioning.

Most veterans obtain medical nexus letters from a legal veterans advocate such as a VA disability lawyer. These professionals know what the VA wants to see in a disability claim and supporting evidence. Seeking professional assistance with your VA claim preparation can strengthen your case and increase your chances of receiving the benefits you deserve.

Learn More About Anxiety VA Ratings Today

To learn more about anxiety VA ratings—including anxiety disability eligibility requirements, types of eligible anxiety disorders, and strategies to help increase your anxiety VA rating—read our free eBook, VA Disability Ratings for Anxiety: An Essential Guide for U.S. Veterans.

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