Veterans Disability Info Blog

How to Win Secondary Service Connection for Physical Diseases Related to PTSD

Over the years, particularly in DIC cases, I have seen veterans advance the theory that heart disease or high blood pressure were caused or aggravated by service-connected PTSD. Usually, the VA denies these claims based on the idea that psychiatric problems are separate from physical problems. Their theory essentially is, “Psychiatric problems don’t cause physical problems and vice versa.” However, I have been successful in winning service connection for many of these cases on an aggravation theory.  The aggravation theory of service connection is where an existing service-connected disability aggravates a non-service-connected disability and makes it worse.

As a veterans disability attorney I approach my clients from a holistic perspective considering how the body and brain are interconnected. No matter what disabilities my clients have, I always research possible connections between their service-connected disabilities and any other health problems.

And the more research I do, the more evidence I find establishing closer links between the brain and the physical body. For example, while trying to prove the occurrence of an in-service personal assault, I retained a renowned psychiatric expert who explained how psychiatric problems can have dermatologic manifestations. In this particular case, the client broke out in hives when under stress. The presence of hives in the service medical records was the only evidence I had to support the occurrence of the assault and my expert used whole brain/skin connection to corroborate the in-service stressor.

In my never-ending quest to stay on the cutting edge of law and science as it pertains to disabled veterans, I ran across a study from the journal Obesity.  The article, “Association of Post-Traumatic Stress Disorder and Obesity in a Nationally Representative Sample,” researchers found a greater likelihood of obesity in people with PTSD.  .  The study indicated a link between PTSD and obesity.  This may not seem important.  After all, the VA does not recognize obesity as a disability for VA purposes. (Although, the American Medical Association recently categorized it as a disease.)

I believe this study is important to disabled veterans with PTSD because although obesity is not considered a “disease” and cannot be service connected, it is a health risk for numerous diseases including sleep apnea. Considering the high rate of sleep apnea in veterans with PTSD, it becomes necessary to find a method of proving service-connection for sleep apnea in the absence of sleep or breathing problems while in service.

In this regard, obesity is a well-known risk factor for sleep apnea. Thus, if a connection between the service-connected PTSD and obesity is established, then sleep apnea can then, in turn, be linked to the PTSD by way of the obesity link. So, if a veteran is service connected for PTSD but has been denied for sleep apnea, then the advocate should examine whether the veteran has gained weight and become obese.  If this is the case-and gaining weight after discharge is common-then a link between the PTSD and obesity should be made. 

But the obesity/PTSD link has broader uses than just sleep apnea. Consider the risk of cardiovascular disease, diabetes, and metabolic syndrome that result from obesity. If a widow is making a claim for service connection for the cause of death, and her husband was service-connected for PTSD, but died of a non-service-connected cardiac event, and he was obese, then this study in the journal Obesity may prove useful in this situation as well.

Moreover, diabetes has vast effects on a person’s health. It is also well-known that excess body fat serves as a risk factor for type II diabetes. So, if a veteran is service-connected for PTSD, but later gains weight and develops diabetes, a skilled advocate should closely examine a link between the obesity and PTSD and resulting diabetes.


Similarly, I too often see advocates taking a simplistic approach to developing strategic theories for disabled veterans.  I believe that a good veterans disability lawyers is also someone who has a great interest in science, medicine and health. There is no substitute for good medical research; it’s just as important as the legal research. Accordingly, any disabled veteran with PTSD who also has other health problems should closely examine whether a link can be made between his PTSD and other physical problems.

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