Depression and anxiety are among the most common secondary conditions veterans claim. Living for years with chronic pain or a serious service-connected condition wears on mental health, and the VA recognizes that connection. This guide explains how to claim these as secondary conditions.
How mental health conditions are rated
All service-connected mental health conditions, including depression and anxiety, are rated under the same General Rating Formula for Mental Disorders (38 CFR 4.130). The levels are 0, 10, 30, 50, 70, and 100 percent.
Like PTSD, these are rated on functional impairment, how much the condition affects your work and social life, not on a symptom checklist.
The secondary connection
You do not always have to connect depression or anxiety to service directly. If a service-connected physical condition caused or worsened your mental health, you can claim it as secondary (38 CFR 3.310).
Common patterns a provider may connect:
- Depression secondary to chronic pain from a back, knee, or other physical condition
- Anxiety secondary to a serious or limiting service-connected condition
- Depression or anxiety secondary to the isolation and lifestyle changes a physical disability forces
What a nexus letter needs
- Confirmation the provider reviewed your records for both the physical condition and the mental health symptoms
- Whether the argument is causation or aggravation
- A clear rationale for how the physical condition affects mental health
- The opinion in VA terms ("at least as likely as not")
A real-world example
A veteran with a service-connected back condition had been struggling with depression for years but never connected the two on paper. A provider explained how years of chronic pain and lost function contributed to his depression and connected it as secondary. It was rated separately, raising his combined total.