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Secondary to Secondary



If I am rated at 20% for my lower back and 20% for sciatic nerve damage, can I claim severe knee pain secondary ?  Also, I have MDD as secondary, could I claim Sleep apnea on top of that ?  Any assistance would be greatly appreciated.



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  • HadIt.com Elder

You can, but you'll have to have a diagnosis or at least something to connect it. Sleep apnea, unless central, is a physical obstruction to breathing. If you have central sleep apnea you'll need a sleep study that says so. 

You can claim knee pain secondary to back pain. That doesn't mean it will be approved, but you can claim it.



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  • HadIt.com Elder

I have a couple secondary to secondary, howerer, the according to the VA in the rating letters, they are all just secondary to the original disability. 

I started with a right foot disability.  I claimed my left foot disability secondary to my right foot disability and won.  Years later, I claimed my left ankle secondary to my left foot.  The VA changed it to left ankle secondary to my right foot.  I won that also.

So, even though that makes perfect sense to me, I have had secondary claims come back as a new claims and have won.  So, there is no rhyme or reason to the average Veteran. 

What I do know for sure is you won't win if you don't claim.  I claim (even a poor one) that is denied is better than no claim at all.

Starts the clock,


Play be thier rules, win by thier rules...

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  • HadIt.com Elder

Welcome to Hadit!

I also have some secondary connected to other secondary disabilities. When you log into va.gov and look at the list of disabilities, it should have a hierarchy/tree-type table showing what is direct and then what is secondary beneath that. It makes it a bit easier to read for some situations such as SMC-S housebound which requires a single 100% rating (or TDIU) plus a separate unrelated 60% or higher rating.

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I have several recent secondary service connected conditions that is due to my long term Nam PTSD and LT use of the PTSD medications that include GERD at 60%, OSA Sleep Apnea 50% and TINNITUS 10%.

Since your MDD is service connected then like PTSD you can claim/contend your Sleep Apnea is due to, caused by and/or aggravated by your VA diagnosed MDD and MDD medications.

In my situation I obtained a medical nexus opinion (MO) from Dr. David Anaise stating in great detail with added medical references how PTSD Stress and PTSD medications causes and aggravates Obstructive Sleep Apnea and the BVA agreed and granted my appeal for OSA with CPAP machine at 50% due to PTSD even though I am 30 lbs overweight for many years.

He also argued that my Vietnam Agent Orange IHD/CAD heart disease and High BP medicine also caused and aggravated or contributed to my OSA as did VA sleep specialist doctor and nurse in their 2017 diagnosis on Axis III.

As an added kicker with my claim and appeal I enclosed copies from Mayo Clinic, Cleveland Clinic, NIH and others describing or reporting that PTSD and PTSD medications causes and aggravates Sleep Apnea in people.  Medications for both MDD and PTSD are the same as both MH conditions have almost same exact symptoms such as depression, etc. You can find these medical studies/reports with a simple Google search.

My PTSD was first diagnosed at Texas VA hospital in 1985 and continuous ever since then.  Also added among other evidence a 2009 letter from my family doctor stating my GERD and Sleep apnea symptoms along with high BP was caused by my Vietnam PTSD and actual 1970 repeated combat incidents. 

Both doctors reviewed many copies of my VA and Army medical records that is necessary for them to do in order for VARO and BVA to consider their opinions creditable.  Like me you will probably have to appeal to the BVA in order to win your claim for OSA. Good luck going forward.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.



Edited by Dustoff 11
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