Many veterans develop depression or anxiety years after service, not from a traumatic event but from living with a service-connected disability: chronic pain that never lets up, a condition that ended a career, or symptoms that shrink daily life. Under 38 CFR 3.310, that pathway has its own basis for compensation.
This guide explains the secondary route. For how the resulting condition is then evaluated, see our anxiety and depression ratings guide; for the mental health series overview, start with our PTSD service connection guide.
What 38 CFR 3.310 requires
A secondary claim has three parts:
- A current diagnosis of the secondary condition - here, a diagnosed mental health disorder
- An already service-connected disability
- Competent medical evidence linking the two, either by causation or by aggravation
Causation and aggravation are different claims
Causation means the service-connected disability caused the mental health condition. Aggravation means a condition the veteran already had was made permanently worse by the service-connected disability, beyond its natural progression. The regulation recognizes both, and compensation for aggravation is based on the degree of worsening attributable to the service-connected disability.
A pre-existing history of depression, then, does not by itself defeat a claim. It changes the question a clinician has to answer - and an opinion that ignores the pre-existing history rather than addressing it tends to carry little weight.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Individual Psychological Evaluation Package
A telehealth evaluation with a psychologist licensed in your state. It includes a one-on-one evaluation of your history, symptoms, and functional impact, a DBQ when clinically appropriate, and a nexus opinion section when the evaluation supports one. It starts with a free screening - you pay nothing unless a full evaluation appears clinically appropriate.
Common pathways
The pathways a clinician may evaluate include:
- Chronic pain from a service-connected musculoskeletal condition contributing to depressive symptoms and sleep disruption
- Loss of function or mobility leading to social withdrawal and reduced activity
- A service-connected condition ending a career or limiting employment
- Another service-connected mental health condition contributing to a distinct additional diagnosis
- Medication effects documented in the treatment record
What a defensible opinion addresses
A useful secondary opinion does more than assert the link. It identifies the service-connected disability and its documented severity, describes the timeline of mental health symptoms against that history, applies recognized medical reasoning to that specific record, and confronts other plausible explanations rather than leaving them unanswered.
It also states the standard in the terms the VA uses - whether the condition is at least as likely as not caused or aggravated by the service-connected disability. Our guide to what 'at least as likely as not' means explains that threshold.
Where to start
Because secondary claims turn on the specific record, the first step is a paid medical records review to determine what your documentation supports. Where a clinical evaluation is needed, our Individual Psychological Evaluation Package begins with a free screening.
Patriot NEXUS Letters provides independent medical evidence, not legal representation or claim filing. We do not guarantee a favorable conclusion or any VA outcome.