Michael Lostritto: Hello everyone and welcome to another edition of CCK Live.
My name is Michael Lostritto, and today I'm joined by
Alex Gamache, an accredited VA claims agent, and also Kaitlyn Degnan, an attorney at the firm.
In this video, we're going to review VA secondary conditions
to depression. So, to start off very basically, what is depression?
Depression is defined as a serious mental health condition that affects the way a person thinks
and feels and acts. Symptoms of depression tend to vary among different individuals, but generally
speaking, common symptoms tend to include things like persistent feelings of sadness,
worthlessness, hopelessness, lack of motivation, or interest in activities that
usually derive pleasure. It can include difficulty sleeping and concentrating,
a change in appetite resulting in weight loss or weight gain, irritability, fatigue. So,
any of those symptoms, all or just a few of them, can all result from depression.
So, depression is a mental health condition, like I said. And as such, VA will write this condition
based on the severity of the condition and assign a rating that can go anywhere from 0% to 10%,
30%, 50%, 70%, or a maximum rating of 100% for the condition. To do this, VA uses its general
rating formula for mental disorders. These ratings are based on the level of social and occupational
impairment that a veteran experiences and the severity of the symptoms
VA uses characterize that impairment.
It's also very common for veterans suffering from depression to develop a secondary condition,
which is what we're going to be talking about today. And so here, veterans are
eligible to receive VA disability benefits for their secondary condition if they can show
that the secondary condition is related to the primary service-connected condition.
So, with that, Kaitlyn, I'll turn to you. Can you tell us a little bit about
generally what is a secondary service-connected condition? How do you get it?
Kaitlyn Degan: So, a secondary service-connected disability is a disability that results from
a condition that is already service-connected. So, in claims for secondary service connection,
a veteran must prove a nexus or evidence linking the secondary disability to their already
service-connected disability. This usually comes in the form of a medical opinion. Importantly,
secondary disabilities are rated in the same manner as other service-connected conditions.
Michael: And that's exactly right. And so, there are a number of
common or typical conditions that can be claimed secondarily to a service-connected
depressive disorder. We're going to go through some of those.
This isn't an exhaustive list, but these are some of the more common conditions that we see
claimed as secondary to depression. So, Kaitlyn, maybe you can describe a little bit about that.
Kaitlyn: Sure. So, the first condition that we're going to talk about are migraines. Migraines are
a form of headaches that can last for many hours and often interfere with a person's
life. And these intense headaches can bring pain, nausea, vomiting, sensitivity to light and sound,
lightheadedness, and blurred vision, among other symptoms.
There's no definitive cause of migraines, but triggers can include hormonal imbalances,
alcohol use, stress, sensory stimulation, certain foods, and then changes in the environment.
Medication can be used to treat migraines, and so can rest,
diet modification, and stress management. Migraines are rated under 38 CFR 4.124a
diagnostic code 8100 from 0 to 50 percent based on their severity and frequency.
Michael: Yeah, and you know, what's interesting too, is that I do see in my practice migraines
claimed secondarily to depressive disorder, quite often.
The reverse is also true. We're not talking that about that specifically today, but as is the case
of migraines and many of the other conditions that were going to be talking about, oftentimes, you
could develop depression or depressive disorder as a result of say migraines or other conditions.
Again, today we're speaking solely about conditions resulting from depression or depressive
disorder, but I think it's just important to note that the reverse or inverse rather
is applicable in many of these situations as well.
So, Alex turning to you. Another two conditions that I think we commonly see
secondary to depression include restless leg syndrome
and erectile dysfunction. So, perhaps you can walk us through those two conditions.
Alex Gamache: Yeah, so regarding the first one of restless leg syndrome. Restless leg syndrome,
or Willis-Ekbomb disease, is a condition that can cause painful and uncomfortable sensations in the
legs as well as an irresistible urge to move them. Restless leg syndrome is often classified as a
sleep disorder and a movement disorder and can be caused by exhaustion and daytime sleepiness.
VA rates restless leg syndrome under diagnostic code 8620, which relates to neuritis.
Ratings for this condition range from mild to severe, going from 10% to 60%.
Regarding the issue of erectile dysfunction. Erectile dysfunction or importance is the
inability to establish and sustain erection for sexual intercourse. Ongoing erectile dysfunction
can cause stress, affects self-esteem, and contribute to relationship issues.
Erectile dysfunction is a common side effect of psychotropic medications,
which are commonly used to treat mental health conditions such as depression.
There is no specific disability rating for erectile dysfunction, so VA rates
the condition under 38 CFR § 4.115b, and the ranges for erectile dysfunction are 0% to 30%.
It's important to note that even if a veteran gets a 0% for erectile dysfunction,
they are eligible to receive special monthly compensation, which is an additional $111
per month. It's special monthly compensation based on the loss of use of a creative organ.
Michael: Yeah, exactly Alex, and thank you. Another condition that we commonly see
secondary to depression are gastrointestinal conditions, or GI conditions.
GI diseases are those that involve the organs of the digestive tract and accessory organs,
and they aid in digestion. Common examples include things like colitis or GERD or IBS,
acid reflux. So, there are a multitude of different conditions that can be GI conditions.
What's interesting is that certain medications, particularly antidepressants and antipsychotics,
are known causes of GI issues. And so, perhaps a veteran is service-connected for depression,
they are prescribed antidepressants. The use of those antidepressants particularly over
an extended period of time, could lead to or result in a GI issue. And so that is something,
those are conditions that we often see claimed and linked secondarily to depression.
VA rates gastrointestinal diseases under 38 CFR section 4.114
of the schedule of ratings for digestive system. There are multiple diagnostic codes
for the various GI conditions that fall under the rating. But generally speaking, the ratings
can range anywhere from 0% non-compensable rating all the way to a maximum 100% rating.
Seizures is another condition. Seizures and epilepsy, I should say, are two other conditions,
affecting the central nervous system. So, they're neurological disorders or conditions which
the brain's activity becomes abnormal and it causes seizures or periods of unusual
behaviors, sensations, and sometimes loss of awareness. What's interesting here is that
oftentimes benzodiazepines, which are prescribed to treat these conditions,
often can have severe side effects, and some of those severe side effects can include seizures.
So, again, a veteran is diagnosed with depression or depressive disorder. They are prescribed
benzodiazepines to treat that mental condition, and unfortunately, as a side effect of that, they
develop some of these neurological conditions. And so, provided of course that the veteran
can show that secondary epilepsy or seizures or neurological condition was caused by or aggravated
by those medications, then secondary service connection can be in order for those conditions.
VA assigns disability ratings for seizures based on the number of seizures that took place in the
past year. So, seizures are rated according to 38 CFR section 4.124 subdivision a, and the
ratings can really range anywhere from a 10% to a 20%, 40, 60, 80, all way up to a 100% rating.
Kaitlyn, can you walk us through and talk a little bit about liver conditions and
how those might be related in some way to a veteran's depressive order?
Kaitlyn: Sure. So, some veterans might turn to the use of alcohol
as a coping mechanism for their service-connected depression.
And VA defines alcoholism or alcohol abuse as the use of alcoholic beverages over time or such
excessive use at any one time that is sufficient to cause disability or death of the user.
Consuming an alcoholic beverage in and of itself does not constitute alcohol abuse.
Rather the defining factors are the length of time that the behavior continues
and whether the behavior is done in excess.
If a veteran experiences alcoholism as a result of a service-connected condition, they can then
be service-connected on a secondary basis for conditions that arise from that alcohol abuse.
A common example is the development of liver conditions due to alcoholism.
So, for example, a veteran drinks successively to cope with their service-connected depression and
develops cirrhosis of the liver as a result. That veteran may be able to receive service-connected
compensation for the cirrhosis of the liver on a secondary basis. And the alcohol essentially
serves as an intermediate step between the service-connected depression and that cirrhosis.
Michael: Alex, what if a veteran is seeking unemployability benefits or TDIU benefits?
How do secondary conditions to depression factor into or help a veteran
who might be seeking TDIU benefits? Can you talk a little bit about that?
Alex: Yeah. So, secondary conditions can be very beneficial to boost veterans' overall
combined rating, and it also allows VA to consider the functional limitations
of all of the veteran's conditions, including the secondary conditions.
Overall, combined ratings can help a veteran achieve TDIU.
So, TDIU, or a total disability based on individual unemployability,
is a monthly benefit that compensates veterans at the 100 percent level if
they are prevented from working because of their conditions.
For more information on TDIU, you can check out one of our YouTube videos that are linked below.
Michael: Yeah. That's terrific. And I think the two points that you mentioned, number one,
getting additional service-connected conditions helps boost potentially
the veteran's overall combined rating to reach the schedular requirements for TDIU. And then,
secondly, I know you talked a little bit about how adding additional service-connected conditions,
secondarily to depression, then allows VA to consider the limitations that result from those
secondary conditions as part of its underlying analysis when it examines whether a veteran has
the functional limitations that would enable them to be warranted for TDIU.
So, thank you both for the great discussion.
For more in-depth information on the conditions and topics discussed in the video,
they can be found on our blog or in the videos or on our YouTube channel.
So, as always, thanks for joining us,
and be sure to subscribe to our channel and follow us on social media.
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