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How to file a secondary claim

For conditions caused or aggravated by an already-service-connected condition (or its medications).

What you need before filing

1. Current diagnosis of the secondary condition in a medical record (VA or civilian).
2. Confirmation that the primary is service-connected at 0% or higher.
3. Nexus letter from a private physician linking the secondary to the primary. Use the Secondary Nexus Letter generator.
4. Statement in Support of Claim describing onset of the secondary, current symptoms, and functional impact. Use the 21-4138 generator.
5. Spouse/family statement (Form 21-10210) if applicable — especially helpful for ED-secondary-to-PTSD claims.

Filling out 21-526EZ for a secondary claim

Section II — claim type

For each secondary condition, select "Secondary" as the claim type.

In the "How does this relate to your service?" field, write something like:

"Secondary to my service-connected Post-Traumatic Stress Disorder (currently rated at 70%). My PTSD and the medications used to treat it (sertraline 100mg daily) have caused/aggravated my erectile dysfunction. See attached nexus letter from Dr. Smith dated [date]."

You can file multiple secondaries on the same form

Use one 21-526EZ to claim multiple conditions, including a mix of primary, secondary, and increase claims. Each gets its own row in Section II. Attach a nexus letter for each non-presumptive condition.

Highest-yield secondary chains

If you're service-connected for any of these, these are the secondaries to investigate first:

• PTSD / Anxiety / Depression → ED (unlocks SMC-K!), sleep apnea, GERD, hypertension, insomnia, migraines
• Diabetes Type II → peripheral neuropathy, ED, retinopathy, kidney disease
• Lumbar/Cervical Spine → sciatica/radiculopathy, opposite-side joint conditions, depression from chronic pain
• Tinnitus → migraines, insomnia, anxiety

See the full Common Secondary Chains table.

The classic "low-hanging fruit": ED Secondary to Mental Health

1. If you're SC for PTSD, anxiety, or depression — and you have any degree of ED — file this.
2. Get a diagnosis in your medical record (PCP or urologist can confirm in one visit).
3. Use the Secondary Nexus generator. Pre-fills with the magic language.
4. If your civilian provider won't write the letter, an IMO costs $300–$1,500. SMC-K pays $139.87/month for life — the IMO pays for itself in 4–10 months.
5. File the secondary 21-526EZ. Rating will likely be 0%, but SMC-K kicks in.

After you file

• VA may schedule a C&P exam for the secondary condition.
• If the primary is already established, the rater only needs to determine: (1) is the secondary diagnosis valid, and (2) is the nexus opinion competent and credible.
• Average decision: ~90–130 days depending on whether a C&P is needed.