Secondary service connection is governed by 38 CFR 3.310, which allows a non-service-connected condition to be rated if it was caused or aggravated by an already service-connected disability. For GERD (or IBS) claimed as secondary to PTSD, the VA generally wants three things: (1) a current diagnosis of GERD, (2) confirmation that PTSD is already service-connected (or being claimed at the same time), and (3) competent medical evidence — typically a nexus opinion — linking the two conditions at the "at least as likely as not" (50% or greater) standard.
A private nexus letter from a psychiatrist or other qualified provider can carry real weight, especially if it explains the medical rationale (for example, how chronic stress, anxiety, or PTSD-related physiological responses can contribute to gastrointestinal symptoms like acid reflux or IBS). The letter is stronger when it cites the veteran's specific symptom history, treatment records, and any relevant medical literature rather than offering only a conclusory statement. Symptom logs — daily or weekly notes tracking flare-ups, triggers, and severity — can also help corroborate the claimed nexus and demonstrate frequency/severity for rating purposes under the relevant digestive system codes (38 CFR Part 4, Schedule of Ratings – Digestive System).
Official 2026 VA monthly compensation, including the 2.8% COLA increase.
Dependent add-ons start at a 30% rating. Child-only and dependent-parent rates: see the full 2026 pay chart.
| Rating | Monthly (2026, incl. 2.8% COLA) |
|---|---|
| 10% | $180.42 |
| 20% | $356.66 |
| 30% | $552.47 |
| 40% | $795.84 |
| 50% | $1,132.90 |
| 60% | $1,435.02 |
| 70% | $1,808.45 |
| 80% | $2,102.15 |
| 90% | $2,362.30 |
| 100% | $3,938.58 |
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Analyze my claim free →Even with a supportive nexus letter, VA adjudicators may order their own Compensation & Pension (C&P) exam, and the outcome depends on how the examiner weighs the private opinion against other evidence. It's common for VA examiners to request additional rationale or to disagree with a private opinion, so a well-documented, detailed nexus letter reduces (but doesn't eliminate) that risk.
At the Board of Veterans' Appeals, across issues decided from 1992 to July 2026, PTSD issues (174,691) came out 20.4% granted, 21.2% denied and 52.5% remanded; service-connection issues (2,302,001) came out 18.8% granted, 30.2% denied and 45.7% remanded (VetAid's Board outcome rates). These are outcomes for cases that were already appealed, not the odds of winning an initial claim, and appealed cases are not a random sample of all claims. These figures describe only cases that were already appealed, which is not a random sample of all claims, so they shouldn't be read as odds of success on an initial secondary-service-connection claim — but they do show that outright denials are not always the end of the road if you have strong evidence.
The concrete next step is to submit the claim (or a supplemental claim, VA Form 20-0995, if already denied) with the nexus letter, symptom logs, and any treatment records clearly organized, and be prepared to request a copy of the C&P exam report afterward to check whether the examiner's rationale actually engaged with the private opinion.
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