Home › Conditions › Secondary claims › Depression ← Chronic Pain
A secondary claim is a condition caused or worsened by one the VA has already service-connected (38 CFR 3.310). The causation fight is already half-won — the VA agreed your chronic pain came from service; the question is only whether it caused or aggravated the depression. That's a medical question with a recognized answer.
The connection
Living with pain every day changes a person — sleep erodes, activity shrinks, work suffers, mood follows. The connection between chronic orthopedic pain and depression is among the best-documented in medicine, and a mental health condition secondary to a service-connected physical one opens the full mental-health rating schedule on top of the physical rating.
How the VA rates depression
General Rating Formula for Mental Disorders (DC 9201–9440, incl. 9411 PTSD, 9434 major depressive disorder, 9400 generalized anxiety)
| Rating | Criteria (38 CFR Part 4 wording) |
|---|---|
| 100% | Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name |
| 70% | Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships |
| 50% | Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships |
| 30% | Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) |
| 10% | Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication |
| 0% | A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication |
There is no 20, 40, 60, 80 or 90 percent level. One combined mental-health rating covers all diagnosed mental disorders — PTSD, depression and anxiety are not stacked.
The listed symptoms are examples, not a checklist; the rating turns on the level of occupational and social impairment (Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013)).
For combat veterans, a claimed in-service stressor related to fear of hostile military or terrorist activity can be established by the veteran's own lay testimony once a VA psychiatrist or psychologist confirms it supports the diagnosis (38 CFR 3.304(f)(3)).
Full criteria, exam and evidence guide: VA rating for PTSD, Depression and Anxiety. And the anchor: VA rating for Back and Neck Conditions.
What the claim needs — the three legs
- The anchor: service connection for the chronic pain (see how that condition is rated). Not connected yet? File both in the same claim — the VA decides the anchor first, then the secondary against it.
- A current diagnosis of depression — the VA rates diagnosed conditions. If you only have the symptoms, file them anyway: the C&P exam supplies the diagnosis, and a "no diagnosis" denial is repaired with a supplemental claim that keeps your date.
- The medical link. An opinion stating it is "at least as likely as not" that the chronic pain caused or aggravated the depression. The VA's own C&P examiner supplies this free in most cases; your own doctor can too. A paid independent opinion is the answer to a denial, not the first move.
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See If You Qualify →Frequently asked questions
Can I claim depression secondary to chronic pain?
Yes, if three things hold: the chronic pain (or its equivalent) is service-connected, you have a current diagnosis of depression, and a medical opinion connects the two. The connection described on this page is a recognized pathway raters see regularly.
Do I need to pay for a nexus letter for depression secondary to chronic pain?
Usually not. The VA's own C&P examiner can supply the connecting opinion at your exam for free, and your own treating doctor can also provide it. A paid independent opinion is worth buying only after a denial for lack of nexus — a supplemental claim within one year keeps the original effective date.
What if the primary condition isn't service-connected yet?
File them together in the same claim. The VA decides the primary first and then the secondary against it in the same decision; a secondary filed alone against a condition the VA has not connected fails. Filing both at once under one Intent to File protects the effective date for both.
Last reviewed 2026-09-19.