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Under 38 C.F.R. § 3.310, a secondary condition is a disability that is proximately due to or aggravated by an already service-connected condition. You do not need to prove the secondary condition happened in service. You need to prove that your existing service-connected condition caused or worsened it.
Per M21-1, Part IV.ii.1.C, the RVSR evaluates secondary service connection claims using the same evidentiary standard as direct claims. The veteran needs a current diagnosis, an already service-connected condition, and a medical nexus linking the two. The nexus can come from a private physician, a C&P examiner, or published medical literature.
A veteran rated at 50% for PTSD receives $1,131.68/month. If that veteran successfully claims sleep apnea secondary to PTSD at 50%, the combined rating jumps to 75% (rounded to 80%) under 38 C.F.R. § 4.25 VA math. That's $2,102.15/month. Add erectile dysfunction secondary to PTSD medications at 0% with SMC-K, and the monthly payment is $2,241.02. That's a $1,109.34/month increase from the same original PTSD rating.
PTSD → Sleep apnea, migraines, GERD, hypertension, bruxism/TMJ, erectile dysfunction (medication side effect), IBS
Back (Lumbar Spine) → Radiculopathy (L/R), depression, opposite hip, opposite knee, erectile dysfunction (medication), GERD (NSAIDs), urinary issues
Knee → Opposite knee, hip, back, ankle, depression, surgical scars
Tinnitus → Hearing loss, depression/anxiety, insomnia, Meniere's disease
TBI → Migraines, PTSD, tinnitus, hearing loss, vision problems, sleep apnea
Secondary conditions are filed using VA Form 21-526EZ (original claim) or VA Form 20-0995 (supplemental claim if previously denied). On the form, you identify the condition you're claiming and note that it is secondary to your already service-connected condition. Per M21-1, Part III.iv.3, the VA has a duty to assist in developing your claim, including ordering a C&P exam to evaluate the nexus.
The strongest secondary claims include: (1) a current diagnosis from your treating physician, (2) a nexus letter from a qualified medical professional explaining the causal or aggravation relationship, and (3) supporting medical literature. Per 38 U.S.C. § 5107(b), the benefit of the doubt goes to the veteran.