Claiming IBS as Secondary to PTSD: Complete VA Disability Guide

Bottom Line Up Front

Irritable Bowel Syndrome (IBS) can be successfully claimed as a secondary condition to service-connected PTSD. The VA recognizes the direct relationship between PTSD and gastrointestinal disorders. With proper documentation showing the nexus between your PTSD and IBS symptoms, you can receive a separate disability rating for the gastrointestinal condition while keeping your PTSD rating intact. Average wait time is 90-120 days; combined rating can reach 30-50% when both conditions are properly documented.

What is IBS and Why Does It Relate to PTSD?

Irritable Bowel Syndrome is a functional gastrointestinal disorder characterized by chronic abdominal pain, bloating, diarrhea, and/or constipation. Research shows that 50-90% of IBS patients have a psychiatric history, and PTSD specifically increases IBS symptoms through multiple physiological pathways:

Stress hormone activation: PTSD triggers constant cortisol and adrenaline release, affecting gut motility
Hypervigilance and gut sensitivity: The nervous system's heightened alert state sensitizes the digestive tract
Autonomic dysfunction: PTSD disrupts the parasympathetic nervous system that controls digestion
Inflammation response: Trauma increases intestinal permeability and inflammatory markers

The VA has established medical precedent recognizing this connection. VA studies show that combat veterans with PTSD have significantly higher IBS incidence rates than the general population.

Eligibility Criteria for Secondary IBS Claim

Primary Requirements

1. Established Service-Connected PTSD Diagnosis

You must already have an approved PTSD rating (minimum 0%, but typically 10% or higher for successful secondary claims)
Your PTSD diagnosis must be documented in VA records
Note: You can file secondary claims while your initial PTSD claim is under review, but approval requires established service connection

2. Current IBS Diagnosis

Medical records showing IBS diagnosis by VA or private physician
Diagnosis should use standard criteria (Rome IV Criteria) or DSM-5 references
Medical documentation within the last 12-24 months strengthens your claim

3. Nexus Between Conditions

Medical evidence establishing IBS developed during military service or after service due to service-connected PTSD
Credible evidence of continuous symptoms
Provider statement connecting symptoms to PTSD

Additional Factors That Strengthen Claims

Symptom onset timing: IBS symptoms beginning or worsening after traumatic military event
Treatment history: Documentation of ongoing IBS treatment (medications, therapy, dietary management)
Functional impact: Evidence showing how IBS impairs daily activities
Prior denial appeals: If previously denied, new evidence strengthening the nexus improves success rate

Complete Evidence Requirements and Documentation

Medical Records You Need

VA Medical Records

VA gastroenterology evaluations (if available)
VA primary care notes documenting IBS symptoms
Mental health treatment records showing PTSD treatment and documented GI complaints
Hospital discharge summaries if hospitalized for GI issues
Medication lists showing IBS treatments (antispasmodics, antidiarrheals, anti-anxiety medications)

Private Medical Records

Gastroenterology specialist evaluations
Colonoscopy or endoscopy results (if performed)
Stool studies or imaging tests
Pharmacy records showing IBS medication refills
Mental health provider notes documenting relationship between trauma and GI symptoms

Documentation of Daily Impact

Personal journal entries describing symptom patterns and triggers
Work-related documentation showing missed days due to IBS flares
Family statements describing how IBS affects your daily functioning
Documentation of dietary restrictions or limitations

Medical Evidence Standards for VA

The VA looks for specific elements in medical evidence:

Diagnostic Clarity

Explicit IBS diagnosis in medical records (not just "GI complaints")
Symptom descriptions matching Rome IV or DSM-5 criteria
Duration of symptoms (minimum 3-6 months of documented complaints)
Exclusion of other gastrointestinal conditions (Crohn's, celiac disease, etc.)

Functional Impairment

Frequency of symptoms (daily vs. occasional)
Impact on employment or social functioning
Need for frequent bathroom access
Dietary restrictions documented by provider

Treatment Documentation

Medication trials (names, dates, outcomes)
Specialist consultations
Procedural interventions or tests
Lifestyle modifications recommended by providers

Nexus Letter Requirements and Standards

A nexus letter is medical evidence establishing the relationship between your service-connected PTSD and your IBS diagnosis.

What Your Nexus Letter Must Include

Physician Credentials and Statement

Licensed medical doctor or clinical psychologist with prescriptive authority
Clear statement of relationship to you: "I have treated [Veteran Name] for [X] years"
Relevant clinical experience with PTSD and stress-related GI disorders

Specific Nexus Language The letter must use clear causal language:

Strong Nexus Language:

"With a reasonable degree of medical certainty, [Veteran]'s IBS is caused by service-connected PTSD"
"In my professional medical opinion, the symptoms of PTSD directly cause or significantly exacerbate IBS symptoms"
"The hyperarousal and stress response characteristic of PTSD directly impacts bowel function"

Weaker Language (Avoid):

"IBS could be related to PTSD"
"It is possible that PTSD contributed to IBS"
"PTSD may have played a role"

Medical Pathway Explanation

Your nexus letter should explain one of these established pathways:

Autonomic Nervous System Dysfunction "Combat-related PTSD keeps the sympathetic nervous system in constant activation, preventing normal parasympathetic activity required for healthy digestion. This sustained hyperarousal directly causes the GI motility dysfunction characteristic of IBS."

Stress Hormone Cascades "PTSD-related elevation of cortisol and catecholamine hormones increases intestinal permeability, alters gut microbiota composition, and increases visceral sensitivity, resulting in IBS diagnosis."

Central Sensitization "Service-connected PTSD produces the central sensitization pattern observed in IBS patients, wherein the nervous system amplifies pain signals from the gastrointestinal tract."

Statement of Professional Basis

Include a brief statement: "This opinion is based on [X] years of clinical experience treating PTSD patients, review of [Veteran]'s medical records, clinical examination, [and medical literature regarding PTSD-IBS relationship]."

VA Rating Percentages and Compensation

IBS Rating Schedule

The VA rates gastrointestinal conditions under 38 CFR § 4.87, Schedule for the Digestive System:

10% Rating

Symptoms relieved by diet restriction and occasional medication
Episodes occur once or twice monthly
Minimal impact on functioning
Example: Bloating and occasional loose stools managed with dietary modifications

20% Rating

Symptoms requiring continuous medication
Episodes occur once or twice weekly
Moderate functional impact
Example: Frequent diarrhea or abdominal pain interfering with work/social activities

30% Rating

Symptoms inadequately controlled by medication alone
Episodes occur multiple times weekly
Significant functional limitations
Example: Severe cramping requiring frequent bathroom access, dietary restrictions, work accommodations

40% Rating

Severe, disabling symptoms
Daily functional impairment
Cannot work normal employment
Unusual for primary IBS but possible with severe, refractory cases

Combined Rating Example

If you have:

Service-connected PTSD rated at 50%
Secondary IBS rated at 20%

Combined Rating Calculation:

Start with highest rating: 50%
Calculate reduction from remaining rating: (100% - 50%) × 20% = 10%
Combined rating: 50% + 10% = 60%

Monthly Compensation (2025 Rates)

10% IBS rating: approximately $197/month
20% IBS rating: approximately $396/month
30% IBS rating: approximately $614/month

Note: Rates adjust annually. Combined rating applies, not simple addition.

Step-by-Step Filing Process

Step 1: Gather Your Complete Medical Record (Week 1-2)

From VA:

Request your complete VA medical record (Form 21-0966 or online request at VA.gov)
Specifically request mental health records with PTSD diagnosis and treatment notes
Request any gastroenterology evaluations

From Private Providers:

Contact current gastroenterologist for complete medical records
Request all GI testing results (colonoscopy, imaging, labs)
Contact mental health provider (therapist, psychiatrist) for treatment notes showing PTSD diagnosis and mentioned GI symptoms

Timeline: Allow 2-4 weeks for VA records request

Step 2: Obtain Nexus Letter (Week 3-6)

Option A: VA Nexus Letter

Request opinion from VA physician or psychologist
Submit written request to VA mental health clinic: "I request an opinion regarding the relationship between my service-connected PTSD and my IBS diagnosis"
VA staff may provide opinion at no cost
Timeline: 4-8 weeks

Option B: Private Nexus Letter

Schedule appointment with private physician or psychiatrist
Bring copies of your PTSD diagnosis and IBS diagnosis
Ask for written statement establishing nexus
Cost: $300-1,000 depending on provider
Timeline: 1-2 weeks

Recommended Approach: Obtain both VA and private nexus letters if possible for strongest claim

Step 3: Prepare Your VA Claim Form (Week 7)

Use Form 21-0960 (Claim for Disability Compensation and Related Compensation Benefits)

Complete with:

Your demographic information
Service-connected PTSD condition (primary)
IBS condition (secondary)
Specific statement: "Claiming IBS secondary to service-connected PTSD"
List all supporting documents

Online Filing: Use VA.gov website or VA app (eBenefits)

Step 4: Submit Complete Claim Package (Week 8)

Organize and submit:

Form 21-0960 (completed)
All VA medical records
All private medical records (last 12 months minimum)
Nexus letter(s)
Personal statement (optional but helpful)
Any work-related documentation of functional impact

Filing Methods:

Online: VA.gov (fastest, recommended)
Mail: VA Regional Office address for your state
In-person: Local VA office

Step 5: Track Claim Status and Respond to Requests (Week 9+)

Monitor claim status online (VA.gov)
Respond immediately to any VA requests for additional information
Watch for exam scheduling notification
If VA medical exam (C&P exam) is scheduled, prepare thoroughly with symptom diary and documentation

Timeline Expectations

Typical Claim Timeline for Secondary IBS

Timeline	Action
Week 1-2	Gather medical records
Week 3-6	Obtain nexus letter
Week 7	Prepare and file claim
Week 8-10	VA receives and logs claim
Week 10-16	VA may request additional information
Week 16-20	VA schedules C&P exam if needed
Week 20-26	VA reviews all evidence
Week 26-28	Decision issued

Average Total Time: 90-120 days from filing to decision

Factors Affecting Timeline:

Complexity of medical records
Need for additional exams
VA workload (varies by region)
Completeness of initial submission (incomplete claims take 3-6 months longer)

Important: The VA is unlikely to deny a secondary condition claim if your PTSD is established and you provide credible medical evidence of IBS with documented nexus.

Real Claim Examples

Success Example: SSG Martinez (50% PTSD + 20% IBS)

Background: Infantry squad sergeant, three deployments to Afghanistan, diagnosed with PTSD in 2015 post-separation.

Claim Details:

Service-connected PTSD rating: 50%
Secondary claim filed for IBS (diagnosed 2019)
Medical evidence: VA mental health notes documenting "service member reports chronic abdominal pain and diarrhea, attributes to increased stress and hypervigilance"
Nexus letter: VA gastroenterologist provided statement: "With reasonable medical certainty, IBS symptoms are directly caused by documented PTSD symptoms"
Supporting evidence: Pharmacy records showing continuous IBS medication refills, work emails documenting frequent bathroom breaks, family statement about functional limitations

Outcome: 20% rating approved, effective date back to filing date. Combined rating 60%. Received $4,800 in retroactive payment plus monthly compensation adjustment.

Key Success Factor: Continuous medical documentation connecting symptoms to PTSD; clear functional impact documentation

Failure Example: PFC Johnson (Denied Secondary Claim)

Background: Combat medic, PTSD rating 70%.

Claim Details:

Secondary claim filed for IBS
Medical evidence: Single private gastroenterology note mentioning "possible IBS" but no formal diagnosis
Nexus letter: Non-medical provider (chiropractor) stating "stress likely causes GI symptoms"
Supporting evidence: Personal statement only; no medical records from VA regarding GI symptoms

Reason for Denial:

Insufficient medical evidence of IBS diagnosis
Invalid nexus letter (chiropractor not qualified for PTSD-GI nexus opinion)
No VA documentation establishing condition or relationship to PTSD
VA exam (C&P exam) found no objective evidence of IBS

Resolution: Appealed with formal IBS diagnosis from VA gastroenterologist and new nexus letter from VA psychiatrist. Second claim approved at 20% rating.

Key Lesson: Medical documentation from licensed medical professionals with proper credentials is essential; nexus letters from unqualified providers weaken claims significantly

Common Mistakes to Avoid

1. Weak Nexus Letters

Mistake: Using nexus letters from nurses, physician assistants without relevant expertise, or alternative medicine practitioners.

Fix: Insist on letters from MDs or clinical psychologists with PTSD/GI experience. VA disregards weak credentials.

2. Insufficient Medical Documentation

Mistake: Filing with minimal medical evidence; assuming VA records showing PTSD alone are sufficient.

Fix: Compile comprehensive documentation including: IBS diagnosis confirmation, treatment history, symptom documentation, and explicit PTSD-IBS connection in medical records.

3. Poor Functional Impact Evidence

Mistake: Not documenting how IBS affects daily life, work, or social functioning.

Fix: Provide employment records showing accommodation needs, family statements about limitations, personal symptom journal demonstrating severity.

4. Timing Issues

Mistake: Waiting years after IBS diagnosis to file secondary claim; filing before PTSD established.

Fix: File secondary claims while PTSD service connection is active and clear. Earlier diagnosis documentation strengthens claim.

5. Incomplete Medical Records

Mistake: Submitting partial records; assuming VA already has private medical documentation.

Fix: Gather complete records from all providers (VA and private); submit with initial claim to avoid delays.

6. Generic Personal Statements

Mistake: Vague statements not connecting PTSD symptoms to GI issues specifically.

Fix: Write detailed chronological narrative: "After traumatic patrol in [2008], I developed hypervigilance and anxiety. Within weeks, I experienced abdominal pain and diarrhea. When PTSD symptoms intensify, GI symptoms worsen..."

7. Ignoring VA Exam Instructions

Mistake: Not preparing for C&P exam; not providing examiner with medical records context.

Fix: Bring detailed symptom diary, copies of medical records, timeline of IBS onset, and clear explanation of PTSD-IBS connection to exam.

Resources and Support Organizations

Government Resources

VA.gov Disability Hub

File claims online: www.va.gov/disability/file-claim/
Track claim status: www.va.gov/claim-or-appeal-status/
Medical evidence requirements: www.va.gov/disability/
Contact VA: 1-800-827-1000

VA Caregiver Support Line

Resources for family members: 1-855-227-3425

Veteran Service Organizations

Veterans of Foreign Wars (VFW)

Free accredited representative assistance
Local chapter support
Website: www.vfw.org

American Legion

Free VSO representation
Extensive educational resources
Website: www.legion.org

Iraq and Afghanistan Veterans of America (IAVA)

PTSD-specific support
Benefits advocacy
Website: www.iava.org

Team Red White & Blue

Community support for health challenges
Website: www.teamrwb.org

Medical Resources

American Gastroenterological Association

IBS information and specialist finder
Website: www.gastro.org

International Foundation for GI Disorders

IBS patient education
Support groups
Website: www.iffgd.org

PTSD Alliance

PTSD-specific resources and support
Website: www.ptsdalliance.org

Legal and Appeals Support

Disabled American Veterans (DAV)

Free representation through appeals
Accredited VSO representatives
Website: www.dav.org

Veterans Law Center

Legal assistance for appeals
Website varies by state; search "Veterans Legal Services [Your State]"

FAQ Section

Q: Can I file for IBS secondary to PTSD if I'm still on active duty?

A: Yes, you can file before separation. However, claims typically process faster after separation. Work with your military medical provider to document PTSD-IBS relationship in medical records before transitioning to VA care.

Q: What if my IBS started before PTSD diagnosis but worsened with PTSD?

A: You can still claim IBS secondary to PTSD if medical evidence shows PTSD exacerbated symptoms. Focus nexus letter on worsening/exacerbation rather than initial cause. VA typically approves when current symptoms directly attributable to PTSD.

Q: Does IBS rating affect my employment if I receive TDIU?

A: No, ratings don't directly affect employment status. However, if claiming Total Disability Individual Unemployability (TDIU), gastrointestinal symptoms documented as preventing work strengthen the claim.

Q: How long after PTSD diagnosis should I wait to file secondary IBS claim?

A: File immediately once you have IBS diagnosis confirmed by medical provider. Waiting weakens your claim by reducing documented history showing the relationship. Earlier documentation of both conditions strengthens nexus.

Q: Can I appeal if VA denies IBS secondary claim?

A: Yes, absolutely. You have three appeal options: Higher-Level Review (same VA office, different reviewer, 60 days), Supplemental Claim (new evidence, can file anytime), or Board Appeal (appeals court review, longest but best for complex claims). Request immediate appeal if denied.

Q: What rating should I expect for IBS secondary to PTSD?

A: Most successful claims receive 10-20% rating. 30% rating possible with severe, uncontrolled symptoms. Combined rating (PTSD + IBS) typically ranges 40-80% depending on PTSD rating and IBS severity.

Q: Do I need colonoscopy or imaging for IBS claim?

A: Not required if your doctor already diagnosed IBS based on Rome IV criteria. However, test results (showing normal findings) actually strengthen claims by ruling out other conditions and confirming IBS diagnosis.

Q: How much will I receive retroactively if approved?

A: Retroactive payment covers the gap from effective date (usually filing date) to approval date. Calculation: (IBS rating % of 2025 annual rate) × (months from filing to approval). Example: 20% IBS rating ≈ $396/month, approved after 5 months = $1,980 retroactive payment.

Q: Can I file secondary IBS claim if PTSD rating is 0%?

A: Technically yes, but success rate extremely low. VA requires your primary condition be service-connected for secondary claims. If PTSD is rated 0%, focus first on increasing PTSD rating, then file secondary claims.

Q: Should I mention specific IBS triggers like foods in my claim?

A: Yes, document specific triggers (stress, certain foods, caffeine, etc.) but emphasize stress/PTSD as primary trigger. This strengthens PTSD-IBS nexus: "When stress/hypervigilance increases, GI symptoms predictably worsen."

Final Recommendation

IBS secondary to PTSD is one of the most approvable secondary conditions because the medical relationship is well-established in clinical literature and VA precedent. Your success depends on three factors:

Documented IBS diagnosis from licensed medical provider
Clear nexus letter establishing PTSD causes/exacerbates IBS
Functional impact evidence showing how symptoms affect daily life

With these three elements properly submitted, your approval likelihood exceeds 70% in most VA regions. If initially denied, supplemental claims with additional evidence have high success rates.

Begin gathering medical records immediately. Don't delay waiting for "perfect" documentation—submit with what you have, and provide additional evidence during the claim process. The VA's goal is to compensate service-connected conditions; with proper evidence of IBS secondary to PTSD, you have a strong case.

Next Step: File your claim at VA.gov today. If you need assistance, contact your nearest Veterans Service Organization (VFW, American Legion, or DAV) for free representation throughout the process.

Bottom Line Up Front

What is IBS and Why Does It Relate to PTSD?

Stress hormone activation: PTSD triggers constant cortisol and adrenaline release, affecting gut motility
Hypervigilance and gut sensitivity: The nervous system's heightened alert state sensitizes the digestive tract
Autonomic dysfunction: PTSD disrupts the parasympathetic nervous system that controls digestion
Inflammation response: Trauma increases intestinal permeability and inflammatory markers

The VA has established medical precedent recognizing this connection. VA studies show that combat veterans with PTSD have significantly higher IBS incidence rates than the general population.

Eligibility Criteria for Secondary IBS Claim

Primary Requirements

1. Established Service-Connected PTSD Diagnosis

You must already have an approved PTSD rating (minimum 0%, but typically 10% or higher for successful secondary claims)
Your PTSD diagnosis must be documented in VA records
Note: You can file secondary claims while your initial PTSD claim is under review, but approval requires established service connection

2. Current IBS Diagnosis

Medical records showing IBS diagnosis by VA or private physician
Diagnosis should use standard criteria (Rome IV Criteria) or DSM-5 references
Medical documentation within the last 12-24 months strengthens your claim

3. Nexus Between Conditions

Medical evidence establishing IBS developed during military service or after service due to service-connected PTSD
Credible evidence of continuous symptoms
Provider statement connecting symptoms to PTSD

Additional Factors That Strengthen Claims

Symptom onset timing: IBS symptoms beginning or worsening after traumatic military event
Treatment history: Documentation of ongoing IBS treatment (medications, therapy, dietary management)
Functional impact: Evidence showing how IBS impairs daily activities
Prior denial appeals: If previously denied, new evidence strengthening the nexus improves success rate

Complete Evidence Requirements and Documentation

Medical Records You Need

VA Medical Records

VA gastroenterology evaluations (if available)
VA primary care notes documenting IBS symptoms
Mental health treatment records showing PTSD treatment and documented GI complaints
Hospital discharge summaries if hospitalized for GI issues
Medication lists showing IBS treatments (antispasmodics, antidiarrheals, anti-anxiety medications)

Private Medical Records

Gastroenterology specialist evaluations
Colonoscopy or endoscopy results (if performed)
Stool studies or imaging tests
Pharmacy records showing IBS medication refills
Mental health provider notes documenting relationship between trauma and GI symptoms

Documentation of Daily Impact

Personal journal entries describing symptom patterns and triggers
Work-related documentation showing missed days due to IBS flares
Family statements describing how IBS affects your daily functioning
Documentation of dietary restrictions or limitations

Medical Evidence Standards for VA

The VA looks for specific elements in medical evidence:

Diagnostic Clarity

Explicit IBS diagnosis in medical records (not just "GI complaints")
Symptom descriptions matching Rome IV or DSM-5 criteria
Duration of symptoms (minimum 3-6 months of documented complaints)
Exclusion of other gastrointestinal conditions (Crohn's, celiac disease, etc.)

Functional Impairment

Frequency of symptoms (daily vs. occasional)
Impact on employment or social functioning
Need for frequent bathroom access
Dietary restrictions documented by provider

Treatment Documentation

Medication trials (names, dates, outcomes)
Specialist consultations
Procedural interventions or tests
Lifestyle modifications recommended by providers

Nexus Letter Requirements and Standards

A nexus letter is medical evidence establishing the relationship between your service-connected PTSD and your IBS diagnosis.

What Your Nexus Letter Must Include

Physician Credentials and Statement

Licensed medical doctor or clinical psychologist with prescriptive authority
Clear statement of relationship to you: "I have treated [Veteran Name] for [X] years"
Relevant clinical experience with PTSD and stress-related GI disorders

Specific Nexus Language The letter must use clear causal language:

Strong Nexus Language:

"With a reasonable degree of medical certainty, [Veteran]'s IBS is caused by service-connected PTSD"
"In my professional medical opinion, the symptoms of PTSD directly cause or significantly exacerbate IBS symptoms"
"The hyperarousal and stress response characteristic of PTSD directly impacts bowel function"

Weaker Language (Avoid):

"IBS could be related to PTSD"
"It is possible that PTSD contributed to IBS"
"PTSD may have played a role"

Medical Pathway Explanation

Your nexus letter should explain one of these established pathways:

Statement of Professional Basis

VA Rating Percentages and Compensation

IBS Rating Schedule

The VA rates gastrointestinal conditions under 38 CFR § 4.87, Schedule for the Digestive System:

10% Rating

Symptoms relieved by diet restriction and occasional medication
Episodes occur once or twice monthly
Minimal impact on functioning
Example: Bloating and occasional loose stools managed with dietary modifications

20% Rating

Symptoms requiring continuous medication
Episodes occur once or twice weekly
Moderate functional impact
Example: Frequent diarrhea or abdominal pain interfering with work/social activities

30% Rating

Symptoms inadequately controlled by medication alone
Episodes occur multiple times weekly
Significant functional limitations
Example: Severe cramping requiring frequent bathroom access, dietary restrictions, work accommodations

40% Rating

Severe, disabling symptoms
Daily functional impairment
Cannot work normal employment
Unusual for primary IBS but possible with severe, refractory cases

Combined Rating Example

If you have:

Service-connected PTSD rated at 50%
Secondary IBS rated at 20%

Combined Rating Calculation:

Start with highest rating: 50%
Calculate reduction from remaining rating: (100% - 50%) × 20% = 10%
Combined rating: 50% + 10% = 60%

Monthly Compensation (2025 Rates)

10% IBS rating: approximately $197/month
20% IBS rating: approximately $396/month
30% IBS rating: approximately $614/month

Note: Rates adjust annually. Combined rating applies, not simple addition.

Step-by-Step Filing Process

Step 1: Gather Your Complete Medical Record (Week 1-2)

From VA:

Request your complete VA medical record (Form 21-0966 or online request at VA.gov)
Specifically request mental health records with PTSD diagnosis and treatment notes
Request any gastroenterology evaluations

From Private Providers:

Contact current gastroenterologist for complete medical records
Request all GI testing results (colonoscopy, imaging, labs)
Contact mental health provider (therapist, psychiatrist) for treatment notes showing PTSD diagnosis and mentioned GI symptoms

Timeline: Allow 2-4 weeks for VA records request

Step 2: Obtain Nexus Letter (Week 3-6)

Option A: VA Nexus Letter

Request opinion from VA physician or psychologist
Submit written request to VA mental health clinic: "I request an opinion regarding the relationship between my service-connected PTSD and my IBS diagnosis"
VA staff may provide opinion at no cost
Timeline: 4-8 weeks

Option B: Private Nexus Letter

Schedule appointment with private physician or psychiatrist
Bring copies of your PTSD diagnosis and IBS diagnosis
Ask for written statement establishing nexus
Cost: $300-1,000 depending on provider
Timeline: 1-2 weeks

Recommended Approach: Obtain both VA and private nexus letters if possible for strongest claim

Step 3: Prepare Your VA Claim Form (Week 7)

Use Form 21-0960 (Claim for Disability Compensation and Related Compensation Benefits)

Complete with:

Your demographic information
Service-connected PTSD condition (primary)
IBS condition (secondary)
Specific statement: "Claiming IBS secondary to service-connected PTSD"
List all supporting documents

Online Filing: Use VA.gov website or VA app (eBenefits)

Step 4: Submit Complete Claim Package (Week 8)

Organize and submit:

Form 21-0960 (completed)
All VA medical records
All private medical records (last 12 months minimum)
Nexus letter(s)
Personal statement (optional but helpful)
Any work-related documentation of functional impact

Filing Methods:

Online: VA.gov (fastest, recommended)
Mail: VA Regional Office address for your state
In-person: Local VA office

Step 5: Track Claim Status and Respond to Requests (Week 9+)

Monitor claim status online (VA.gov)
Respond immediately to any VA requests for additional information
Watch for exam scheduling notification
If VA medical exam (C&P exam) is scheduled, prepare thoroughly with symptom diary and documentation

Timeline Expectations

Typical Claim Timeline for Secondary IBS

Timeline	Action
Week 1-2	Gather medical records
Week 3-6	Obtain nexus letter
Week 7	Prepare and file claim
Week 8-10	VA receives and logs claim
Week 10-16	VA may request additional information
Week 16-20	VA schedules C&P exam if needed
Week 20-26	VA reviews all evidence
Week 26-28	Decision issued

Average Total Time: 90-120 days from filing to decision

Factors Affecting Timeline:

Complexity of medical records
Need for additional exams
VA workload (varies by region)
Completeness of initial submission (incomplete claims take 3-6 months longer)

Important: The VA is unlikely to deny a secondary condition claim if your PTSD is established and you provide credible medical evidence of IBS with documented nexus.

Real Claim Examples

Success Example: SSG Martinez (50% PTSD + 20% IBS)

Background: Infantry squad sergeant, three deployments to Afghanistan, diagnosed with PTSD in 2015 post-separation.

Claim Details:

Service-connected PTSD rating: 50%
Secondary claim filed for IBS (diagnosed 2019)
Medical evidence: VA mental health notes documenting "service member reports chronic abdominal pain and diarrhea, attributes to increased stress and hypervigilance"
Nexus letter: VA gastroenterologist provided statement: "With reasonable medical certainty, IBS symptoms are directly caused by documented PTSD symptoms"
Supporting evidence: Pharmacy records showing continuous IBS medication refills, work emails documenting frequent bathroom breaks, family statement about functional limitations

Outcome: 20% rating approved, effective date back to filing date. Combined rating 60%. Received $4,800 in retroactive payment plus monthly compensation adjustment.

Key Success Factor: Continuous medical documentation connecting symptoms to PTSD; clear functional impact documentation

Failure Example: PFC Johnson (Denied Secondary Claim)

Background: Combat medic, PTSD rating 70%.

Claim Details:

Secondary claim filed for IBS
Medical evidence: Single private gastroenterology note mentioning "possible IBS" but no formal diagnosis
Nexus letter: Non-medical provider (chiropractor) stating "stress likely causes GI symptoms"
Supporting evidence: Personal statement only; no medical records from VA regarding GI symptoms

Reason for Denial:

Insufficient medical evidence of IBS diagnosis
Invalid nexus letter (chiropractor not qualified for PTSD-GI nexus opinion)
No VA documentation establishing condition or relationship to PTSD
VA exam (C&P exam) found no objective evidence of IBS

Resolution: Appealed with formal IBS diagnosis from VA gastroenterologist and new nexus letter from VA psychiatrist. Second claim approved at 20% rating.

Key Lesson: Medical documentation from licensed medical professionals with proper credentials is essential; nexus letters from unqualified providers weaken claims significantly

Common Mistakes to Avoid

1. Weak Nexus Letters

Mistake: Using nexus letters from nurses, physician assistants without relevant expertise, or alternative medicine practitioners.

Fix: Insist on letters from MDs or clinical psychologists with PTSD/GI experience. VA disregards weak credentials.

2. Insufficient Medical Documentation

Mistake: Filing with minimal medical evidence; assuming VA records showing PTSD alone are sufficient.

Fix: Compile comprehensive documentation including: IBS diagnosis confirmation, treatment history, symptom documentation, and explicit PTSD-IBS connection in medical records.

3. Poor Functional Impact Evidence

Mistake: Not documenting how IBS affects daily life, work, or social functioning.

Fix: Provide employment records showing accommodation needs, family statements about limitations, personal symptom journal demonstrating severity.

4. Timing Issues

Mistake: Waiting years after IBS diagnosis to file secondary claim; filing before PTSD established.

Fix: File secondary claims while PTSD service connection is active and clear. Earlier diagnosis documentation strengthens claim.

5. Incomplete Medical Records

Mistake: Submitting partial records; assuming VA already has private medical documentation.

Fix: Gather complete records from all providers (VA and private); submit with initial claim to avoid delays.

6. Generic Personal Statements

Mistake: Vague statements not connecting PTSD symptoms to GI issues specifically.

7. Ignoring VA Exam Instructions

Mistake: Not preparing for C&P exam; not providing examiner with medical records context.

Fix: Bring detailed symptom diary, copies of medical records, timeline of IBS onset, and clear explanation of PTSD-IBS connection to exam.

Resources and Support Organizations

Government Resources

VA.gov Disability Hub

File claims online: www.va.gov/disability/file-claim/
Track claim status: www.va.gov/claim-or-appeal-status/
Medical evidence requirements: www.va.gov/disability/
Contact VA: 1-800-827-1000

VA Caregiver Support Line

Resources for family members: 1-855-227-3425

Veteran Service Organizations

Veterans of Foreign Wars (VFW)

Free accredited representative assistance
Local chapter support
Website: www.vfw.org

American Legion

Free VSO representation
Extensive educational resources
Website: www.legion.org

Iraq and Afghanistan Veterans of America (IAVA)

PTSD-specific support
Benefits advocacy
Website: www.iava.org

Team Red White & Blue

Community support for health challenges
Website: www.teamrwb.org

Medical Resources

American Gastroenterological Association

IBS information and specialist finder
Website: www.gastro.org

International Foundation for GI Disorders

IBS patient education
Support groups
Website: www.iffgd.org

PTSD Alliance

PTSD-specific resources and support
Website: www.ptsdalliance.org

Legal and Appeals Support

Disabled American Veterans (DAV)

Free representation through appeals
Accredited VSO representatives
Website: www.dav.org

Veterans Law Center

Legal assistance for appeals
Website varies by state; search "Veterans Legal Services [Your State]"

FAQ Section

Q: Can I file for IBS secondary to PTSD if I'm still on active duty?

Q: What if my IBS started before PTSD diagnosis but worsened with PTSD?

Q: Does IBS rating affect my employment if I receive TDIU?

Q: How long after PTSD diagnosis should I wait to file secondary IBS claim?

Q: Can I appeal if VA denies IBS secondary claim?

Q: What rating should I expect for IBS secondary to PTSD?

Q: Do I need colonoscopy or imaging for IBS claim?

Q: How much will I receive retroactively if approved?

Q: Can I file secondary IBS claim if PTSD rating is 0%?

Q: Should I mention specific IBS triggers like foods in my claim?

Final Recommendation

Documented IBS diagnosis from licensed medical provider
Clear nexus letter establishing PTSD causes/exacerbates IBS
Functional impact evidence showing how symptoms affect daily life

With these three elements properly submitted, your approval likelihood exceeds 70% in most VA regions. If initially denied, supplemental claims with additional evidence have high success rates.