VA Secondary Conditions to IBS 

Irritable Bowel Syndrome is a chronic gastrointestinal condition that affects veterans at a higher rate than the general population. While IBS itself can be debilitating, many veterans also suffer from secondary conditions that develop because of IBS. 

What Conditions Are Secondary To IBS? 

A secondary condition is a disability caused or aggravated by a service-connected condition. For veterans with IBS, these secondary conditions can range from gastrointestinal issues to mental health disorders. Establishing a secondary service connection involves proving that the secondary condition is directly related to the primary service-connected condition—in this case, IBS. 

GERD 

Gastroesophageal Reflux Disease (GERD) is one of the most common secondary conditions associated with IBS. GERD occurs when stomach acid frequently flows back into the esophagus, leading to symptoms such as heartburn, chest pain, and difficulty swallowing. The chronic abdominal discomfort and stress associated with IBS can exacerbate GERD symptoms, leading to a cycle where each condition worsens the other. 

See the VA ratings for GERD secondary to IBS (and how to win your claim!) 

Important Note: The connection between GERD and IBS is complex, and the VA may not issue separate ratings for both conditions due to the similarity of their symptoms. This is to avoid pyramiding, where the VA compensates for the same symptoms under multiple diagnoses. However, the VA might assign a single rating under a broader gastrointestinal condition if both GERD and IBS are present. 

Hemorrhoids 

Hemorrhoids are another common secondary condition related to IBS. Chronic diarrhea or constipation, both frequent symptoms of IBS, can lead to the development of hemorrhoids—swollen veins in the rectum or anus that cause pain, itching, and bleeding. 

Hemorrhoids are rated under Diagnostic Code 7336, with ratings up to 20% for severe cases involving persistent bleeding and secondary complications like anemia. Find out more about the VA ratings for hemorrhoids 

Establishing Secondary Service Connection: Hemorrhoids Due to Irritable Bowel Syndrome: Case Example 

In a notable decision, the Board of Veterans’ Appeals granted service connection for hemorrhoids as secondary to irritable bowel syndrome (IBS) in a veteran who served from November 1996 to August 2000.  

The Veteran successfully argued that her hemorrhoids were caused by her service-connected IBS. The Board granted service connection for the hemorrhoids, recognizing the direct link between the frequent, severe episodes of diarrhea and constipation caused by IBS and the development of hemorrhoids.  

Key Factors in Establishing the Secondary Connection: 

• Medical Evidence Linking IBS and Hemorrhoids: The Board’s decision was strongly influenced by the medical evidence showing a direct relationship between the Veteran’s IBS and her hemorrhoids. The Veteran’s medical records consistently documented the severe alternating episodes of diarrhea and constipation characteristic of IBS. These episodes were found to directly contribute to the worsening of the Veteran’s hemorrhoids, a condition frequently associated with such gastrointestinal issues. 
• Personal Testimony and Symptom Documentation: The Veteran’s personal testimony and consistent documentation of her symptoms played a crucial role in establishing the connection between her IBS and hemorrhoids. She provided detailed accounts of how her IBS symptoms led to frequent hemorrhoidal flare-ups, which significantly impacted her daily life and required ongoing treatment. 
• Overcoming Negative VA Opinion: Initially, a February 2015 VA examination opined against the secondary connection, suggesting that the hemorrhoids were not related to the Veteran’s IBS. However, the Board found this opinion unconvincing, particularly since the rationale cited factors such as diarrhea and constipation—symptoms directly associated with IBS—as potential causes for hemorrhoids. The Board ultimately resolved the doubt in favor of the Veteran, granting service connection based on the cumulative evidence that pointed to a clear link between her IBS and hemorrhoids. 

For veterans suffering from IBS and related gastrointestinal disorders, it’s important to document how these conditions contribute to other health issues, such as hemorrhoids. By clearly demonstrating this connection, veterans can successfully advocate for the benefits they deserve. 

Anxiety 

Anxiety is a mental health condition that frequently develops in veterans dealing with chronic IBS. The unpredictability of IBS symptoms, along with the pain and discomfort they cause, can lead to significant stress and anxiety. Veterans may experience panic attacks, social anxiety, or generalized anxiety from living with IBS. 

VA Ratings for Anxiety Secondary to IBS 

Anxiety is rated under the General Rating Formula for Mental Disorders (Diagnostic Code 9400). Ratings range from 0% for mild symptoms to 100% for total occupational and social impairment. 

Secondary Service Connection for Irritable Bowel Syndrome Due to Generalized Anxiety Disorder: Case Example 

In a case involving a veteran who served from August 1943 to March 1946, the Board of Veterans’ Appeals granted service connection for irritable bowel syndrome (IBS) as secondary to the veteran’s service-connected generalized anxiety disorder.  

The veteran’s anxiety disorder was directly linked to his military service, specifically his role as a firefighter during World War II, which caused significant stress and anxiety that persisted long after his service. 

Key Factors that Won the Claim: 

• Established Anxiety Disorder: The veteran’s generalized anxiety disorder was diagnosed and attributed to his military service, where he faced high-stress situations as a firefighter. 
• Medical Link Between Anxiety and IBS: A VA examiner confirmed that patients with anxiety often suffer from IBS, establishing a direct connection between the veteran’s psychological condition and his gastrointestinal issues. 

The veteran’s IBS was recognized as a secondary condition resulting from his service-connected anxiety disorder. Proper medical documentation and a clear link between the primary and secondary conditions are essential for successful claims. 

Depression 

Depression is another mental health condition that can develop as a secondary condition to IBS. The chronic pain and lifestyle disruptions caused by IBS can lead to feelings of hopelessness, sadness, and a loss of interest in daily activities. Depression can further worsen IBS symptoms, creating a vicious cycle. 

VA Ratings for Depression Secondary to IBS 

Like anxiety, depression is rated under the General Rating Formula for Mental Disorders (Diagnostic Code 9434). Ratings depend on the severity of symptoms and their impact on daily functioning. 

Case Study: Depression Secondary to Irritable Bowel Syndrome (IBS) 

In this case, a veteran who served from April 1988 to September 1988 and from November 1990 to July 1991 was granted service connection for depression as secondary to his service-connected irritable bowel syndrome (IBS). The veteran experienced a range of symptoms, including fatigue, memory problems, anxiety, sleep issues, and depression, which were linked to his IBS.  

The Board of Veterans’ Appeals reviewed extensive medical evidence, including reports linking psychosocial difficulties and cognitive impairments to IBS. 

Key Factors That Won This Claim: 

• Service Connection for IBS: The veteran was previously granted service connection for IBS. 
• Psychiatric Symptoms Linked to IBS: Medical evidence indicated that the veteran’s depression, anxiety, and other psychiatric symptoms were connected to his IBS. 
• VA Neuropsychological Evaluation: A VA neuropsychologist noted that the veteran’s IBS could contribute to his decreased functioning and cognitive complaints, supporting the link between IBS and depression. 

The Board found that the evidence supported the claim that the veteran’s depression was secondary to his service-connected IBS, ultimately granting service connection for the psychiatric disorder.  

Migraines 

Migraines are severe headaches that can be triggered or worsened by the stress and physical discomfort of IBS. Some veterans find that their migraine symptoms intensify during IBS flare-ups, making it difficult to manage both conditions simultaneously. 

VA Ratings for Migraines Secondary to IBS 

Migraines are rated under Diagnostic Code 8100, with ratings ranging from 0% for mild, infrequent headaches to 50% for severe, prostrating migraines that cause significant impairment. 

Case Study: Migraines Secondary to Irritable Bowel Syndrome (IBS) 

In this case, a veteran who served from July 1966 to March 1970 successfully claimed service connection for migraines as secondary to his service-connected irritable bowel syndrome (IBS). The Board of Veterans’ Appeals reviewed evidence that demonstrated a causal link between the veteran’s migraines and IBS, ultimately granting the claim. 

Key Factors That Won the Case: 

• Medical Evidence Linking Conditions: Multiple VA medical professionals consistently supported the connection between the veteran’s migraines and his IBS, noting that migraines were a “part and parcel” of the IBS process. 
• Consistent Medical Opinions: VA examiners and private medical professionals provided consistent opinions over time, confirming the connection between migraines and IBS, with no contradictory medical evidence. 
• Absence of Opposing Evidence: The Board noted the absence of any credible medical opinions denying the relationship between the veteran’s migraines and IBS, strengthening the veteran’s case. 

The consistent medical evidence linking the veteran’s migraines to his service-connected IBS led the Board to grant secondary service connection for migraines, emphasizing the importance of medical documentation in substantiating claims. 

Fibromyalgia 

Fibromyalgia is a chronic pain condition that can develop as a secondary condition to IBS. Veterans with IBS may experience widespread pain, fatigue, and cognitive difficulties, which are hallmarks of fibromyalgia. The connection between IBS and fibromyalgia is well-documented, and veterans with both conditions may qualify for additional VA benefits. Learn more about Fibromyalgia VA Ratings here.

VA Ratings for Fibromyalgia Secondary to IBS 

Fibromyalgia is rated under Diagnostic Code 5025, with ratings ranging from 10% to 40%, depending on the frequency and severity of symptoms. 

Case Study: Fibromyalgia Secondary to Irritable Bowel Syndrome (IBS) 

In this case, a veteran successfully obtained a separate, compensable disability rating for fibromyalgia as secondary to his service-connected irritable bowel syndrome (IBS). The Board of Veterans’ Appeals reviewed the evidence, ultimately granting a 40 percent rating for fibromyalgia with IBS. 

Key Factors That Contributed to Getting Secondary Connected: 

• Medical Evidence of Separate Conditions: The veteran provided consistent medical evidence showing that his fibromyalgia and IBS were separate and distinct conditions, not merely symptoms of his psychiatric disorder. This was supported by statements from multiple healthcare providers. 
• Consistent Symptomatology: The veteran’s symptoms of fibromyalgia, including whole-body pain, tender points, stiffness, and sleep disturbances, were consistently documented throughout the appeal period, demonstrating a chronic and severe condition. 
• Credible Lay Evidence: The veteran and his spouse provided competent lay evidence that supported the severity and chronic nature of the symptoms, which aligned with the medical findings. 
• Lack of Effective Treatment: Despite medication and other therapies, the veteran’s symptoms were refractory to treatment, further justifying a higher rating under the diagnostic criteria. 

The Board granted a 40 percent disability rating for fibromyalgia with IBS, recognizing the chronic, severe nature of the conditions and the failure of treatment to alleviate symptoms.  

Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome (CFS) is characterized by extreme fatigue that doesn’t improve with rest and may be worsened by IBS. The constant physical and emotional stress of managing IBS can contribute to the development of CFS, leading to additional challenges in daily life. Learn more about Chronic Fatigue Syndrome (CFS) VA Ratings here.

VA Ratings for CFS Secondary to IBS 

CFS is rated under Diagnostic Code 6354, with ratings ranging from 10% for mild symptoms to 100% for debilitating fatigue that severely limits daily activities. 

Case Study: Chronic Fatigue Secondary to Irritable Bowel Syndrome (IBS) 

In this case, a veteran successfully obtained service connection for chronic fatigue as secondary to her service-connected irritable bowel syndrome (IBS). The Board of Veterans’ Appeals reviewed the evidence, ultimately granting the claim based on the relationship between chronic fatigue and IBS. 

Key Factors That Contributed to Getting Secondary Connected: 

• Medical Evidence of Association: The veteran’s medical records consistently documented chronic fatigue, with both VA and private medical opinions supporting a link between the fatigue and her service-connected IBS. A VA examiner specifically opined that chronic fatigue was as likely as not related to chronic IBS. 
• Veteran’s Testimony: During the Board hearing, the veteran credibly reported that her fatigue worsened during IBS flare-ups, reinforcing the connection between the two conditions. 
• Application of Reasonable Doubt Doctrine: The evidence was found to be in relative equipoise regarding the exact cause of the chronic fatigue. In such cases, the Board applied the reasonable doubt doctrine, attributing the symptom to the service-connected disability (IBS) in the veteran’s favor. 

The Board granted service connection for chronic fatigue as a symptom of IBS, recognizing the consistent medical evidence and the veteran’s credible testimony.  

Case Study: Multiple Conditions Secondary to Irritable Bowel Syndrome (IBS)

A veteran successfully obtained service connection for multiple conditions secondary to his service-connected irritable bowel syndrome (IBS). This case provides a comprehensive overview of how various conditions, including psychiatric disorders, gastrointestinal issues, and other symptoms, can be intricately connected to a primary service-connected condition like IBS.

Background

The veteran served on active duty from April 1988 to September 1988 and from November 1990 to July 1991, with documented service in Southwest Asia during the Gulf War. The veteran’s appeal involved multiple claims for service connection and increased ratings for various conditions. Central to this case was the connection between the veteran’s service-connected IBS and several other conditions, including fatigue, headaches, memory problems, anxiety, depression, gastroesophageal reflux disease (GERD), and a sleep disorder.

Conditions Granted Secondary Service Connection

• Chronic Fatigue: Linked directly to IBS flare-ups since 1996. Service connection granted as fatigue was recognized as a symptom of IBS.
• Headaches: Continuous headaches linked to both service-related medication (pyridostigmine) and IBS. Service connection granted as secondary to IBS.
• Memory Problems: Cognitive issues tied to the psychological impact of IBS. Service connection granted due to the link between IBS and cognitive difficulties.
• Anxiety and Depression: Mental health conditions exacerbated by the stress and impact of IBS on daily life. Service connection granted for both conditions as secondary to IBS.
• Gastroesophageal Reflux Disease (GERD): GERD symptoms linked to IBS, with overlap in gastrointestinal disturbances. Service connection granted, recognizing GERD as secondary to IBS.
• Sleep Disorder: Sleep disturbances connected to IBS and associated anxiety and depression. Service connection granted due to the interconnected nature of IBS and sleep problems.
• Diverticulosis: Diagnosed post-service, diverticulosis found to have clinical overlap with IBS. Service connection granted, considering diverticulosis as part of the broader gastrointestinal issues linked to IBS.

Factors Contributing to Successful Claim

• Consistent Medical Evidence: The veteran’s medical records consistently linked each secondary condition to IBS, providing a clear chain of causation (e.g., fatigue linked to IBS flare-ups).
• Supporting Documentation: The veteran provided evidence from various sources, such as the VA, private providers, and relevant medical literature, which supported the connection between IBS and the secondary conditions (e.g., studies linking mental health issues to gastrointestinal disorders).
• Credible Testimony: The veteran’s own testimony regarding the impact of IBS on daily life and how it exacerbated other conditions was found credible and supported by the medical records (e.g., reports of increased fatigue during IBS flare-ups).
• Application of the Benefit of the Doubt Doctrine: In cases where the cause of a symptom could not be conclusively attributed to one condition over another, the Board resolved all reasonable doubt in favor of the veteran, attributing the symptoms to the service-connected IBS.

This case exemplifies how a single service-connected condition, such as IBS, can have widespread effects on a veteran’s health, leading to secondary service connections for multiple conditions. The Board’s decision to grant service connection for these conditions showcases the importance of considering the cumulative impact of service-connected disabilities on a veteran’s overall health.

Overlapping Conditions with IBS 

In addition to the secondary conditions discussed earlier, there are other overlapping conditions that often coexist with IBS and can further complicate your symptoms and treatment. These might be good things to consider mentioning to your doctor when considering how to get service-connected for IBS or other related conditions. 

• Chronic Pelvic Pain: Particularly common in women with IBS, this condition can add to the discomfort and difficulty in managing IBS symptoms. 
• Interstitial Cystitis: A chronic bladder condition that may lead to additional urinary issues and pain, often seen with IBS. 
• Celiac Disease: While distinct from IBS, celiac disease shares similar gastrointestinal symptoms and can sometimes be mistaken for or occur alongside IBS. 
• Functional Dyspepsia: Characterized by upper abdominal discomfort and bloating, this condition can overlap with IBS, making it more challenging to pinpoint the exact cause of symptoms. 

Using Secondary Conditions to Obtain TDIU 

Veterans who are unable to maintain “substantially gainful employment” due to IBS may be eligible for Total Disability based on Individual Unemployability (TDIU). While the ratings for IBS alone might not typically qualify a veteran for TDIU, veterans with additional service-connected conditions such as mental health disorders or GERD could be eligible.

TDIU provides compensation at the same rate as a 100% disability rating, even if the veteran’s combined rating is below 100%. Veterans will typically be eligible for TDIU if they have: 

• At least one service-connected disability rated at 60% or more disabling, or 
• Two or more service-connected disabilities with at least one rated at 40% or more disabling and a combined rating of 70% or more.