CASE STUDIES

Success Stories

We provide medically supported documentation and expert guidance to help strengthen VA disability claims — including primary service connection, secondary conditions, Aid & Attendance, PACT Act claims, and §1151 cases.

Each case study on this page is based on real veterans we've assisted, with all personal details removed to protect privacy.

Our focus is on accurate medical reasoning, clear evidence analysis, and properly structured documentation — never guarantees, pressure tactics, or copy-paste templates.

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Secondary Service Connection

Obstructive Sleep Apnea (OSA) Granted Secondary to Service-Connected PTSD With Obesity as an Intermediate Step

Marine Corps Veteran • Severe OSA • Service-Connected PTSD • Obesity

Challenge:

This U.S. Marine Corps veteran had an established service connection for Post - Traumatic Stress Disorder (PTSD) and a medically confirmed diagnosis of severe Obstructive Sleep Apnea (OSA).

When the veteran sought VA disability compensation for OSA as a secondary condition, the claim was denied. The VA attributed the condition primarily to obesity and did not recognize a secondary relationship between PTSD and OSA.

What existed before:

Service connection for Post-Traumatic Stress Disorder (PTSD).
A confirmed diagnosis of severe Obstructive Sleep Apnea (OSA) supported by sleep study evidence.
Medical documentation of chronic sleep disruption, excessive daytime fatigue, and impaired daily functioning.
Class II obesity, which the VA cited as the primary cause of OSA.
No medical opinion addressing whether PTSD caused or aggravated the veteran’s OSA, or whether obesity functioned as an intermediate factor rather than an independent cause

Our contribution:

A comprehensive review of the veteran’s medical records, sleep studies, and PTSD symptom history was conducted to assess whether a secondary service connection could be medically supported.

Key steps included:
Evaluating the physiological and behavioral effects of PTSD on sleep architecture and respiratory function.
Reviewing medical literature regarding the relationship between PTSD, sleep disruption, and the development or worsening of OSA.
Analyzing whether obesity acted as an intermediate step influenced by PTSD-related symptoms rather than a sole etiology.
Coordinating the preparation of a medical nexus opinion that clearly addressed causation and aggravation using VA-recognized standards

Key Takeaway

After submission of a medically supported NEXUS opinion explaining how the veteran’s service-connected PTSD contributed to or aggravated his Obstructive Sleep Apnea - despite the presence of obesity - the VA granted secondary service connection for OSA.

This case illustrates that obesity does not automatically preclude secondary service connection when competent medical evidence explains the relationship between a service-connected condition and the claimed disability.

Secondary Service Connection

Vertigo as Secondary to Service-Connected Tinnitus

OIF Army veteran • Chronic tinnitus • Episodic vertigo and imbalance

Challenge:

The veteran’s vertigo claim was previously denied. VA stated: “The evidence does not show your vertigo is proximately due to or the result of your service-connected tinnitus. No medical relationship has been established.”

What existed before:

Service-connected tinnitus.
Episodes of dizziness and imbalance

Our contribution:

Review of auditory and balance-related patterns documented in treatment notes
Identification of symptom timing consistent with secondary vestibular involvement
Chronological analysis comparing tinnitus onset with vertigo development
Structured secondary-service-connection explanation using existing evidence

Key Takeaway

After the secondary-connection documentation - NEXUS LETTER was submitted, the veteran later received a favorable VA decision granting vertigo secondary to tinnitus.

SMC/Aid & Attendance

Aid & Attendance for Veteran With Severe Mobility & Cognitive Decline

Mid-1970s Army veteran • Progressive neurologic decline • Frequent falls

Challenge:

VA initially denied A&A stating that "The overall evidence does not show a single service-connected disability is the sole or partial cause of the need for A&A OR that a totally disability service-connected conditions results in the need for assistance."

What existed before:

Service connection for orthopedic + mental health/neurological conditions
Documented falls.
PCP notes describing “supervision needed with medications”

The record lacked functional analysis showing how service-connected disabilities impacted ADLs and safety.

Our contribution:

Created structured ADL/IADL breakdown
Linked fall risk to SC balance disorder
Explained cognitive fatigue related to SC neurological condition
Added timeline of progressive deterioration.

Key Takeaway

After the updated assessment and supporting documentation were submitted, the veteran later received a favorable VA decision granting SMC-L (Aid & Attendance). Individual outcomes always depend on the full body of evidence.

Secondary Service Connection

Irritable Bowel Syndrome (IBS) as Secondary to Anxiety/Depression

Early-2000s Air Force veteran • Generalised Anxiety disorder with depressive features • Stress-triggered IBS

Challenge:

Service treatment records do not any complaints or diagnosis related to IBS. The evidence does not demonstrate that gastrointestinal symptoms are secondary to your service-connected anxiety/depression. No medical relationship was established.

What existed before:

IBS diagnosis
SC anxiety/depression
Notes showing symptom flares during MH episodes

Our contribution:

Review of symptom fluctuations tied to stress and mental health episodes
Identification of GI patterns consistent with secondary aggravation
Chronological mapping of mental health treatment and IBS progression
Structured secondary-service-connection explanation using existing evidence

Key Takeaway

Following submission of the new opinion, the veteran later received a favorable decision granting service connection for Irritable Bowel Syndrome (IBS). We supported the claim with medical rationale - NEXUS Letter. VA made the final decision.

Primary Service Connection

Primary Service Connection for GERD

Early-2000s Marine veteran • Repeated in-service stomach complaints • Chronic reflux after deployment

Challenge:

The VA denied GERD because there was no formal in-service diagnosis. The STRs contained few notations of “stomach pain” and prescription of antacids.

What existed before:

STR notations of GI discomfort
Post-service GERD diagnosis.

Our contribution:

Highlighted repeated GI complaints in STRs
Explained pathophysiology of chronic reflux
Demonstrated post-service continuity through medical records
Connected dietary exposure during deployment to symptom onset

Key Takeaway

Once the updated medical rationale and continuity-of-symptom documentation were submitted, the veteran later received a favorable VA decision granting primary service connection for GERD.

Secondary Service Connection

Migraines as Secondary to Tinnitus

Early-2000s Air Force veteran • Long-term headaches • No in-service documentation

Challenge:

VA denied migraines as “not related” to service or any service‑connected disabilities, despite long‑term headache complaints.

What existed before:

Longstanding headache complaints
Recent formal diagnosis of migraine disorder
Existing service connection for chronic tinnitus

The record lacked a clear medical explanation tying migraines to existing service‑connected issues.

Our contribution:

Physiologic explanation of how Tinnitus can trigger migraine patterns
Chronological analysis of Tinnitus, and migraine onset
Structured opinion supporting migraines as secondary to service‑connected conditions.

Key Takeaway

After the secondary nexus opinion was added to the file, the veteran later received a favorable VA decision granting migraines as secondary to service‑connected disabilities.

Secondary Service Connection

Obstructive Sleep Apnea (OSA) Granted Secondary to Service-Connected PTSD With Obesity as an Intermediate Step

Marine Corps Veteran • Severe OSA • Service-Connected PTSD • Obesity

Challenge:

This U.S. Marine Corps veteran had an established service connection for Post - Traumatic Stress Disorder (PTSD) and a medically confirmed diagnosis of severe Obstructive Sleep Apnea (OSA).

What existed before:

Service connection for Post-Traumatic Stress Disorder (PTSD).
A confirmed diagnosis of severe Obstructive Sleep Apnea (OSA) supported by sleep study evidence.
Medical documentation of chronic sleep disruption, excessive daytime fatigue, and impaired daily functioning.
Class II obesity, which the VA cited as the primary cause of OSA.
No medical opinion addressing whether PTSD caused or aggravated the veteran’s OSA, or whether obesity functioned as an intermediate factor rather than an independent cause

Our contribution:

A comprehensive review of the veteran’s medical records, sleep studies, and PTSD symptom history was conducted to assess whether a secondary service connection could be medically supported.

Key steps included:
Evaluating the physiological and behavioral effects of PTSD on sleep architecture and respiratory function.
Reviewing medical literature regarding the relationship between PTSD, sleep disruption, and the development or worsening of OSA.
Analyzing whether obesity acted as an intermediate step influenced by PTSD-related symptoms rather than a sole etiology.
Coordinating the preparation of a medical nexus opinion that clearly addressed causation and aggravation using VA-recognized standards

Key Takeaway

Secondary Service Connection

Vertigo as Secondary to Service-Connected Tinnitus

OIF Army veteran • Chronic tinnitus • Episodic vertigo and imbalance

Challenge:

What existed before:

Service-connected tinnitus.
Episodes of dizziness and imbalance

Our contribution:

Review of auditory and balance-related patterns documented in treatment notes
Identification of symptom timing consistent with secondary vestibular involvement
Chronological analysis comparing tinnitus onset with vertigo development
Structured secondary-service-connection explanation using existing evidence

Key Takeaway

After the secondary-connection documentation - NEXUS LETTER was submitted, the veteran later received a favorable VA decision granting vertigo secondary to tinnitus.

SMC/Aid & Attendance

Aid & Attendance for Veteran With Severe Mobility & Cognitive Decline

Mid-1970s Army veteran • Progressive neurologic decline • Frequent falls

Challenge:

What existed before:

Service connection for orthopedic + mental health/neurological conditions
Documented falls.
PCP notes describing “supervision needed with medications”

The record lacked functional analysis showing how service-connected disabilities impacted ADLs and safety.

Our contribution:

Created structured ADL/IADL breakdown
Linked fall risk to SC balance disorder
Explained cognitive fatigue related to SC neurological condition
Added timeline of progressive deterioration.

Key Takeaway

Secondary Service Connection

Irritable Bowel Syndrome (IBS) as Secondary to Anxiety/Depression

Early-2000s Air Force veteran • Generalised Anxiety disorder with depressive features • Stress-triggered IBS

Challenge:

What existed before:

IBS diagnosis
SC anxiety/depression
Notes showing symptom flares during MH episodes

Our contribution:

Review of symptom fluctuations tied to stress and mental health episodes
Identification of GI patterns consistent with secondary aggravation
Chronological mapping of mental health treatment and IBS progression
Structured secondary-service-connection explanation using existing evidence

Key Takeaway

Primary Service Connection

Primary Service Connection for GERD

Early-2000s Marine veteran • Repeated in-service stomach complaints • Chronic reflux after deployment

Challenge:

The VA denied GERD because there was no formal in-service diagnosis. The STRs contained few notations of “stomach pain” and prescription of antacids.

What existed before:

STR notations of GI discomfort
Post-service GERD diagnosis.

Our contribution:

Highlighted repeated GI complaints in STRs
Explained pathophysiology of chronic reflux
Demonstrated post-service continuity through medical records
Connected dietary exposure during deployment to symptom onset

Key Takeaway

Once the updated medical rationale and continuity-of-symptom documentation were submitted, the veteran later received a favorable VA decision granting primary service connection for GERD.

Secondary Service Connection

Migraines as Secondary to Tinnitus

Early-2000s Air Force veteran • Long-term headaches • No in-service documentation

Challenge:

VA denied migraines as “not related” to service or any service‑connected disabilities, despite long‑term headache complaints.

What existed before:

Longstanding headache complaints
Recent formal diagnosis of migraine disorder
Existing service connection for chronic tinnitus

The record lacked a clear medical explanation tying migraines to existing service‑connected issues.

Our contribution:

Physiologic explanation of how Tinnitus can trigger migraine patterns
Chronological analysis of Tinnitus, and migraine onset
Structured opinion supporting migraines as secondary to service‑connected conditions.

Key Takeaway

After the secondary nexus opinion was added to the file, the veteran later received a favorable VA decision granting migraines as secondary to service‑connected disabilities.

What These Case Studies Show

•Many VA denials are driven by incomplete or unclear medical rationale, not by a lack of symptoms.
•SMC, PTSD, migraine, sleep apnea, and secondary claims often require detailed functional and clinical explanation.
•Personalized, ethical medical opinions are more persuasive than generic, template-style letters.
•Our focus is on clear, defensible documentation that helps VA fully understand the medical side of your claim.

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