Can obesity be service-connected?

Obesity is a health hardship for many veterans and often their obesity is caused by factors relating to their time in military service. Service-connected physical and mental health conditions may limit their ability to sustain healthy eating habits and exercise, leading to weight gain that then causes other conditions such as sleep apnea, hypertension, and diabetes. However, the VA says that obesity itself cannot be service-connected for disability purposes, leaving many veterans to deal with the consequences of their weight gain on their own.

But - did you know - obesity can serve as an "intermediate step" to a service-connected condition? Here is a common generic example that I frequently write letters about:

Veteran Smith is service-connected for a mental health condition (this could be PTSD, depression, anxiety, adjustment disorder, etc.). His mental health has greatly affected his physical health - to cope with his mental health symptoms, the veteran eats a lot of comfort food and snacks throughout the day, and drinks alcohol most nights to help him sleep. Though he previously exercised every day while in service, his mental health problems have decreased his motivation to exercise, and he mostly stays at home, isolating himself and disengaging from social events that would keep him active. These factors have led to weight gain and eventual obesity, and the consequences to his overall health are severe. Obesity and nightly alcohol use caused him to develop sleep apnea and hypertension. The veteran is trying to get service-connected for these two additional conditions because he logically knows that his time in service caused him to develop these disorders, but the VA says there is no record of these conditions existing while he was in service, and that there is no evidence that mental health problems cause sleep apnea and hypertension, so they deny his disability claim.

Veteran Smith's case is all too common, but luckily, the veteran can gather evidence that will show his sleep apnea and hypertension are caused by his service-connected mental health condition with obesity as an "intermediate step" between the conditions.

What is obesity as an "intermediate step"?

The VA ruling on obesity recognizes it as an "intermediate step" in disability claims. This means that while obesity itself is not classified as a disability for VA compensation, it can serve as a bridge between a service-connected disability and a new secondary condition. For example, if a veteran has a service-connected knee injury that leads to limited mobility and subsequent weight gain (obesity), and this obesity then causes another condition like hypertension, the veteran can claim hypertension as a secondary service connection through the obesity intermediate step​ (Veterans Law Office of Amy B. Kretkowski)​.

To successfully use obesity as an intermediate step, the veteran must show three things:

1. The service-connected disability caused or aggravated the obesity - meaning the veteran was not obese prior to the onset of the SC disability, or that the SC disability caused the veteran to gain more weight than would have otherwise been expected.

2. Obesity was a significant factor in causing the secondary condition.

3. The secondary condition would not have occurred without the obesity caused by the service-connected disability (Berry Law)​.
   

This approach helps veterans connect conditions that arise indirectly from their service, ensuring they receive the necessary support and compensation for their health issues.

How can I show obesity as an "intermediate step"?

It is always wise to consult a professional who is certified to offer advice regarding your specific VA disability claim. They can help you understand the correct type of claim and paperwork to file, and discuss the types of evidence you would need to submit to support your claim with the VA. Certified professionals who can offer advice about VA disability claims include:

1. Veterans Service Officers (VSOs): These are accredited representatives who work for recognized veterans organizations, such as the American Legion, Disabled American Veterans (DAV), and Veterans of Foreign Wars (VFW). VSOs are trained and certified by the VA to assist veterans with their claims free of charge​.

2. Accredited Attorneys: Lawyers who are accredited by the VA can represent veterans in their disability claims. These attorneys must meet specific qualifications set by the VA, including completing continuing legal education related to veterans' benefits law​ (Berry Law)​.

3. Accredited Claims Agents: These are non-attorney representatives who are accredited by the VA to assist veterans with their claims. Like attorneys, they must pass an exam and meet other qualifications set by the VA .

4. State and County Veterans Affairs Offices: Many states and counties have their own veterans affairs offices staffed with certified personnel who can help veterans with their claims and benefits .

A professional may suggest that you obtain a "nexus letter" from a medical or mental health professional who can review your records and provide their independent opinion about how obesity is an "intermediate step" in your VA disability claim. If you take this route, it is important to obtain a nexus statement from a professional who is familiar with the VA guidelines and knows how to write a strong nexus letter based on evidence from your medical records, and who supports their opinion with plenty of strong scientific research and a strong logical rationale for their opinion. A good nexus letter will be personalized just for you based on the specific details of your claim, and will use the language required by the VA to establish service connection (e.g. "at least as likely as not" language).

If you decide you need a nexus letter to support your claim for obesity as an "intermediate step" between your service-connected disability and a new secondary disability, consider a few factors. If a mental health condition is the issue that caused your obesity or resulted from obesity, then you likely need a psychologist or psychiatrist to write your nexus letter. As the owner of Veteran Disability Services, I provide letters such as these frequently and have a great track record for getting veterans service-connected for conditions caused by obesity resulting from a service-connected condition. A common example is service-connected PTSD/depression/anxiety ---> obesity ---> sleep apnea, hypertension, diabetes. Please reach out if you need this type of nexus letter and set up a free consultation.

Conditions unrelated to mental health require a nexus letter from a physician or other medical professional like a physician's assistant or nurse practitioner. It's possible that your own private physician might be willing to write you a simple nexus letter, but you would likely have to provide them with proper advice on what elements are required for a nexus letter of this sort.