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About one in three veterans seeking treatment for health concerns are battling depression and anxiety, according to the VA, highlighting the profound connection between military service and mental health. The statistics also underscore the need for mental health resources for veterans and military families.
Distressing experiences of warfare, being in life-threatening situations, or witnessing others' injuries or deaths can cause veterans significant emotional distress. It's the primary cause of many of them developing PTSD, which itself includes symptoms of heightened anxiety. However, among the causes of anxiety and depression among veterans are those related to their health issues, which often occur after the military years. Receiving a cancer diagnosis is life-altering for everyone and impacts mental health. The VA Central Cancer Registry reports nearly 50,000 cancer cases annually, with the three most frequently diagnosed cancers being:
Even though survival rates are improving, many cancer patients experience lingering symptoms related to cancer treatment, a real challenge to their mental health. Additionally, cancer survivorship can cause lasting physical effects and sometimes comes with late-appearing adverse effects of cancer treatments such as:
- chemotherapy
- radiation
- surgery
- transplant
- immunotherapy
- hormone therapy
- cryoablation
More often than not, recovery after cancer brings about psychological and social complexities usually left unaddressed, among them depression or anxiety. Statistically, one in four people who have cancer or recovering from it experience depression; it can happen at any point during the cancer journey. For some veterans, depression starts soon after diagnosis. For others, it can take weeks or even months after cancer treatment ends to develop depression manifested in symptoms such as:
- feeling sad, fatigue, worthlessness, guilt, or hopelessness
- losing interest or pleasure in everyday activities
- disturbances in sleep
- anxiety or restlessness
- constant irritability
- difficulty concentrating or remembering things
- loss of appetite and weight loss
- increased appetite and weight gain
- thoughts of death or suicide
Managing depression is different for everyone; it's a very personal and individualized process based on the veteran's specific situation, lifestyle, and needs. Treatment might include standard medical treatments combined with alternative ones to improve quality of life through:
- psychotherapy ( talk therapy)
- medication
- light therapy
- mindfulness meditation
Anxiety is another consequence of veterans' traumatic experiences. The combination of receiving a cancer diagnosis and secondary conditions stemming from it, like anxiety, can significantly impact a veteran's well-being. With anxiety, they may experience a range of physical and psychological symptoms, such as:
- being nervous or on edge
- not being able to stop or control your worries
- worrying too much
- having trouble relaxing
- restlessness, having a hard time to sit still
- becoming easily annoyed or irritable
- being constantly afraid
While "having anxiety" is often used in a casual context to describe nervousness or unease, anxiety is a serious mental health condition in a clinical sense recognized by the DSM-5. Moreover, anxiety left untreated can make veterans' cancer treatment and recovery more complex and can lead to other health problems, such as:
- weakened immune system
- digestive problems
- worse treatment side effects
- slower physical recovery
- poorer quality of life
- decreased survival chances
Managing anxiety has similar treatments to depression available, in some cases combining standard medical treatments with alternative ones:
- psychotherapy (talk therapy)
- medication
- cognitive behavioral therapy
- yoga
- reflexology
- acupuncture
Veterans' Compensation for Depression or Anxiety
Being aware of how the VA rates depression is often a necessity when filing for disability benefits. Mental health conditions can be rated anywhere from 0 percent to 100 percent. All mental health disability ratings are determined by the:
- the severity of the condition
- the level of social and occupational impairment
Specifically, depressive disorder is rated under Diagnostic Code 9434. To establish direct service connections for depression, veterans will typically need the following:
- current depression diagnosis in medical records
- proof of the in-service event
- medical nexus between the depression and the in-service event
Unlike PTSD claims, for depression and anxiety claims, veterans don't need to prove a specific traumatic event or "stressor." Instead, they can underscore psychological symptoms of anxiety and depression that began during or shortly after their service and persist to the present day. Many cancer survivor veterans are left with permanent worries about a cancer recurrence or depression occurring due to changes to their physical appearance. They may need to become more dependent on others, deepening their depression or anxiety.
For these mental health conditions - depression and anxiety - that develop secondary to cancer and cancer treatment, veterans can file a VA disability claim. By identifying depression and anxiety as secondary conditions, veterans can potentially increase the overall VA disability rating.
The PACT Act does not explicitly list depression or anxiety as a presumptive condition. However, veterans who have diseases related to toxic exposure may experience depression as a secondary condition, which can qualify as secondary to a presumptive condition under the PACT Act.
It's important to note that veterans who are receiving treatment for cancer caused by military service are provided with a temporary 100% rating; once the tumor is in remission, the rating is reduced to 0%.
How to Apply for Depression or Anxiety as a Secondary Condition
The first step is to fill out and file the Application for Disability Compensation and Related Compensation Benefits, VA Form 21-526EZ. It is the general form you'll need to file to receive compensation for your service-related condition. While many veterans receive diagnoses for depression and anxiety, proof of service connection is still required.
The next step is the Depression Questionnaires - the VA offers screening questionnaires and provides a self-assessment (anonymous screening) to help vets decide whether or not to seek professional medical attention for their symptoms. Completing the questionnaires can serve as an essential piece of evidence and a starting point in addressing any service-related depression and receiving the benefits you deserve. However, your application must be backed by evidence that links your current diagnosis with active service or an illness deriving from it. Submitting the following will support your VA disability compensation for depression:
- Medical records and statements from your periodic mental health visits to address your depression.
- Medical nexus - you need a medical opinion that links your depression or anxiety to your primary service-connected conditions and states that it is "as likely as not" that your physical condition is causing or aggravating your depression or anxiety.
- Personal statement - in cases where there's no medical documentation, a detailed personal statement can help. While veterans can't self-diagnose, they can describe the experienced depressive symptoms and how they affect their life, work, and relationships.
- Statements from family members, friends, or coworkers who can witness how depression impacts you.
All this information is submitted to the VA as nexus letters and buddy statements using VA Form 21-4138, Statement in Support of Claim. Applicants with sufficient medical evidence supporting their claim mustn't undergo the C&P Exam; it is where nexus letters and buddy statements come into effect.
Supporting veterans in filing claims
Veterans can substantially increase the VA disability rating by adding depression as a secondary condition and ensuring fair pay for the full extent of their disabilities. Filing a successful VA disability claim for depression requires gathering sufficient evidence to prove your case, and for many, it can be a complex process.
Furthermore, filling out the forms can be daunting, and claims can be denied because of incorrect fill-outs. You should consider asking for legal aid if you're struggling with the claims process. We can help by connecting you with legal experts ready to help you navigate the process and improve your chances of a successful claim.