The research & law behind your claim
Every citation behind your claim is real and checkable — each links to its PubMed or DOI record and the controlling law. The VA weighs evidence it can verify, so we show you every source. Browse the peer-reviewed studies and the controlling law behind VA claims, by condition and legal theory.
Medical evidence by condition
580 verified, peer-reviewed studies across 32 condition groups — each links out to its real PubMed or DOI record. These are the sources our nexus drafts draw from; nothing here is invented.
Acquired Flatfoot
38 CFR DC 5276Foot structure and intensive training/overuse driving pes planus and related lower-extremity overuse injury in recruits and service members.
- Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med. 1993;2(7):773-7. PMID:7906597. doi:10.1001/archfami.2.7.773. Direct
- Esterman A, Pilotto L. Foot shape and its effect on functioning in Royal Australian Air Force recruits. Part 2: Pilot, randomized, controlled trial of orthotics in recruits with flat feet. Mil Med. 2005;170(7):629-33. PMID:16130647. doi:10.7205/milmed.170.7.629. Direct
- Finnern M Jr, Ryan P, Anderson C. Occupational Outcomes of Reconstructive Surgery for Adult Acquired Flatfoot Deformity. Mil Med. 2017;182(11):e2066-e2068. PMID:29087883. doi:10.7205/MILMED-D-17-00201. DirectAggravation
- Kaufman KR, Brodine SK, Shaffer RA, Johnson CW, Cullison TR. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999;27(5):585-93. PMID:10496574. doi:10.1177/03635465990270050701. Direct
- Song J, Choe K, Neary M, Zifchock RA, Cameron KL, Trepa M, Hannan MT, Hillstrom H. Comprehensive biomechanical characterization of feet in USMA cadets: Comparison across race, gender, arch flexibility, and foot types. Gait Posture. 2018;60:175-180. PMID:29247970. doi:10.1016/j.gaitpost.2017.12.001. Direct
- Wang X, Wang PS, Zhou W. Risk factors of military training-related injuries in recruits of Chinese People's Armed Police Forces. Chin J Traumatol. 2003;6(1):12-7. PMID:12542958.
Helmet/NVG head-borne loads, aircrew exposures, load carriage, and trauma producing chronic neck pain and cervical spine disease in service members.
- Yuan X, Stewart E, Colahan C, Pasquina P, Isaacson B, Pav V, Hando B. Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021. Mil Med. 2024;189(Suppl 4):22-33. PMID:39570071. doi:10.1093/milmed/usae045. Direct
- Riches A, Spratford W, Witchalls J, Newman P. A Systematic Review and Meta-Analysis About the Prevalence of Neck Pain in Fast Jet Pilots. Aerosp Med Hum Perform. 2019;90(10):882-890. PMID:31558197. doi:10.3357/AMHP.5360.2019. Direct
- Petren-Mallmin M, Linder J. Cervical spine degeneration in fighter pilots and controls: a 5-yr follow-up study. Aviat Space Environ Med. 2001;72(5):443-6. PMID:11346010. Direct
- Salmon DM, Harrison MF, Neary JP. Neck pain in military helicopter aircrew and the role of exercise therapy. Aviat Space Environ Med. 2011;82(10):978-87. PMID:21961403. doi:10.3357/asem.2841.2011. Direct
- Wallace JB, Newman PM, McGarvey A, Osmotherly PG, Spratford W, Gabbett TJ. Factors associated with neck pain in fighter aircrew: a systematic review and meta-analysis. Occup Environ Med. 2021;78(12):900-912. PMID:33790029. doi:10.1136/oemed-2020-107103. Direct
- Tang L, Zhang YH, Du SH, Wang XQ. Prevalence and related factors for neck pain in military personnel: a systematic review. EFORT Open Rev. 2024;9(8):806-816. PMID:39087493. doi:10.1530/EOR-23-0150. Direct
- Caberwal T, Cecchini AS, Wentz LM, Berry-Cabán CS. Prevalence of Neck Pain in Soldiers as a Result of Mild Traumatic Brain Injury-Associated Trauma. Mil Med. 2024;189(1-2):e182-e187. PMID:37384536. doi:10.1093/milmed/usad228. DirectSecondaryAggravation
- Harrison MF, Coffey B, Albert WJ, Fischer SL. Night vision goggle-induced neck pain in military helicopter aircrew: a literature review. Aerosp Med Hum Perform. 2015;86(1):46-55. PMID:25565533. doi:10.3357/AMHP.4027.2015. Direct
Chronic Ankle Instability
38 CFR DC 5270, 5271, 5272, 5274High incidence of ankle sprains and chronic lateral ankle instability from military training, load carriage, and uneven terrain.
- Waterman BR, Belmont PJ Jr, Cameron KL, Deberardino TM, Owens BD. Epidemiology of ankle sprain at the United States Military Academy. Am J Sports Med. 2010;38(4):797-803. PMID:20145281. doi:10.1177/0363546509350757. Direct
- Bulathsinhala L, Hill OT, Scofield DE, Haley TF, Kardouni JR. Epidemiology of Ankle Sprains and the Risk of Separation From Service in U.S. Army Soldiers. J Orthop Sports Phys Ther. 2015;45(6):477-84. PMID:25899214. doi:10.2519/jospt.2015.5733. Direct
- Orr JD, Dawson LK, Garcia EJ, Kirk KL. Incidence of osteochondral lesions of the talus in the United States military. Foot Ankle Int. 2011;32(10):948-54. PMID:22224323. doi:10.3113/FAI.2011.0948. Direct
- Fraser JJ, MacGregor AJ, Ryans CP, Dreyer MA, Gibboney MD, Rhon DI. Sex and occupation are salient factors associated with lateral ankle sprain risk in military tactical athletes. J Sci Med Sport. 2021;24(7):677-682. PMID:33707156. doi:10.1016/j.jsams.2021.02.016. Direct
- Knapik JJ, Spiess A, Swedler DI, Grier TL, Darakjy SS, Jones BH. Systematic review of the parachute ankle brace: injury risk reduction and cost effectiveness. Am J Prev Med. 2010;38(1 Suppl):S182-8. PMID:20117591. doi:10.1016/j.amepre.2009.10.012. Direct
- Goodrich E, Vopat B, Herda A. Treatment of Chronic Ankle Instability in the Military Population: A Systematic Review. Foot Ankle Spec. 2024;17(3):208-215. PMID:34991374. doi:10.1177/19386400211068239. Direct
- Orr JD, Robbins J, Waterman BR. Management of chronic lateral ankle instability in military service members. Clin Sports Med. 2014;33(4):675-92. PMID:25280616. doi:10.1016/j.csm.2014.06.011. DirectAggravation
- Rhon DI, Greenlee TA, Cook CE, Westrick RB, Umlauf JA, Fraser JJ. Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System. Int J Sports Phys Ther. 2021;16(5):1313-1322. PMID:34631252. doi:10.26603/001c.27912. DirectAggravation
- Goodrich E, Morris B, Hermanns C, Herda A, Tarakemeh A, Vopat B. Epidemiology of Ankle Sprain in the Active-Duty Military Population. JBJS Rev. 2022;10(6). PMID:35679429. doi:10.2106/JBJS.RVW.21.00232. Direct
- Cameron KL, Owens BD, DeBerardino TM. Incidence of ankle sprains among active-duty members of the United States Armed Services from 1998 through 2006. J Athl Train. 2010;45(1):29-38. PMID:20064045. doi:10.4085/1062-6050-45.1.29. Direct
Chronic Multisymptom Illness
38 CFR DC 6354Gulf War deployment exposures and chronic multisymptom illness associated with chronic fatigue syndrome/ME in veterans.
- Institute of Medicine (US) Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. The National Academies Press, Washington, DC; 2015. PMID:25695122. doi:10.17226/19012. Available at: https://doi.org/10.17226/19012. Direct
- Reid S, Hotopf M, Hull L, Ismail K, Unwin C, Wessely S. Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. Am J Epidemiol. 2001;153(6):604-9. PMID:11257069. doi:10.1093/aje/153.6.604. Direct
- Ismail K, Kent K, Sherwood R, Hull L, Seed P, David AS, Wessely S. Chronic fatigue syndrome and related disorders in UK veterans of the Gulf War 1990-1991: results from a two-phase cohort study. Psychol Med. 2008;38(7):953-61. PMID:17892626. doi:10.1017/S0033291707001560. Direct
- Kipen HM, Hallman W, Kang H, Fiedler N, Natelson BH. Prevalence of chronic fatigue and chemical sensitivities in Gulf Registry Veterans. Arch Environ Health. 1999;54(5):313-8. PMID:10501146. doi:10.1080/00039899909602493. Direct
- McCauley LA, Joos SK, Barkhuizen A, Shuell T, Tyree WA, Bourdette DN. Chronic fatigue in a population-based study of Gulf War veterans. Arch Environ Health. 2002;57(4):340-8. PMID:12530602. doi:10.1080/00039890209601419. Direct
- Li M, Xu C, Yao W, Mahan CM, Kang HK, Sandbrink F, Zhai P, Karasik PA. Self-reported post-exertional fatigue in Gulf War veterans: roles of autonomic testing. Front Neurosci. 2014;7:269. PMID:24431987. doi:10.3389/fnins.2013.00269. Direct
- Smylie AL, Broderick G, Fernandes H, Razdan S, Barnes Z, Collado F, Sol C, Fletcher MA, Klimas N. A comparison of sex-specific immune signatures in Gulf War illness and chronic fatigue syndrome. BMC Immunol. 2013;14:29. PMID:23800166. doi:10.1186/1471-2172-14-29. Direct
- Proctor SP, Heaton KJ, White RF, Wolfe J. Chemical sensitivity and chronic fatigue in Gulf War veterans: a brief report. J Occup Environ Med. 2001;43(3):259-64. PMID:11285874. doi:10.1097/00043764-200103000-00014.
- Washington SD, Rayhan RU, Garner R, Provenzano D, Zajur K, Addiego FM, VanMeter JW, Baraniuk JN. Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Brain Commun. 2020;2(2):fcaa070. PMID:32954325. doi:10.1093/braincomms/fcaa070.
- Porter B, Long K, Rull RP, Dursa EK. Prevalence of Chronic Multisymptom Illness/Gulf War Illness Over Time Among Millennium Cohort Participants, 2001 to 2016. J Occup Environ Med. 2020;62(1):4-10. PMID:31626064. doi:10.1097/JOM.0000000000001716.
- James LM, Georgopoulos AP. At the Root of 3 "Long" Diseases: Persistent Antigens Inflicting Chronic Damage on the Brain and Other Organs in Gulf War Illness, Long-COVID-19, and Chronic Fatigue Syndrome. Neurosci Insights. 2022;17:26331055221114817. PMID:35910083. doi:10.1177/26331055221114817.
- Bose D, Chatterjee S, Older E, Seth R, Janulewicz P, Saha P, Mondal A, Carlson JM. Host gut resistome in Gulf War chronic multisymptom illness correlates with persistent inflammation. Commun Biol. 2022;5(1):552. PMID:35672382. doi:10.1038/s42003-022-03494-7.
Chronic Obstructive Pulmonary Disease
38 CFR DC 6510, 6511, 6512, 6513, 6514, 6522…Open burn-pit smoke and aerosolized desert particulate exposure in the Southwest Asia theater (Iraq, Afghanistan, and the broader theater) as a cause of chronic respiratory disease; and, for the sinonasal conditions, the recognized secondary pathways to chronic rhinosinusitis under 38 C.F.R. § 3.310 (GERD/laryngopharyngeal reflux, septal deviation from in-service nasal trauma, and asthma/type 2 airway inflammation).
- Barth SK, Dursa EK, Peterson MR, Schneiderman A. Prevalence of respiratory diseases among veterans of Operation Enduring Freedom and Operation Iraqi Freedom: results from the National Health Study for a New Generation of U.S. Veterans. Mil Med. 2014;179(3):241-5. PMID:24594456. doi:10.7205/MILMED-D-13-00338. Direct
- Hill CJ, Meyer CD, McLean JE, Anderson DC, Hao Y, Lin FC, Kimple AJ, Capra GG. Burn Pit Exposure Is Associated With Increased Sinonasal Disease. J Occup Environ Med. 2022;64(8):629-634. PMID:35673272. doi:10.1097/JOM.0000000000002551. Direct
- Waibel KH. Allergic rhinitis in the Middle East. Mil Med. 2005;170(12):1026-8. PMID:16491940. doi:10.7205/milmed.170.12.1026. Direct
- National Academies of Sciences, Engineering, and Medicine; Committee on the Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations. National Academies Press (Washington, DC); 2020. PMID:33030852. Available at: https://nap.nationalacademies.org/catalog/25837. Direct
- Briggs EE, Schlosser NJ, Nguyen SA, Ryan MT, Duffy AN. Deployment as a Risk Factor of Rhinologic Disease: Systematic Review and Meta-Analysis. Mil Med. 2026;191(1-2):e95-e101. PMID:40574701. doi:10.1093/milmed/usaf302. Direct
- Workman AD, Lee RJ, Cohen NA. Aerosolized Particulate Matter and Blunting of Ciliary Dynamic Responses: Implications for Veterans and Active Duty Military in Southwest Asia. Mil Med. 2024;189(7-8):e1537-e1543. PMID:38287786. doi:10.1093/milmed/usae007. Direct
- Lee YK, Tsai M, Anderson L, Wang V, Yusin J. Chronic Nonallergic Rhinosinusitis Associated With Military Burn Pit Exposure. Cureus. 2025;17(5):e84584. PMID:40546639. doi:10.7759/cureus.84584. Direct
- Almekdash MH, Han J, Guffey D, Christie IC, Helmer DA, Wu TD. Association of a Veterans Affairs Toxic Exposure Medical Evaluation with Symptom-related Care. Ann Am Thorac Soc. 2025;22(8):1176-1182. PMID:40245340. doi:10.1513/AnnalsATS.202408-835OC. Direct
- Krefft SD, Zell-Baran LM. Deployment-Related Respiratory Disease: Where Are We? Semin Respir Crit Care Med. 2023;44(3):370-377. PMID:37068518. doi:10.1055/s-0043-1764407. Direct
- Watanabe M, Kurai J, Tomita K, Sano H, Abe S, Saito R, Minato S, Igishi T, Burioka N, Sako T, Yasuda K, Mikami M, Kurita S, Tokuyasu H, Ueda Y, Konishi T, Yamasaki A, Aiba S, Oshimura M, Shimizu E. Effects on asthma and induction of interleukin-8 caused by Asian dust particles collected in western Japan. J Asthma. 2014;51(6):595-602. PMID:24628524. doi:10.3109/02770903.2014.903965. Direct
- Goudie AS. Desert dust and human health disorders. Environ Int. 2014;63:101-13. PMID:24275707. doi:10.1016/j.envint.2013.10.011. Direct
- Fussell JC, Kelly FJ. Mechanisms underlying the health effects of desert sand dust. Environ Int. 2021;157:106790. PMID:34333291. doi:10.1016/j.envint.2021.106790. Direct
- Berman R, Rose CS, Downey GP, Day BJ, Chu HW. Role of Particulate Matter from Afghanistan and Iraq in Deployment-Related Lung Disease. Chem Res Toxicol. 2021;34(12):2408-2423. PMID:34808040. doi:10.1021/acs.chemrestox.1c00090. Direct
- Soy FK, Yazici H, Kulduk E, Dundar R, Tas Gulen S, Dogan S, Haberal Can I. The effects of dust storms on quality of life of allergic patients with or without asthma. Kulak Burun Bogaz Ihtis Derg. 2016;26(1):19-27. PMID:26794331. doi:10.5606/kbbihtisas.2016.56254. Direct
- Goronfolah L. Aeroallergens, atopy and allergic rhinitis in the Middle East. Eur Ann Allergy Clin Immunol. 2016;48(1):5-21. PMID:26808447. Direct
- Shin SH, Ye MK, Lee DW, Chae MH. Asian Sand Dust Particles Enhance the Development of Aspergillus fumigatus Biofilm on Nasal Epithelial Cells. Int J Mol Sci. 2022;23(6):3030. PMID:35328451. doi:10.3390/ijms23063030. Direct
- Ichinose T, Hiyoshi K, Yoshida S, Takano H, Inoue K, Nishikawa M, Mori I, Kawazato H, Yasuda A, Shibamoto T. Asian sand dust aggravates allergic rhinitis in guinea pigs induced by Japanese cedar pollen. Inhal Toxicol. 2009;21(12):985-93. PMID:19552583. doi:10.1080/08958370802672883. Direct
- Jung JH, Kang IG, Cha HE, Choe SH, Kim ST. Effect of Asian sand dust on mucin production in NCI-H292 cells and allergic murine model. Otolaryngol Head Neck Surg. 2012;146(6):887-94. PMID:22402586. doi:10.1177/0194599812439011. Direct
- Dursa EK, Tadesse BE, Carter CE, Culpepper WJ, Schneiderman AI, Rumm PD. Respiratory illness among Gulf War and Gulf War era veterans who use the Department of Veterans Affairs for healthcare. Am J Ind Med. 2020;63(11):980-987. PMID:32851693. doi:10.1002/ajim.23172. Direct
- Maccarone J, Redlich CA, Timmons A, Korpak AM, Smith NL, Nakayama KS, Baird CP, Ciminera P. Sinusitis and rhinitis among US veterans deployed to Southwest Asia and Afghanistan after September 11, 2001. J Allergy Clin Immunol Glob. 2025;4(1):100367. PMID:39659739. doi:10.1016/j.jacig.2024.100367. Direct
- Elam T, Raiculescu S, Biswal S, Zhang Z, Orestes M, Ramanathan M. Air Pollution Exposure and the Development of Chronic Rhinosinusitis in the Active Duty Population. Mil Med. 2023;188(7-8):e1957-64. PMID:35015888. doi:10.1093/milmed/usab535. Direct
- Autio TJ, Tapiainen T, Koskenkorva T, Narkio M, Lappalainen M, Nikkari S, Hemmila H, Koskela KA, Koskela M, Koivunen P, Alho OP. The role of microbes in the pathogenesis of acute rhinosinusitis in young adults. Laryngoscope. 2015;125(1):E1-7. PMID:25093843. doi:10.1002/lary.24862. Direct
- Autio TJ, Koskenkorva T, Narkio M, Leino TK, Koivunen P, Alho OP. Imaging follow-up study of acute rhinosinusitis. Laryngoscope. 2016;126(9):1965-70. PMID:27557439. doi:10.1002/lary.25843. Direct
- Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39. PMID:25832968. doi:10.1177/0194599815572097.
- Keating MK, Phillips JC, Phillips J. Chronic Rhinosinusitis. Am Fam Physician. 2023;108(4):370-377. PMID:37843944.
- Lechien JR, Saussez S, Hopkins C. Association between laryngopharyngeal reflux, gastroesophageal reflux and recalcitrant chronic rhinosinusitis: A systematic review. Clin Otolaryngol. 2023;48(4):501-514. PMID:36895147. doi:10.1111/coa.14047. SecondaryAggravation
- Hanna BC, Wormald PJ. Gastroesophageal reflux and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2012;20(1):15-18. PMID:22157165. doi:10.1097/MOO.0b013e32834e8f11. SecondaryAggravation
- Nikkerdar N, Karimi A, Bazmayoon F, Golshah A. Comparison of the Type and Severity of Nasal Septal Deviation between Chronic Rhinosinusitis Patients Undergoing Functional Endoscopic Sinus Surgery and Controls. Int J Dent. 2022;2022:2925279. PMID:35510085. doi:10.1155/2022/2925279. Secondary
- Malpani SN, Deshmukh P. Deviated Nasal Septum a Risk Factor for the Occurrence of Chronic Rhinosinusitis. Cureus. 2022;14(10):e30261. PMID:36381736. doi:10.7759/cureus.30261. Secondary
- Laidlaw TM, Mullol J, Woessner KM, Amin N, Mannent LP. Chronic Rhinosinusitis with Nasal Polyps and Asthma. J Allergy Clin Immunol Pract. 2021;9(3):1133-1141. PMID:33065369. doi:10.1016/j.jaip.2020.09.063. SecondaryAggravation
- Rosati MG, Peters AT. Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis. Am J Rhinol Allergy. 2016;30(1):44-47. PMID:26867529. doi:10.2500/ajra.2016.30.4252. Secondary
- Khan AH, Gouia I, Kamat S, Johnson R, Small M, Siddall J. Prevalence and Severity Distribution of Type 2 Inflammation-Related Comorbidities Among Patients with Asthma, Chronic Rhinosinusitis with Nasal Polyps, and Atopic Dermatitis. Lung. 2023;201(1):57-63. PMID:36808551. doi:10.1007/s00408-023-00603-z. Secondary
- Kim SY, Park B, Lim H, Kim M, Kong IG, Choi HG. Gastroesophageal reflux disease increases the risk of chronic rhinosinusitis: a nested case-control study using a national sample cohort. Int Forum Allergy Rhinol. 2019;9(4):357-362. PMID:30548214. doi:10.1002/alr.22259. Secondary
- Wu C, Zhang Z, Yan X, Wang L, Yu L, Jiang Y. Causal Relationship Between Gastroesophageal Reflux Disease and the Risk of Chronic Rhinosinusitis: Insights from Multivariable and Mediation Mendelian Randomization Analysis. Ear Nose Throat J. 2024;. PMID:39363451. doi:10.1177/01455613241286611. Secondary
- Stevens WW, Peters AT. Immunodeficiency in chronic sinusitis: recognition and treatment. Am J Rhinol Allergy. 2015;29(2):115-118. PMID:25785751. doi:10.2500/ajra.2015.29.4144. Secondary
Chronic Widespread Pain
38 CFR DC 5025Gulf War service and PTSD/central-sensitization mechanisms associated with fibromyalgia and chronic widespread pain in veterans.
- Institute of Medicine (US) Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. The National Academies Press, Washington, DC; 2006. doi:10.17226/11729. Available at: https://doi.org/10.17226/11729. Direct
- Mohanty AF, Helmer DA, Muthukutty A, McAndrew LM, Carter ME, Judd J, Garvin JH, Samore MH, Gundlapalli AV. Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration. J Rehabil Res Dev. 2016;53(1):45-58. PMID:26934034. doi:10.1682/JRRD.2014.10.0265. Direct
- Blanchard M, Molina-Vicenty HD, Stein PK, Li X, Karlinsky J, Alpern R, Reda DJ, Toomey R. Medical Correlates of Chronic Multisymptom Illness in Gulf War Veterans. Am J Med. 2019;132(4):510-518. PMID:30576630. doi:10.1016/j.amjmed.2018.11.045.
- Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, Toomey R, Jackson LW. Gulf War veterans' health: medical evaluation of a U.S. cohort. Ann Intern Med. 2005;142(11):881-90. PMID:15941694. doi:10.7326/0003-4819-142-11-200506070-00005.
- Grady EP, Carpenter MT, Koenig CD, Older SA, Battafarano DF. Rheumatic findings in Gulf War veterans. Arch Intern Med. 1998;158(4):367-71. PMID:9487234. doi:10.1001/archinte.158.4.367.
- Lacefield K, Samph SP, Orbon S, Otis J. Integrated intervention for comorbid posttraumatic stress disorder and fibromyalgia: A pilot study of women veterans. Psychol Trauma. 2020;12(7):725-729. PMID:32757579. doi:10.1037/tra0000635.
- Lewis JD, Wassermann EM, Chao W, Ramage AE, Robin DA, Clauw DJ. Central sensitization as a component of post-deployment syndrome. NeuroRehabilitation. 2012;31(4):367-72. PMID:23232159. doi:10.3233/NRE-2012-00805.
Contact Dermatitis
38 CFR DC 7806Occupational skin irritant/allergen exposure and deployment conditions associated with eczema and contact/atopic dermatitis in service members.
- Henning JS, Firoz BF. Combat dermatology: the prevalence of skin disease in a deployed dermatology clinic in Iraq. J Drugs Dermatol. 2010;9(3):210-4. PMID:20232580. Direct
- Gelman AB, Norton SA, Valdes-Rodriguez R, Yosipovitch G. A review of skin conditions in modern warfare and peacekeeping operations. Mil Med. 2015;180(1):32-7. PMID:25562855. doi:10.7205/MILMED-D-14-00240. Direct
- Jeter J, Bowen C. Atopic Dermatitis and Implications for Military Service. Mil Med. 2019;184(5-6):e177-e182. PMID:31054223. doi:10.1093/milmed/usy427. Direct
- Bailey MS. Tropical skin diseases in British military personnel. J R Army Med Corps. 2013;159(3):224-8. PMID:24109145. doi:10.1136/jramc-2013-000124. Direct
- Wolf R, Orion E, Matz H. Contact dermatitis in military personnel. Clin Dermatol. 2002;20(4):439-44. PMID:12208633. doi:10.1016/s0738-081x(02)00246-8. Direct
- Slodownik D, Reiss A, Mashiach Y, Ingber A, Sprecher E, Moshe S. Textile and Shoe Allergic Contact Dermatitis in Military Personnel. Dermatitis. 2018;29(4):196-199. PMID:30024451. doi:10.1097/DER.0000000000000390. Direct
- Contestable JJ. Jet Fuel-Associated Occupational Contact Dermatitis. Mil Med. 2017;182(3):e1870-e1873. PMID:28290976. doi:10.7205/MILMED-D-16-00217. Direct
- Chong WS. Dermatology in the military field: What physicians should know?. World J Clin Cases. 2013;1(7):208-11. PMID:24340268. doi:10.12998/wjcc.v1.i7.208. Direct
- Senel E, Dogruer Senel S, Salmanoglu M. Prevalence of skin diseases in civilian and military population in a Turkish military hospital in the central Black Sea region. J R Army Med Corps. 2015;161(2):112-5. PMID:25091572. doi:10.1136/jramc-2014-000267. Direct
- Friess M. [Afghanistan-a dermatologist on military deployment]. Hautarzt. 2020;71(6):432-434. PMID:32409871. doi:10.1007/s00105-020-04580-9. Direct
- Fregert S, Gruvberger B, Goransson K, Norman S. Allergic contact dermatitis from chromate in military textiles. Contact Dermatitis. 1978;4(4):223-4. PMID:710099. doi:10.1111/j.1600-0536.1978.tb03792.x. Direct
- Burke KR, Larrymore DC, Cho S. Treatment consideration for US military members with skin disease. Cutis. 2019;103(6):329-332. PMID:31348457. Direct
- Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. J Am Acad Dermatol. 2019;80(6):1526-1532.e7. PMID:29864464. doi:10.1016/j.jaad.2018.05.1241. Direct
- Riegleman KL, Farnsworth GS, Wong EB. Atopic dermatitis in the US military. Cutis. 2019;104(3):144-147. PMID:31675397.
- Ispireli M, Buchukuri I, Ebanoidze T, Durglishvili G, Durglishvili N, Chkhikvishvili N, Beridze L. CORRELATES OF ATOPIC DERMATITIS CHARACTERISTICS IN MILITARY PERSONNEL. Georgian Med News. 2023;(343):33-37. PMID:38096512.
- Russell A, Williamson S, Rosenberg A, Cho S. Reappraising the Use of Systemic Immunomodulators for Psoriasis and Eczema in the Military. Mil Med. 2024;189(11-12):e2374-e2381. PMID:38607726. doi:10.1093/milmed/usae139.
- Karagounis TK, Cohen DE. Occupational Hand Dermatitis. Curr Allergy Asthma Rep. 2023;23(4):201-212. PMID:36749448. doi:10.1007/s11882-023-01070-5.
- Jacobsen G, Rasmussen K, Bregnhøj A, Isaksson M, Diepgen TL, Carstensen O. Causes of irritant contact dermatitis after occupational skin exposure: a systematic review. Int Arch Occup Environ Health. 2022;95(1):35-65. PMID:34665298. doi:10.1007/s00420-021-01781-0.
Coronary Artery Disease
38 CFR DC 7005PTSD/combat-stress association with incident ischemic heart disease supporting secondary service connection.
- National Academies of Sciences, Engineering, and Medicine; Institute of Medicine, Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Update 2008. The National Academies Press, Washington, DC; 2009. doi:10.17226/12662. Available at: https://doi.org/10.17226/12662. Direct
- National Academies of Sciences, Engineering, and Medicine; Institute of Medicine, Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Update 2010. The National Academies Press, Washington, DC; 2011. doi:10.17226/13166. Available at: https://doi.org/10.17226/13166. Direct
- National Academies of Sciences, Engineering, and Medicine; Institute of Medicine, Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Update 2014. The National Academies Press, Washington, DC; 2016. doi:10.17226/21845. Available at: https://doi.org/10.17226/21845. Direct
- National Academies of Sciences, Engineering, and Medicine, Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eleventh Biennial Update). Veterans and Agent Orange: Update 11 (2018). The National Academies Press, Washington, DC; 2018. doi:10.17226/25137. Available at: https://doi.org/10.17226/25137. Direct
- Yi SW, Ryu SY, Ohrr H, Hong JS. Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study. Int J Epidemiol. 2014;43(6):1825-34. PMID:25186308. doi:10.1093/ije/dyu183. Direct
- Kim KH, Kim W, Kang WY, Cho SC, Hwang SH, Kang C, In Nam D, Jeong IH, Kim W, Hong YJ, Park KH, Kim SH, Lee SW. The impact of Agent Orange on characteristics of coronary artery lesion and repeat revascularization. Int J Cardiol. 2014;174(1):187-9. PMID:24767129. doi:10.1016/j.ijcard.2014.03.182. Direct
- Neveills S, Engler M, Battaglia C, Kaizer L, Gokhale M, Leonard R. Major Adverse Coronary Events Status Post Percutaneous Coronary Intervention in Veterans Exposed to Agent Orange Versus Non-Exposed. Mil Med. 2026;191(7-8):e1501-e1507. PMID:41603351. doi:10.1093/milmed/usaf627. Direct
- Crum-Cianflone NF, Bagnell ME, Schaller E, Boyko EJ, Smith B, Maynard C, Ulmer CS, Vernalis M, Smith TC. Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces. Circulation. 2014;129(18):1813-20. PMID:24619462. doi:10.1161/CIRCULATIONAHA.113.005407. Direct
- Vaccarino V, Goldberg J, Rooks C, Shah AJ, Veledar E, Faber TL, Votaw JR, Forsberg CW, Bremner JD. Post-traumatic stress disorder and incidence of coronary heart disease: a twin study. J Am Coll Cardiol. 2013;62(11):970-8. PMID:23810885. doi:10.1016/j.jacc.2013.04.085. Direct
- Kubzansky LD, Koenen KC, Spiro A 3rd, Vokonas PS, Sparrow D. Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Arch Gen Psychiatry. 2007;64(1):109-16. PMID:17199060. doi:10.1001/archpsyc.64.1.109. Direct
- Boscarino JA. A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosom Med. 2008;70(6):668-76. PMID:18596248. doi:10.1097/PSY.0b013e31817bccaf. Direct
- Beristianos MH, Yaffe K, Cohen B, Byers AL. PTSD and Risk of Incident Cardiovascular Disease in Aging Veterans. Am J Geriatr Psychiatry. 2016;24(3):192-200. PMID:25555625. doi:10.1016/j.jagp.2014.12.003. Direct
- Ebrahimi R, Lynch KE, Beckham JC, Dennis PA, Viernes B, Tseng CH, Shroyer ALW, Sumner JA. Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans. JAMA Cardiol. 2021;6(6):642-651. PMID:33729463. doi:10.1001/jamacardio.2021.0227. SecondaryAggravation
- Ebrahimi R, Dennis PA, Shroyer ALW, Tseng CH, Alvarez CA, Beckham JC, Sumner JA. Pathways Linking Post-Traumatic Stress Disorder to Incident Ischemic Heart Disease in Women: Call to Action. JACC Adv. 2024;3(1):100744. PMID:38939802. doi:10.1016/j.jacadv.2023.100744. SecondaryAggravation
- Vaccarino V, Shah AJ, Moncayo V, Nye J, Piccinelli M, Ko YA, Ma X, Murrah N, Shallenberger L, Driggers E, Levantsevych OM, Hammadah M, Lima BB, Young A, O'Neal W, Alkhalaf M, Haffar A, Raggi P, Goldberg J, Smith NL, Garcia EV, Quyyumi AA, Bremner JD. Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study. Biol Psychiatry. 2022;91(7):615-625. PMID:34865854. doi:10.1016/j.biopsych.2021.09.016. SecondaryAggravation
- Lima BB, Hammadah M, Pearce BD, Shah A, Moazzami K, Kim JH, Sullivan S, Levantsevych O, Lewis TT, Weng L, Elon L, Li L, Raggi P, Bremner JD, Quyyumi A, Vaccarino V. Association of Posttraumatic Stress Disorder With Mental Stress-Induced Myocardial Ischemia in Adults After Myocardial Infarction. JAMA Netw Open. 2020;3(4):e202734. PMID:32286655. doi:10.1001/jamanetworkopen.2020.2734. SecondaryAggravation
- Song H, Fang F, Arnberg FK, Mataix-Cols D, Fernández de la Cruz L, Almqvist C, Fall K, Lichtenstein P, Thorgeirsson G, Valdimarsdóttir UA. Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study. BMJ. 2019;365:l1255. PMID:30971390. doi:10.1136/bmj.l1255. Secondary
- Moazzami K, Garcia M, Sullivan S, Lewis TT, Bremner JD, Razavi AC, Shallenberger L, Sun YV, Raggi P, Shah AJ, Quyyumi AA, Vaccarino V. Association Between Symptoms of Chronic Psychological Distress and Myocardial Ischemia Induced by Mental Stress in Patients With Coronary Artery Disease. J Am Heart Assoc. 2023;12(21):e030305. PMID:37929719. doi:10.1161/JAHA.123.030305. SecondaryAggravation
- Passos IC, Vasconcelos-Moreno MP, Costa LG, Kunz M, Brietzke E, Quevedo J, Salum G, Magalhães PV, Kapczinski F, Kauer-Sant'Anna M. Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry. 2015;2(11):1002-12. PMID:26544749. doi:10.1016/S2215-0366(15)00309-0. Secondary
- Ge F, Yuan M, Li Y, Zhang W. Posttraumatic Stress Disorder and Alterations in Resting Heart Rate Variability: A Systematic Review and Meta-Analysis. Psychiatry Investig. 2020;17(1):9-20. PMID:31995968. doi:10.30773/pi.2019.0112. Secondary
- van den Berk-Clark C, Secrest S, Walls J, Hallberg E, Lustman PJ, Schneider FD, Scherrer JF. Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occurring smoking: A systematic review and meta-analysis. Health Psychol. 2018;37(5):407-416. PMID:29698016. doi:10.1037/hea0000593. Secondary
- Rorabaugh BR, Mabe NW, Seeley SL, Stoops TS, Mucher KE, Ney CP, Goodman CS, Hertenstein BJ, Rush AE, Kasler CD, Sargeant AM, Zoladz PR. Myocardial fibrosis, inflammation, and altered cardiac gene expression profiles in rats exposed to a predator-based model of posttraumatic stress disorder. Stress. 2020;23(2):125-135. PMID:31347429. doi:10.1080/10253890.2019.1641081. Secondary
Degenerative Disc Disease
38 CFR DC 5237, 5238, 5239, 5242, 5243, 5244…Heavy load-bearing/rucksack carriage and low back pain incidence in service members.
- Celtikci E, Yakar F, Celtikci P, Izci Y. Relationship between individual payload weight and spondylolysis incidence in Turkish land forces. Neurosurg Focus. 2018;45(6):E12. PMID:30544316. doi:10.3171/2018.8.FOCUS18375. Direct
- Knox JB, Deal JB Jr, Knox JA. Lumbar Disc Herniation in Military Helicopter Pilots vs. Matched Controls. Aerosp Med Hum Perform. 2018;89(5):442-445. PMID:29673429. doi:10.3357/AMHP.4935.2018. Direct
- Cohen SP, Nguyen C, Kapoor SG, Anderson-Barnes VC, Foster L, Shields C, McLean B, Wichman T, Plunkett A. Back pain during war: an analysis of factors affecting outcome. Arch Intern Med. 2009;169(20):1916-23. PMID:19901146. doi:10.1001/archinternmed.2009.380. Direct
- Rozali A, Rampal KG, Shamsul Bahri MT, Sherina MS, Shamsul Azhar S, Khairuddin H, Sulaiman A. Low back pain and association with whole body vibration among military armoured vehicle drivers in Malaysia. Med J Malaysia. 2009;64(3):197-204. PMID:20527267. Direct
- Yang Y, Liu S, Ling M, Ye C. Prevalence and Potential Risk Factors for Occupational Low Back Pain Among Male Military Pilots: A Study Based on Questionnaire and Physical Function Assessment. Front Public Health. 2021;9((no issue)):744601. PMID:35059371. doi:10.3389/fpubh.2021.744601. Direct
- Knox JB, Orchowski JR, Scher DL, Owens BD, Burks R, Belmont PJ. Occupational driving as a risk factor for low back pain in active-duty military service members. Spine J. 2014;14(4):592-7. PMID:23992937. doi:10.1016/j.spinee.2013.06.029. Direct
- Ernat J, Knox J, Orchowski J, Owens B. Incidence and risk factors for acute low back pain in active duty infantry. Mil Med. 2012;177(11):1348-51. PMID:23198512. doi:10.7205/milmed-d-12-00183. Direct
- Steelman T, Lewandowski L, Helgeson M, Wilson K, Olsen C, Gwinn D. Population-based Risk Factors for the Development of Degenerative Disk Disease. Clin Spine Surg. 2018;31(8):E409-E412. PMID:29985801. doi:10.1097/BSD.0000000000000682. SecondaryAggravation
Degenerative Joint Disease
38 CFR DC 5055, 5256, 5257, 5258, 5259, 5260…Elevated incidence of knee osteoarthritis and post-traumatic OA in military service members.
- Beisheim-Ryan EH, Gorczynski SR, Smith RW, Farrokhi S. Quantifying the Functional Impact of Chronic Patellofemoral Pain and Its Relationship to Perceived Duty-related Medical Readiness Among Active Duty Service Members. Mil Med. 2026;191(1-2):e18-e25. PMID:40261269. doi:10.1093/milmed/usaf131. Direct
- Tropf JG, Colantonio DF, Tucker CJ, Rhon DI. Epidemiology of Meniscus Injuries in the Military Health System and Predictive Factors for Arthroscopic Surgery. J Knee Surg. 2022;35(10):1048-1055. PMID:35259766. doi:10.1055/s-0042-1744189. Direct
- Rodriguez MJ, Garcia EJ, Dickens JF. Primary and Posttraumatic Knee Osteoarthritis in the Military. J Knee Surg. 2019;32(2):134-137. PMID:30609440. doi:10.1055/s-0038-1676956. Direct
- Cooper C, McAlindon T, Coggon D, Egger P, Dieppe P. Occupational activity and osteoarthritis of the knee. Ann Rheum Dis. 1994;53(2):90-3. PMID:8129467. doi:10.1136/ard.53.2.90. Direct
- Manninen P, Heliovaara M, Riihimaki H, Suoma-Iainen O. Physical workload and the risk of severe knee osteoarthritis. Scand J Work Environ Health. 2002;28(1):25-32. PMID:11871849. doi:10.5271/sjweh.643. Direct
- Rhon DI, Perez KG, Eskridge SL. Risk of post-traumatic knee osteoarthritis after knee injury in military service members. Musculoskeletal Care. 2019;17(1):113-119. PMID:30609244. doi:10.1002/msc.1378. DirectSecondaryAggravation
Diabetes Mellitus
38 CFR DC 7913Herbicide (Agent Orange) exposure association with type 2 diabetes underpinning the presumptive.
- Institute of Medicine, Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes. The National Academies Press, Washington, DC; 2000. doi:10.17226/9982. Available at: https://doi.org/10.17226/9982. PresumptiveDirect
- National Academies of Sciences, Engineering, and Medicine, Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eleventh Biennial Update). Veterans and Agent Orange: Update 11 (2018). The National Academies Press, Washington, DC; 2018. doi:10.17226/25137. Available at: https://doi.org/10.17226/25137. PresumptiveDirect
- Henriksen GL, Ketchum NS, Michalek JE, Swaby JA. Serum dioxin and diabetes mellitus in veterans of Operation Ranch Hand. Epidemiology. 1997;8(3):252-8. PMID:9115019. doi:10.1097/00001648-199705000-00005. PresumptiveDirect
- Longnecker MP, Michalek JE. Serum dioxin level in relation to diabetes mellitus among Air Force veterans with background levels of exposure. Epidemiology. 2000;11(1):44-8. PMID:10615842. doi:10.1097/00001648-200001000-00010. PresumptiveDirect
- Michalek JE, Pavuk M. Diabetes and cancer in veterans of Operation Ranch Hand after adjustment for calendar period, days of spraying, and time spent in Southeast Asia. J Occup Environ Med. 2008;50(3):330-40. PMID:18332783. doi:10.1097/JOM.0b013e31815f889b. PresumptiveDirect
- Seo S, Kim YA, Lee Y, Kim YJ, Kim BJ, An JH, Jin H, Do AR, Park K, Won S, Seo JH. Epigenetic link between Agent Orange exposure and type 2 diabetes in Korean veterans. Front Endocrinol (Lausanne). 2024;15:1375459. PMID:39072272. doi:10.3389/fendo.2024.1375459. PresumptiveDirect
- Boyko EJ, Jacobson IG, Smith B, Ryan MAK, Hooper TI, Amoroso PJ, Gackstetter GD, Barrett-Connor E, Smith TC. Risk of diabetes in U.S. military service members in relation to combat deployment and mental health. Diabetes Care. 2010;33(8):1771-7. PMID:20484134. doi:10.2337/dc10-0296. SecondaryAggravation
- Vancampfort D, Rosenbaum S, Ward PB, Steel Z, Lederman O, Lamwaka AV, Richards JW, Stubbs B. Type 2 Diabetes Among People With Posttraumatic Stress Disorder: Systematic Review and Meta-Analysis. Psychosom Med. 2016;78(4):465-73. PMID:26867081. doi:10.1097/PSY.0000000000000297. SecondaryAggravation
- Steenland K, Calvert G, Ketchum N, Michalek J. Dioxin and diabetes mellitus: an analysis of the combined NIOSH and Ranch Hand data. Occup Environ Med. 2001;58(10):641-648. PMID:11555685. doi:10.1136/oem.58.10.641. PresumptiveDirect
- Scherrer JF, Salas J, Wang W, Freedland KE, Lustman PJ, Schnurr PP, Cohen BE, Jaffe AS. Posttraumatic Stress Disorder and Type 2 Diabetes Outcomes in Veterans. JAMA Netw Open. 2024;7(8):e2427569. PMID:39136942. doi:10.1001/jamanetworkopen.2024.27569. SecondaryAggravation
Erectile Dysfunction
38 CFR DC 7522Erectile dysfunction in veterans arises predominantly as a SECONDARY condition — to PTSD and depression and to the serotonergic medication used to treat them, to service-connected diabetes mellitus and hypertension and antihypertensive therapy, to obstructive sleep apnea, to lumbar and spinal cord pathology, and to treatment for service-connected prostate cancer — with a real minority DIRECT lane in deployment genitourinary and pelvic blast trauma.
- Cosgrove DJ, Gordon Z, Bernie JE, Hami S, Montoya D, Stein MB, Monga M. Sexual dysfunction in combat veterans with post-traumatic stress disorder. Urology. 2002;60(5):881-4. PMID:12429320. doi:10.1016/s0090-4295(02)01899-x. SecondaryAggravation
- Hosain GM, Latini DM, Kauth M, Goltz HH, Helmer DA. Sexual dysfunction among male veterans returning from Iraq and Afghanistan: prevalence and correlates. J Sex Med. 2013;10(2):516-23. PMID:23088675. doi:10.1111/j.1743-6109.2012.02978.x. SecondaryAggravation
- Montejo AL, Montejo L, Navarro-Cremades F. Sexual side-effects of antidepressant and antipsychotic drugs. Curr Opin Psychiatry. 2015;28(6):418-23. PMID:26382168. doi:10.1097/YCO.0000000000000198. SecondaryAggravation
- Kouidrat Y, Pizzol D, Cosco T, Thompson T, Carnaghi M, Bertoldo A, Solmi M, Stubbs B, Veronese N. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med. 2017;34(9):1185-1192. PMID:28722225. doi:10.1111/dme.13403. SecondaryAggravation
- Castillo O Jr, Chen IK, Amini E, Yafi FA, Barham DW. Male Sexual Health Related Complications Among Combat Veterans. Sex Med Rev. 2022;10(4):691-697. PMID:36028434. doi:10.1016/j.sxmr.2022.06.002. Direct
- Way BM, Griffin KR, Kraus SW, Tsai J, Pietrzak RH. Erectile Dysfunction in a U.S. National Sample of Male Military Veterans. Mil Med. 2023;188(9-10):2837-2843. PMID:35792506. doi:10.1093/milmed/usac187. SecondaryAggravation
- Tran JK, Dunckel G, Teng EJ. Sexual dysfunction in veterans with post-traumatic stress disorder. J Sex Med. 2015;12(4):847-55. PMID:25665140. doi:10.1111/jsm.12823. SecondaryAggravation
- Bentsen IL, Giraldi AG, Kristensen E, Andersen HS. Systematic Review of Sexual Dysfunction Among Veterans with Post-Traumatic Stress Disorder. Sex Med Rev. 2015;3(2):78-87. PMID:27784548. doi:10.1002/smrj.47. SecondaryAggravation
- Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med. 2021;18(8):1398-1426. PMID:34257051. doi:10.1016/j.jsxm.2021.05.011. SecondaryAggravation
- Marks S. A clinical review of antidepressants, their sexual side-effects, post-SSRI sexual dysfunction, and serotonin syndrome. Br J Nurs. 2023;32(14):678-682. PMID:37495413. doi:10.12968/bjon.2023.32.14.678. SecondaryAggravation
- Hidalgo-Tamola J, Chitaley K. Review type 2 diabetes mellitus and erectile dysfunction. J Sex Med. 2009;6(4):916-926. PMID:19067787. doi:10.1111/j.1743-6109.2008.01116.x. SecondaryAggravation
- Dilixiati D, Waili A, Tuerxunmaimaiti A, Tao L, Zebibula A, Rexiati M. Risk factors for erectile dysfunction in diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024;15:1368079. PMID:38638136. doi:10.3389/fendo.2024.1368079. SecondaryAggravation
- Weinberg AE, Eisenberg M, Patel CJ, Chertow GM, Leppert JT. Diabetes severity, metabolic syndrome, and the risk of erectile dysfunction. J Sex Med. 2013;10(12):3102-9. PMID:24010555. doi:10.1111/jsm.12318. Secondary
- Lu CC, Jiann BP, Sun CC, Lam HC, Chu CH, Lee JK. Association of glycemic control with risk of erectile dysfunction in men with type 2 diabetes. J Sex Med. 2009;6(6):1719-1728. PMID:19473477. doi:10.1111/j.1743-6109.2009.01219.x. SecondaryAggravation
- Sarma AV, Hotaling JM, de Boer IH, Dunn RL, Oerline MK, Singh K, Goldberg J, Jacobson A, Braffett B, Herman WH, Pop-Busui R, Wessells H. Blood pressure, antihypertensive medication use, and risk of erectile dysfunction in men with type I diabetes. J Hypertens. 2019;37(5):1070-1076. PMID:30882596. doi:10.1097/HJH.0000000000001988. Secondary
- Palmer MR, Holt SK, Sarma AV, Dunn RL, Hotaling JM, Cleary PA, Braffett BH, Martin C, Herman WH, Jacobson AM, Wessells H. Longitudinal Patterns of Occurrence and Remission of Erectile Dysfunction in Men With Type 1 Diabetes. J Sex Med. 2017;14(10):1187-1194. PMID:28847704. doi:10.1016/j.jsxm.2017.07.012. Secondary
- Hermans MP, Ahn SA, Rousseau MF. Erectile dysfunction, microangiopathy and UKPDS risk in type 2 diabetes. Diabetes Metab. 2009;35(6):484-9. PMID:19897395. doi:10.1016/j.diabet.2009.06.003. Secondary
- Hostnik B, Tonin G, Janez A, Klen J. Erectile Dysfunction in Diabetes Mellitus: A Comprehensive Narrative Review of Pathophysiology, Genetic Association Studies and Therapeutic Approaches. Endocrinol Diabetes Metab. 2025;8(5):e70099. PMID:40960125. doi:10.1002/edm2.70099. Secondary
- Fonseca V, Jawa A. Endothelial and erectile dysfunction, diabetes mellitus, and the metabolic syndrome: common pathways and treatments?. Am J Cardiol. 2005;96(12B):13M-18M. PMID:16387560. Secondary
- Janak JC, Orman JA, Soderdahl DW, Hudak SJ. Epidemiology of Genitourinary Injuries among Male U.S. Service Members Deployed to Iraq and Afghanistan: Early Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project. J Urol. 2017;197(2):414-419. PMID:27506692. doi:10.1016/j.juro.2016.08.005. Direct
- Nnamani NS, Pugh MJ, Amuan ME, Eapen BC, Hudak SJ, Liss MA, Orman JA. Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration. Mil Med. 2019;184(3-4):e297-e301. PMID:30124961. doi:10.1093/milmed/usy196. Direct
- Lucas PA, Page PRJ, Phillip RD, Bennett AN. The impact of genital trauma on wounded servicemen: qualitative study. Injury. 2014;45(5):825-829. PMID:24560873. doi:10.1016/j.injury.2013.12.009. Direct
- Pedersen A, Stinner DJ, McLaughlin HC, Bailey JR, Walter JR, Hsu JR. Characteristics of genitourinary injuries associated with pelvic fractures during operation Iraqi Freedom and operation Enduring Freedom. Mil Med. 2015;180(3 Suppl):64-7. PMID:25747634. doi:10.7205/MILMED-D-14-00410. Direct
- Liu Q, Zhang Y, Wang J, Li S, Cheng Y, Guo J, Tang Y, Zeng H, Zhu Z. Erectile Dysfunction and Depression: A Systematic Review and Meta-Analysis. J Sex Med. 2018;15(8):1073-1082. PMID:29960891. doi:10.1016/j.jsxm.2018.05.016. SecondaryAggravation
- Kellesarian SV, Malignaggi VR, Feng C, Javed F. Association between obstructive sleep apnea and erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res. 2018;30(3):129-140. PMID:29795528. doi:10.1038/s41443-018-0017-7. SecondaryAggravation
- Hwang JH, Ong HL, Chen YC. Surgical treatments for obstructive sleep apnea decrease the risk of erectile dysfunction: A nationwide cohort study. Andrology. 2022;10(3):477-485. PMID:34748688. doi:10.1111/andr.13126. SecondaryAggravation
- Burchardt M, Burchardt T, Baer L, Kiss AJ, Pawar RV, Shabsigh A, de la Taille A, Hayek OR, Shabsigh R. Hypertension is associated with severe erectile dysfunction. J Urol. 2000;164(4):1188-91. PMID:10992363. SecondaryAggravation
- de Oliveira AA, Nunes KP. Hypertension and Erectile Dysfunction: Breaking Down the Challenges. Am J Hypertens. 2021;34(2):134-142. PMID:32866225. doi:10.1093/ajh/hpaa143. SecondaryAggravation
- Siddiqui MA, Seng C, Shanmugam N, Yeo W, Zhang K, Chong HC, Tat JCL, Guo CM, Tan SB, Yue WM. Two-year outcome of erectile dysfunction in patients younger than 50 years with fracture-unrelated lumbar spine disease requiring surgical decompression: a prospective study. Spine (Phila Pa 1976). 2013;38(10):846-50. PMID:23222569. doi:10.1097/BRS.0b013e318280923d. SecondaryAggravation
- Sangondimath G, Mallepally AR, Mascharenhas A, Chhabra HS. Sexual and Bladder Dysfunction in Cauda Equina Syndrome: Correlation with Clinical and Urodynamic Studies. Asian Spine J. 2020;14(6):782-789. PMID:32429016. doi:10.31616/asj.2019.0305. SecondaryAggravation
- Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al.; ProtecT Study Group. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med. 2016;375(15):1425-1437. PMID:27626365. doi:10.1056/NEJMoa1606221. SecondaryAggravation
- Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh J, Khera M, McVary KT, Miner MM, Nelson CJ, Sadeghi-Nejad H, Seftel AD, Shindel AW. Erectile Dysfunction: AUA Guideline. American Urological Association; 2018. PMID:29746858. doi:10.1016/j.juro.2018.05.004.
Femoroacetabular Impingement
38 CFR DC 5250, 5251, 5252, 5253, 5254, 5255Load-bearing, training overuse, and post-traumatic mechanisms driving femoroacetabular impingement and hip osteoarthritis in service members.
- Scher DL, Belmont PJ Jr, Mountcastle S, Owens BD. The incidence of primary hip osteoarthritis in active duty US military servicemembers. Arthritis Rheum. 2009;61(4):468-75. PMID:19333991. doi:10.1002/art.24429. Direct
- Williams TR, Puckett ML, Denison G, Shin AY, Gorman JD. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings. Skeletal Radiol. 2002;31(5):277-81. PMID:11981604. doi:10.1007/s00256-002-0485-0. Direct
- Kuhn KM, Riccio AI, Saldua NS, Cassidy J. Acetabular retroversion in military recruits with femoral neck stress fractures. Clin Orthop Relat Res. 2010;468(3):846-51. PMID:19588210. doi:10.1007/s11999-009-0969-5. Direct
- Barkley C, Wong WK, Knapik JJ, Westrick RB. The Presence of Hip Joint Effusion on MRI Is Predictive of a Grade 4 Femoral Neck Stress Injury. Mil Med. 2023;188(7-8):e1828-e1834. PMID:36611263. doi:10.1093/milmed/usac347. Direct
- Jorgensen AY, Waterman BR, Hsiao MS, Belmont PJ. Functional outcomes of hip arthroplasty in active duty military service members. J Surg Orthop Adv. 2013;22(1):16-22. PMID:23449050. doi:10.3113/jsoa.2013.0016. Direct
- Thomas DD, Bernhardson AS, Bernstein E, Dewing CB. Hip Arthroscopy for Femoroacetabular Impingement in a Military Population. Am J Sports Med. 2017;45(14):3298-3304. PMID:28937803. doi:10.1177/0363546517726984. Direct
- Jochimsen KN, Jacobs CA, Duncan ST. Femoroacetabular impingement is more common in military veterans with end-stage hip osteoarthritis than civilian patients: a retrospective case control study. Mil Med Res. 2019;6(1):27. PMID:31439033. doi:10.1186/s40779-019-0218-5. Direct
- Hillery BL, Goldman AH, Velosky AG, Amoako MY, Leggit JC, Highland KB. Time to Total Hip Arthroplasty Among Patients in the US Military Health System. JAMA Netw Open. 2025;8(10):e2539971. PMID:41148135. doi:10.1001/jamanetworkopen.2025.39971. Direct
Frequent Nighttime Urination
38 CFR DC 7542Obstructive sleep apnea as a recognized cause of nocturia/nocturnal polyuria (secondary service connection).
- Perveen MM, Mayo-Malasky HE, Lee-Wong MF, Tomaska JM, Forsyth E, Gravely A, Klein MA, Trembley JH, Butterick TA, Promisloff RA, Ginex PK, Barach P, Szema AM. Gross Hematuria and Lower Urinary Tract Symptoms Associated With Military Burn Pits Exposures in US Veterans Deployed to Iraq and Afghanistan. J Occup Environ Med. 2023;65(9):740-744. PMID:37367635. doi:10.1097/JOM.0000000000002919. Direct
- O'Shea SD, Pope R, Freire K, Orr R. Prevalence of lower urinary tract symptoms in a cohort of Australian servicewomen and female veterans. Int Urogynecol J. 2023;34(4):885-896. PMID:35763047. doi:10.1007/s00192-022-05254-x. Direct
- Markland A, Chu H, Epperson CN, Nodora J, Shoham D, Smith A, Sutcliffe S, Townsend M, Zhou J, Bavendam T. Occupation and lower urinary tract symptoms in women: A rapid review and meta-analysis from the PLUS research consortium. Neurourol Urodyn. 2018;37(8):2881-2892. PMID:30272814. doi:10.1002/nau.23806. Direct
- Fu Z, Wang F, Dang X, Zhou T. The association between diabetes and nocturia: A systematic review and meta-analysis. Front Public Health. 2022;10(924488). PMID:36262225. doi:10.3389/fpubh.2022.924488. SecondaryAggravation
- Dani H, Esdaille A, Weiss JP. Nocturia: aetiology and treatment in adults. Nat Rev Urol. 2016;13(10):573-83. PMID:27455894. doi:10.1038/nrurol.2016.134. Direct
- Di Bello F, Napolitano L, Abate M, Collà Ruvolo C, Morra S, Califano G, Capece M, Creta M. "Nocturia and obstructive sleep apnea syndrome: A systematic review". Sleep Med Rev. 2023;69:101787. PMID:37167825. doi:10.1016/j.smrv.2023.101787. SecondaryAggravation
- Zhou J, Xia S, Li T, Liu R. Association between obstructive sleep apnea syndrome and nocturia: a meta-analysis. Sleep Breath. 2020;24(4):1293-1298. PMID:31907825. doi:10.1007/s11325-019-01981-6. SecondaryAggravation
- Vrooman OPJ, van Kerrebroeck PEV, van Balken MR, van Koeveringe GA, Rahnama'i MS. Nocturia and obstructive sleep apnoea. Nat Rev Urol. 2024;21(12):735-753. PMID:38783115. doi:10.1038/s41585-024-00887-7. SecondaryAggravation
- Niimi A, Suzuki M, Yamaguchi Y, Ishii M, Fujimura T, Nakagawa T, Fukuhara H, Kume H. Sleep Apnea and Circadian Extracellular Fluid Change as Independent Factors for Nocturnal Polyuria. J Urol. 2016;196(4):1183-9. PMID:27105762. doi:10.1016/j.juro.2016.04.060. SecondaryAggravation
- Yu CC, Huang CY, Kuo WK, Chen CY. Continuous positive airway pressure improves nocturnal polyuria in ischemic stroke patients with obstructive sleep apnea. Clin Interv Aging. 2019;14:241-247. PMID:30774323. doi:10.2147/CIA.S193448. SecondaryAggravation
- Hashim H, Blanker MH, Drake MJ, Djurhuus JC, Meijlink J, Morris V, Petros P, Wen JG, Wein A. International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function. Neurourol Urodyn. 2019;38(2):499-508. PMID:30644584. doi:10.1002/nau.23917. Direct
- Hashim H, Drake MJ. Basic concepts in nocturia, based on international continence society standards in nocturnal lower urinary tract function. Neurourol Urodyn. 2018;37(S6):S20-S24. PMID:30070389. doi:10.1002/nau.23781. Direct
- Hofmeester I, Kollen BJ, Steffens MG, Bosch JL, Drake MJ, Weiss JP, Blanker MH. Impact of the International Continence Society (ICS) report on the standardisation of terminology in nocturia on the quality of reports on nocturia and nocturnal polyuria: a systematic review. BJU Int. 2015;115(4):520-36. PMID:24684483. doi:10.1111/bju.12753. Direct
- Ochoa DC, Hashim H. The Importance of Terminology for Quantifying Nocturia in Practice. Eur Urol Focus. 2022;8(1):81-85. PMID:35094963. doi:10.1016/j.euf.2022.01.008. Direct
- Zumrutbas AE, Bozkurt AI, Alkis O, Toktas C, Cetinel B, Aybek Z. The Prevalence of Nocturia and Nocturnal Polyuria: Can New Cutoff Values Be Suggested According to Age and Sex? Int Neurourol J. 2016;20(4):304-310. PMID:28043108. doi:10.5213/inj.1632558.279. Direct
- Fujimura T, Yamada Y, Sugihara T, Azuma T, Suzuki M, Fukuhara H, Nakagawa T, Kume H, Igawa Y, Homma Y. Nocturia in men is a chaotic condition dominated by nocturnal polyuria. Int J Urol. 2015;22(5):496-501. PMID:25631284. doi:10.1111/iju.12710. Direct
- Drangsholt S, Ruiz MJA, Peyronnet B, Rosenblum N, Nitti V, Brucker B. Diagnosis and management of nocturia in current clinical practice: who are nocturia patients, and how do we treat them? World J Urol. 2019;37(7):1389-1394. PMID:30288596. doi:10.1007/s00345-018-2511-4. Direct
- Aucar N, Fagalde I, Zanella A, Capalbo O, Aroca-Martinez G, Favre G, Musso CG. Nocturia: its characteristics, diagnostic algorithm and treatment. Int Urol Nephrol. 2023;55(1):107-114. PMID:35945304. doi:10.1007/s11255-022-03317-y. Direct
- Chang TL, Kuo HC. Nocturia, nocturnal polyuria, and nocturnal enuresis in adults: What we know and what we do not know. Tzu Chi Med J. 2024;36(4):370-376. PMID:39421492. doi:10.4103/tcmj.tcmj_53_24. Direct
- Vaughan CP, Brown CJ, Goode PS, Burgio KL, Allman RM, Johnson TM 2nd. The association of nocturia with incident falls in an elderly community-dwelling cohort. Int J Clin Pract. 2010;64(5):577-583. PMID:20456212. doi:10.1111/j.1742-1241.2009.02326.x. Direct
- König M, Malsch C, Marino J, Vetter VM, Komleva Y, Demuth I, Steinhagen-Thiessen E. Nocturia as a clinical marker of loss of function and resilience or risk factor for frailty in older adults? Results of the Berlin Aging Study II. Geroscience. 2025;47(3):4139-4151. PMID:39888584. doi:10.1007/s11357-025-01525-9. Direct
- Wang T, Huang W, Zong H, Zhang Y. The Efficacy of Continuous Positive Airway Pressure Therapy on Nocturia in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Int Neurourol J. 2015;19(3):178-84. PMID:26620900. doi:10.5213/inj.2015.19.3.178. SecondaryAggravation
- Vrooman OPJ, van Balken MR, van Koeveringe GA, van Kerrebroeck PVA, Driessen LEMJ, Schouten LJ, Rahnama'i MS. The effect of continuous positive airway pressure on nocturia in patients with obstructive sleep apnea syndrome. Neurourol Urodyn. 2020;39(4):1124-1128. PMID:32125734. doi:10.1002/nau.24329. SecondaryAggravation
- Miyazaki T, Kojima S, Yamamuro M, Sakamoto K, Izumiya Y, Tsujita K, Yamamoto E, Tanaka T, Kaikita K, Hokimoto S, Ogawa H. Nocturia in Patients With Sleep-Disordered Breathing and Cardiovascular Disease. Circ J. 2015;79(12):2632-40. PMID:26477355. doi:10.1253/circj.CJ-15-0654. SecondaryAggravation
- Boyd BAJ, Gibson CJ, Van Den Eeden SK, McCaw B, Subak LL, Thom D, Huang AJ. Interpersonal Trauma as a Marker of Risk for Urinary Tract Dysfunction in Midlife and Older Women. Obstet Gynecol. 2020;135(1):106-112. PMID:31809425. doi:10.1097/AOG.0000000000003586. Secondary
- Umlauf MG, Chasens ER. Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep Med Rev. 2003;7(5):403-411. PMID:14573376. doi:10.1053/smrv.2002.0273. SecondaryAggravation
- Liu S, Liu L. [Effect of treatment with continuous positive airway pressure on nocturnal polyuria in patients with obstructive sleep apnea syndrome]. [Article in Chinese] Zhonghua Jie He He Hu Xi Za Zhi. 2001;24(3):158-160. PMID:11802958. SecondaryAggravation
- Krieger J. Regulation of plasma volume during obstructive sleep apnoea. J Sleep Res. 1995;4(S1):107-111. PMID:10607185. doi:10.1111/j.1365-2869.1995.tb00198.x. SecondaryAggravation
- Chughtai B, Forde JC, Thomas DD, Laor L, Hossack T, Woo HH, Te AE, Kaplan SA. Benign prostatic hyperplasia. Nat Rev Dis Primers. 2016;2:16031. PMID:27147135. doi:10.1038/nrdp.2016.31. Secondary
- Klugherz LJ, Mansukhani MP, Kolla BP. Effects of Commonly Prescribed Medications on Sleep: A Review of the Literature. Mayo Clin Proc. 2025;100(5):856-867. PMID:40318905. doi:10.1016/j.mayocp.2025.02.005. Secondary
Gastroesophageal Reflux Disease
38 CFR DC 7346PTSD/combat-stress and deployment exposures associated with gastroesophageal reflux disease in service members and veterans.
- Koch TR, Emory TS. Evaluation of chronic gastrointestinal symptoms following Persian Gulf War exposure. Mil Med. 2005;170(8):696-700. PMID:16173212. doi:10.7205/milmed.170.8.696. PresumptiveDirect
- Yousef A, Ahmed ST, H Nguyen Wenker T, Nono-Djotsa ABS, Boyle SH, Gifford EJ, Malhotra D, Chandler H, Bandi S, Helmer DA. Upper gastrointestinal symptoms and Gulf War Illness in a clinical cohort of US veterans: a retrospective, cross-sectional study. BMJ Open Gastroenterol. 2025;12(1):e001859. PMID:40912694. doi:10.1136/bmjgast-2025-001859. PresumptiveDirect
- Wang WF, Guo XX, Yang YS. Gastrointestinal problems in modern wars: clinical features and possible mechanisms. Mil Med Res. 2015;2:15. PMID:26301101. doi:10.1186/s40779-015-0042-5. Presumptive
- Daniele DO, Oh GT, O'Donnell FL, Clark LL. Incidence of gastroesophageal reflux disease (GERD), active component, U.S. Armed Forces, 2005-2014. MSMR. 2015;22(7):14-17. PMID:26207411. Direct
- Tuteja AK, Talley NJ, Stoddard GJ, Samore MH, Verne GN. Risk factors for upper and lower functional gastrointestinal disorders in Persian Gulf War Veterans during and post-deployment. Neurogastroenterol Motil. 2019;31(3):e13533. PMID:30697884. doi:10.1111/nmo.13533. DirectPresumptive
- Porter CK, Gloor K, Cash BD, Riddle MS. Risk of functional gastrointestinal disorders in U.S. military following self-reported diarrhea and vomiting during deployment. Dig Dis Sci. 2011;56(11):3262-3269. PMID:21643738. doi:10.1007/s10620-011-1762-3. DirectPresumptive
- Maule AL, Janulewicz PA, Sullivan KA, Krengel MH, Yee MK, McClean M, White RF. Meta-analysis of self-reported health symptoms in 1990-1991 Gulf War and Gulf War-era veterans. BMJ Open. 2018;8(2):e016086. PMID:29440208. doi:10.1136/bmjopen-2017-016086. DirectPresumptive
- Herregods TV, van Hoeij FB, Oors JM, Bredenoord AJ, Smout AJ. Effect of Running on Gastroesophageal Reflux and Reflux Mechanisms. Am J Gastroenterol. 2016;111(7):940-6. PMID:27068716. doi:10.1038/ajg.2016.122. Direct
- Schey R, Dickman R, Parthasarathy S, Quan SF, Wendel C, Merchant J, Powers J, Han B, van Handel D, Fass R. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology. 2007;133(6):1787-95. PMID:18054551. doi:10.1053/j.gastro.2007.09.039. Direct
- Chung TH, Lee J, Kim MC. Impact of night-shift work on the prevalence of erosive esophagitis in shipyard male workers. Int Arch Occup Environ Health. 2016;89(6):961-966. PMID:27129469. doi:10.1007/s00420-016-1130-x. Direct
- Fujiwara Y, Machida A, Watanabe Y, Shiba M, Tominaga K, Watanabe T, Oshitani N, Higuchi K, Arakawa T. Association between dinner-to-bed time and gastro-esophageal reflux disease. Am J Gastroenterol. 2005;100(12):2633-2636. PMID:16393212. doi:10.1111/j.1572-0241.2005.00354.x. Direct
- Wickramasinghe N, Thuraisingham A, Jayalath A, Wickramasinghe D, Samarasekara N, Yazaki E, Devanarayana NM. The association between symptoms of gastroesophageal reflux disease and perceived stress: A countrywide study of Sri Lanka. PLoS One. 2023;18(11):e0294135. PMID:37943748. doi:10.1371/journal.pone.0294135. Direct
- Okuyama M, Takaishi O, Nakahara K, Iwakura N, Hasegawa T, Oyama M, Inoue A, Ishizu H, Satoh H, Fujiwara Y. Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scand J Gastroenterol. 2017;52(1):44-49. PMID:27571846. doi:10.1080/00365521.2016.1224383. Direct
- Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):591-599. PMID:22314561. Direct
- Chen HT, Chuang HY, Hsieh TY, Wu PS, Lin FJ, Huang HC, Yang CC, Kuo CH. Shift work is significantly and positively associated with possible gastro-esophageal reflux disease: A meta-analysis study. Front Public Health. 2022;10(n/a (article number series)):980603. PMID:36504996. doi:10.3389/fpubh.2022.980603. Direct
- Xue J, Zhao Y, Wang Z, Ren N, Zhou C, Qin S. Rotating night shift work is associated with an increased risk of gastroesophageal reflux disease (GERD) symptoms among workers in China: A cross-sectional study. Int J Clin Pract. 2021;75(4):e13848. PMID:33220144. doi:10.1111/ijcp.13848. Direct
- Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016;14(2):175-182.e1-3. PMID:25956834. doi:10.1016/j.cgh.2015.04.176. Direct
- de la Hoz RE, Christie J, Teamer JA, Bienenfeld LA, Afilaka AA, Crane M, Levin SM, Herbert R. Reflux symptoms and disorders and pulmonary disease in former World Trade Center rescue and recovery workers and volunteers. J Occup Environ Med. 2008;50(12):1351-1354. PMID:19092489. doi:10.1097/JOM.0b013e3181845f9b. Direct
- Malhotra D, Boyle SH, Gifford EJ, Sullivan BA, Nguyen Wenker TH, Abs ND, Ahmed ST, Upchurch J. Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder. Neurogastroenterol Motil. 2023;35(5):e14548. PMID:36942766. doi:10.1111/nmo.14548. SecondaryAggravationPresumptive
- Guadagnoli L, Mashimo H, Lo WK. Assessment of Post-traumatic Stress Disorder Among Objective Esophageal Motility and Reflux Phenotypes in Symptomatic Veterans. J Clin Psychol Med Settings. 2023;30(3):606-617. PMID:36378471. doi:10.1007/s10880-022-09920-6. SecondaryAggravation
- Li J, Brackbill RM, Stellman SD, Farfel MR, Miller-Archie SA, Friedman S, Walker DJ, Thorpe LE. Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City. Am J Gastroenterol. 2011;106(11):1933-41. PMID:21894225. doi:10.1038/ajg.2011.300. SecondaryAggravation
- Litcher-Kelly L, Lam Y, Broihier JA, Brand DL, Banker SV, Kotov R, Bromet E, Bucobo JC. Longitudinal study of the impact of psychological distress symptoms on new-onset upper gastrointestinal symptoms in World Trade Center responders. Psychosom Med. 2014;76(9):686-93. PMID:25373890. doi:10.1097/PSY.0000000000000116. SecondaryAggravation
- Li C, Wu ZH, Pan XL, Yuan K. Effect of continuous positive airway pressure on gastroesophageal reflux in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath. 2021;25(3):1203-1210. PMID:33118054. doi:10.1007/s11325-020-02224-9. Secondary
- El Hage Chehade N, Fu Y, Ghoneim S, Shah S, Song G, Fass R. Association between obstructive sleep apnea and gastroesophageal reflux disease: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2023;38(8):1244-1251. PMID:37300443. doi:10.1111/jgh.16245. Secondary
- Feng Z, Wu S, Wang M, Wang H, Hou Y, Yi H, Xiao F, Xu L, Dong X, Han F. A high arousal threshold is associated with nocturnal gastroesophageal reflux in obstructive sleep apnea. Sleep Med. 2025;129:297-305. PMID:40081280. doi:10.1016/j.sleep.2025.03.004. Secondary
- Watson NF, Mystkowski SK. Aerophagia and gastroesophageal reflux disease in patients using continuous positive airway pressure: a preliminary observation. J Clin Sleep Med. 2008;4(5):434-8. PMID:18853700. SecondaryAggravation
- Kuribayashi S, Kusano M, Kawamura O, Shimoyama Y, Maeda M, Hisada T, Ishizuka T, Dobashi K, Mori M. Mechanism of gastroesophageal reflux in patients with obstructive sleep apnea syndrome. Neurogastroenterol Motil. 2010;22(6):611-e172. PMID:20236246. doi:10.1111/j.1365-2982.2010.01485.x. Secondary
- Dent J, Holloway RH, Eastwood PR. Systematic review: relationships between sleep and gastro-oesophageal reflux. Aliment Pharmacol Ther. 2013;38(7):657-73. PMID:23957437. doi:10.1111/apt.12445. Secondary
- Tawk M, Goodrich S, Kinasewitz G, Orr W. The effect of 1 week of continuous positive airway pressure treatment in obstructive sleep apnea patients with concomitant gastroesophageal reflux. Chest. 2006;130(4):1003-8. PMID:17035431. Secondary
- Elfanagely Y, Atsawarungruangkit A, Scharfen J, Pavlech L, Moss SF. Association Between Obstructive Sleep Apnea and Barrett's Esophagus: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2021;66(11):3689-3697. PMID:33236316. doi:10.1007/s10620-020-06709-1. SecondaryAggravation
- Wu ZH, Yang XP, Niu X, Xiao XY, Chen X. The relationship between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease: a meta-analysis. Sleep Breath. 2019;23(2):389-397. PMID:29987514. doi:10.1007/s11325-018-1691-x. Secondary
- Emilsson OI, Janson C, Benediktsdottir B, Juliusson S, Gislason T. Nocturnal gastroesophageal reflux, lung function and symptoms of obstructive sleep apnea: Results from an epidemiological survey. Respir Med. 2012;106(3):459-66. PMID:22197048. doi:10.1016/j.rmed.2011.12.004. Secondary
- Shepherd K, Hillman D, Eastwood P. Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal reflux. J Clin Sleep Med. 2013;9(1):13-7. PMID:23319899. doi:10.5664/jcsm.2328. SecondaryAggravation
- Shepherd K, Hillman D, Holloway R, Eastwood P. Mechanisms of nocturnal gastroesophageal reflux events in obstructive sleep apnea. Sleep Breath. 2011;15(3):561-70. PMID:20711680. doi:10.1007/s11325-010-0404-x. Secondary
- Demeter P, Pap A. The relationship between gastroesophageal reflux disease and obstructive sleep apnea. J Gastroenterol. 2004;39(9):815-20. PMID:15565398. Secondary
- Lim KG, Morgenthaler TI, Katzka DA. Sleep and Nocturnal Gastroesophageal Reflux: An Update. Chest. 2018;154(4):963-971. PMID:29859888. doi:10.1016/j.chest.2018.05.030. Secondary
- Friedman M, Gurpinar B, Lin HC, Schalch P, Joseph NJ. Impact of treatment of gastroesophageal reflux on obstructive sleep apnea-hypopnea syndrome. Ann Otol Rhinol Laryngol. 2007;116(11):805-11. PMID:18074664. doi:10.1177/000348940711601103. Aggravation
- Shepherd K, Orr W. Mechanism of Gastroesophageal Reflux in Obstructive Sleep Apnea: Airway Obstruction or Obesity? J Clin Sleep Med. 2016;12(1):87-94. PMID:26446244. doi:10.5664/jcsm.5402. SecondaryAggravation
Generalized Anxiety Disorder
38 CFR DC 9400Prevalence and course of anxiety disorders in service members and veterans, supporting direct and secondary service connection.
- Sareen J, Cox BJ, Afifi TO, Stein MB, Belik SL, Meadows G, Asmundson GJG. Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel. Arch Gen Psychiatry. 2007;64(7):843-52. PMID:17606818. doi:10.1001/archpsyc.64.7.843. Direct
- Stein MB, Kessler RC, Heeringa SG, Jain S, Campbell-Sills L, Colpe LJ, Fullerton CS, Nock MK, Sampson NA, Schoenbaum M, Sun X, Thomas ML, Ursano RJ. Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Am J Psychiatry. 2015;172(11):1101-1111. PMID:26337036. doi:10.1176/appi.ajp.2015.14121572. Direct
- Milanak ME, Gros DF, Magruder KM, Brawman-Mintzer O, Frueh BC. Prevalence and features of generalized anxiety disorder in Department of Veteran Affairs primary care settings. Psychiatry Res. 2013;209(2):173-9. PMID:23659756. doi:10.1016/j.psychres.2013.03.031. Direct
- Sareen J, Belik SL, Afifi TO, Asmundson GJG, Cox BJ, Stein MB. Canadian military personnel's population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations. Am J Public Health. 2008;98(12):2191-2198. PMID:18923111. doi:10.2105/AJPH.2008.134205. Direct
- Black DW, Carney CP, Forman-Hoffman VL, Letuchy E, Peloso P, Woolson RF, Doebbeling BN. Depression in veterans of the first Gulf War and comparable military controls. Ann Clin Psychiatry. 2004;16(2):53-61. PMID:15328898. doi:10.1080/10401230490452645. Direct
- Boulos D, Fikretoglu D. Influence of military component and deployment-related experiences on mental disorders among Canadian military personnel who deployed to Afghanistan: a cross-sectional survey. BMJ Open. 2018;8(3):e018735. PMID:29530906. doi:10.1136/bmjopen-2017-018735. Direct
- Richardson JD, Thompson A, King L, Ketcheson F, Shnaider P, Armour C, St Cyr K, Sareen J, Elhai JD, Zamorski MA. Comorbidity Patterns of Psychiatric Conditions in Canadian Armed Forces Personnel. Can J Psychiatry. 2019;64(7):501-510. PMID:30599762. doi:10.1177/0706743718816057. Direct
- Macdonald-Gagnon G, Stefanovics EA, Potenza MN, Pietrzak RH. Generalized anxiety and mild anxiety symptoms in U.S. military veterans: Prevalence, characteristics, and functioning. J Psychiatr Res. 2024;171:263-270. PMID:38325107. doi:10.1016/j.jpsychires.2024.02.013. DirectSecondaryAggravation
- Pankratz L, Sommer JL, Bolton SL, Sareen J, Enns MW, Afifi TO, El-Gabalawy R, Mota N. Prevalence and predictors of anxiety disorder courses in the Canadian Armed Forces. J Anxiety Disord. 2022;92:102612. PMID:36252350. doi:10.1016/j.janxdis.2022.102612. Direct
High Blood Pressure
38 CFR DC 7101Herbicide exposure and hypertension (National Academies Update 11: sufficient evidence of an association, the basis for the PACT Act presumptive) and open-burn-pit deployment, plus combat exposure and injury severity, occupational job strain, rotating shift work and noise as direct exposures — with the PTSD/combat-stress and obstructive-sleep-apnea pathways supporting secondary service connection.
- National Academies of Sciences, Engineering, and Medicine; Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eleventh Biennial Update). Veterans and Agent Orange: Update 11 (2018). The National Academies Press, Washington, DC; 2018. doi:10.17226/25137. Available at: https://doi.org/10.17226/25137. PresumptiveDirect
- Savitz DA, Woskie SR, Bello A, Gaither R, Gasper J, Jiang L, Rennix C, Wellenius GA, Trivedi AN. Deployment to Military Bases With Open Burn Pits and Respiratory and Cardiovascular Disease. JAMA Netw Open. 2024;7(4):e247629. PMID:38662371. doi:10.1001/jamanetworkopen.2024.7629. Direct
- Cypel YS, Kress AM, Eber SM, Schneiderman AI, Davey VJ. Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans. J Occup Environ Med. 2016;58(11):1127-1136. PMID:27820763. doi:10.1097/JOM.0000000000000876. PresumptiveDirect
- Kang HK, Dalager NA, Needham LL, Patterson DG Jr, Lees PS, Yates K, Matanoski GM. Health status of Army Chemical Corps Vietnam veterans who sprayed defoliant in Vietnam. Am J Ind Med. 2006;49(11):875-84. PMID:17006952. doi:10.1002/ajim.20385. PresumptiveDirect
- Howard JT, Stewart IJ, Kolaja CA, Sosnov JA, Rull RP, Torres I, Janak JC, Walker LE, Trone DW, Armenta RF. Hypertension in military veterans is associated with combat exposure and combat injury. J Hypertens. 2020;38(7):1293-1301. PMID:31990903. doi:10.1097/HJH.0000000000002364. Direct
- Granado NS, Smith TC, Swanson GM, Harris RB, Shahar E, Smith B, Boyko EJ, Wells TS, Ryan MA. Newly reported hypertension after military combat deployment in a large population-based study. Hypertension. 2009;54(5):966-73. PMID:19752293. doi:10.1161/HYPERTENSIONAHA.109.132555. Direct
- Howard JT, Sosnov JA, Janak JC, Gundlapalli AV, Pettey WB, Walker LE, Stewart IJ. Associations of Initial Injury Severity and Posttraumatic Stress Disorder Diagnoses With Long-Term Hypertension Risk After Combat Injury. Hypertension. 2018;71(5):824-832. PMID:29555664. doi:10.1161/HYPERTENSIONAHA.117.10496. Direct
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- Landsbergis PA, Dobson M, Koutsouras G, Schnall P. Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am J Public Health. 2013;103(3):e61-71. PMID:23327240. doi:10.2105/AJPH.2012.301153. Direct
- Bolm-Audorff U, Hegewald J, Pretzsch A, Freiberg A, Nienhaus A, Seidler A. Occupational Noise and Hypertension Risk: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020;17(17):6281. PMID:32872306. doi:10.3390/ijerph17176281. Direct
- Manohar S, Thongprayoon C, Cheungpasitporn W, Mao MA, Herrmann SM. Associations of rotational shift work and night shift status with hypertension: a systematic review and meta-analysis. J Hypertens. 2017;35(10):1929-1937. PMID:28650914. doi:10.1097/HJH.0000000000001442. Direct
- Smoley BA, Smith NL, Runkle GP. Hypertension in a population of active duty service members. J Am Board Fam Med. 2008;21(6):504-11. PMID:18988717. doi:10.3122/jabfm.2008.06.070182. Direct
- van Kempen E, Babisch W. The quantitative relationship between road traffic noise and hypertension: a meta-analysis. J Hypertens. 2012;30(6):1075-86. PMID:22473017. doi:10.1097/HJH.0b013e328352ac54. Direct
- Wang Q, Xi B, Liu M, Zhang Y, Fu M. Short sleep duration is associated with hypertension risk among adults: a systematic review and meta-analysis. Hypertens Res. 2012;35(10):1012-8. PMID:22763475. doi:10.1038/hr.2012.91. Direct
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- Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378-84. PMID:10805822. doi:10.1056/NEJM200005113421901. Secondary
- Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ, Barbe F, Vicente E, Wei Y. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012;307(20):2169-76. PMID:22618924. doi:10.1001/jama.2012.3418. Secondary
- Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension. A population-based study. Ann Intern Med. 1994;120(5):382-8. PMID:8304655. doi:10.7326/0003-4819-120-5-199403010-00005. Secondary
- Turnbull CD, Sen D, Kohler M, Petousi N, Stradling JR. Effect of Supplemental Oxygen on Blood Pressure in Obstructive Sleep Apnea (SOX). A Randomized Continuous Positive Airway Pressure Withdrawal Trial. Am J Respir Crit Care Med. 2019;199(2):211-219. PMID:30025470. doi:10.1164/rccm.201802-0240OC. Secondary
- Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897-904. PMID:7560081. doi:10.1172/JCI118235. Secondary
- Prabhakar NR, Kumar GK. Mechanisms of sympathetic activation and blood pressure elevation by intermittent hypoxia. Respir Physiol Neurobiol. 2010;174(1-2):156-61. PMID:20804865. doi:10.1016/j.resp.2010.08.021. Secondary
- Shang W, Zhang Y, Liu L, Chen F, Wang G, Han D. Benefits of continuous positive airway pressure on blood pressure in patients with hypertension and obstructive sleep apnea: a meta-analysis. Hypertens Res. 2022;45(11):1802-1813. PMID:35701490. doi:10.1038/s41440-022-00954-9. Secondary
- Haentjens P, Van Meerhaeghe A, Moscariello A, De Weerdt S, Poppe K, Dupont A, Velkeniers B. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. 2007;167(8):757-64. PMID:17452537. doi:10.1001/archinte.167.8.757. Secondary
- Schein ASO, Kerkhoff AC, Coronel CC, Plentz RDM, Sbruzzi G. Continuous positive airway pressure reduces blood pressure in patients with obstructive sleep apnea; a systematic review and meta-analysis with 1000 patients. J Hypertens. 2014;32(9):1762-73. PMID:24979300. doi:10.1097/HJH.0000000000000250. Secondary
- Martinez-Garcia MA, Capote F, Campos-Rodriguez F, Lloberes P, Diaz de Atauri MJ, Somoza M, Masa JF, Gonzalez M, Sacristan L. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310(22):2407-15. PMID:24327037. doi:10.1001/jama.2013.281250. Secondary
- Iftikhar IH, Valentine CW, Bittencourt LRA, Cohen DL, Fedson AC, Gislason T, Penzel T, Phillips CL, Yu-sheng L. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J Hypertens. 2014;32(12):2341-50; discussion 2350. PMID:25243523. doi:10.1097/HJH.0000000000000372. Secondary
- Sumner JA, Kubzansky LD, Roberts AL, Gilsanz P, Chen Q, Winning A, Forman JP, Rimm EB, Koenen KC. Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women. Psychol Med. 2016;46(15):3105-3116. PMID:27534802. Secondary
- Bourassa KJ, Anderson L, Brown JC, Dennis PA, Garrett ME, Ashley-Koch AE, Beckham JC, Kimbrel NA. Trauma, posttraumatic stress disorder, and incident chronic disease. Ann Behav Med. 2025;59(1):kaaf095. PMID:41350112. doi:10.1093/abm/kaaf095. Secondary
- Sumner JA, Kubzansky LD, Roberts AL, Chen Q, Rimm EB, Koenen KC. Not all posttraumatic stress disorder symptoms are equal: fear, dysphoria, and risk of developing hypertension in trauma-exposed women. Psychol Med. 2020;50(1):38-47. PMID:30606272. doi:10.1017/S0033291718003914. Secondary
- Gaffey AE, Redeker NS, Rosman L, Mullington JM, Brandt CA, Haskell SG, Burg MM. The role of insomnia in the association between posttraumatic stress disorder and hypertension. J Hypertens. 2020;38(4):641-648. PMID:31725076. doi:10.1097/HJH.0000000000002311. Secondary
- Wingenfeld K, Whooley MA, Neylan TC, Otte C, Cohen BE. Effect of current and lifetime posttraumatic stress disorder on 24-h urinary catecholamines and cortisol: results from the Mind Your Heart Study. Psychoneuroendocrinology. 2015;52:83-91. PMID:25459895. doi:10.1016/j.psyneuen.2014.10.023. Secondary
- Martin ZT, Shah AJ, Ko YA, Sheikh SA, Daaboul O, Haddad G, Goldberg J, Smith NL, Lewis TT, Quyyumi AA, Bremner JD, Vaccarino V. Exaggerated Peripheral and Systemic Vasoconstriction During Trauma Recall in Posttraumatic Stress Disorder: A Co-Twin Control Study. Biol Psychiatry. 2024;96(4):278-286. PMID:38142719. doi:10.1016/j.biopsych.2023.12.014. Secondary
- Bartoli F, Carrà G, Crocamo C, Carretta D, Clerici M. Metabolic syndrome in people suffering from posttraumatic stress disorder: a systematic review and meta-analysis. Metab Syndr Relat Disord. 2013;11(5):301-8. PMID:23758060. doi:10.1089/met.2013.0010. Secondary
- Ulmer CS, Calhoun PS, Bosworth HB, Dennis MF, Beckham JC. Nocturnal blood pressure non-dipping, posttraumatic stress disorder, and sleep quality in women. Behav Med. 2013;39(4):111-21. PMID:24236808. doi:10.1080/08964289.2013.813434. Secondary
Indirect Inguinal Hernia
38 CFR DC 7338Occupational mechanical exposures — heavy lifting, carrying, and prolonged standing/walking characteristic of military duty — and their association with inguinal hernia requiring repair.
- Kuijer PPFM, Hondebrink D, Hulshof CTJ, Van der Molen HF. Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE. Hernia. 2020;24(5):943-950. PMID:32474653. doi:10.1007/s10029-020-02236-0. Direct
- Kang SK, Burnett CA, Freund E, Sestito J. Hernia: is it a work-related condition?. Am J Ind Med. 1999;36(6):638-44. PMID:10561684. doi:10.1002/(sici)1097-0274(199912)36:6<638::aid-ajim6>3.0.co;2-w. Direct
- Carbonell JF, Sanchez JL, Peris RT, Ivorra JC, Del Bano MJ, Sanchez CS, Arraez JI, Greus PC. Risk factors associated with inguinal hernias: a case control study. Eur J Surg. 1993;159(9):481-6. PMID:8274556. Direct
- Ashindoitiang JA, Ibrahim NA, Akinlolu OO. Risk factors for inguinal hernia in adult male Nigerians: a case control study. Int J Surg. 2012;10(7):364-7. PMID:22676975. doi:10.1016/j.ijsu.2012.05.016. Direct
- Schwab R, Becker HP, Fackeldey V. Inguinal hernia repair in German military hospitals. Mil Med. 2004;169(12):962-5. PMID:15646186. doi:10.7205/milmed.169.12.962. Direct
- Vad MV, Frost P, Bay-Nielsen M, Svendsen SW. Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair. Occup Environ Med. 2012;69(11):802-809. PMID:22935954. doi:10.1136/oemed-2012-100787.
- Vad MV, Frost P, Rosenberg J, Andersen JH, Svendsen SW. Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors: a longitudinal study. Occup Environ Med. 2017;74(11):769-775. PMID:28546321. doi:10.1136/oemed-2016-104160.
- Vad MV, Frost P, Svendsen SW. Occupational mechanical exposures and reoperation after first-time inguinal hernia repair: a prognosis study in a male cohort. Hernia. 2015;19(6):893-900. PMID:25537572. doi:10.1007/s10029-014-1339-0.
- Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJ. Risk factors for inguinal hernia in women: a case-control study. Am J Epidemiol. 1997;146(9):721-726. PMID:9366619. doi:10.1093/oxfordjournals.aje.a009347.
- Flich J, Alfonso JL, Delgado F, Prado MJ, Cortina P. Inguinal hernia and certain risk factors. Eur J Epidemiol. 1992;8(2):277-282. PMID:1644149. doi:10.1007/BF00144814.
Heavy load carriage, rucksack carriage, and spinal trauma producing cervical and lumbar radiculopathy in service members.
- Schoenfeld AJ, Laughlin M, Bader JO, Bono CM. Characterization of the incidence and risk factors for the development of lumbar radiculopathy. J Spinal Disord Tech. 2012;25(3):163-167. PMID:22543563. doi:10.1097/BSD.0b013e3182146e55. Direct
- Schoenfeld AJ, George AA, Bader JO, Caram PM Jr. Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009. J Spinal Disord Tech. 2012;25(1):17-22. PMID:21430568. doi:10.1097/BSD.0b013e31820d77ea. Direct
- Schoenfeld AJ, Nelson JH, Burks R, Belmont PJ Jr. Incidence and risk factors for lumbar degenerative disc disease in the United States military 1999-2008. Mil Med. 2011;176(11):1320-1324. PMID:22165663. doi:10.7205/milmed-d-11-00061. Direct
- Wahlström J, Burström L, Johnson PW, Nilsson T, Järvholm B. Exposure to whole-body vibration and hospitalization due to lumbar disc herniation. Int Arch Occup Environ Health. 2018;91(6):689-694. PMID:29855719. doi:10.1007/s00420-018-1316-5. Direct
- Bovenzi M, Schust M, Menzel G, Hofmann J, Hinz B. A cohort study of sciatic pain and measures of internal spinal load in professional drivers. Ergonomics. 2015;58(7):1088-1102. PMID:25076386. doi:10.1080/00140139.2014.943302. Direct
- Mastalerz A, Maruszyńska I, Kowalczuk K, Garbacz A, Maculewicz E. Pain in the Cervical and Lumbar Spine as a Result of High G-Force Values in Military Pilots-A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(20):13413. PMID:36293993. doi:10.3390/ijerph192013413. Direct
- Anderson AB, Braswell MJ, Pisano AJ, Watson NI, Dickens JF, Helgeson MD, Brooks DI, Wagner SC. Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System. Spine (Phila Pa 1976). 2021;46(6):E392-E397. PMID:33181775. doi:10.1097/BRS.0000000000003815. Direct
- Ikeda DS, Meister M, Porensky P, Yokoi H, Ravindra VM. Lumbar Fusion for Active Duty Service Members Performed at an Overseas Military Treatment Facility: A 2-Year Retrospective Analysis. Mil Med. 2023;188(7-8):e1763-e1769. PMID:35788861. doi:10.1093/milmed/usac193. Direct
- Lawlor MC, Cirillo MN, Holly KE, Bovonratwet P, Striano BM, Coles C, Koehlmoos TP, Schoenfeld AJ. Is Civilian Hospital Treatment of Lumbar Spinal Disorders Associated With Greater Odds of Fusion Procedures?. Clin Orthop Relat Res. 2025;483(10):1939-1947. PMID:40153716. doi:10.1097/CORR.0000000000003487. Direct
- Selkirk SM, Ruff R. Low back pain, radiculopathy. Handb Clin Neurol. 2016;136:1027-33. PMID:27430456. doi:10.1016/B978-0-444-53486-6.00053-3. Direct
- Cohen SP, Greuber E, Vought K, Lissin D. Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain: Unmet Medical Need. Clin J Pain. 2021;37(9):707-717. PMID:34265792. doi:10.1097/AJP.0000000000000963. Direct
- Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015;372(13):1240-8. PMID:25806916. doi:10.1056/NEJMra1410151. Secondary
- Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019;367:l6273. PMID:31744805. doi:10.1136/bmj.l6273. Secondary
- Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine (Phila Pa 1976). 2006;31(18):2151-61. PMID:16915105. doi:10.1097/01.brs.0000231761.73859.2c. Secondary
- Dower A, Davies MA, Ghahreman A. Pathologic Basis of Lumbar Radicular Pain. World Neurosurg. 2019;128:114-121. PMID:31028982. doi:10.1016/j.wneu.2019.04.147. Secondary
- Mulleman D, Mammou S, Griffoul I, Watier H, Goupille P. Pathophysiology of disk-related sciatica. I.--Evidence supporting a chemical component. Joint Bone Spine. 2006;73(2):151-8. PMID:16046173. doi:10.1016/j.jbspin.2005.03.003. Secondary
- Risbud MV, Shapiro IM. Role of cytokines in intervertebral disc degeneration: pain and disc content. Nat Rev Rheumatol. 2014;10(1):44-56. PMID:24166242. doi:10.1038/nrrheum.2013.160. Secondary
- Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018;18(9):1715-1721. PMID:29792997. doi:10.1016/j.spinee.2018.05.018. Secondary
- Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine (Phila Pa 1976). 2008;33(22):2464-72. PMID:18923325. doi:10.1097/BRS.0b013e318183a4a2. Secondary
- Tawa N, Rhoda A, Diener I. Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: a systematic literature review. BMC Musculoskelet Disord. 2016;17(1):386. PMID:27600883. doi:10.1186/s12891-016-1236-z. Secondary
- Li Y, Fredrickson V, Resnick DK. How should we grade lumbar disc herniation and nerve root compression? A systematic review. Clin Orthop Relat Res. 2015;473(6):1896-902. PMID:24825130. doi:10.1007/s11999-014-3674-y. Secondary
- Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Varonen H, Kalso E, Ukkola O, Viikari-Juntura E. Cardiovascular and lifestyle risk factors in lumbar radicular pain or clinically defined sciatica: a systematic review. Eur Spine J. 2007;16(12):2043-54. PMID:17525856. doi:10.1007/s00586-007-0362-6.
- Rodriguez-Soto AE, Jaworski R, Jensen A, Niederberger B, Hargens AR, Frank LR, Kelly KR, Ward SR. Effect of load carriage on lumbar spine kinematics. Spine (Phila Pa 1976). 2013;38(13):E783-91. PMID:23524870. doi:10.1097/BRS.0b013e3182913e9f. Direct
- Rodriguez-Soto AE, Berry DB, Palombo L, Valaik E, Kelly KR, Ward SR. Effect of Load Magnitude and Distribution on Lumbar Spine Posture in Active-duty Marines. Spine (Phila Pa 1976). 2017;42(5):345-351. PMID:27310023. doi:10.1097/BRS.0000000000001742. Direct
Major Depressive Disorder
38 CFR DC 9434, 9440Deployment and military-service mental-health burden and the course of major depressive disorder in service members and veterans.
- Gadermann AM, Engel CC, Naifeh JA, Nock MK, Petukhova M, Santiago PN, Wu B, Zaslavsky AM, Kessler RC. Prevalence of DSM-IV major depression among U.S. military personnel: meta-analysis and simulation. Mil Med. 2012;177(8 Suppl):47-59. PMID:22953441. doi:10.7205/MILMED-D-12-00103. Direct
- Bonde JP, Utzon-Frank N, Bertelsen M, Borritz M, Eller NH, Nordentoft M, Olesen K, Rod NH, Rugulies R. Risk of depressive disorder following disasters and military deployment: systematic review with meta-analysis. Br J Psychiatry. 2016;208(4):330-6. PMID:26892850. doi:10.1192/bjp.bp.114.157859. Direct
- Kessler RC, Heeringa SG, Stein MB, Colpe LJ, Fullerton CS, Hwang I, Naifeh JA, Nock MK, Petukhova M, Sampson NA, Schoenbaum M, Zaslavsky AM, Ursano RJ. Thirty-day prevalence of DSM-IV mental disorders among nondeployed soldiers in the US Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). JAMA Psychiatry. 2014;71(5):504-513. PMID:24590120. doi:10.1001/jamapsychiatry.2014.28. Direct
- Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. Am J Public Health. 2009;99(9):1651-1658. PMID:19608954. doi:10.2105/AJPH.2008.150284. Direct
- Thomas JL, Wilk JE, Riviere LA, McGurk D, Castro CA, Hoge CW. Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Arch Gen Psychiatry. 2010;67(6):614-23. PMID:20530011. doi:10.1001/archgenpsychiatry.2010.54. Direct
- Wells TS, LeardMann CA, Fortuna SO, Smith B, Smith TC, Ryan MAK, Boyko EJ, Blazer D. A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. Am J Public Health. 2010;100(1):90-9. PMID:19910353. doi:10.2105/AJPH.2008.155432. Direct
- Jacobson IG, Horton JL, Leardmann CA, Ryan MAK, Boyko EJ, Wells TS, Smith B, Smith TC. Posttraumatic stress disorder and depression among U.S. military health care professionals deployed in support of operations in Iraq and Afghanistan. J Trauma Stress. 2012;25(6):616-23. PMID:23184886. doi:10.1002/jts.21753. Direct
- Fear NT, Jones M, Murphy D, Hull L, Iversen AC, Coker B, Machell L, Sundin J, Woodhead C, Jones N, Greenberg N, Landau S, Dandeker C, Rona RJ, Hotopf M, Wessely S. What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet. 2010;375(9728):1783-97. PMID:20471076. doi:10.1016/S0140-6736(10)60672-1. Direct
- Anderson L, Campbell-Sills L, Ursano RJ, Kessler RC, Sun X, Heeringa SG, Nock MK, Bliese PD, Gonzalez OI, Wynn GH, Jain S, Stein MB. Prospective associations of perceived unit cohesion with postdeployment mental health outcomes. Depress Anxiety. 2019;36(6):511-521. PMID:30694009. doi:10.1002/da.22884. Direct
- Trivedi RB, Post EP, Sun H, Pomerantz A, Saxon AJ, Piette JD, Maynard C, Arnow B, Curtis I, Fihn SD, Nelson K. Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans. Am J Public Health. 2015;105(12):2564-2569. PMID:26474009. doi:10.2105/AJPH.2015.302836. Direct
- Reger MA, Smolenski DJ, Skopp NA, Metzger-Abamukong MJ, Kang HK, Bullman TA, Gahm GA. Suicide Risk Among Wounded U.S. Service Members. Suicide Life Threat Behav. 2017;47(2):242-247. PMID:27492873. doi:10.1111/sltb.12282. Direct
- Enns MW, Mota N, Afifi TO, Bolton SL, Richardson JD, Patten SB, Sareen J. Course and Predictors of Major Depressive Disorder in the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey. Can J Psychiatry. 2021;66(11):971-981. PMID:33406886. doi:10.1177/0706743720984677. DirectSecondaryAggravation
- Lazar SG. The mental health needs of military service members and veterans. Psychodyn Psychiatry. 2014;42(3):459-78. PMID:25211433. doi:10.1521/pdps.2014.42.3.459. DirectSecondary
- Breslau N, Davis GC, Peterson EL, Schultz LR. A second look at comorbidity in victims of trauma: the posttraumatic stress disorder-major depression connection. Biol Psychiatry. 2000;48(9):902-9. PMID:11074228. doi:10.1016/s0006-3223(00)00933-1. Secondary
- Dekel S, Solomon Z, Horesh D, Ein-Dor T. Posttraumatic stress disorder and depressive symptoms: joined or independent sequelae of trauma? J Psychiatr Res. 2014;54:64-9. PMID:24703578. doi:10.1016/j.jpsychires.2014.03.003. Secondary
- Rytwinski NK, Scur MD, Feeny NC, Youngstrom EA. The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. J Trauma Stress. 2013;26(3):299-309. PMID:23696449. doi:10.1002/jts.21814. Secondary
- Stander VA, Thomsen CJ, Highfill-McRoy RM. Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clin Psychol Rev. 2014;34(2):87-98. PMID:24486520. doi:10.1016/j.cpr.2013.12.002. Secondary
- Shalev AY, Freedman S, Peri T, Brandes D, Sahar T, Orr SP, Pitman RK. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998;155(5):630-7. PMID:9585714. doi:10.1176/ajp.155.5.630. Secondary
- Nichter B, Haller M, Norman S, Pietrzak RH. Risk and protective factors associated with comorbid PTSD and depression in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res. 2020;121:56-61. PMID:31765837. doi:10.1016/j.jpsychires.2019.11.008. Secondary
- Armenta RF, Walter KH, Geronimo-Hara TR, Porter B, Stander VA, LeardMann CA. Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans. BMC Psychiatry. 2019;19(1):396. PMID:31836015. doi:10.1186/s12888-019-2375-1. Secondary
- Held P, Smith LJ, Parmar AM, Pridgen SA, Smith DL, Klassen B. Veterans' 12-month PTSD and depression outcomes following 2- and 3-week intensive cognitive processing therapy-based treatment. Eur J Psychotraumatol. 2024;15(1). PMID:38770596. doi:10.1080/20008066.2024.2350908. Secondary
- Morris MC, Compas BE, Garber J. Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):301-15. PMID:22459791. doi:10.1016/j.cpr.2012.02.002. Secondary
- Eswarappa M, Neylan TC, Whooley MA, Metzler TJ, Cohen BE. Inflammation as a predictor of disease course in posttraumatic stress disorder and depression: A prospective analysis from the Mind Your Heart Study. Brain Behav Immun. 2019;75:220-227. PMID:30389462. doi:10.1016/j.bbi.2018.10.012. Secondary
- Averill CL, Satodiya RM, Scott JC, Wrocklage KM, Schweinsburg B, Averill LA, Akiki TJ, Amoroso T, Southwick SM, Krystal JH, Abdallah CG. Posttraumatic Stress Disorder and Depression Symptom Severities Are Differentially Associated With Hippocampal Subfield Volume Loss in Combat Veterans. Chronic Stress (Thousand Oaks). 2017;1. PMID:29520395. doi:10.1177/2470547017744538. Secondary
- Ploski JE, Vaidya VA. The Neurocircuitry of Posttraumatic Stress Disorder and Major Depression: Insights Into Overlapping and Distinct Circuit Dysfunction-A Tribute to Ron Duman. Biol Psychiatry. 2021;90(2):109-117. PMID:34052037. doi:10.1016/j.biopsych.2021.04.009. Secondary
- Zhu Z, Galatzer-Levy IR, Bonanno GA. Heterogeneous depression responses to chronic pain onset among middle-aged adults: a prospective study. Psychiatry Res. 2014;217(1-2):60-6. PMID:24679514. doi:10.1016/j.psychres.2014.03.004. Secondary
- Xue Q, Pan A, Gong J, Wen Y, Peng X, Pan J, Pan XF. Association between arthritis and depression risk: a prospective study and meta-analysis. J Affect Disord. 2020;273:493-499. PMID:32560945. doi:10.1016/j.jad.2020.04.038. Secondary
- Outcalt SD, Kroenke K, Krebs EE, Chumbler NR, Wu J, Yu Z, Bair MJ. Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life. J Behav Med. 2015;38(3):535-43. PMID:25786741. doi:10.1007/s10865-015-9628-3. Secondary
- Nicassio PM, Wallston KA. Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis. J Abnorm Psychol. 1992;101(3):514-20. PMID:1500608. doi:10.1037//0021-843x.101.3.514. Secondary
- Angst F, Benz T, Lehmann S, Wagner S, Simmen BR, Sandor PS, Gengenbacher M, Angst J. Extended overview of the longitudinal pain-depression association: A comparison of six cohorts treated for specific chronic pain conditions. J Affect Disord. 2020;273:508-516. PMID:32560947. doi:10.1016/j.jad.2020.05.044. SecondaryAggravation
- Liu J, Jin H, Yon DK, Soysal P, Koyanagi A, Smith L, Shin JI, Li YS, Rahmati M, Zhang J. Risk Factors for Depression in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Orthopedics. 2024;47(5):e225-e232. PMID:39208396. doi:10.3928/01477447-20240821-10. SecondaryAggravation
- Ji L, Qiao X, Jin Y, Si H, Liu X, Wang C. Functional disability mediates the relationship between pain and depression among community-dwelling older adults: Age and sex as moderators. Geriatr Nurs. 2021;42(1):137-144. PMID:33401094. doi:10.1016/j.gerinurse.2020.12.010. Secondary
- Humo M, Lu H, Yalcin I. The molecular neurobiology of chronic pain-induced depression. Cell Tissue Res. 2019;377(1):21-43. PMID:30778732. doi:10.1007/s00441-019-03003-z. Secondary
- Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433-45. PMID:14609780. doi:10.1001/archinte.163.20.2433. Secondary
- Tripuraneni KR, Anderson MB, Cholewa JM, Smith K, VanAndel DC, Redfern RE, Barnett SL. Is There a Change in Anxiety and Depression Following Total Knee Arthroplasty? J Arthroplasty. 2024;39(9 Suppl 2):S185-S190. PMID:38346581. doi:10.1016/j.arth.2024.02.009. Secondary
- Boakye PA, Olechowski C, Rashiq S, Verrier MJ, Kerr B, Witmans M, Baker G, Joyce A, Dick BD. A Critical Review of Neurobiological Factors Involved in the Interactions Between Chronic Pain, Depression, and Sleep Disruption. Clin J Pain. 2016;32(4):327-36. PMID:26035521. doi:10.1097/AJP.0000000000000260. Secondary
Median Nerve Entrapment
38 CFR DC 8515Repetitive forceful hand/wrist use and vibration exposure (occupational) associated with carpal tunnel syndrome in service members.
- Palmer BN. Carpal tunnel syndrome, active component, U.S. Armed Forces, 2000-2010. MSMR. 2011;18(7):12-5. PMID:21815710. Direct
- Lalumandier JA, McPhee SD, Riddle S, Shulman JD, Daigle WW. Carpal tunnel syndrome: effect on Army dental personnel. Mil Med. 2000;165(5):372-8. PMID:10826385. Direct
- Shaffer SW, Koreerat NR, Gordon LB, Santillo DR, Moore JH, Greathouse DG. Median and ulnar neuropathies in U.S. Army Medical Command Band members. Med Probl Perform Art. 2013;28(4):188-94. PMID:24337029. Direct
- Vihlborg P, Pettersson H, Makdoumi K, Wikstrom S, Bryngelsson IL, Selander J, Graff P. Carpal Tunnel Syndrome and Hand-Arm Vibration: A Swedish National Registry Case-Control Study. J Occup Environ Med. 2022;64(3):197-201. PMID:34873137. doi:10.1097/JOM.0000000000002451. Direct
- Newington L, Harris EC, Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 2015;29(3):440-53. PMID:26612240. doi:10.1016/j.berh.2015.04.026. Direct
- Wolf JM, Mountcastle S, Owens BD. Incidence of carpal tunnel syndrome in the US military population. Hand (N Y). 2009;4(3):289-93. PMID:19172361. doi:10.1007/s11552-009-9166-y. Direct
- Garland FC, Garland CF, Doyle EJ Jr, Balazs LL, Levine R, Pugh WM, Gorham ED. Carpal tunnel syndrome and occupation in U.S. Navy enlisted personnel. Arch Environ Health. 1996;51(5):395-407. PMID:8896390. doi:10.1080/00039896.1996.9934428. Direct
- Deal JB, Magee AJ. Carpal Tunnel Syndrome in Military Aviators. Mil Med. 2020;185(9-10):e1506-e1509. PMID:32601681. doi:10.1093/milmed/usaa077. Direct
- Tabatabaeifar S, Dalbøge A. Carpal tunnel syndrome and occupational hand exposures: a Danish nationwide cohort study. Occup Environ Med. 2024;81(8):417-424. PMID:39160073. doi:10.1136/oemed-2024-109568. Direct
- Giersiepen K, Spallek M. Carpal tunnel syndrome as an occupational disease. Dtsch Arztebl Int. 2011;108(14):238-42. PMID:21547163. doi:10.3238/arztebl.2011.0238. Direct
Mild Traumatic Brain Injury
38 CFR DC 8045Blast overpressure, mounted and dismounted IED exposure, combat and training head trauma, and repetitive low-level blast from breaching, artillery and heavy weapons as the DIRECT cause of traumatic brain injury in service members — the deployment-era epidemiology establishing the in-service injury event, the imaging and neuropathology evidence that blast produces an objectively distinct brain injury, and the longitudinal evidence that symptoms and disability persist for years after separation, which is the basis on which residuals-of-TBI claims are most often denied.
- Institute of Medicine (US) Committee on Gulf War and Health: Brain Injury in Veterans and Long-Term Health Outcomes. Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury. National Academies Press (Washington, DC); 2008. PMID:25009909. doi:10.17226/12436. Available at: https://www.ncbi.nlm.nih.gov/books/NBK214701/. Direct
- Eapen BC, Bowles AO, Sall J, Lang AE, Hoppes CW, Stout KC, Kretzmer T, Cifu DX. The management and rehabilitation of post-acute mild traumatic brain injury. U.S. Dept. of Veterans Affairs & Dept. of Defense (synopsis published in Brain Inj); 2022. PMID:35152817. doi:10.1080/02699052.2022.2033848. Direct
- Terrio H, Brenner LA, Ivins BJ, Cho JM, Helmick K, Schwab K, Scally K, Bretthauer R, Warden D. Traumatic brain injury screening: preliminary findings in a US Army Brigade Combat Team J Head Trauma Rehabil. 2009;24(1):14-23. PMID:19158592. doi:10.1097/HTR.0b013e31819581d8. Direct
- Mac Donald CL, Johnson AM, Cooper D, Nelson EC, Werner NJ, Shimony JS, Snyder AZ, Raichle ME, Witherow JR, Fang R, Flaherty SF, Brody DL. Detection of blast-related traumatic brain injury in U.S. military personnel N Engl J Med. 2011;364(22):2091-2100. PMID:21631321. doi:10.1056/NEJMoa1008069. Direct
- Carr W, Kelley AL, Toolin CF, Weber NS. Association of MOS-Based Blast Exposure With Medical Outcomes Front Neurol. 2020;11:619. PMID:32849167. doi:10.3389/fneur.2020.00619. Direct
- Shively SB, Horkayne-Szakaly I, Jones RV, Kelly JP, Armstrong RC, Perl DP. Characterisation of interface astroglial scarring in the human brain after blast exposure: a post-mortem case series Lancet Neurol. 2016;15(9):944-953. PMID:27291520. doi:10.1016/S1474-4422(16)30057-6. Direct
- Barnes DE, Byers AL, Gardner RC, Seal KH, Boscardin WJ, Yaffe K. Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans JAMA Neurol. 2018;75(9):1055-1061. PMID:29801145. doi:10.1001/jamaneurol.2018.0815. Direct
- Mac Donald CL, Barber J, Jordan M, Johnson AM, Dikmen S, Fann JR, Temkin N. Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury JAMA Neurol. 2017;74(7):821-829. PMID:28459953. doi:10.1001/jamaneurol.2017.0143. Direct
- Lindquist LK, Love HC, Elbogen EB. Traumatic Brain Injury in Iraq and Afghanistan Veterans: New Results From a National Random Sample Study J Neuropsychiatry Clin Neurosci. 2017;29(3):254-259. PMID:28121256. doi:10.1176/appi.neuropsych.16050100. Direct
- Chase RP, Nevin RL. Population estimates of undocumented incident traumatic brain injuries among combat-deployed US military personnel J Head Trauma Rehabil. 2015;30(1):E57-64. PMID:24810487. doi:10.1097/HTR.0000000000000061. Direct
- Helmick KM, Spells CA, Malik SZ, Davies CA, Marion DW, Hinds SR. Traumatic brain injury in the US military: epidemiology and key clinical and research programs Brain Imaging Behav. 2015;9(3):358-66. PMID:25972118. doi:10.1007/s11682-015-9399-z. Direct
- Trotter BB, Robinson ME, Milberg WP, McGlinchey RE, Salat DH. Military blast exposure, ageing and white matter integrity Brain. 2015;138(Pt 8):2278-92. PMID:26033970. doi:10.1093/brain/awv139. Direct
- Martindale SL, Kolaja CA, Belding JN, Liu L, Rull RP, Trone DW, Rowland JA. Blast exposure and long-term diagnoses among veterans: a millennium cohort study investigation of high-level blast and low-level blast Front Neurol. 2025;16:1599351. PMID:40823299. doi:10.3389/fneur.2025.1599351. Direct
Obstructive Sleep Apnea
38 CFR DC 6847Deployment-associated OSA risk and rising in-service incidence, plus the sleep-restriction and sleep-fragmentation physiology that reduces genioglossus drive and raises upper-airway collapsibility — supporting DIRECT service connection; with the PTSD, nasal-obstruction, post-injury weight-gain, and TBI pathways supporting secondary service connection.
- Mysliwiec V, Gill J, Lee H, Baxter T, Pierce R, Barr TL, Krakow B, Roth BJ. Sleep disorders in US military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. Chest. 2013;144(2):549-557. PMID:23681455. doi:10.1378/chest.13-0088. Direct
- Colvonen PJ, Masino T, Drummond SP, Myers US, Angkaw AC, Norman SB. Obstructive sleep apnea and posttraumatic stress disorder among OEF/OIF/OND veterans. J Clin Sleep Med. 2015;11(5):513-518. PMID:25665698. doi:10.5664/jcsm.4692. SecondaryAggravation
- Figorilli M, Velluzzi F, Redolfi S. Obesity and sleep disorders: A bidirectional relationship. Nutr Metab Cardiovasc Dis. 2025;35(6):104014. PMID:40180826. doi:10.1016/j.numecd.2025.104014. SecondaryAggravation
- Landvater J, Kim S, Caswell K, Kwon C, Odafe E, Roe G, Tripathi A, Vukovics C. Traumatic brain injury and sleep in military and veteran populations: A literature review. NeuroRehabilitation. 2024;55(3):245-270. PMID:39121144. doi:10.3233/NRE-230380. SecondaryAggravation
- Caldwell JA, Knapik JJ, Shing TL, Kardouni JR, Lieberman HR. The association of insomnia and sleep apnea with deployment and combat exposure in the entire population of US army soldiers from 1997 to 2011: a retrospective cohort investigation. Sleep. 2019;42(8):zsz112. PMID:31106808. doi:10.1093/sleep/zsz112. Direct
- Caldwell JA, Knapik JJ, Kusumpa S, Roy TC, Taylor KM, Lieberman HR. Insomnia and sleep apnea in the entire population of US Army soldiers: Associations with deployment and combat exposure 2010-2019, a retrospective cohort investigation. Sleep Health. 2025;11(1):14-24. PMID:39438179. doi:10.1016/j.sleh.2024.09.004. Direct
- Moore BA, Tison LM, Palacios JG, Peterson AL, Mysliwiec V. Incidence of insomnia and obstructive sleep apnea in active duty United States military service members. Sleep. 2021;44(7):zsab024. PMID:33532830. doi:10.1093/sleep/zsab024. Direct
- Goldstein LA, Bernhard PA, Hoffmire CA, Schneiderman A, Maguen S. Prevalence of Obstructive Sleep Apnea Among Veterans and Nonveterans. Am J Health Promot. 2025;39(2):215-223. PMID:39136615. doi:10.1177/08901171241273443. Direct
- Alexander M, Ray MA, Hébert JR, Youngstedt SD, Zhang H, Steck SE, Bogan RK, Burch JB. The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010. Sleep. 2016;39(7):1399-1410. PMID:27091538. doi:10.5665/sleep.5972. Direct
- Huang Y, Xu J, Zheng S, Xu S, Wang Y, Du J, Xiao L, Zhang R, Wang H, Tang Y, Su T. The risk factors for insomnia and sleep-disordered breathing in military communities: A meta-analysis. PLoS One. 2021;16(5):e0250779. PMID:33956821. doi:10.1371/journal.pone.0250779. Direct
- Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 2013;36(2):167-174. PMID:23372263. doi:10.5665/sleep.2364. Direct
- Mysliwiec V, Brock MS, Pruiksma KE, Straud CL, Taylor DJ, Hansen S, Foster SN, Mithani S, Zwetzig S, Gerwell K, Young-McCaughan S, Powell T, Blue Star JA, Cassidy DG, Mintz J, Peterson AL. A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel. Sleep. 2022;45(12):zsac203. PMID:36006786. doi:10.1093/sleep/zsac203. Direct
- Mysliwiec V, Pruiksma KE, Brock MS, Straud C, Taylor DJ, Hansen S, Foster SN, Gerwell K, Moore BA, Carrizales FA, Young-McCaughan S, Vanecek R, Mintz J, Peterson AL. The Military Service Sleep Assessment: an instrument to assess factors precipitating sleep disturbances in U.S. military personnel. J Clin Sleep Med. 2021;17(7):1401-1409. PMID:33682675. doi:10.5664/jcsm.9206. Direct
- Matsangas P, Shattuck NL. Sleep quality, occupational factors, and psychomotor vigilance performance in the U.S. Navy sailors. Sleep. 2020;43(12):zsaa118. PMID:32531020. doi:10.1093/sleep/zsaa118. Direct
- Leiter JC, Knuth SL, Bartlett D Jr. The effect of sleep deprivation on activity of the genioglossus muscle. Am Rev Respir Dis. 1985;132(6):1242-1245. PMID:3935019. doi:10.1164/arrd.1985.132.6.1242. Direct
- Sériès F, Roy N, Marc I. Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med. 1994;150(2):481-485. PMID:8049833. doi:10.1164/ajrccm.150.2.8049833. Direct
- Persson HE, Svanborg E. Sleep deprivation worsens obstructive sleep apnea. Comparison between diurnal and nocturnal polysomnography. Chest. 1996;109(3):645-650. PMID:8617071. doi:10.1378/chest.109.3.645. Direct
- Caldwell JA, Knapik JJ. Trends and Factors Associated with Insomnia and Sleep Apnea in U.S. Military Aviators, 2006-2022. Aerosp Med Hum Perform. 2025;96(1):23-30. PMID:39853290. doi:10.3357/AMHP.6524.2024. Direct
- Capener DC, Brock MS, Hansen SL, Matsangas P, Mysliwiec V. An Initial Report of Sleep Disorders in Women in the U.S. Military. Mil Med. 2018;183(9-10):e266-e271. PMID:29425355. doi:10.1093/milmed/usx116. Direct
- Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Intern Med. 2001;161(12):1514-1519. PMID:11427099. doi:10.1001/archinte.161.12.1514. SecondaryAggravation
- Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol. 1997;99(2):S757-S762. PMID:9042068. doi:10.1016/s0091-6749(97)70124-6. SecondaryAggravation
- Ferreira NB, Ponte A, Castelo Grande A, Pimenta AC, Pinto CS, Bousquet J, Drummond M, Sousa-Pinto B. Frequency of obstructive sleep apnea in patients with asthma or allergic rhinitis: a systematic review and meta-analysis. Sleep Med. 2025;134:106705. PMID:40774162. doi:10.1016/j.sleep.2025.106705. SecondaryAggravation
- Camacho M, Riaz M, Capasso R, Ruoff CM, Guilleminault C, Kushida CA, Certal V. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep. 2015;38(2):279-286. PMID:25325439. doi:10.5665/sleep.4414. SecondaryAggravation
- Wu J, Zhao G, Li Y, Zang H, Wang T, Wang D, Han D. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: A meta-analysis. Medicine (Baltimore). 2017;96(5):e6008. PMID:28151900. doi:10.1097/MD.0000000000006008. SecondaryAggravation
- Cha H, Kim D, Lee HW, Lee Y, Baek BJ, Lee JY, Choi JH. Relationship between chronic rhinosinusitis and risk of obstructive sleep apnea. Sci Rep. 2024;14(1):21379. PMID:39271710. doi:10.1038/s41598-024-71923-0. SecondaryAggravation
- Fried J, Yuen E, Li A, Zhang K, Nguyen SA, Gudis DA, Rowan NR, Schlosser RJ. Rhinologic disease and its impact on sleep: a systematic review. Int Forum Allergy Rhinol. 2021;11(7):1074-1086. PMID:33275331. doi:10.1002/alr.22740. SecondaryAggravation
- Wellman A, Genta PR, Owens RL, Edwards BA, Sands SA, Loring SH, White DP, Jackson AC, Pedersen OF, Butler JP. Test of the Starling resistor model in the human upper airway during sleep. J Appl Physiol (1985). 2014;117(12):1478-1485. PMID:25324514. doi:10.1152/japplphysiol.00259.2014. SecondaryAggravation
- Garvey E, Duffy A, Tekumalla S, Naimi B, Kahn C, Yang A, Urdang Z, Farquhar D, Rosen M, Nyquist GG, Toskala E, Rabinowitz M. Obstructive Sleep Apnea and Chronic Rhinosinusitis: Understanding the Impact of OSA on CRS Disease Burden. Otolaryngol Head Neck Surg. 2024;171(6):1879-1886. PMID:39575579. doi:10.1002/ohn.934. SecondaryAggravation
- Cai Y, Goldberg AN, Chang JL. The Nose and Nasal Breathing in Sleep Apnea. Otolaryngol Clin North Am. 2020;53(3):385-395. PMID:32192710. doi:10.1016/j.otc.2020.02.002. SecondaryAggravation
- Ishii L, Roxbury C, Godoy A, Ishman S, Ishii M. Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis. Otolaryngol Head Neck Surg. 2015;153(3):326-333. PMID:26183522. doi:10.1177/0194599815594374. SecondaryAggravation
- Cao Y, Wu S, Zhang L, Yang Y, Cao S, Li Q. Association of allergic rhinitis with obstructive sleep apnea: A meta-analysis. Medicine (Baltimore). 2018;97(51):e13783. PMID:30572534. doi:10.1097/MD.0000000000013783. SecondaryAggravation
- Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011;268(9):1365-1373. PMID:21340561. doi:10.1007/s00405-010-1469-7. SecondaryAggravation
- Yang H, Huyett P, Wang TY, Sumner J, Azarbarzin A, Labarca GPT, Messineo L, Gell LK, Aishah A, Hu WH, White DP, Sands SA, Wellman A, Vena D. Mouth Closure and Airflow in Patients With Obstructive Sleep Apnea: A Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2024;150(11):1012-1019. PMID:39361293. doi:10.1001/jamaoto.2024.3319. SecondaryAggravation
- Shah AJ, Vaccarino V, Goldberg J, Huang M, Ko YA, Ma X, Levantsevych OM, Smith NL, Alagar N, Mousselli I, Johnson DA, Clifford GD, Bremner JD, Bliwise DL. Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins. JAMA Netw Open. 2024;7(6):e2416352. PMID:38913378. doi:10.1001/jamanetworkopen.2024.16352. SecondaryAggravation
- Haynes ZA, Stewart IJ, Poltavskiy EA, Holley AB, Janak JC, Howard JT, Watrous J, Walker LE, Wickwire EM, Werner K, Zarzabal LA, Sim A, Gundlapalli A, Collen JF. Obstructive sleep apnea among survivors of combat-related traumatic injury: a retrospective cohort study. J Clin Sleep Med. 2022;18(1):171-179. PMID:34270410. doi:10.5664/jcsm.9530. Secondary
- Chinoy ED, Carey FR, Kolaja CA, Jacobson IG, Cooper AD, Markwald RR. The bi-directional relationship between post-traumatic stress disorder and obstructive sleep apnea and/or insomnia in a large U.S. military cohort. Sleep Health. 2022;8(6):606-614. PMID:36163136. doi:10.1016/j.sleh.2022.07.005. Secondary
- Zhang Y, Weed JG, Ren R, Tang X, Zhang W. Prevalence of obstructive sleep apnea in patients with posttraumatic stress disorder and its impact on adherence to continuous positive airway pressure therapy: a meta-analysis. Sleep Med. 2017;36:125-132. PMID:28735910. doi:10.1016/j.sleep.2017.04.020. Secondary
- Gupta MA, Simpson FC. Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med. 2015;11(2):165-75. PMID:25406268. doi:10.5664/jcsm.4466. Secondary
- Lyons R, Barbir LA, Owens R, Colvonen PJ. STOP-BANG screener vs objective obstructive sleep apnea testing among younger veterans with PTSD and insomnia: STOP-BANG does not sufficiently detect risk. J Clin Sleep Med. 2022;18(1):67-73. PMID:34216197. doi:10.5664/jcsm.9498. Secondary
- Noland MDW, Paolillo EW, Noda A, Lazzeroni LC, Holty JC, Kuschner WG, Yesavage J, Kinoshita LM. Impact of PTSD and Obstructive Sleep Apnea on Cognition in Older Adult Veterans. J Geriatr Psychiatry Neurol. 2023;36(5):386-396. PMID:36592096. doi:10.1177/08919887221149132. SecondaryAggravation
- van Liempt S, Arends J, Cluitmans PJM, Westenberg HGM, Kahn RS, Vermetten E. Sympathetic activity and hypothalamo-pituitary-adrenal axis activity during sleep in post-traumatic stress disorder: a study assessing polysomnography with simultaneous blood sampling. Psychoneuroendocrinology. 2013;38(1):155-65. PMID:22776420. doi:10.1016/j.psyneuen.2012.05.015. Secondary
- Kaplan GB, Lakis GA, Zhoba H. Sleep-wake and arousal dysfunctions in post-traumatic stress disorder: Role of orexin systems. Brain Res Bull. 2022;186:106-122. PMID:35618150. doi:10.1016/j.brainresbull.2022.05.006. Secondary
- Zhang Y, Ren R, Yang L, Zhou J, Sanford LD, Tang X. The effect of treating obstructive sleep apnea with continuous positive airway pressure on posttraumatic stress disorder: A systematic review and meta-analysis with hypothetical model. Neurosci Biobehav Rev. 2019;102:172-183. PMID:31042558. doi:10.1016/j.neubiorev.2019.03.019. SecondaryAggravation
- Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years' follow-up: population based cohort study. BMJ. 2018;361:k1951. PMID:29793997. doi:10.1136/bmj.k1951. Secondary
- Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-21. PMID:11122588. SecondaryAggravation
- Jha A, Sharma SK, Tandon N, Lakshmy R, Kadhiravan T, Handa KK, Gupta R, Pandey RM, Chaturvedi PK. Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism. Sleep Med. 2006;7(1):55-61. PMID:16198143. SecondaryAggravation
- Zhang M, Zhang W, Tan J, Zhao M, Zhang Q, Lei P. Role of hypothyroidism in obstructive sleep apnea: a meta-analysis. Curr Med Res Opin. 2016;32(6):1059-64. PMID:26907534. doi:10.1185/03007995.2016.1157461. SecondaryAggravation
- Lu N, Chen B. Causal association between hypothyroidism and obstructive sleep apnea: A bidirectional 2-sample Mendelian Randomization study. Medicine (Baltimore). 2024;103(42):e40114. PMID:39432624. doi:10.1097/MD.0000000000040114. Secondary
- Zhang H, Wu Z, Chen Q, Yu G, Chen L, Ma Y, Chen Y. Subtype-specific causal effects of hypothyroidism on obstructive sleep apnea: A bidirectional Mendelian randomization study. Medicine (Baltimore). 2025;104(27):e43266. PMID:40629611. doi:10.1097/MD.0000000000043266. Secondary
- Pancholi C, Chaudhary SC, Gupta KK, Sawlani KK, Verma SK, Singh A, Verma AK, Usman K, Atam V. Obstructive sleep apnea in hypothyroidism. Ann Afr Med. 2022;21(4):403-409. PMID:36412342. doi:10.4103/aam.aam_134_21. Secondary
- Kuczyński W, Gabryelska A, Mokros Ł, Białasiewicz P. Obstructive sleep apnea syndrome and hypothyroidism — merely concurrence or causal association?. Pneumonol Alergol Pol. 2016;84(5):302-6. PMID:27672073. doi:10.5603/PiAP.2016.0038. SecondaryAggravation
Herbicide (Agent Orange) and other toxic/organophosphate exposures and combat nerve trauma associated with peripheral neuropathy in veterans.
- Michalek JE, Akhtar FZ, Arezzo JC, Garabrant DH, Albers JW. Serum dioxin and peripheral neuropathy in veterans of Operation Ranch Hand. Neurotoxicology. 2001;22(4):479-490. PMID:11577805. doi:10.1016/s0161-813x(01)00052-3. Direct
- Yi SW, Ohrr H, Hong JS, Yi JJ. Agent Orange exposure and prevalence of self-reported diseases in Korean Vietnam veterans. J Prev Med Public Health. 2013;46(5):213-225. PMID:24137524. doi:10.3961/jpmph.2013.46.5.213. Direct
- Department of Veterans Affairs. Disease associated with exposure to certain herbicide agents: peripheral neuropathy. Federal Register (Department of Veterans Affairs final rule); 2013. PMID:24040683. Available at: https://pubmed.ncbi.nlm.nih.gov/24040683/. Direct
- Wang JD, Chang YC, Kao KP, Huang CC, Lin CC, Yeh WY. An outbreak of N-hexane induced polyneuropathy among press proofing workers in Taipei. Am J Ind Med. 1986;10(2):111-118. PMID:3752095. doi:10.1002/ajim.4700100202. Direct
- de la Monte SM, Goel A. Agent Orange Reviewed: Potential Role in Peripheral Neuropathy and Neurodegeneration. J Mil Veterans Health. 2022;30(2):17-26. PMID:36785586.
- Kim JS, Lim HS, Cho SI, Cheong HK, Lim MK. Impact of Agent Orange exposure among Korean Vietnam veterans. Ind Health. 2003;41(3):149-57. PMID:12916744. doi:10.2486/indhealth.41.149.
- Yi SW, Hong JS, Ohrr H, Yi JJ. Agent Orange exposure and disease prevalence in Korean Vietnam veterans: the Korean veterans health study. Environ Res. 2014;133:56-65. PMID:24906069. doi:10.1016/j.envres.2014.04.027.
- Howard IM, Sedarsky K, Gallagher M, Miller M, Puffer RC. Combat-related peripheral nerve injuries. Muscle Nerve. 2025;71(5):768-781. PMID:38837797. doi:10.1002/mus.28168.
- Lotti M. Low-level exposures to organophosphorus esters and peripheral nerve function. Muscle Nerve. 2002;25(4):492-504. PMID:11932966. doi:10.1002/mus.10086.
- Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis. Prim Care Diabetes. 2020;14(5):435-444. PMID:31917119. doi:10.1016/j.pcd.2019.12.005. SecondaryAggravation
Plantar Fasciopathy
38 CFR DC 5269Running, marching, prolonged standing, and load carriage driving plantar fasciitis in the military population.
- Scher DL, Belmont PJ Jr, Bear R, Mountcastle SB, Orr JD, Owens BD. The incidence of plantar fasciitis in the United States military. J Bone Joint Surg Am. 2009;91(12):2867-72. PMID:19952249. doi:10.2106/JBJS.I.00257. Direct
- Xu J, Saliba S, Fraser J. Burden and risk factors for plantar fasciopathy in the military population from 2006 to 2015: a retrospective cohort study. BMJ Mil Health. 2026;172(3):236-241. PMID:39904534. doi:10.1136/military-2024-002869. Direct
- Roy TC. Diagnoses and mechanisms of musculoskeletal injuries in an infantry brigade combat team deployed to Afghanistan evaluated by the brigade physical therapist. Mil Med. 2011;176(8):903-8. PMID:21882780. doi:10.7205/milmed-d-11-00006. DirectAggravation
- Purcell RL, Schroeder IG, Keeling LE, Formby PM, Eckel TT, Shawen SB. Clinical Outcomes After Extracorporeal Shock Wave Therapy for Chronic Plantar Fasciitis in a Predominantly Active Duty Population. J Foot Ankle Surg. 2018;57(4):654-657. PMID:29622498. doi:10.1053/j.jfas.2017.11.030. DirectAggravation
Post-traumatic Headache
38 CFR DC 8100Deployment-related traumatic brain injury and post-traumatic headache/migraine in service members and veterans.
- Jankosky CJ, Hooper TI, Granado NS, Scher A, Gackstetter GD, Boyko EJ, Smith TC; Millennium Cohort Study Team. Headache disorders in the millennium cohort: epidemiology and relations with combat deployment. Headache. 2011;51(7):1098-1111. PMID:21675968. doi:10.1111/j.1526-4610.2011.01914.x. Direct
- Theeler BJ, Mercer R, Erickson JC. Prevalence and impact of migraine among US Army soldiers deployed in support of Operation Iraqi Freedom. Headache. 2008;48(6):876-882. PMID:18549370. doi:10.1111/j.1526-4610.2008.01159.x. Direct
- Helseth EK, Erickson JC. The prevalence and impact of migraine on US Military officer trainees. Headache. 2008;48(6):883-889. PMID:18005047. doi:10.1111/j.1526-4610.2007.00962.x. Direct
- Theeler BJ, Flynn FG, Erickson JC. Headaches after concussion in US soldiers returning from Iraq or Afghanistan. Headache. 2010;50(8):1262-1272. PMID:20553333. doi:10.1111/j.1526-4610.2010.01700.x. Direct
- Theeler BJ, Flynn FG, Erickson JC. Chronic daily headache in U.S. soldiers after concussion. Headache. 2012;52(5):732-738. PMID:22404747. doi:10.1111/j.1526-4610.2012.02112.x. Direct
- Theeler BJ, Erickson JC. Mild head trauma and chronic headaches in returning US soldiers. Headache. 2009;49(4):529-534. PMID:19220499. doi:10.1111/j.1526-4610.2009.01345.x. Direct
- Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453-463. PMID:18234750. doi:10.1056/NEJMoa072972. Direct
- Theeler B, Lucas S, Riechers RG 2nd, Ruff RL. Post-traumatic headaches in civilians and military personnel: a comparative, clinical review. Headache. 2013;53(6):881-900. PMID:23721236. doi:10.1111/head.12123. Direct
- Theeler BJ, Erickson JC. Posttraumatic headache in military personnel and veterans of the iraq and afghanistan conflicts. Curr Treat Options Neurol. 2012;14(1):36-49. PMID:22116663. doi:10.1007/s11940-011-0157-2. Direct
- Theeler BJ, Kenney K, Prokhorenko OA, Fideli US, Campbell W, Erickson JC. Headache triggers in the US military. Headache. 2010;50(5):790-794. PMID:19925623. doi:10.1111/j.1526-4610.2009.01571.x. Direct
- Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012;153(12):2432-2440. PMID:23073072. doi:10.1016/j.pain.2012.08.014. Direct
- Wilk JE, Herrell RK, Wynn GH, Riviere LA, Hoge CW. Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. Psychosom Med. 2012;74(3):249-257. PMID:22366583. doi:10.1097/PSY.0b013e318244c604. Direct
- Riechers RG 2nd, Walker MF, Ruff RL. Post-traumatic headaches. Handb Clin Neurol. 2015;128:567-78. PMID:25701908. doi:10.1016/B978-0-444-63521-1.00036-4. SecondaryAggravationDirect
- Neely ET, Midgette LA, Scher AI. Clinical review and epidemiology of headache disorders in US service members: with emphasis on post-traumatic headache. Headache. 2009;49(7):1089-96. PMID:19583598. doi:10.1111/j.1526-4610.2009.001460.x.
- Gasperi M, Schuster NM, Franklin B, Nievergelt CM, Stein MB, Afari N. Migraine Prevalence, Environmental Risk, and Comorbidities in Men and Women Veterans. JAMA Netw Open. 2024;7(3):e242299. PMID:38483390. doi:10.1001/jamanetworkopen.2024.2299.
- Couch JR, Stewart KE. Headache Prevalence at 4-11 Years After Deployment-Related Traumatic Brain Injury in Veterans of Iraq and Afghanistan Wars and Comparison to Controls: A Matched Case-Controlled Study. Headache. 2016;56(6):1004-21. PMID:27237921. doi:10.1111/head.12837. SecondaryAggravation
- Coffman C, Reyes D, Hess MC, Giakas AM, Thiam M, Sico JJ, Seng E, Renthal W. Relationship Between Headache Characteristics and a Remote History of TBI in Veterans: A 10-Year Retrospective Chart Review. Neurology. 2022;99(2):e187-e198. PMID:35470141. doi:10.1212/WNL.0000000000200518. SecondaryAggravation
- Becker WJ. Cervicogenic headache: evidence that the neck is a pain generator. Headache. 2010;50(4):699-705. PMID:20456156. doi:10.1111/j.1526-4610.2010.01648.x. SecondaryAggravation
- Nitsche L, Helbach J, Stubenrauch S, Lakeberg M, Bantel C, Hoffmann F. The association between posttraumatic stress disorder and migraine: A systematic review. Headache. 2026;66(4):963-975. PMID:41705319. doi:10.1111/head.70058. Secondary
- Smitherman TA, Kolivas ED. Trauma exposure versus posttraumatic stress disorder: relative associations with migraine. Headache. 2013;53(5):775-86. PMID:23464926. doi:10.1111/head.12063. Secondary
- Afari N, Harder LH, Madra NJ, Heppner PS, Moeller-Bertram T, King C, Baker DG. PTSD, combat injury, and headache in Veterans Returning from Iraq/Afghanistan. Headache. 2009;49(9):1267-76. PMID:19788469. doi:10.1111/j.1526-4610.2009.01517.x. Secondary
- Arcaya MC, Lowe SR, Asad AL, Subramanian SV, Waters MC, Rhodes J. Association of posttraumatic stress disorder symptoms with migraine and headache after a natural disaster. Health Psychol. 2017;36(5):411-418. PMID:27929328. doi:10.1037/hea0000433. Secondary
- Peterlin BL, Tietjen GE, Brandes JL, Rubin SM, Drexler E, Lidicker JR, Meng S. Posttraumatic stress disorder in migraine. Headache. 2009;49(4):541-51. PMID:19245387. doi:10.1111/j.1526-4610.2009.01368.x. SecondaryAggravation
- Minen MT, Begasse De Dhaem O, Kroon Van Diest A, Powers S, Schwedt TJ, Lipton R, Silbersweig D. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry. 2016;87(7):741-9. PMID:26733600. doi:10.1136/jnnp-2015-312233. Secondary
- Peterlin BL, Nijjar SS, Tietjen GE. Post-traumatic stress disorder and migraine: epidemiology, sex differences, and potential mechanisms. Headache. 2011;51(6):860-8. PMID:21592096. doi:10.1111/j.1526-4610.2011.01907.x. Secondary
- Stubberud A, Buse DC, Kristoffersen ES, Linde M, Tronvik E. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain. 2021;22(1):155. PMID:34930118. doi:10.1186/s10194-021-01369-6. Secondary
- Sauro KM, Becker WJ. The stress and migraine interaction. Headache. 2009;49(9):1378-86. PMID:19619238. doi:10.1111/j.1526-4610.2009.01486.x. Secondary
- Maleki N, Becerra L, Borsook D. Migraine: maladaptive brain responses to stress. Headache. 2012;52(Suppl 2):102-6. PMID:23030541. doi:10.1111/j.1526-4610.2012.02241.x. Secondary
- Suzuki K, Suzuki S, Shiina T, Kobayashi S, Hirata K. Central Sensitization in Migraine: A Narrative Review. J Pain Res. 2022;15:2673-2682. PMID:36101891. doi:10.2147/JPR.S329280. Secondary
- McGeary DD, Resick PA, Penzien DB, McGeary CA, Houle TT, Eapen BC, Jaramillo CA, Nabity PS, Reed DE 2nd. Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Neurol. 2022;79(8):746-757. PMID:35759281. doi:10.1001/jamaneurol.2022.1567. Aggravation
- Ashina H, Eigenbrodt AK, Seifert T, Sinclair AJ, Scher AI, Schytz HW, Lee MJ, De Icco R, Finkel AG, Ashina M. Post-traumatic headache attributed to traumatic brain injury: classification, clinical characteristics, and treatment. Lancet Neurol. 2021;20(6):460-469. PMID:34022171. doi:10.1016/S1474-4422(21)00094-6. Secondary
- Ashina H, Dodick DW, Barber J, Temkin NR, Chong CD, Adler JS, Shubin Stein K, Schwedt TJ, Manley GT. Prevalence of and Risk Factors for Post-traumatic Headache in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. Mayo Clin Proc. 2023;98(10):1515-1526. PMID:37480909. doi:10.1016/j.mayocp.2023.02.026. SecondaryAggravation
- Chen MH, Sung YF, Chien WC, Chung CH, Chen JW. Risk of Migraine after Traumatic Brain Injury and Effects of Injury Management Levels and Treatment Modalities: A Nationwide Population-Based Cohort Study in Taiwan. J Clin Med. 2023;12(4):1530. PMID:36836064. doi:10.3390/jcm12041530. Secondary
- Nabity PS, Jaramillo CA, Resick PA, McGeary CA, Eapen BC, Straud CL, Hale WJ, Houle TT, Litz BT, Mintz J, Penzien DB, Young-McCaughan S, Keane TM, Peterson AL, McGeary DD. Persistent posttraumatic headaches and functioning in veterans: Injury type can matter. Headache. 2021;61(9):1334-1341. PMID:34570899. doi:10.1111/head.14210. SecondaryAggravation
- Howard L, Dumkrieger G, Chong CD, Ross K, Berisha V, Schwedt TJ. Symptoms of Autonomic Dysfunction Among Those With Persistent Posttraumatic Headache Attributed to Mild Traumatic Brain Injury: A Comparison to Migraine and Healthy Controls. Headache. 2018;58(9):1397-1407. PMID:30156267. doi:10.1111/head.13396. SecondaryAggravation
- Kamins J, Charles A. Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets. Headache. 2018;58(6):811-826. PMID:29757458. doi:10.1111/head.13312. Secondary
- Chong CD, Nikolova J, Dumkrieger GM. Migraine and Posttraumatic Headache: Similarities and Differences in Brain Network Connectivity. Semin Neurol. 2022;42(4):441-448. PMID:36323298. doi:10.1055/s-0042-1757929. Secondary
- Kamins JL, Karimi R, Hoffman A, Prins ML, Giza CC. Biomarkers and Endophenotypes of Post-traumatic Headaches. Curr Pain Headache Rep. 2024;28(12):1185-1193. PMID:39136870. doi:10.1007/s11916-024-01255-1. Secondary
- Williams KA, Lawson RM, Perurena OH, Coppin JD. Management of Chronic Migraine and Occipital Neuralgia in Post 9/11 Combat Veterans. Mil Med. 2019;184(7-8):e207-e211. PMID:30690565. doi:10.1093/milmed/usy405. Secondary
- Capi M, Pomes LM, Andolina G, Curto M, Martelletti P, Lionetto L. Persistent Post-Traumatic Headache and Migraine: Pre-Clinical Comparisons. Int J Environ Res Public Health. 2020;17(7):2585. PMID:32283843. doi:10.3390/ijerph17072585. Secondary
Post-traumatic Stress Disorder
38 CFR DC 9411Combat and deployment stressor exposure and the epidemiology of PTSD in service members and veterans, supporting direct service connection.
- Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351(1):13-22. PMID:15229303. doi:10.1056/NEJMoa040603. Direct
- Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science. 2006;313(5789):979-82. PMID:16917066. doi:10.1126/science.1128944. Direct
- Smith TC, Ryan MAK, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D. New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. BMJ. 2008;336(7640):366-71. PMID:18198395. doi:10.1136/bmj.39430.638241.AE. Direct
- Xue C, Ge Y, Tang B, Liu Y, Kang P, Wang M, Zhang L. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS One. 2015;10(3):e0120270. PMID:25793582. doi:10.1371/journal.pone.0120270. Direct
- Phillips CJ, LeardMann CA, Gumbs GR, Smith B. Risk factors for posttraumatic stress disorder among deployed US male marines. BMC Psychiatry. 2010;10:52. PMID:20579379. doi:10.1186/1471-244X-10-52. Direct
- Kang HK, Natelson BH, Mahan CM, Lee KY, Murphy FM. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. Am J Epidemiol. 2003;157(2):141-8. PMID:12522021. doi:10.1093/aje/kwf187. Direct
- Wisco BE, Marx BP, Miller MW, Wolf EJ, Mota NP, Krystal JH, Southwick SM, Pietrzak RH. Probable Posttraumatic Stress Disorder in the US Veteran Population According to DSM-5: Results From the National Health and Resilience in Veterans Study. J Clin Psychiatry. 2016;77(11):1503-1510. PMID:27631148. doi:10.4088/JCP.15m10188. Direct
- Shalev A, Liberzon I, Marmar C. Post-Traumatic Stress Disorder. N Engl J Med. 2017;376(25):2459-2469. PMID:28636846. doi:10.1056/NEJMra1612499. Direct
- Kimerling R, Gima K, Smith MW, Street A, Frayne S. The Veterans Health Administration and military sexual trauma. Am J Public Health. 2007;97(12):2160-6. PMID:17971558. doi:10.2105/AJPH.2006.092999. Direct
- Kimerling R, Street AE, Pavao J, Smith MW, Cronkite RC, Holmes TH, Frayne SM. Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. Am J Public Health. 2010;100(8):1409-12. PMID:20558808. doi:10.2105/AJPH.2009.171793. Direct
- Wilson LC. The Prevalence of Military Sexual Trauma: A Meta-Analysis. Trauma Violence Abuse. 2018;19(5):584-597. PMID:30415636. doi:10.1177/1524838016683459. Direct
- Millegan J, Milburn EK, LeardMann CA, Street AE, Williams D, Trone DW, Crum-Cianflone NF. Recent Sexual Trauma and Adverse Health and Occupational Outcomes Among U.S. Service Women. J Trauma Stress. 2015;28(4):298-306. PMID:26201507. doi:10.1002/jts.22028. Direct
- Millegan J, Wang L, LeardMann CA, Miletich D, Street AE. Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military. J Trauma Stress. 2016;29(2):132-40. PMID:27077493. doi:10.1002/jts.22081. Direct
- Suris A, Lind L. Military sexual trauma: a review of prevalence and associated health consequences in veterans. Trauma Violence Abuse. 2008;9(4):250-69. PMID:18936282. doi:10.1177/1524838008324419. Direct
- Gates MA, Holowka DW, Vasterling JJ, Keane TM, Marx BP, Rosen RC. Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychol Serv. 2012;9(4):361-382. PMID:23148803. doi:10.1037/a0027649. Direct
- Richardson LK, Frueh BC, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Aust N Z J Psychiatry. 2010;44(1):4-19. PMID:20073563. doi:10.3109/00048670903393597. Direct
Postinfectious Irritable Bowel Syndrome
38 CFR DC 7319Deployment-acquired infectious gastroenteritis (travelers' diarrhea, Campylobacter, Shigella, norovirus, C. difficile) as the documented antecedent of post-infectious irritable bowel syndrome in active-duty and deployed US personnel, together with the operational-stress and Southwest Asia theater literature that places functional gastrointestinal disorders including IBS among the chronic multisymptom presentations of Gulf War service.
- Riddle MS, Welsh M, Porter CK, Nieh C, Boyko EJ, Gackstetter G, Hooper TI. The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study Am J Gastroenterol. 2016;111(1):93-104. PMID:26729548. doi:10.1038/ajg.2015.386. Direct
- Gutiérrez RL, Riddle MS, Porter CK. Increased risk of functional gastrointestinal sequelae after Clostridium difficile infection among active duty United States military personnel (1998-2010) Gastroenterology. 2015;149(6):1408-14. PMID:26255560. doi:10.1053/j.gastro.2015.07.059. Direct
- Nono Djotsa ABS, Nguyen Wenker TH, Ahmed ST, Ghosh S, Malhotra D, Boyle SH, Gifford EJ, Sims KJ, White DL, Steele L, Helmer DA. Irritable Bowel Syndrome in Veterans With Gulf War Illness Evaluated at VA's War-Related Illness and Injury Study Center Mil Med. 2024;189(11-12):e2644-e2654. PMID:38771213. doi:10.1093/milmed/usae260. Direct
- Trivedi KH, Schlett CD, Tribble DR, Monteville MR, Sanders JW, Riddle MS. The impact of post-infectious functional gastrointestinal disorders and symptoms on the health-related quality of life of US military personnel returning from deployment to the Middle East Dig Dis Sci. 2011;56(12):3602-9. PMID:21647652. doi:10.1007/s10620-011-1766-z. Direct
- Goodwin L, Bourke JH, Forbes H, Hotopf M, Hull L, Jones N, Rona RJ, Wessely S, Fear NT. Irritable bowel syndrome in the UK military after deployment to Iraq: what are the risk factors? Soc Psychiatry Psychiatr Epidemiol. 2013;48(11):1755-65. PMID:23636672. doi:10.1007/s00127-013-0699-6. Direct
- Marshall JK, Thabane M, Garg AX, Clark WF, Salvadori M, Collins SM; Walkerton Health Study Investigators. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery Gastroenterology. 2006;131(2):445-50. PMID:16890598. doi:10.1053/j.gastro.2006.05.053. Direct
- Marshall JK, Thabane M, Garg AX, Clark WF, Moayyedi P, Collins SM; Walkerton Health Study Investigators. Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery Gut. 2010;59(5):605-11. PMID:20427395. doi:10.1136/gut.2009.202234. Direct
- Klem F, Wadhwa A, Prokop LJ, Sundt WJ, Farrugia G, Camilleri M, Singh S, Grover M. Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis Gastroenterology. 2017;152(5):1042-1054.e1. PMID:28069350. doi:10.1053/j.gastro.2016.12.039. Direct
- Spiller R, Garsed K. Postinfectious irritable bowel syndrome Gastroenterology. 2009;136(6):1979-88. PMID:19457422. doi:10.1053/j.gastro.2009.02.074. Direct
- Shin A, Xu H, Imperiale TF. The Prevalence, Humanistic Burden, and Health Care Impact of Irritable Bowel Syndrome Among United States Veterans Clin Gastroenterol Hepatol. 2023;21(4):1061-1069.e1. PMID:35964894. doi:10.1016/j.cgh.2022.08.005. Direct
- Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. 2021. PMID:33315591. doi:10.14309/ajg.0000000000001036. Direct
- Zhang B, Verne ML, Fields JZ, Verne GN, Zhou Q. Intestinal Hyperpermeability in Gulf War Veterans With Chronic Gastrointestinal Symptoms J Clin Gastroenterol. 2019;53(7):e298-e302. PMID:30260809. doi:10.1097/MCG.0000000000001135. Direct
- Robbins R, Helmer D, Monahan P, Hunt S, McAndrew L, Nazario M, Brown WJ, Chao W, Navarro A, Sall J. Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline. U.S. Dept. of Veterans Affairs & U.S. Dept. of Defense; 2022. PMID:35410746. doi:10.1016/j.mayocp.2022.01.031. Available at: https://www.healthquality.va.gov/guidelines/mr/cmi/. Direct
- Mohammed I, Cherkas LF, Riley SA, Spector TD, Trudgill NJ. Genetic influences in irritable bowel syndrome: a twin study Am J Gastroenterol. 2005;100(6):1340-4. PMID:15929767. doi:10.1111/j.1572-0241.2005.41700.x. Direct
Ringing In The Ears
38 CFR DC 6260Military noise and blast exposure as the direct cause of tinnitus — prospective new-onset incidence in service members against a civilian baseline, plus the cochlear-synaptopathy ("hidden hearing loss") mechanism that explains tinnitus with a NORMAL audiogram, which is the basis on which these claims are most often denied.
- Arun P, Rossetti F, Wilder DM, Wang Y, Gist ID, Long JB. Blast Exposure Causes Long-Term Degeneration of Neuronal Cytoskeletal Elements in the Cochlear Nucleus: A Potential Mechanism for Chronic Auditory Dysfunctions. Front Neurol. 2021;12:652190. PMID:33841318. doi:10.3389/fneur.2021.652190. Direct
- Theodoroff SM, Lewis MS, Folmer RL, Henry JA, Carlson KF. Hearing impairment and tinnitus: prevalence, risk factors, and outcomes in US service members and veterans deployed to the Iraq and Afghanistan wars. Epidemiol Rev. 2015;37:71-85. PMID:25600417. doi:10.1093/epirev/mxu005. Direct
- Geronimo-Hara TRT, Belding JN, Warner SG, Trone DW, Rull RP. Incidence and Risk Factors for Tinnitus Among Military Service Members in the Millennium Cohort Study. Am J Audiol. 2025;34(2):330-343. PMID:40268697. doi:10.1044/2025_AJA-24-00198. Direct
- Henry JA, Griest SE, Blankenship C, Thielman EJ, Theodoroff SM, Hammill T, Carlson KF. Impact of Tinnitus on Military Service Members. Mil Med. 2019;184(Suppl 1):604-614. PMID:30901434. doi:10.1093/milmed/usy328. Direct
- Yankaskas K. Prelude: noise-induced tinnitus and hearing loss in the military. Hear Res. 2013;295:3-8. PMID:22575206. doi:10.1016/j.heares.2012.04.016. Direct
- Henry JA, Griest S, Reavis KM, Grush L, Theodoroff SM, Young S, Thielman EJ, Carlson KF. Noise Outcomes in Servicemembers Epidemiology (NOISE) Study: Design, Methods, and Baseline Results. Ear Hear. 2021;42(4):870-885. PMID:33974792. doi:10.1097/AUD.0000000000000974. Direct
- Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959-965. PMID:27441392. doi:10.1001/jamaoto.2016.1700. Direct
- Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after "temporary" noise-induced hearing loss. J Neurosci. 2009;29(45):14077-85. PMID:19906956. doi:10.1523/JNEUROSCI.2845-09.2009. Direct
- Liberman MC, Kujawa SG. Cochlear synaptopathy in acquired sensorineural hearing loss: Manifestations and mechanisms. Hear Res. 2017;349:138-147. PMID:28087419. doi:10.1016/j.heares.2017.01.003. Direct
- Hickman TT, Smalt C, Bobrow J, Quatieri T, Liberman MC. Blast-induced cochlear synaptopathy in chinchillas. Sci Rep. 2018;8(1):10740. PMID:30013117. doi:10.1038/s41598-018-28924-7. Direct
- Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model. J Neurosci. 2011;31(38):13452-7. PMID:21940438. doi:10.1523/JNEUROSCI.2156-11.2011. Direct
- Bramhall NF, Theodoroff SM, McMillan GP, Kampel SD, Buran BN. Associations Between Physiological Correlates of Cochlear Synaptopathy and Tinnitus in a Veteran Population. J Speech Lang Hear Res. 2023;66(11):4635-4652. PMID:37889209. doi:10.1044/2023_JSLHR-23-00234. Direct
- Bramhall NF, Konrad-Martin D, McMillan GP, Griest SE. Auditory Brainstem Response Altered in Humans With Noise Exposure Despite Normal Outer Hair Cell Function. Ear Hear. 2017;38(1):e1-e12. PMID:27992391. doi:10.1097/AUD.0000000000000370. Direct
- Bramhall NF, Konrad-Martin D, McMillan GP. Tinnitus and Auditory Perception After a History of Noise Exposure: Relationship to Auditory Brainstem Response Measures. Ear Hear. 2018;39(5):881-894. PMID:29337762. doi:10.1097/AUD.0000000000000544. Direct
- Vasilkov V, Caswell-Midwinter B, Zhao Y, de Gruttola V, Jung DH, Liberman MC, Maison SF. Evidence of cochlear neural degeneration in normal-hearing subjects with tinnitus. Sci Rep. 2023;13(1):19870. PMID:38036538. doi:10.1038/s41598-023-46741-5. Direct
- Wu PZ, Liberman LD, Bennett K, de Gruttola V, O'Malley JT, Liberman MC. Primary Neural Degeneration in the Human Cochlea: Evidence for Hidden Hearing Loss in the Aging Ear. Neuroscience. 2019;407:8-20. PMID:30099118. doi:10.1016/j.neuroscience.2018.07.053. Direct
- Chen F, Zhao F, Mahafza N, Lu W. Detecting Noise-Induced Cochlear Synaptopathy by Auditory Brainstem Response in Tinnitus Patients With Normal Hearing Thresholds: A Meta-Analysis. Front Neurosci. 2021;15:778197. PMID:34987358. doi:10.3389/fnins.2021.778197. Direct
- Jafari Z, Baguley D, Kolb BE, Mohajerani MH. A Systematic Review and Meta-Analysis of Extended High-Frequency Hearing Thresholds in Tinnitus With a Normal Audiogram. Ear Hear. 2022;43(6):1643-1652. PMID:35612517. doi:10.1097/AUD.0000000000001229. Direct
Sensorineural Hearing Loss
38 CFR DC 6100Hazardous military noise exposure (weapons, aircraft, armor, blast) and noise-induced sensorineural hearing loss in service members.
- Gordon JS, Griest SE, Thielman EJ, Carlson KF, Helt WJ, Lewis MS, Blankenship C, Austin D, Theodoroff SM, Henry JA. Audiologic characteristics in a sample of recently-separated military Veterans: The Noise Outcomes in Servicemembers Epidemiology Study (NOISE Study). Hear Res. 2017;349:21-30. PMID:27913314. doi:10.1016/j.heares.2016.11.014. Direct
- Fausti SA, Wilmington DJ, Gallun FJ, Myers PJ, Henry JA. Auditory and vestibular dysfunction associated with blast-related traumatic brain injury. J Rehabil Res Dev. 2009;46(6):797-810. PMID:20104403. doi:10.1682/jrrd.2008.09.0118. Direct
- Hecht QA, Hammill TL, Calamia PT, Smalt CJ, Brungart DS. Characterization of acute hearing changes in United States military populations. J Acoust Soc Am. 2019;146(5):3839. PMID:31795720. doi:10.1121/1.5132710. Direct
- Lucas JW, Zelaya CE. Hearing Difficulty, Vision Trouble, and Balance Problems Among Male Veterans and Nonveterans. National Center for Health Statistics (National Health Statistics Reports); 2020. PMID:32600517. Available at: https://pubmed.ncbi.nlm.nih.gov/32600517/. Direct
- Centers for Disease Control and Prevention. Severe hearing impairment among military veterans--United States, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(28):955-958. PMID:21775950. Direct
- Lloyd Soderlund L, McKenna EA, Tastad K, Paul M. Prevalence of permanent threshold shifts in the United States Air Force hearing conservation program by career field, 2005-2011. J Occup Environ Hyg. 2016;13(5):383-392. PMID:26720128. doi:10.1080/15459624.2015.1123814. Direct
- Karch SJ, Capó-Aponte JE, McIlwain DS, Lo M, Krishnamurti S, Staton RN, Jorgensen-Wagers K. Hearing Loss and Tinnitus in Military Personnel with Deployment-Related Mild Traumatic Brain Injury. US Army Med Dep J. 2016;(Oct-Dec):52-63. PMID:27613210. Direct
- MacGregor AJ, Joseph AR, Markwald RR, Dougherty AL. The Relationship Between Blast-related Hearing Threshold Shift and Insomnia in U.S. Military Personnel. Mil Med. 2021;186(9-10):844-849. PMID:33580669. doi:10.1093/milmed/usaa567. Direct
- Pfannenstiel TJ. Noise-induced hearing loss: a military perspective. Curr Opin Otolaryngol Head Neck Surg. 2014;22(5):384-7. PMID:25188428. doi:10.1097/MOO.0000000000000083.
- Alamgir H, Turner CA, Wong NJ, Cooper SP, Betancourt JA, Henry J, Senchak AJ, Hammill TL. The impact of hearing impairment and noise-induced hearing injury on quality of life in the active-duty military population: challenges to the study of this issue. Mil Med Res. 2016;3:11. PMID:27076916. doi:10.1186/s40779-016-0082-5.
- Reavis KM, McMillan GP, Carlson KF, Joseph AR, Snowden JM, Griest S, Henry JA. Occupational Noise Exposure and Longitudinal Hearing Changes in Post-9/11 US Military Personnel During an Initial Period of Military Service. Ear Hear. 2021;42(5):1163-1172. PMID:33974789. doi:10.1097/AUD.0000000000001008.
- McIntire A, Miller T, Thapa S, Joseph A, Carlson KF, Reavis KM, Hughes CK. Blast Exposure Associations With Hearing Loss and Self-Reported Hearing Difficulty. Otolaryngol Head Neck Surg. 2024;171(5):1370-1378. PMID:38984918. doi:10.1002/ohn.890.
- Orru H, Luha A, Pindus M, Jõgeva R, Vahisalu M, Lekk U, Indermitte E, Merisalu E. Hearing loss among military personnel in relation to occupational and leisure noise exposure and usage of personal protective equipment. Noise Health. 2020;22(107):90-98. PMID:33402609. doi:10.4103/nah.NAH_12_19.
Shoulder Impingement
38 CFR DC 5024, 5201, 5202, 5203Repetitive overhead load, heavy lifting, and training/combat trauma driving rotator-cuff and shoulder instability injuries in service members.
- Hadid A, Belzer N, Shabshin N, Zeilig G, Gefen A, Epstein Y. The effect of mechanical strains in soft tissues of the shoulder during load carriage. J Biomech. 2015;48(15):4160-4165. PMID:26542788. doi:10.1016/j.jbiomech.2015.10.020. Direct
- Isaacson B, Hando B, Pav V, Wagner L, Colahan C, Pasquina P, Yuan X. Upper Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021. Mil Med. 2024;189(Suppl 4):34-44. PMID:39570070. doi:10.1093/milmed/usae047. Direct
- Hsiao MS, Cameron KL, Tucker CJ, Benigni M, Blaine TA, Owens BD. Shoulder impingement in the United States military. J Shoulder Elbow Surg. 2015;24(9):1486-92. PMID:25865088. doi:10.1016/j.jse.2015.02.021. Direct
- Yow BG, Wade SM, Bedrin MD, Rue JH, LeClere LE. The Incidence of Posterior and Combined AP Shoulder Instability Treatment with Surgical Stabilization Is Higher in an Active Military Population than in the General Population: Findings from the US Naval Academy. Clin Orthop Relat Res. 2021;479(4):704-708. PMID:33094964. doi:10.1097/CORR.0000000000001530. Direct
- Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168-73. PMID:17581976. doi:10.1177/0363546506295179. Direct
- Zhou L, Gee SM, Posner MA, Cameron KL. Concomitant Glenohumeral Instability and Rotator Cuff Injury: An Epidemiologic and Case-Control Analysis in Military Cadets. J Am Acad Orthop Surg Glob Res Rev. 2022;6(4):e22.00049. PMID:35412499. doi:10.5435/JAAOSGlobal-D-22-00049. Direct
- Kampa RJ, Clasper J. Incidence of SLAP lesions in a military population. J R Army Med Corps. 2005;151(3):171-5. PMID:16440960. doi:10.1136/jramc-151-03-07. Direct
- Christensen DL, Elsenbeck MJ, Wolfe JA, Nickel WN, Roach W, Waltz RA, Dickens JF, LeClere LE. Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging. Mil Med. 2020;185(9-10):e1556-e1561. PMID:32601668. doi:10.1093/milmed/usaa122. DirectAggravation
- Green CK, Scanaliato JP, Turner RC, Sandler AB, Dunn JC, Parnes N. Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients. Orthop J Sports Med. 2023;11(7):23259671231181906. PMID:37435424. doi:10.1177/23259671231181906. DirectAggravation
- Scanaliato JP, Dunn JC, Fares AB, Czajkowski H, Parnes N. Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study. Am J Sports Med. 2022;50(2):334-340. PMID:34898288. doi:10.1177/03635465211061602. Direct
- Leggit JC, Wu H, Janvrin M, Korona-Bailey J, Koehlmoos TP, Schneider EB. Non-Operative Shoulder Dysfunction in the United States Military. Mil Med. 2023;188(5-6):e1003-e1009. PMID:34865115. doi:10.1093/milmed/usab468. Direct
- Parnes N, Perrine J, DeFranco MJ. Outcomes of Simultaneous Arthroscopic Rotator Cuff Repair and Inferior Labral Repair Among Active Patients Younger Than 40 Years. Orthopedics. 2021;44(3):e326-e330. PMID:34039192. doi:10.3928/01477447-20210414-01. Direct
Unstable Scar
38 CFR DC 7800, 7801, 7802, 7804, 7805Service-incurred wounds, burns, and surgeries producing painful, unstable, or neuropathic residual scars.
- Wolf SE, Kauvar DS, Wade CE, Cancio LC, Renz EP, Horvath EE, White CE, Park MS, Wanek S, Albrecht MA, Blackbourne LH, Barillo DJ, Holcomb JB. Comparison between civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom. Ann Surg. 2006;243(6):786-92; discussion 792-5. PMID:16772782. doi:10.1097/01.sla.0000219645.88867.b7. Direct
- Foster MA, Moledina J, Jeffery SLA. Epidemiology of U.K. military burns. J Burn Care Res. 2011;32(3):415-20. PMID:21422938. doi:10.1097/BCR.0b013e318217fa13. Direct
- Niedzielski LS, Chapman MT. Changes in burn scar contracture: utilization of a severity scale and predictor of return to duty for service members. J Burn Care Res. 2015;36(3):e212-9. PMID:25501771. doi:10.1097/BCR.0000000000000148. Direct
- Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet. 2016;388(10052):1427-1436. PMID:27707499. doi:10.1016/S0140-6736(16)31406-4. Direct
- Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1-2):113-25. PMID:20927486. doi:10.2119/molmed.2009.00153. Direct
- Tredget EE, Shupp JW, Schneider JC. Scar Management Following Burn Injury. J Burn Care Res. 2017;38(3):146-147. PMID:28338518. doi:10.1097/BCR.0000000000000548. Direct
- Greer N, Sayer N, Kramer M, Koeller E, Velasquez T. Prevalence and Epidemiology of Combat Blast Injuries from the Military Cohort 2001-2014. Department of Veterans Affairs (US) — VA Evidence Synthesis Program; 2016. PMID:28813129. Available at: https://pubmed.ncbi.nlm.nih.gov/28813129/. Direct
- Singh AK, Ditkofsky NG, York JD, Abujudeh HH, Avery LA, Brunner JF, Sodickson AD, Lev MH. Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon Bombing. Radiographics. 2016;36(1):295-307. PMID:26761543. doi:10.1148/rg.2016150114. Direct
- Ogawa R, Akita S, Akaishi S, Aramaki-Hattori N, Dohi T, Hayashi T, Kishi K, Kono T, Matsumura H, Muneuchi G, Murao N, Nagao M, Okabe K, Shimizu F, Tosa M, Tosa Y, Yamawaki S, Ansai S, Inazu N, Kamo T, Kazki R, Kuribayashi S. Diagnosis and Treatment of Keloids and Hypertrophic Scars-Japan Scar Workshop Consensus Document 2018. Burns Trauma. 2019;7(39). PMID:31890718. doi:10.1186/s41038-019-0175-y. Direct
- Miletta NR, Donelan MB, Hivnor CM. Management of trauma and burn scars: the dermatologist's role in expanding patient access to care. Cutis. 2017;100(1):18-20. PMID:28873104. Direct
- Ngaage M, Agius M. The Psychology of Scars: A Mini-Review. Psychiatr Danub. 2018;30(Suppl 7):633-638. PMID:30439862. Direct
- Hong YK, Chang YH, Lin YC, Chen B, Guevara BEK, Hsu CK. Inflammation in Wound Healing and Pathological Scarring. Adv Wound Care (New Rochelle). 2023;12(5):288-300. PMID:36541356. doi:10.1089/wound.2021.0161.
- Leszczynski R, da Silva CA, Pinto ACPN, Kuczynski U, da Silva EM. Laser therapy for treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2022;9(9):CD011642. PMID:36161591. doi:10.1002/14651858.CD011642.pub2.
- Goodwin B, Mitchell J, Major E, Podwojniak A, Brancaccio H, Rusinak K, King M, Tahir H. The efficacy of topical 8% capsaicin patches for the treatment of postsurgical neuropathic pain: a systematic review. Pain Manag. 2024;14(10-11):591-598. PMID:39589498. doi:10.1080/17581869.2024.2433931.
- Fredman R, Edkins RE, Hultman CS. Fat Grafting for Neuropathic Pain After Severe Burns. Ann Plast Surg. 2016;76 Suppl 4:S298-303. PMID:26678099. doi:10.1097/SAP.0000000000000674.
- Kline CM, Lucas CE, Ledgerwood AM. Directed neurectomy for treatment of chronic postsurgical neuropathic pain. Am J Surg. 2013;205(3):246-8; discussion 248-9. PMID:23357521. doi:10.1016/j.amjsurg.2012.10.010.
Controlling law by theory
The CFR sections and published cases each theory of service connection actually rests on. This describes the legal standard raters evaluate against — it is never a prediction about any claim.
Regulation (CFR / USC)
38 C.F.R. § 3.303
Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)
Case law
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)
The three-element test: current disability, in-service event, and a nexus between them.
Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)
Federal Circuit restatement of the same three direct-service-connection elements.
Caluza v. Brown, 7 Vet. App. 498 (1995)
The evidentiary framework a rater weighs each element against.
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)
Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)
A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)
A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).
McLendon v. Nicholson, 20 Vet. App. 79 (2006)
A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.
38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)
When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.
How to read this
This is educational information about the evidentiary standards and medical literature relevant to VA disability claims — not legal or medical advice, and never a prediction about any claim or rating. Every study links to its PubMed or DOI record so you can verify it yourself; every legal authority is cited as it appears in filings. If you want a nexus opinion built to this standard for your own records, it's drafted from your file and routed to a licensed provider to review and sign.
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