Substance Use Disorder Secondary to Mental Health
Veterans with post-traumatic stress disorder, depression, anxiety, and other service-connected mental health conditions often turn to alcohol or drugs to cope. If you use substances to get relief from mental health symptoms, you may find yourself increasingly dependent on substances to survive. Substance use disorder is a medical condition that requires long-term treatment and support.
The VA awards compensation for secondary conditions that stem from service-connected conditions and acknowledges that mental health disorders can lead to secondary substance use disorder. In this guide, you will discover how to qualify for benefits for substance use disorder secondary to mental health and prove the connection.
On This Page
- The Connection Between Mental Health and Substance Use Disorder
- Does the VA Recognize Substance Use Disorder as a Secondary Condition?
- Mental Health Conditions Linked to Substance Use
- VA Disability Benefits for Substance Use Disorder Secondary to Mental Health
- Applying for VA Benefits for Substance Use Disorder Secondary to Mental Health
- Seeking Help for Substance Use and Mental Health Disorders
The Connection Between Mental Health and Substance Use Disorder
Veterans with service-connected mental health conditions face higher risks of substance use problems. According to the VA’s National Center for PTSD, over four out of 10 adults with post-traumatic stress disorder, or PTSD, have drug or alcohol use problems. Veterans with a history of PTSD are two times more likely to have alcohol use problems and three times more likely to have drug use problems than veterans without PTSD.
Numerous studies have documented higher rates of alcohol use disorder among veterans with PTSD, major depression, and generalized anxiety disorder. Many veterans are reluctant to seek help for mental health conditions due to stigma. Instead, they turn to drugs or alcohol as self-medication to temporarily escape nightmares, intrusive thoughts, anxiety, chronic pain, and other symptoms.
Treatment for Substance Use Disorder
The VA recognizes substance use disorder as a medical condition. Thus, the VA provides the following resources for those dealing with substance abuse issues:
- Medical treatment
- Counseling
- Behavioral therapy
- Medication management
- Residential treatment
- Support groups
When seeking treatment for substance use, you also need treatment for the underlying mental health condition. In particular, many VA facilities offer specialized programs to address the combination of PTSD and substance use disorder.
Seeking help for a mental health condition is not a sign of weakness, but strength. Serving in the military exposes you to extreme trauma. Mental health challenges are common responses.
Does the VA Recognize Substance Use Disorder as a Secondary Condition?
The VA does not view substance use itself as a primary service-connected disabling condition. However, it does recognize substance use disorder as a medical condition and a legitimate secondary condition that often develops due to underlying service-connected conditions. For instance, the VA acknowledges that substance use disorder often develops as a progression of certain mental health conditions, such as PTSD and depression.
When evaluating a disability claim for substance use, the VA will consider whether it arose from attempts to cope with symptoms of a service-connected mental health condition.
How To Prove Substance Use Service Connection
To establish service connection for substance use as a secondary condition to mental health, you need medical evidence that shows a clear link between your primary service-connected condition and substance use disorder. Your documentation should include the following:
- Medical records from before military service to the present day
- A formal diagnosis of both conditions
- A timeline showing how substance abuse developed in response to the mental health condition
- Buddy statements about how your substance use has progressed
Mental Health Conditions Linked to Substance Use
If you have developed a substance use disorder since returning from service, it may have stemmed from an underlying disabling condition. Thus, you may be entitled to compensation for both the service-connected and the secondary condition combined. The following are some common service-related conditions linked to substance abuse:
Post-Traumatic Stress Disorder, or PTSD
Drugs and alcohol can provide short-term relief for many common symptoms of post-traumatic stress disorder, such as intrusive memories, nightmares, and hypervigilance. If you are living with PTSD, drug and alcohol use can make it worse in the long run, and you will need increasing amounts over time to get the same relief.
Depression and Anxiety
Depression and chronic anxiety can drive veterans toward substance use as an escape from emotional pain and constant worry. Although alcohol and drugs may temporarily lift your mood or help you relax, they can intensify symptoms in the long run and put you at risk of dependency on the substances.
Traumatic Brain Injury, or TBI
TBIs can cause mood disorders, chronic pain, insomnia, personality changes, and cognitive impairments. A 2024 study of 52,700 post-9/11 veterans found that those with a confirmed mild TBI had a significantly heightened risk of substance use and alcohol use disorder and overdose compared to those without a TBI.
Other Mental Health Conditions
The following mental health conditions also lead to substance use disorders:
Substance use disorders often develop as you attempt to self-medicate a mental health condition you have trouble controlling.
VA Disability Benefits for Substance Use Disorder Secondary to Mental Health
The VA provides disability compensation for substance use disorders when they are secondary to service-connected mental health conditions.
Eligibility for VA Disability
Substance use alone is not considered a service-connected disability. The VA will not grant benefits solely for a substance use disorder without an underlying service-connected condition. However, many veterans with substance use disorder also have co-occurring mental health disorders.
To qualify for VA disability compensation for substance use, you must prove that you have each of the following:
- A service-connected disabling condition that results in disability
- A substance use disorder that stems from a service-connected condition and results in disability
Disability Ratings
The VA evaluates mental health conditions using the criteria in its ratings schedule to assess your occupational and social impairment. If the VA finds you have a substance use disorder secondary to a rated mental health condition, you will receive a disability rating for each. The VA will then use its combined ratings table to calculate your overall rating and determine your monthly disability benefits.
For example, suppose you received a 70% rating for PTSD and a 50% rating for alcohol use disorder secondary to PTSD. According to the VA’s rating tables, your combined rating would be 90%. In 2025, your monthly benefit would be $3,831.30 if you are single or $4,044.91 if you are married.
Requirements for Service Connection
You will need medical documentation to prove that your substance use disorder is secondary to a mental health condition. If your mental health condition has not previously been rated, your documentation must include information about both conditions.
The VA will look for evidence that your substance use began or worsened after your service-connected mental health condition started. Treatment records showing you used substances to manage specific symptoms help establish this connection. You will also need a medical opinion from a qualified expert explicitly stating that your substance use disorder is related to your service-connected mental health condition.
Applying for VA Benefits for Substance Use Disorder Secondary to Mental Health
Applying for disability benefits involves gathering evidence and completing an application.
Filing a Claim for VA Disability
To start a VA disability claim, you will need to complete VA Form 21-526EZ. You can submit your completed form through the VA’s website, by mail, or in person at your nearest VA regional office. Include information about your service-connected mental health condition, and list your substance use disorder as a secondary condition. Be specific about how your mental health symptoms led to your substance use disorder. Submit information addressing the following:
- The dates your mental health symptoms began
- When you started using substances
- How your dependency on substances has increased
- The specific symptoms that the substance use relieved
The more details you provide, the easier it will be for the examiner to understand your claim.
Gathering Medical Documentation
Thorough medical documentation is crucial for a successful claim. You will need the following records:
- Medical records
- A formal diagnosis of your mental health and substance use disorders
- Treatment notes from all providers and mental health professionals
- Psychiatric evaluations
- Records of substance use treatment programs, counseling sessions, or hospitalizations
Working with a Veterans Service Officer, or VSO
An accredited Veterans Service Officer can bring valuable insight to the process and what types of details to include with your application. A VSO can also review your medical records and advise you on what additional evidence you need. There is no cost to work with a VSO. You can find a VSO in your area through the VA’s search tool.
Appealing a Denied Claim
If the VA denies your claim, don’t give up. A denial does not automatically mean your claim lacks merit. You have a right to appeal. Review the decision letter to understand the reason for the denial. Common reasons include insufficient medical evidence, a lack of a clear medical nexus, or technical issues with the application.
You can file an appeal through the following avenues:
- Supplemental Claim: Submit new and relevant evidence
- Higher-Level Review: Ask a senior reviewer to review your claim
- Board of Veterans’ Appeals: Ask a Veterans Law Judge to review your claim
Each option has separate timelines and requirements. A VSO or VA-accredited attorney at Veterans Guide can help you choose the best appeal strategy for your situation.
Seeking Help for Substance Use and Mental Health Disorders
IF you are a veteran struggling with substance use, an underlying mental health condition may be the reason. Military service often causes mental health conditions, including PTSD, depression, and anxiety. These conditions frequently lead to substance use disorders. When this happens, additional disability compensation may be available.
Mental health conditions and substance use disorders are legitimate health conditions that stem from military service. You served with honor, and you have earned compensation for any disabilities that your service may have caused. At Veterans Guide, we’re dedicated to helping veterans get their benefits. We can help you understand the claim process and connect you to caring advocates who can help.
Contact us today to learn more.
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