Secondary claim guide

Nexus Letter for AFib Secondary to PTSD

Medically reviewed by the Patriot Path Medical Team

Licensed MD reviewers • Last updated: October 19, 2026

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VA can service connect AFib secondary to PTSD under 38 CFR 3.310 when medical evidence links them, by causation or aggravation. One veteran study found a modest association, not proof; a study of women veterans found no significant link. DC 7010 pays 10 or 30 percent for ECG-confirmed AFib needing interventions or control, and a grant can leave your combined rating unchanged.

Three more things belong up front. This page does not claim a proven cause, because the research does not show one, and VA does not ask for proof: it asks whether the evidence for and against is in approximate balance. Board decisions on this pairing include grants, denials and remands, and each is "binding only with regard to the specific case decided" under 38 CFR 20.1303. And you may not need to buy a letter: in one 2025 Board decision (A25105908) the veteran won through his prescribed medications with no private letter in the file.

An illustrative example

A veteran is service connected for PTSD at 70 percent, and that is his only rating. For a year he has had spells of a pounding, irregular heartbeat. A two-week monitor records paroxysmal atrial fibrillation, his cardiologist starts a daily pill to control it, and he needs one cardioversion that year. Suppose a reasoned opinion links the AFib to his PTSD and VA grants service connection.

On those facts DC 7010's 10 percent row fits: one treatment intervention in the year, and daily oral medication to control. With PTSD at 70 and AFib at 10 as his only two ratings, Table I of 38 CFR 4.25 gives 73, which rounds to 70, so his combined rating does not change. The grant still puts the AFib on the record as service connected under 38 CFR 3.310. If he later needs five or more interventions in a year, the question becomes the rating, and 70 combined with 30 is 79, which rounds to 80.

We put this example together from the rating rules to show the arithmetic. It is not a client and not a case result, and it predicts nothing for any claim.

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Is There a Real Link Between PTSD and AFib?

The honest answer is a small one in some studies and none in another. No study we found shows PTSD to be a cause of atrial fibrillation. The largest veteran study found an association that is modest after adjustment, and the low end of its confidence range sits at or close to no effect. Each finding below is labelled for what it measured and in whom.

The largest veteran study: a modest association

Rosman and colleagues (Journal of the American Heart Association, 2019) followed 988,090 veterans who first used VA health care between October 2001 and November 2014 and had no atrial fibrillation at the start. Their mean age was about 30, 87.8 percent were men, and mean follow-up was 4.8 years, with 2,491 new AFib diagnoses. Before adjustment, a PTSD diagnosis went with a hazard ratio of 1.31 (95 percent confidence interval 1.19 to 1.43). After adjusting for age, sex, race and ethnicity, hypertension, coronary disease, heart attack, diabetes, sleep apnea, obesity, alcohol and drug abuse, smoking and depression, it was 1.13 (1.02 to 1.24), about 13 percent higher. Adding each veteran's use of health care brought it to 1.11 (1.00 to 1.23) (PMID 31564191).

The same study, for proportion

In Rosman's final model, hypertension carried a hazard ratio of 2.41, alcohol abuse 1.81 and obstructive sleep apnea 1.69, each larger than PTSD's 1.13. The PTSD group also carried more of those risks: alcohol abuse was recorded in 25.81 percent of veterans with PTSD against 4.53 percent without, sleep apnea in 15.55 against 6.60 percent, and hypertension in 19.43 against 10.11 percent. SSRI or SNRI antidepressants were recorded in 81.37 against 18.88 percent, and the authors did not adjust for them. They wrote that residual confounding "cannot be ruled out" and that the findings "require validation in more diverse populations".

Women veterans: no significant link

Ebrahimi and colleagues (EClinicalMedicine, 2026) matched 101,448 women veterans with PTSD to the same number without, 202,896 in all, mean age 39.1, and followed them about 6 years. New atrial fibrillation or flutter occurred in 840 women with PTSD and 699 without: hazard ratio 1.07 (0.97 to 1.18), p = 0.16, not statistically significant, although PTSD was linked to several other heart and vascular outcomes in the same study. The paper's summary panel lists atrial fibrillation among its significant findings; its Table 2, results and discussion say it was not, and we follow the table. A null result does not show there is no link, because the range runs up to 1.18 (PMID 42751178).

Stress disorders as a group, not PTSD alone

Song and colleagues (BMJ, 2019) compared 136,637 Swedes with any stress-related disorder (PTSD, acute stress reaction, adjustment disorder and other stress reactions) with 171,314 of their unaffected full siblings. Beyond the first year after diagnosis, the outcome the paper calls "arrhythmia" was about 12 percent higher (hazard ratio 1.12, 1.04 to 1.21). The paper's text reports no figure for atrial fibrillation itself, the exposure is not PTSD alone, the people were not veterans, and the authors had no data on alcohol consumption or smoking and did not adjust for sleep apnea. The sibling design does control for shared family background (PMID 30971390).

Genes: no shared signal for AFib

A 2025 genetic study (Lukas and colleagues, Translational Psychiatry) found no clear genetic correlation between PTSD and atrial fibrillation (rg 0.03, p = 0.16), while PTSD did share genetic signal with coronary disease, hypertension and heart failure (rg 0.21 to 0.32). A genetic correlation is not a causal test, so this does not rule a link out; it is one more result that does not point toward one (PMID 39755697).

Mental health conditions more broadly

A Swedish study of 3,815,546 parents (Mo and colleagues, European Journal of Preventive Cardiology, 2025) found any psychiatric disorder linked to a 28 percent higher AFib rate (adjusted hazard ratio 1.28, 1.27 to 1.29; 1.32 in a sibling analysis), with stress-related disorders among the subtypes linked; the abstract gives no figure for them (PMID 41392705). Two pooled analyses (meta-analyses) of cohort studies disagree with each other. One from 2022 found anxiety (1.10, 1.02 to 1.19), depression (1.25, 1.12 to 1.39) and work stress (1.18, 1.05 to 1.32) linked to new AFib (PMID 35618103). One from 2020 found none of anxiety, anger, depression or work stress significant (anxiety 1.10, 0.97 to 1.24; depression 1.15, 0.98 to 1.35) (PMID 32311930). Neither included PTSD as an exposure.

Sleep: insomnia and AFib, measured in veterans

In 1,063,723 post-9/11 veterans followed a mean 9.6 years (Gaffey and colleagues, Journal of the American Heart Association, 2023), an insomnia diagnosis went with an adjusted AFib hazard ratio of 1.32 (1.21 to 1.43), and 1.38 when veterans with sleep apnea were excluded. In the same model, a combined variable for generalized anxiety, major depression or PTSD was 1.13 (1.05 to 1.21); that is a composite, not PTSD alone (PMID 37791503).

Mechanism: physiology and reviews, not outcome evidence

A meta-analysis of heart-rate variability found lower resting parasympathetic measures and a higher resting heart rate in people with PTSD than in healthy controls (Schneider, 2020, PMID 32854795); that is physiology, not AFib outcomes. A brief narrative review (Fu, 2022) found that the causal links between PTSD, autonomic dysfunction and cardiovascular risk "remain unknown" (PMID 34844132). A narrative review that is not about PTSD describes the autonomic nervous system as both a trigger and a substrate for AFib (Malik, 2024, PMID 39084720). These describe a plausible pathway. None shows that the pathway produces AFib in veterans with PTSD.

What this means for a claim

Put together, the evidence is one positive and one null veteran cohort that measured PTSD and AFib directly, a broader Swedish signal for stress disorders as a group, no shared genetic signal, no randomized or causal evidence, and a plausible but unproven mechanism. That is a small, inconsistent association.

It is enough to make the question a fair one for a physician to weigh in one veteran's file. It is not enough to answer the question for him. Both veteran cohorts studied younger veterans (mean ages about 30 and 39), and whether the result holds for older veterans is not known. An opinion that says the science settles it overstates the science, and a VA examiner can say so.

How VA Decides AFib Secondary to PTSD

Two routes run through 38 CFR 3.310, and one standard of proof runs through both.

Route one: the PTSD caused the AFib

38 CFR 3.310(a): "disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition."

VA's manual states the causation test as but-for. The secondary disability must be shown to be "the result of, or would not have occurred but for, an SC disability" (M21-1 Part V, Subpart ii, Chapter 2, Section D, Block 1.b). The same block adds that "the primary disability need not be SC, or even diagnosed, at the time the secondary disability is incurred." So AFib that began before VA granted the PTSD is not excluded for that reason.

Route two: the PTSD made AFib worse

38 CFR 3.310(b) covers "Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease". It then sets a gate: VA "will not concede" aggravation "unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury."

VA's manual applies a broader test than that natural-progress wording. In a note at Block 1.a it says that, in accordance with Spicer v. McDonough, VA "will apply the broader but-for standard and will no longer consider natural progress of the NSC disability when deciding a claim based on aggravation of an NSC disability by an SC disability." Another note in the same block says permanent worsening "is not required". That is VA's stated practice in its manual, not new regulation text.

The baseline still matters, in both directions. Block 1.c lets the baseline rest on medical evidence or on "any other credible evidence, including lay evidence", with a note that lay evidence on its own may not be enough. Block 1.g keeps the deduction: "The evaluation assigned will reflect the difference between the current and baseline levels of severity." And Block 1.f cuts against the veteran: "Do not assume a baseline of 0 percent when a baseline cannot be established by the available evidence", and when no baseline can be established after development, the aggravation claim "must be denied." Block 1.h allows a grant at 0 percent when the worsening does not reach a higher rating level.

The standard: approximate balance, not proof

38 CFR 3.102 defines reasonable doubt as "one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim", and directs that "such doubt will be resolved in favor of the claimant." It also says the doubt must be "within the range of probability as distinguished from pure speculation or remote possibility."

The phrase "at least as likely as not" is not in 3.102; we counted it in the section text and it appears zero times. It is how VA medical opinions conventionally express that balance, and Board remand orders ask examiners for it in those words, for example "at least as likely as not (50 percent or greater probability)" in 18149468 (non-precedential, 38 CFR 20.1303). The words alone carry nothing. The Board decisions below weigh the reasons behind them.

What a VA examiner has to answer

For aggravation, VA's manual lists what the examiner's report must separately address: the current severity of the AFib; an opinion whether any increase "would not have occurred but for" the service-connected disability, or the condition "would have been less severe but for" it, "including where the SC disability has interfered with or impeded treatment"; and "an adequate analysis with medical considerations supporting the opinion" (Block 1.e).

In the decisions we read, VA opinions that skipped part of that were sent back. In 22001161 (2022) the Board wrote that "the May 2020 examiner neglected to address the Veteran's service-connected posttraumatic stress disorder (PTSD)" and directed that "The examiner must provide separate findings and rationales relating to causation and aggravation." In A25047908, A25041291 and A25043387 (2025) the Board remanded because the VA opinion did not address aggravation. All are non-precedential under 38 CFR 20.1303.

Getting VA to order an examination at all

VA does not order an examination on every secondary claim. M21-1 Part IV, Subpart i, Chapter 1, Section B, Block 1.e requires lay or medical evidence of a current disability or symptoms, evidence of a service-connected primary disability, and an "indication that the claimed secondary condition may be associated with the primary disability or may have been aggravated by the primary disability." It says "the threshold for ordering an examination is low", but that "A generalized statement merely asserting a conclusion that a condition is secondary to an SC disability is not sufficient".

Two Board files sit on either side of it. In 18149468 (2018) a veteran wrote that his doctor had told him his AFib may be secondary to his PTSD; the Board noted that "There is no medical opinion of record which addresses this theory of entitlement" and remanded for one, including a baseline if aggravation was found. In 1800688 (2018) the PTSD theory rested on the veteran's and his representative's assertions, with nothing medical behind it, and the Board found "a VA examination is not necessary to decide the claim." Both are non-precedential under 38 CFR 20.1303.

Palpitations or AFib: The 38 CFR 4.14 Overlap Question

A racing heart can be part of PTSD itself. Atrial fibrillation is a rhythm disorder seen on a tracing. VA rates the first inside the PTSD evaluation and, if it is service connected, the second under the heart schedule. The rule that keeps the two apart is the pyramiding rule.

The evaluation of the same disability under various diagnoses is to be avoided.38 CFR 4.14, first sentence

Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided.38 CFR 4.14, last sentence

Between those sentences, 4.14 names tachycardia and nervousness among the manifestations that can arise from more than one cause, some service connected and some not. A fast heartbeat is in the regulation's own text.

The mental-disorder formula already counts part of this. 38 CFR 4.130 lists "panic attacks (weekly or less often)" in its 30 percent row and "panic attacks more than once a week" in its 50 percent row. When a pounding heart is part of the panic or anxiety the PTSD evaluation already accounts for, 4.14 bars evaluating that same manifestation again under a heart code.

DC 7010 sits right on the edge. Its Note (1) lists sinus tachycardia, as well as atrial fibrillation and atrial flutter, among its examples of supraventricular tachycardia. So the rhythm on the tracing matters: a fast but regular sinus rhythm during anxiety and atrial fibrillation are different findings, even when both feel like a racing heart.

ECG-confirmed atrial fibrillation rated on DC 7010's own criteria (treatment interventions, or continuous oral medication or vagal maneuvers to control) is measured on different things than the PTSD evaluation. VA's manual states the test for separate ratings: "To warrant separate evaluations, symptoms considered must be distinct and not overlap" (M21-1 Part V, Subpart iii, Chapter 13, Block 1.h). That block's worked example is PTSD with anxiety against fibromyalgia, not a heart condition, so applying it to a racing heart is reasoning by analogy. A note at Part V, Subpart ii, Chapter 3, Section D, Block 2.b, citing Esteban v. Brown, adds: "Separate evaluations are warranted where none of the symptomatology for any one condition duplicates or overlaps another."

We found no M21-1 topic and no Board decision that rules on PTSD-versus-AFib overlap specifically. The test is applied to each veteran's symptoms. Separate evaluations are not automatic, and they are not barred either.

Two-column diagram with no people, titled one feeling, two different findings. The left column is headed racing heart or palpitations as part of the anxiety response, and reads: part of the PTSD picture; 38 CFR 4.130 lists panic attacks in its 30 and 50 percent rows; rated inside the PTSD evaluation. The right column is headed atrial fibrillation confirmed on an ECG, and reads: a rhythm diagnosis seen on a tracing; rated under Diagnostic Code 7010 on treatment interventions, or continuous oral medication or vagal maneuvers to control. A bar across the middle reads: 38 CFR 4.14, evaluating the same manifestation under different diagnoses is to be avoided. A footer reads: separate ratings are warranted where the symptoms are distinct and do not overlap, M21-1 Part V, Subpart ii, Chapter 3, Section D, Block 2.b; by analogy, Part V, Subpart iii, Chapter 13, Block 1.h. A small note in the left column reads: a recording made during symptoms tells them apart. — One feeling, two different findings, and the rule that keeps the same manifestation from being evaluated twice.

Where the overlap has shown up in Board files

In 18147996 (2018) the Board granted sinus tachycardia, not atrial fibrillation, as secondary to PTSD with anxiety and depression; the word fibrillation does not appear in the decision. A VA physician had called the veteran's generalized anxiety disorder "the more likely cause of his intermittent sinus tachycardia, along with his deconditioning." The Board decided service connection only and set no percentage for the tachycardia, and it did not discuss 4.14.

In A25060522 (2025) a private opinion relied in part on PTSD that "causes him nightmares and heart pounding at night", a symptom that also sits inside the psychiatric picture; the Board did not discuss overlap. In 0727311 (2007) an examiner's opinion about PTSD and "symptoms of palpitations" was read by the Board as aggravation of the atrial fibrillation. These are facts in decided cases, not rulings on 4.14, and each decision is non-precedential under 38 CFR 20.1303.

Why a recording during symptoms settles the question

A 2009 systematic review in JAMA found that history and examination are not accurate enough to exclude a significant arrhythmia in most patients with palpitations, and that prolonged ECG monitoring matching symptoms to the rhythm is needed to make the diagnosis for most patients with recurrent palpitations. A known panic disorder made an arrhythmia less likely (likelihood ratio 0.26), but the confidence interval reached 1.01, so it rules nothing out (PMID 19920238).

The 2023 ACC/AHA/ACCP/HRS atrial fibrillation guideline, in its full text, says an initial AF diagnosis should be made by a clinician using "visual interpretation of the electrocardiographic signals" (PMID 38033089). One Taiwanese insurance study linked panic disorder to later AF diagnoses (adjusted hazard ratio 1.73, 1.26 to 2.37), on 48 cases; it was not about PTSD, and its abstract describes matching on enrollment time, age, sex and comorbidities, not on how often patients saw doctors (PMID 23107841).

Describe your symptoms to every clinician and examiner exactly as they happen. Whether a racing heart is anxiety, sinus tachycardia or atrial fibrillation is answered by the tracing, not by how the symptom is worded.

What AFib Secondary to PTSD Can Pay

VA rates atrial fibrillation under DC 7010, supraventricular tachycardia, in 38 CFR 4.104. The current text came from a final rule published at 86 FR 54089 on September 30, 2021, effective November 14, 2021. Any description of DC 7010 in terms of episodes per year, Holter monitoring or lone atrial fibrillation is quoting the earlier text. For a claim pending when the text changed, the Board in A26001783 (2026) considered both versions, to "rate based on whichever is most favorable to the Veteran" (non-precedential, 38 CFR 20.1303).

DC 7010, Supraventricular tachycardia, 38 CFR 4.104 (rows as printed)

DC 7010, Supraventricular tachycardia, 38 CFR 4.104 (rows as printed)
Row text	Rating
Confirmed by ECG, with five or more treatment interventions per year	30 percent
Confirmed by ECG, with one to four treatment interventions per year; or, confirmed by ECG with either continuous use of oral medications to control or use of vagal maneuvers to control	10 percent

DC 7010 prints no 0 percent row and no row above 30 percent.

Note (1): Examples of supraventricular tachycardia include, but are not limited to: Atrial fibrillation, atrial flutter, sinus tachycardia, sinoatrial nodal reentrant tachycardia, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, atrial tachycardia, junctional tachycardia, and multifocal atrial tachycardia.38 CFR 4.104, DC 7010

Note (2): For the purposes of this diagnostic code, a treatment intervention occurs whenever a symptomatic patient requires intravenous pharmacologic adjustment, cardioversion, and/or ablation for symptom relief.38 CFR 4.104, DC 7010

Below the 10 percent row, 38 CFR 4.31 supplies the number: "In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met." ECG-confirmed AFib with no treatment intervention in the year and no continuous oral medication or vagal maneuvers to control it is rated 0 percent. That is still a grant of service connection.

Note (2) is narrow. The 2021 rule's discussion explains why VA declined to add emergency room visits as such: "ER visits do not necessarily require intravenous pharmacologic adjustment, cardioversion, or ablation to block or control the condition and any associated disability. When they do, the proposed evaluation criteria can accommodate this situation." The same discussion records that VA added oral medications and vagal maneuvers at commenters' request.

The heart's METs-based General Rating Formula is not the route for DC 7010. In A26009895 (2026) the Board wrote that "the General Formula only applies '[u]nless otherwise directed' and here, Diagnostic Code 7010 specifies other rating criteria. The General Formula is therefore not applicable" (non-precedential, 38 CFR 20.1303).

Blood thinners: an open question

The 10 percent row turns in part on "continuous use of oral medications to control". Whether an anticoagulant taken only to prevent stroke meets that wording is unresolved. The words anticoagulant and blood thinner appear nowhere in 4.104, in the 2021 final rule, or in the M21-1 articles we read, and no Board decision we read construes the point; the two 10 percent decisions we read do not name the medication.

The 2023 ACC/AHA/ACCP/HRS guideline, in its full text, says that for AF above a stated stroke-risk level "anticoagulation is recommended to prevent stroke and systemic thromboembolism" (PMID 38033089). DC 7010's row says only "to control", and nothing we read says whether VA treats stroke prevention as use "to control". VA's manual has a continuous-medication rule for aspirin (M21-1 Part V, Subpart iii, Chapter 5, Block 2.c), written for the 10 percent continuous-medication criterion of the General Rating Formula. That rule requires that a medical professional advised the veteran to use aspirin "to reduce disability from the SC cardiovascular disorder or to prevent additional disability from that disorder". It does not mention DC 7010 or anticoagulants. We make no promise either way.

One evaluation for the rhythm codes

38 CFR 4.104: "For DCs 7009, 7010, 7011, and 7015, a single evaluation will be assigned under the diagnostic code that reflects the predominant disability picture." VA's manual gives the reason: "The impairment and disability resulting from one or more types of arrhythmia, evaluated under 38 CFR 4.104, DCs 7009-7011 and 7015, are essentially indistinguishable. Consequently, assignment of multiple evaluations under any of these DCs would be in violation of 38 CFR 4.14" (M21-1 Part V, Subpart iii, Chapter 5, Block 2.e).

The 2021 rule's preamble, which is commentary and not regulation text, calls "predominant disability picture" a term of art that "generally describes the disability that allows for the highest compensable evaluation." So AFib together with a slow rhythm needing a pacemaker, for example, gets one evaluation across those codes, not two.

Other heart disease alongside the AFib is a different rule

The single-evaluation sentence covers the four rhythm codes only. Heart disease rated under the General Rating Formula is handled differently, and that formula's Note (3) lists "arrhythmia, palpitations" among the heart failure symptoms it counts. For AFib alongside, say, coronary disease, VA's manual sets a case-by-case test: "consider whether the criteria for evaluating the disability and/or the symptoms of the disability are separate and distinct and apply 38 CFR 4.14 and any other condition-specific guidance." It continues: "When the evaluation criteria are separate and distinct, the symptoms do not overlap, and no specific prohibition applies, separate evaluations are warranted" (M21-1 Part V, Subpart iii, Chapter 5, Block 2.f).

How an AFib rating adds to a PTSD rating

Ratings are not added. 38 CFR 4.25(a) combines them through Table I, largest first, and converts the result "to the nearest number divisible by 10, and combined values ending in 5 will be adjusted upward." Under 4.25(b) that conversion "will be done only once per rating decision, will follow the combining of all disabilities, and will be the last procedure in determining the combined degree of disability."

The table below is scoped to a file where PTSD and AFib are the only two ratings. Read both directions: for a veteran at 70 percent for PTSD, a 10 percent AFib rating may change nothing in the combined number; at 30 or 50 percent it does, and a 30 percent AFib rating moves 70 to 80. With other ratings in the file, every rating is combined in order of severity using unrounded values, and the rounding comes once at the end, so these rows do not carry over.

Combined value under 38 CFR 4.25 Table I, where PTSD and AFib are your only two ratings

Combined value under 38 CFR 4.25 Table I, where PTSD and AFib are your only two ratings
PTSD rating	AFib rating	Table I value	Combined rating after rounding
70 percent	10 percent	73	70 percent (no change)
50 percent	10 percent	55	60 percent
30 percent	10 percent	37	40 percent
70 percent	30 percent	79	80 percent
50 percent	30 percent	65	70 percent

Cells read from Table I in 38 CFR 4.25 as published in the eCFR issue of August 27, 2026. 55 and 65 end in 5 and are adjusted upward under 4.25(a).

Table diagram with no people, titled what an AFib rating adds, where PTSD and AFib are your only two ratings, 38 CFR 4.25 Table I. Five rows, each showing the PTSD rating, the AFib rating, the Table I value and the combined rating after rounding: 70 and 10 give 73, rounded to 70, marked no change; 50 and 10 give 55, rounded to 60; 30 and 10 give 37, rounded to 40; 70 and 30 give 79, rounded to 80; 50 and 30 give 65, rounded to 70. A footer reads: rounding to the nearest 10 happens once, after every rating is combined; with other ratings in the file, these rows do not carry over. — The same five pairs, scoped to a file with only these two ratings.

The combined percentage is not the only thing a rating can reach. In A26009895 (2026) the Board kept the AFib at 10 percent and granted a total rating based on individual unemployability, finding that "the Veteran's service-connected atrial fibrillation, by itself, has rendered him unemployable" on a treating VA physician's opinion. That veteran's service-connected disabilities combined to 90 percent, including PTSD at 50 and sleep apnea at 50, and the Board also granted special monthly compensation under subsection (s) because he was "unemployable solely due to his service-connected atrial fibrillation and the remainder of his service-connected disabilities are ratable at 60 percent or more." That decision is non-precedential under 38 CFR 20.1303; it shows that a 10 percent row does not by itself decide everything a veteran receives.

The full DC 7010 and DC 7011 walk-through, with the rating estimator, is on our arrhythmia and AFib page.

What Board Decisions on AFib and PTSD Show

We read 54 Board decision files for this page and rely on 24 of them, each read at its ORDER block and the analysis behind it. The 22 below decided an AFib question; two more (1214416 and 18147996) appear elsewhere on this page, each for the narrow point it supports. On the AFib-and-PTSD question itself, 19 decisions: 6 granted service connection, on the different bases each entry sets out, 5 denied it and 8 sent it back for a new or better opinion. That is a convenience sample, drawn from one page of one Board search plus web searches, so those counts are not grant rates and predict nothing.

Under 38 CFR 20.1303, "previously issued Board decisions will be considered binding only with regard to the specific case decided." The rule goes on: "each case presented to the Board will be decided on the basis of the individual facts of the case in light of applicable procedure and substantive law." Each entry below is described only for the issue it decided.

Service connection granted

Citation Nr A26026116 (decided March 24, 2026)

Granted: service connection for atrial fibrillation as secondary to service-connected PTSD, and obstructive sleep apnea as secondary to PTSD, in the same decision.

An October 2025 private opinion cited literature on proposed pathways ("chronic inflammation, persistent sympathetic nervous system activation, and unhealthy lifestyle factors like poor diet or smoking") and concluded the AFib "fits the sequence of causation by PTSD" (the Board's summary of the opinion; the decision does not quote the clinician). The Board gave it probative weight because it was "based on a review of the claims file and consideration of the Veteran's statements." No VA opinion addressed the secondary theory, and the Board found a remand for one was not warranted.

Why it matters. A private opinion carried this claim, but it was uncontradicted: the Board did not weigh it against a negative VA opinion, because none existed on that theory.