When Military Experience Creates Lasting Anxiety

You’ve been out of the military for years, but you still can’t relax. You worry excessively about things that others brush off. Your heart races in crowds. You avoid situations that feel unpredictable. You might think this is just “who you are now,” but these symptoms may represent a diagnosable anxiety disorder connected to your military service. Unlike PTSD, which is widely recognized in veteran populations, anxiety disorders are often overlooked or misdiagnosed—yet they’re equally valid conditions for VA disability claims.

This article explains anxiety disorders from a psychiatrist’s perspective: the different types, how military service causes or contributes to anxiety conditions, and the complex diagnostic challenge of differentiating service-connected anxiety from PTSD-related anxiety.

Types of Anxiety Disorders in Veterans

Anxiety disorders are a family of conditions characterized by excessive fear, worry, and related behavioral disturbances. The DSM-5 recognizes several distinct anxiety disorders, each with specific diagnostic criteria.

1. Generalized Anxiety Disorder (GAD)

Core Features:

• Excessive worry about multiple topics (work, health, family, finances)
• Difficulty controlling the worry
• Present more days than not for at least 6 months
• Associated with restlessness, fatigue, concentration difficulty, irritability, muscle tension, or sleep disturbance

In Veterans: GAD often develops from the chronic unpredictability and hypervigilance required during military service. The “always on alert” mentality doesn’t turn off after discharge, transforming into pervasive, uncontrollable worry.

2. Panic Disorder

Core Features:

• Recurrent unexpected panic attacks (sudden surges of intense fear)
• Physical symptoms: palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness
• Persistent worry about having another panic attack
• Behavioral changes to avoid panic triggers

In Veterans: Panic attacks can be triggered by reminders of service trauma (crowded spaces reminiscent of combat zones, loud noises) or develop independently from chronic stress exposure during service.

3. Social Anxiety Disorder (Social Phobia)

Core Features:

• Intense fear of social situations where one might be judged or scrutinized
• Fear of embarrassment or humiliation
• Avoidance of social situations or enduring them with intense distress
• Disproportionate to the actual threat

In Veterans: Veterans may develop social anxiety after service due to difficulty relating to civilians, fear of being asked about service experiences, or concern about displaying emotional reactions in public.

4. Specific Phobias

Core Features:

• Intense, irrational fear of specific objects or situations
• Common phobias: heights, enclosed spaces, flying, blood, animals
• Avoidance or intense distress when encountering the phobic stimulus

In Veterans: Specific phobias may develop from traumatic in-service experiences (fear of confined spaces after being trapped in a vehicle, fear of heights after a fall during training).

5. Agoraphobia

Core Features:

• Fear of situations where escape might be difficult or help unavailable
• Common triggers: public transportation, open spaces, enclosed spaces, crowds, being outside the home alone
• Avoidance of these situations

In Veterans: Agoraphobia can develop secondary to PTSD or panic disorder, with veterans avoiding situations that feel unsafe or overwhelming.

Service-Connected vs. Non-Service-Connected Anxiety

To establish service connection for an anxiety disorder, you must prove the condition is related to military service. This can occur through several pathways:

Pathway 1: Direct Service Connection

The anxiety disorder developed during service or shortly after due to service experiences:

• Combat exposure causing hypervigilance that persists as GAD
• Military sexual trauma leading to social anxiety and fear of situations reminiscent of the assault
• Near-death experiences during training causing panic attacks
• Deployment stress and chronic unpredictability leading to generalized anxiety

Pathway 2: Secondary Service Connection

The anxiety disorder was caused by another service-connected condition:

• Anxiety secondary to PTSD (hyperarousal manifesting as GAD)
• Anxiety secondary to TBI (neurological damage causing anxiety symptoms)
• Anxiety secondary to chronic pain (worry about pain flares, functional limitations)

Pathway 3: Aggravation of Pre-Existing Condition

You had mild anxiety before service, but military experience significantly worsened it:

• Pre-service mild social anxiety becoming severe and disabling after military sexual trauma
• Pre-service panic attacks becoming more frequent and severe during combat deployments

For aggravation claims, medical evidence must show the condition worsened beyond natural progression.

What Does NOT Qualify:

• Anxiety that developed years after service with no connection to service experiences or service-connected conditions
• Anxiety caused entirely by post-service civilian life events (divorce, job loss, civilian trauma)

Generalized Anxiety vs. PTSD-Related Anxiety: Differentiating the Conditions

This is where diagnostic complexity arises. PTSD includes hyperarousal symptoms (hypervigilance, exaggerated startle, difficulty concentrating) that look very similar to generalized anxiety. How does a psychiatrist differentiate them?

Key Diagnostic Distinctions:

1. Trauma Specificity

• PTSD: Anxiety symptoms are specifically tied to trauma reminders. The veteran is hypervigilant for threats related to their traumatic experience.
• GAD: Worry and anxiety are not trauma-specific. The veteran worries about everyday concerns (health, finances, family safety) unrelated to the original trauma.

2. Re-Experiencing Symptoms

• PTSD: Includes intrusive memories, nightmares, flashbacks of the trauma.
• GAD: Does not include re-experiencing. Anxiety is about future concerns, not past trauma reliving.

3. Avoidance Patterns

• PTSD: Avoidance is specific to trauma reminders (avoiding crowds because they trigger combat memories).
• GAD: Avoidance is based on diffuse worry (avoiding social events due to general anxiety, not trauma triggers).

4. Nature of the Fear

• PTSD: Fear is based on past traumatic events and their recurrence.
• GAD: Worry is about potential future negative events that may never happen.

Clinical Reality: Veterans can have both PTSD and a comorbid anxiety disorder. Alternatively, what appears to be GAD may actually be hyperarousal symptoms of PTSD. This is why expert psychiatric evaluation is critical for accurate diagnosis and appropriate VA claims.

Read more about PTSD diagnostic criteria

How IMOs Differentiate Anxiety Conditions

An Independent Medical Opinion from a board-certified psychiatrist provides the diagnostic clarity VA claims require. Here’s how expert evaluations differentiate anxiety presentations:

1. Comprehensive Symptom Review

The psychiatrist systematically evaluates all anxiety symptoms and PTSD criteria to determine which diagnosis (or diagnoses) best fit the clinical picture.

Questions the psychiatrist considers:

• Are intrusive memories or nightmares present? (PTSD)
• Is worry trauma-specific or generalized? (PTSD vs. GAD)
• Do panic attacks occur randomly or in response to trauma triggers? (Panic Disorder vs. PTSD)
• Is social avoidance due to fear of judgment or trauma reminders? (Social Anxiety vs. PTSD)

2. Timeline Analysis

When did anxiety symptoms begin? Did they start during service, immediately after trauma exposure, or years later? The temporal relationship helps establish causation.

Example Timeline Supporting Service Connection:

• 2008-2010: Infantry deployment to Afghanistan, combat exposure
• 2011: Veteran reports starting to feel “on edge” constantly, difficulty sleeping
• 2013: First panic attack in crowded mall
• 2015-2025: Progressive worsening of anxiety symptoms, avoidance of crowds, persistent worry

This timeline shows anxiety developing shortly after combat service and worsening over time—supporting service connection.

3. Functional Impairment Assessment

The IMO addresses how anxiety symptoms impair occupational and social functioning, which determines VA rating severity:

• Can the veteran maintain employment?
• Are relationships affected?
• Does the veteran avoid situations necessary for daily life?
• How severe is the distress?

4. Nexus Opinion with Medical Rationale

The psychiatrist provides a clear opinion linking the anxiety disorder to service:

“Based on comprehensive review of the veteran’s service records documenting deployment to a combat zone, clinical interview revealing symptoms meeting DSM-5 criteria for generalized anxiety disorder, and timeline showing symptom onset shortly after service, it is my opinion to a reasonable degree of medical certainty (greater than 50% probability) that the veteran’s GAD is at least as likely as not caused by the chronic stress and hypervigilance required during combat deployment. The medical literature supports that prolonged combat exposure can lead to persistent anxiety states beyond PTSD. The veteran’s symptoms—excessive worry, hypervigilance, difficulty relaxing—represent a continuation of the threat-detection system that was adaptive during deployment but has become maladaptive in civilian life.”

Key Takeaways

• Anxiety disorders in veterans include GAD, panic disorder, social anxiety, specific phobias, and agoraphobia, each with distinct diagnostic criteria.
• Service connection can be primary (caused by service) or secondary (caused by another service-connected condition).
• Differentiating PTSD-related anxiety from independent anxiety disorders requires expert psychiatric evaluation examining trauma-specificity, re-experiencing symptoms, and avoidance patterns.
• Veterans can have both PTSD and comorbid anxiety disorders, qualifying for separate ratings for each condition.
• Independent Medical Opinions provide the diagnostic clarity and nexus evidence VA claims require, especially for complex presentations.

How VetNexusMD Can Help

Dr. Ronald Lee specializes in psychiatric evaluations for anxiety disorder claims. As a board-certified psychiatrist, Dr. Lee provides comprehensive diagnostic assessments that differentiate anxiety disorders from PTSD, establish service connection, and address VA rating criteria.

Dr. Lee’s Independent Medical Opinions include:

• DSM-5 diagnostic evaluation for anxiety disorders
• Differential diagnosis distinguishing anxiety from PTSD or comorbid conditions
• Timeline analysis linking anxiety onset to service experiences
• Medical rationale citing neuroscience and psychiatric literature
• Clear “at least as likely as not” nexus statements
• Functional impairment analysis for VA rating purposes

Whether you’re filing a primary anxiety claim, secondary claim, or appealing a denial, Dr. Lee’s expertise ensures your evaluation meets the highest clinical and legal standards.

Learn more about psychiatric Independent Medical Opinions or request a consultation today.

Frequently Asked Questions

Can I have both PTSD and an anxiety disorder?
Yes. PTSD and anxiety disorders (like GAD or panic disorder) are distinct diagnoses and can co-occur. If both are service-connected, you may receive separate ratings for each condition, or they may be rated together depending on symptom overlap. A psychiatrist can determine the appropriate diagnostic formulation.

What if my anxiety disorder wasn’t diagnosed until years after service?
Delayed diagnosis doesn’t prevent service connection. Many veterans don’t seek mental health treatment for years after discharge. A psychiatric IMO can establish that symptoms began during or shortly after service even if formal diagnosis came later, using your account of symptom timeline and any available contemporaneous evidence.

Do I need to be in treatment to file an anxiety disorder claim?
No, but treatment records documenting symptoms strengthen your claim. If you haven’t sought treatment, a comprehensive Independent Medical Opinion becomes critical to document current symptoms and establish diagnosis.

What if the VA examiner said my anxiety is “just part of PTSD”?
This is a common issue. If the examiner concluded your anxiety symptoms are subsumed under your PTSD diagnosis, you can submit an Independent Medical Opinion from a psychiatrist arguing that your symptoms meet criteria for a separate anxiety disorder. The VA must consider this evidence.

Can anxiety be secondary to physical conditions like chronic pain or TBI?
Absolutely. Chronic pain frequently causes anxiety about pain flares and functional limitations. TBI can cause anxiety through neurological damage to brain regions regulating fear and worry. These are valid secondary service connection claims requiring medical nexus evidence.

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VetNexusMD provides Independent Medical Opinions for VA disability claims. We do not provide psychiatric treatment or establish doctor-patient treatment relationships. For mental health treatment, please contact the VA or a licensed mental health provider.