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How is a PTSD Claim Initiated?
According to the United States Department of Veterans Affairs, 11-20% of soldiers who served in Iraq and Afghanistan are living with Post Traumatic Stress Disorder. To establish service connection for any disability, the veteran must prove the following elements:
- A current disability
- An event, injury, or disease that occurred during service, and
- A causal relationship between the event in service and the current disability
Additional information is needed to establish service connection for PTSD, such as:
- A clinical diagnosis of PTSD under the standards of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.
- Proof of an in-service stressor.
- Medical evidence linking the in-service stressor and the diagnosis of PTSD.
How are In-Service Stressors Verified?
Submitting a PTSD claim involves proving the link between a significant in-service stressor event and the resulting PTSD. The three most common types of stressors are:
- Combat or fear of hostile military activity while serving in a combat zone
- Military sexual trauma (MST) claims and personal assault claims, and
- Non-combat-related stressors such as car accidents, natural disasters, or training accidents
In-service stressors typically do not need to be verified in cases where the veteran feared hostile military or terrorist activity. However, non-combat and other in-service personal assault claims require supporting evidence of the claimed stressor. Evidence to support these claims may be found through the following means:
- Service personnel records
- Pay and hazard pay records
- Military occupation evidence
- Military performance reports
- Buddy statements
- Unit and organizational histories
- War diaries
- Monthly summaries
The requirement for corroborating evidence is waived in the following situations:
- PTSD was diagnosed in service
- The stressor event occurred during combat with hostile forces
- The stressor event was related to the veteran’s fear of an actual threat of hostile military or terrorist act
- The stressor event was related to the veteran’s time spent as a prisoner of war
Why are PTSD Claims Denied?
While every PTSD case is different, there are certain basic reasons why these claims are typically denied, such as:
- Insufficient evidence: This is one of the most common reasons for claim denial, as supporting evidence of an in-service stressor is required.
- Missing records: The VA may deny a claim without the proper records, such as a veteran’s service record.
- Submitting the wrong forms: Veterans must complete the appropriate forms for VA disability. For a PTSD claim, veterans should submit the appropriate claims form (VA Form 21-526 for the first claim for PTSD, or VA Form 21-0995, 21-0996, or an appeal to the Board following a denial. VA will also request that the veteran complete VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD.
How Much Compensation Are PTSD Claims Worth?
Once an in-service stressor has been identified, the VA will assign a disability rating. If the disabled veteran’s rating is 10% or higher, the VA will pay disability compensation. Disability ratings are assigned based on the severity, frequency, and duration of symptoms.
A veteran may qualify for benefits at a 100% rating level if he or she cannot maintain substantially gainful employment. This is known as Total Disability Based on Individual Unemployability, or TDIU, due to service-connected disabilities.
VA mental health disability claims are rated as follows:
General Rating Formula for Mental Disorders
| Rating | |
| Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. | 100 |
| Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. | 70 |
| Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. | 50 |
| Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). | 30 |
| Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. | 10 |
| A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. | 0 |
What to Do After a PTSD Claim Denial?
If a PTSD claim was denied or received a disability rating that was lower than expected, there are options for continuing to pursue an approved claim, such as:
- File a supplemental claim: This will offer new or additional evidence that supports the case.
- Request a higher-level review: This will determine whether an error or difference of opinion will change the decisions. This choice does not allow for additional or new evidence; it only requires a senior reviewer to reevaluate the claim.
- Board of Veterans’’ Appeal: Initiating the Board of Veterans’’ Appeal process allows the veteran to appeal to a Veterans’’ Law Judge in Washington, D.C., for a further review of the case. The veteran can request a direct review, submit additional evidence, or petition for a hearing.
An experienced attorney will be able to help ensure that the best option is chosen given a case’s unique circumstances.
How Can I Increase My Chances for a Successful Appeal?
There are a few steps for appealing a PTSD disability claim that may be beneficial:
- Know the dates of the appeal: Applicants are only allowed one year to file an appeal from the denial date.
- Consider why the claim may have been denied
- Strengthen the medical evidence
- File appropriate paperwork
Do I Need an Attorney?
The VA disability claim process is a confusing one. For the best chances of success, call our attorneys who know the law and can use it to your favor. Call us today at 608-490-9449 or fill out a contact form for a free consultation.
