VA PTSD Claims: The Basis
As a former rating specialist for the US Department of Veterans Affairs, I can tell you first hand that a claim for PTSD is one of the most complicated and time consuming claims the VA handles. As a result -- an unfortunate result -- many veterans wait years for decisions on these claims. This article provides a brief overview of the process in the hope that veterans will be equipped to better understand the process and deal with its challenges.
To obtain a disability rating for PTSD, a veteran must demonstrate three elements:
A current diagnosis of PTSD by a medical professional.
A corroborated in-service stressor.
Medical evidence linking the PTSD diagnosis to the claimed stressor.
The First Element: Medical Diagnosis of PTSD
To obtain a rating for PTSD, the veteran must first establish that he currently suffers from Post Traumatic Stress Disorder. VA disability benefits are intended to compensate present conditions and disabilities. The VA will not award compensation if the veteran was diagnosed with PTSD in the past, but does not presently suffer from the condition. Similarly, the VA will not award benefits to someone because they may be predisposed to developing PTSD in the future. The veteran must suffer from a present condition.
Additionally, this element requires that a competent medical professional diagnose the condition using the criteria established in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (commonly referred to as the “DSM-IV”). The veteran may not rely a self-diagnosis, or the fact that his friends, family, co-workers, or fellow veterans believe that he exhibits symptoms consistent with PTSD.
The Second Element: An In-service Stressor
In addition to obtaining a current diagnosis of PTSD from a qualified medical professional, the veteran must also show that he or she suffered from an in-service stressor. If the veteran’s claimed stressor is related to an event for which he or she received a combat medal, then the VA will deem that it is sufficient if the claimed stressor is consistent with the nature and circumstances of combat service.
However, many veterans suffer from stressors not associated with an incident for which a combat medal was awarded. When that happens, the VA will request that the veteran provide a detailed account of the claimed stressor. The VA will generally ask for as much detail of the event as possible. The number and types of questions may vary, but here is a brief list of some of the most common examples.
The date of the event (within a two month time frame).
The veteran’s unit designation at the time of the event.
The names and contact information of other service members who witnessed the event.
The names and unit designations of anyone who was killed in the event
Whether a report of the incident was filed and, if so, by which unit.
Whether treatment for any wounds suffered in the event was sought, if so, at what medical facility.
If treated at a field dispensary, to which unit was it attached.
Whether any military equipment was lost or damaged in the event, if so, to which unit was it attached.
Many veterans are surprised, and sometimes insulted, by the amount of information requested. The VA’s insistence on receiving this information becomes more understandable when the veteran realizes some of the obstacles that the rating specialist must overcome. Frequently the incident occurred years, sometimes decades, before the veteran filed the claim. Compounding this issue, the VA does not automatically have access to all of the records maintained by the Department of Defense or National Archives. This assumes that someone recorded the incident in a formal record at all. Over time many records have been lost, and until recently neither the VA nor DOD maintained records in more easily accessible electronic format. Further, a large number of VA employees never served in the military, and are unfamiliar with both the rigors of combat as well as the everyday life of a soldier, sailor, airman, or marine.
The questions asked by the VA’s employees are designed to enable the regional office to corroborate the claimed stressor via information from the Joint Services Records Research Center (“JSRRC”). JSRRC will not accept a request for records research that doesn’t include very specific information. If the veteran fails to provide sufficient information to make a request to JSRRC, and has not supplied enough information of his own to corroborate the stressor, the claim will be denied. If the regional office is able to make a request to JSRRC, the veteran waits. And waits. And waits. JSRRC commonly takes six months or more to respond.
The Third Element: Medical Evidence Linking the Diagnosis and Stressor
To obtain a rating from the VA for PTSD, it is not enough for the veteran to show that he or she currently suffers from PTSD. It is also not enough to demonstrate the existence of an in-service stressor. The veteran must also demonstrate that the PTSD is caused (or linked) to the stressor. For example, a veteran may have experienced combat during service, and never suffered any mental health consequences from the experience. However, at some point after service, the veteran suffered a traumatic event in his civilian life that caused him to suffer PTSD. If the veteran’s mental health condition is determined to be medically linked to the event occurring after service, rather than to an event occurring service, the claim will be denied.
The Compensation and Pension Examination
The VA recognizes that many veterans may not have access to private mental health treatment. Accordingly, in most instances the VA will provide a veteran with a mental health examination at no cost. This examination, called a compensation and pension examination (or a “C&P exam” for short) will generally not be provided until after the veteran establishes sufficient evidence of an in-service stressor. Accordingly, the veteran will be well served to do everything in his or her power to provide the VA with as much evidence of the in-service stressor as possible, including the information that the VA will need to corroborate the event.
The Home Stretch: Rating the Evidence
If the examination provides enough information for the claim to be rated (either granted or denied), then the claim will be assigned to a rating specialist. Sometimes the rating specialist is able to address the veteran’s file in a reasonably efficient amount of time. More often than not, however, the specialist is managing a caseload of hundreds of other claims as well, which may mean that the veteran will need to wait until the specialist has an opportunity to address the claim. Once the specialist has completed the rating, the file will be sent to the authorization team, where again, it will wait for processing. After the authorization team has approved the rating, the VA will issue a letter granting or denying benefits to the veteran.
In recent years the VA has undertaken steps to attempt to reduce some of the delays in the claims process. The efforts have resulted in mixed success. Some regional offices now move faster than others. Some stages of the process now move faster than others. However, to date the VA has been unable to implement a cure to resolve many of these issues -- and complicated claims such as those involving PTSD remain challenging and lengthy. Notwithstanding these challenges, veterans should be aware that there are lots of resources, veterans service officers, and attorneys who stand ready to assist them.
This article is authored through the collaborative efforts of Shana Dunn and other legal professionals at West & Dunn, a law firm dedicated to providing high quality legal services to individuals and businesses, with a particular focus on assisting veterans of the United States Armed Forces. If you have questions or would like assistance with your VA claim, the attorneys at West & Dunn can be reached at 608-535-6420.