Filing a Claim for PTSD: The Basics

This article provides a brief overview of the PTSD claims 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:

1. A current diagnosis of PTSD by a medical professional.
2. A corroborated in-service stressor.
3. 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, 5th Edition (commonly referred to as the “DSM-V”). The veteran may not rely on a self-diagnosis, or the fact that his friends, family, co-workers, or fellow veterans believe that he exhibits symptoms consistent with PTSD.

It is important that the diagnosis be made by a qualified healthcare professional, such as a psychiatrist, psychologist, or other licensed mental health professional who is trained to assess and diagnose mental health disorders.

This medical diagnosis must clearly document the presence of PTSD symptoms, which can include severe anxiety, flashbacks, nightmares, avoidance behaviors, hypervigilance, and difficulties with personal relationships and daily functioning.

The diagnosis must reflect the current severity of the condition, as the VA bases its disability rating on how much the PTSD symptoms impair the veteran’s occupational and social functioning. Detailed medical records supporting the diagnosis are essential in establishing this element of the claim. These records may include clinical evaluations, therapy notes, and standardized assessment tools like the Disability Benefits Questionnaire (DBQ) used during VA examinations.

Veterans should ensure that their medical evidence is thorough and up-to-date to demonstrate the ongoing impact of PTSD on their lives. Without a current and competent diagnosis meeting the VA’s criteria, the claim for VA disability compensation is unlikely to succeed.

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.

This crucial element, often referred to as the “nexus,” requires thorough documentation from qualified medical professionals who can provide a clear and convincing opinion that the PTSD symptoms are connected to the in-service stressor. The medical evidence should explain how the veteran’s military experience contributed to or caused the current psychiatric disorder.

Establishing this link can sometimes be challenging, especially if the veteran has multiple traumatic experiences or if the symptoms began or worsened after leaving military service. In such cases, detailed medical opinions, supported by clinical evaluations and psychological assessments, become vital to demonstrate the service connection.

Furthermore, the VA may require the veteran to undergo a Compensation and Pension (C&P) examination, where a VA-appointed mental health professional evaluates the veteran’s condition and provides an expert opinion on the connection between the PTSD and the in-service stressor. This examination plays a significant role in the VA’s decision-making process.

Without sufficient medical evidence linking the PTSD diagnosis to the claimed in-service stressor, the VA is likely to deny the claim due to insufficient evidence of a service-connected disability. Therefore, veterans are encouraged to seek assistance from qualified healthcare providers and veteran service organizations to obtain thorough supporting documentation and strengthen their claims.

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 C&P exam is a critical step in the VA disability claim process for PTSD. During this exam, a VA-appointed mental health professional will assess the veteran’s current mental health status, focusing on the presence and severity of PTSD symptoms. The examiner will evaluate how these symptoms affect the veteran’s daily life, including social interactions, occupational functioning, and personal relationships.

Veterans should be prepared to discuss their symptoms openly and honestly during the C&P exam. It is important to provide detailed descriptions of how PTSD impacts their everyday activities, such as difficulties with concentration, sleep disturbances, panic attacks, or avoidance behaviors. Being candid about the challenges faced can help ensure the examiner has a full understanding of the veteran’s condition.

It is also crucial for veterans to bring any relevant medical records, personal statements, or buddy statements to the exam, as these documents can support the evaluation. Buddy statements, which are written accounts from fellow service members who witnessed the in-service stressor or observed the veteran’s symptoms, can be particularly valuable in corroborating the claim.

While the C&P exam can be stressful, veterans should remember that the examiner’s role is to gather accurate information to determine the appropriate disability rating. Preparing in advance, understanding the purpose of the exam, and seeking support from veterans service organizations or legal representatives can help veterans navigate this important phase of the claims process more confidently.

In some cases, veterans may be asked to undergo additional examinations or evaluations if the initial C&P exam does not provide sufficient information. Persistence and thorough documentation remain key to achieving a successful VA disability claim for PTSD.

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, Travis James West, and other legal professionals at West & Dunn, a law firm dedicated to providing quality legal services and business counseling to individuals and businesses, with a particular focus on assisting the veterans.