Post-Traumatic Stress Disorder (PTSD) is a topic frequently discussed when it comes to VA Disability Claims. PTSD is a mental health condition triggered by a traumatic event (otherwise known as a stressor) in an individual’s life.
PTSD claims can complicate the already confusing and murky VA claims process. While there have been regulations passed in the past, a Veteran with a PTSD claim will face various unique challenges. We have created a helpful guide to help you understand how to build and file your PTSD claim.
The Three Requirements That Make Up a PTSD Claim
Three requirements make up a PTSD claim. Providing adequate information on these three requirements is vital to receiving a PTSD claim.
The three requirements are:
- A current diagnosis of PTSD
- Evidence of a stressor in-service
- A medical nexus opinion linking the current diagnosis to the in-service stressor
A Current Diagnosis of PTSD
This is the first and most obvious step in receiving VA benefits for PTSD. A psychiatrist, psychologist, or licensed medical professional must diagnose that the Veteran is currently suffering from disabling PTSD. Statements regarding a veteran’s PTSD from counselors, social workers, or other therapists that are not medical doctors will not be considered a diagnosis of PTSD by the VA.
According to the DSM-5, this diagnosis must conform to 8 different criteria :
1) A stressor (at least one).
The person exposed to death, threatened death, actual or threatened serious injury, actual or threatened sexual violence. The stressor can be direct, witnessed in person, indirect through a close relative or friend, or repeated extreme exposure to details of the event through professional duties. However, indirect non-professional exposure (i.e., television, movies, etc.) is not included.
2) Intrusion symptoms associated with the stressor.
These include one or more of the following:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
- Recurrent distressing dreams that refer to the traumatic event(s)
- Dissociative reactions (i.e., flashbacks), in which the individual feels or acts as if the traumatic event(s) were recurring
- Intense or prolonged psychological distress to symbolic cues that resemble something from the traumatic experience(s)
- Marked psychological reactions to symbolic cues that resemble something from the traumatic experience(s)
3) Avoidance symptoms associated with the stressor.
The Veteran must demonstrate one of the following:
- Avoidance of or effort to avoid distressing memories, thoughts, or feelings about the traumatic event(s)
- Avoidance of or effort to avoid external reminders (people, places, conversations, things, situations) that arouse distressing memories, thoughts, or feelings
4) Negative alterations with cognition and mood regarding stressors.
A Veteran must exhibit at least two of the following:
- Inability to recall features of the traumatic event (dissociative amnesia that is not induced by substances or injury)
- Persistent negative beliefs and expectations about self or the world
- Persistent distorted blame of self or others for the traumatic event
- Persistent negative trauma-related emotions
- Markedly diminished interest in pre-trauma activities
- Feels alienation from others
- Constricted affect (inability to experience positive emotions)
5) Alterations in arousal and reactivity are associated with the stressor.
The Veteran must demonstrate at least two of the following:
- Irritable or aggressive behaviors
- Self-destructive or reckless behavior
- Exaggerated startle response
- Problems with concentration
- Sleep disturbance
6) Duration of the disturbance of symptoms (from criteria 2, 3, 4, and 5).
Evidence must demonstrate that these symptoms have lasted at least one month.
7) Functional impairment.
Veterans must demonstrate that disturbances listed in the 6th criterion caused significant distress or social impairment.
8) The disturbance is not attributable to the physiological effects of substances (i.e., medication, drugs, alcohol, other medical conditions, etc.)
Dissociative symptoms must be one of the following:
- Depersonalization: feeling detached, as if they were an outside observer
- Derealization: the world is “dream-like” or distant
It is important that the diagnosing doctor fully describes why they feel the Veteran has PTSD and how the symptoms meet the specific criteria. All of this medical evidence must show that it is “as likely as not” that the Veteran currently has disabling PTSD.
One of the challenges with a PTSD claim is getting a service connection. PTSD is not presumed to be service-related, so a Veteran will need to have more than just a current diagnosis. Without evidence of an in-service stressor, a Veteran will not be able to win their claim.
The VA requires “credible supporting evidence that the claimed in-service stressor occurred.”
This does not mean that the Veteran must have engaged in combat. Any traumatic event that satisfies the diagnostic criteria mentioned above can be a sufficient stressor.
However, there are different rules for combat vs. non-combat events.
If a Veteran can show that they were in combat, then a statement may be all that is needed to prove an in-service stressor. Records that may help prove combat experience include:
- Veteran’s DD214
- Certain medals and awards received
- Unit records showing the date and location of unit assignment
If a Veteran did not engage in combat, they must provide more evidence besides a statement. Sometimes a service record or documents listed above can help support a claim. Still, other sources that include details about the people involved, dates, location, and a description of the event should be included if possible. Examples may include:
- Statements from fellow Veterans that served with them
- Statements from family or friends who knew them before and after service
There are also a few additional exceptions where the Veteran does not need to prove that the stressor occurred. These instances include:
- Receiving a diagnosis of PTSD while in-service
- The stressor event occurred while the Veteran was engaged in combat with the enemy
- The stressor event was related to fear of hostile military or terrorist activities
- Must have a VA psychiatrist or psychologist confirm that the stressor is sufficient enough to support a diagnosis of PTSD
For VA purposes, fear of hostile military or terrorist activity means that a Veteran experienced, witnessed or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, such as from:
- An actual or potential improvised explosive device
- Vehicle-embedded explosive device
- Incoming artillery, rocket, or mortar fire
- Small arms fire, including suspected sniper fire
- An attack upon friendly military aircraft
The VA’s Duty to Assist
The VA must “make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claim for a benefit under a law administered by the Secretary.” This duty is called the duty to assist and requires the VA to assist in obtaining relevant records and obtaining medical examinations or medical opinions.
This requires the VA to get records such as:
- Service personnel records
- Service medical records
- VA medical records
- Private medical records relevant to claim
Suppose the VA receives a PTSD claim, and the file does not confirm the in-service stressor. In that case, they will ask the Veteran to provide details regarding the claimed stressor event, such as:
- A stressor/incident that can be documented
- The location where the incident took place
- The approximate date (within a two-month period) of the incident and
- The unit of assignment at the time the stressor/incident occurred
Why might the necessary records not be in official documentation? Perhaps the Veteran suffered from personal assault, or there was a traumatic incident in their personal life (i.e., loss of a spouse/significant other, child, or close friend). It is important to remember that the requirement for service connection is that the event “occurred in service” and not specifically that the stressor is service-related.
When there is not enough evidence to corroborate the claimed PTSD stressor, the VA will make a formal finding that there was lack of sufficient information to document the occurrence of the stressful event. This formal finding must include the following information:
- The actions are taken to acquire the information
- All procedures for developing evidence of the claimed stressor were properly followed
- Evidence of all efforts to obtain evidence is in the claims file
- An explanation saying further efforts to obtain evidence would be futile
- A statement that the information needed to document the stressor is unavailable
If the VA does not fulfill its duty to assist, don’t give up! Suppose a claim is later reopened and granted. In that case, a Veteran may be entitled to get benefits back to the initial claim that was denied based on lack of evidence of an in-service stressor.
A Medical Nexus Opinion
A nexus is a link between the Veterans’ current PTSD diagnosis and their in-service stressor. The current diagnosis must be related to their in-service stressor.
The nexus must be proven by medical evidence, such as an opinion by a qualified doctor. Another great option for establishing a nexus is through records from a Vet Center. Vet Centers have licensed social workers that will take the time to document the connection between the Veterans’ stressor and their current diagnosis.
Obtaining Correct Compensation
Once a Veteran establishes a service connection for their PTSD claim, the battle isn’t over. It is important to make sure the VA gives them the correct compensation.
Compensation is based on the disability rating that is assigned to the Veteran. The rating is based on how severe the Veteran’s PTSD symptoms are.
Because these ratings are based on symptoms, medical documentation is crucial. It is important to have records documenting symptoms and their effects on the veteran’s life.
A Veteran will use a Compensation and Pension (C&P) Exam to help them determine an appropriate rating. The Veteran should review the PTSD rating criteria (as listed above) and discuss it with family and friends. This will allow them to ensure the C&P examiner can get as much information as possible and provide an accurate report.
It is also recommended to seek a second opinion if you have the means to do so. While regulations state that a VA psychiatrist/psychologist has to confirm that a stressor is adequate to support PTSD, the VA is required to consider medical opinions of qualified experts outside of the VA. You can always obtain a second opinion if a C&P examiner provides insufficient information.
This is your case and your benefits. It is important to fight for your cause and obtain the benefits you deserve for serving our country.
Most importantly, remember that no matter what happens with your claim, it is vital that you seek help to deal with your symptoms. PTSD is one of the leading causes of suicide among Veterans and seeking help will reduce the risk of suicide. If you are experiencing thoughts of harming yourself or others, please call 911 immediately. Other resources available for Veterans include:
- 911 or go to the nearest emergency room;
- Veterans Crisis Line – 1-800-273-8255 and press 1 or text 838255;
- Wounded Warrior Project
- The Soldier Project has a list of resources including homeless programs, financial assistance for medications, therapy programs, and support groups.
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