Eventually a veteran will receive a rating decision from the VA which will state whether his or her PTSD has been determined to be service connected, and if so, what the rating is. The veteran may also be awarded or denied TDIU (see Part Five). At this point, the veteran will need to decide whether or not to appeal all or parts of the decision. The veteran has one year from the date on the notice letter accompanying the rating decision to file a Notice of Disagreement (NOD). After the VA receives the NOD, it will send the veteran a Statement of the Case (SOC). The veteran has 60 days from the date on the notice letter accompanying the SOC in order to file VA Form 9, which is the formal appeal to the Board of Veteran Affairs.
For a denial of service connection, the veteran will need to determine where the problem is. Is it the initial diagnosis of PTSD, the stressor, or the nexus? If the problem is the initial diagnosis, for instance, if the C&P examiner did not diagnosis the veteran with PTSD, the veteran should seek another opinion from an expert in diagnosing PTSD. An independent medical examination (IME) is a valuable resource for a veteran during the appeal process. The IME should clearly lay out the diagnosis of PTSD and the stressor, and also include a nexus statement that provides it is at least as likely as not that the current diagnosis of PTSD is related to the stressor. It is also recommended that the IME use language straight out of the regulations, such as “gross impairment in thought processes or communication” or “near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively” so that the VA does not have to guess where the veteran falls on the rating chart. The veteran should also attempt to gather more corroborative evidence of the stressor, if possible. This could be from additional service records that may not have been part of the initial claim file, or even lay statements from family and friends. Any additional information that the veteran can provide to a doctor conducting an IME and to the VA will help during the appeal process.
Even if service connection has been granted for PTSD, the VA might have assigned the wrong rating. If the veteran is unhappy with the rating assigned by the VA for his or her PTSD, he or she should look at the rating formula chart and see if the higher rating better approximates his or her symptoms, and if so, file an appeal. The veteran should be prepared to show that his or her social and occupational impairment is greater than that which is described in the assigned rating (emphasizing the occupational – remember that the purpose of VA benefits is to compensate veterans for an impairment in earning capacity), so therefore a higher rating would be more appropriate.
It is probably obvious by this point that the VA benefits process is long and often frustrating, as claims move up and down the claims through appeals and remands, while all the veteran wants is for the VA to get it right. We hope that this PTSD Claim Guide has shed some light on the process for PTSD claims and will help you be well-informed as you navigate the system in order to get the compensation you deserve.
Continue to Part Seven for links to helpful resources for PTSD and MST.