PTSD claims can complicate the already confusing and murky claims process. Even with the new regulations passed in 2010 that make it easier for veterans with PTSD to qualify for VA benefits, a veteran with a PTSD claim will face unique challenges. There are three requirements that make up a claim for PTSD: (1) a current diagnosis; (2) an in-service stressor; and (3) a link between the current diagnosis and stressor.
- Current Diagnosis: The first step to receiving VA benefits for PTSD requires the veteran to have a current diagnosis. A psychiatrist, psychologist, licensed social worker, or other mental health care practitioner must diagnosis the veteran with PTSD in order to show that the veteran is currently suffering from PTSD. Additionally, the diagnosis must conform to specific criteria and it is important the diagnosing doctor provide a report that fully describes why he feels the veteran has PTSD and how the veteran’s 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.
- In-Service Stressor: One of the challenges with a PTSD claim is getting service connection. PTSD is not presumed to be related to service, so a veteran will need to have more than just a current diagnosis. The veteran must show that the stressful event that caused PTSD occurred during service. This does not mean that the veteran must have engaged in combat. Any traumatic event that satisfies the diagnostic criteria 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 from the veteran 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 date and location of unit assignments
On the other hand, if the veteran did not engage in combat, they must provide more evidence than their statement alone. Sometimes the veteran’s service records can help support the veteran’s claim, but other sources of information that include details about the people involved, dates, location, and a description of the event can be used. Examples of supporting evidence include:
- Statements from fellow veterans that served with you
- Statements from family and/or friends who knew you before and after service
- Nexus: This is the link between the veteran’s current PTSD diagnosis and their in-service stressor; the veteran’s current diagnosis must be related to their in-service stressor. The nexus must be proven by medical evidence such as an opinion from a qualified doctor. Another great resource for establishing a nexus, is records from a Vet Center. Vet Centers have licensed social workers that will take the time to document the connection between the veteran’s stressor and their current diagnosis.
Keep in mind that, proving each one of the three requirements above is vital to getting a PTSD claim service-connected. If the proof falls short in one area, service-connection will be denied.
Once a veteran establishes service-connection for their PTSD claim, the battle isn’t over. It is important that the veteran do what they can to make sure the VA gives them the correct compensation. Compensation is based on the rating assigned to a veteran (for example, 50%). This rating is based on how severe the veteran’s PTSD symptoms are. Because the ratings are based on the veteran’s symptoms, it’s important to have medical records that detail the symptoms suffered by the veteran, and how they affect the veteran’s life. Again, this is another area where having medical opinions is crucial to building a strong case. The VA will use a C&P exam to help them determine what the appropriate rating is. A veteran should review the PTSD rating criteria used by the VA and discuss with family and friends how they see PTSD affecting the veteran. This will allow the veteran to make sure the C&P examiner can get as much information as possible that will allow them to provide an accurate report.