My PTSD Claim Was Denied! What Can I Do Now?
Applying for disability benefits through The Department of Veterans Affairs (VA), can be a lengthy and daunting process. And the most frustrating part of it all? Many veterans end up being denied for their PTSD disability claim, even when they have medical evidence.
Being denied after the long, arduous task of filing a benefits claim can be a tremendously frustrating experience–especially after putting in hard work, time, emotional and mental efforts, and even efforts from family and friends.
However, even if you were denied benefits, there is still hope. Consider applying for an appeal to your claims decision, and potentially getting help through this process, to ensure success the next time around.
Read on to learn more about this process and what it entails.
Can I Get VA Disability Benefits for PTSD?
Chances are, if you’ve already been through the claims process, you are aware that you can get PTSD related VA disability benefits, as long as the reasons are service-connected.
However, if you are just getting started in this process, you may be wondering what you need to do to get started.
To prove service connection, a claim must show:
- Clinically diagnosed PTSD under the standards of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
- Proof of an in-service stressor
- Medical evidence of a link between the in-service stressor and the current PTSD diagnosis.
Most of the time extra evidence will be needed about the event that caused the in-service distress or trauma. However, in some cases this is not needed.
Some examples of the types of proof could be treatment records or personnel reports, news reports, witness statements, buddy letters or similar documentation.
The requirement for corroborating evidence is waived and a veterans own testimony may be enough, if the following is true:
- PTSD was diagnosed in service
- The stressor event occurred during combat with hostile forces
- The stressor event was related to the veteran’s fear of an actual threat of hostile military or terrorist act
- The stressor event was related to the veteran’s time as a prisoner of war
The Biggest Reasons Your Claim May Have Been Denied
Even though PTSD has been found to be one of the most common conditions suffered by veterans, the VA has been known for denying many of the claims submitted to get disability benefits.
Under 38 CFR § 3.304(f), service connection for PTSD requires medical evidence diagnosing the condition under 38 CFR § 4.125(a).
You must provide evidence that there is a link between current symptoms and an in-service stressor. There must also be credible supporting evidence that the claimed in-service stressor actually occurred.
Even though 38 USC § 5107(b) provides that the VA must give you the “benefit of the doubt,” the VA continues to deny PTSD claims because of errors and evidence issues. Denials are actually relatively common, and you aren’t alone.
Generally, there are four main reasons your PTSD claim may have been denied. Even one of these can be enough, but it’s possible you could qualify for more than one.
1. Insufficient Evidence
Evidence can come in a variety of forms: buddy letters, NEXUS letters, medical records, personnel records, etc. And evidence is absolutely critical in order to win your claim. In fact, it’s probably the biggest reason why your PTSD claim may be denied.
Do you have enough medical evidence to prove your disability? And do you have proof of service connection (nexus)? These are the biggest questions you should ask!
2. You Submitted the Wrong Forms
The VA requires disabled veterans to fill out specific forms to apply form VA disability. Similar to how submitting incomplete forms or information, an incorrect form can also trigger a denial. For those claiming Post-Traumatic Stress Disorder (PTSD), they must send in a statement on VA Form 21-0781 – Statement in Support of Claim for Service Connection for PTSD.
3. Your PTSD Stressor is Unclear
If you can’t provide a clear service-connected stressor that was the cause of your clinically diagnosed PTSD, then your claim will most likely be denied. You must have a clear service-related stressors in order to qualify for VA disability benefits for PTSD.
4. A Mistake the VA Made
The VA is constantly working through thousands of veteran disability claims, and their employees sometimes are only human. It’s not uncommon to hear that the VA is at fault for a PTSD claim being denied.
An important thing to note, is to keep track of everything in regards to your claim and to assume nothing when it comes to the VA’s assistance.
Keep track of your records, double check that they’ve been received, report bad C&P exams and be sure to file an appeal to correct your claim, if it is necessary!
Denied Mental Health Benefits? Let Us Help!
If you have been denied mental health benefits, or are attempting to increase your rating, the team at Hill & Ponton may be able to assist you. Click the button below to get more information.
How Much Compensation Can I Get for PTSD?
Once you are granted service-connection for PTSD by the VA, they will assign you a disability rating. If you are at 10 percent or higher, they will pay you disability compensation.
If your PTSD rating is not at 100 percent, you still may qualify for disability benefits at the 100 rating level if you can’t maintain substantially gainful employment. This is called Total Disability Based on Individual Unemployability (TDIU) due to service-connected disabilities.
A veteran’s PTSD can be rated as 0, 10, 30, 50, 70 or 100 percent–and these ratings are assigned based on factors such as severity, frequency and duration of symptoms.
How Do I File a PTSD VA Claim Appeal?
After receiving a denial of benefits, you have one year to file an appeal with the VA.
There are a few steps for appealing the decision made about your PTSD disability claim:
1. Know the dates of your appeal.
As previously mentioned, you have one year to file an appeal from your denial date. Know exactly how long you have to appeal. You don’t want to miss this opportunity.
2. Consider why your claim may have been denied.
You want to try and understand why the VA might have denied your claim. Review your rating decision carefully. Make a plan for addressing your appeal based on this information and what may have been missing the first time around.
Did you forget to submit a proper form? Was there insufficient evidence? Did your C&P exam not go as well as expected? These are all things to consider.
3. Strengthen your medical evidence.
Gather as much medical evidence as you can in regards to your condition. Submitting strong evidence will only help your chances of a successful appeal. Also take time to start gathering other supporting evidence like personnel statements, buddy statements, and statements from family and friends.
4. File appropriate paperwork.
You want to know for certain what paperwork you are filing is correct. For example, you will need to submit a statement on form VA Form 21-0781 – Statement in Support of Claim for Service Connection for PTSD.
Steps for Submitting a PTSD Claim
Perhaps you are just getting started filing for a PTSD Claim. If that is the case, you’ll need to follow important steps to ensure this goes successfully.
If you do get denied, remember–there is still hope! You can check out the aforementioned information and potentially consider contacting Hill & Ponton to help you with the appeals process.
We do not assist with the initial process of filing a claim, however here’s a list of some of the important steps you’ll need to take:
1. Providing Medical Evidence of Current Disability
A service member’s diagnosis must be based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Medical providers must indicate the level of disability per the VA’s rating schedule.
Note: The VA may deny a claim if there is an issue with the diagnosis or if the service member fails to attend a Compensation and Pension (C&P) examination.
2. Prove the link between the in-service stressor and PTSD
Once the first step is completed, then there must be proof provided to show the link between the in-service stressor and PTSD. There are a few different types of in-service stressors in PTSD cases, which can include:
- Combat or hostile enemy zone claims
- Military sexual trauma (MST) claims
- Non-combat-related PTSD cases occurring during peacetime
Verifying In-Service Stressors
In cases where the veteran was diagnosed with PTSD while still in the military, the in-service injury is generally established.
However, the VA’s discharge may pose obstacles to obtaining benefits.
For example, in hostile enemy zone cases, the in-service stressor related to the veterans’ fear of hostile military or terrorists does not need corroboration. Non-combat and in-service personal assault claims require credible supporting evidence.
Evidence of these stressors can be obtained in things like:
- military personnel records
- service medical records
- buddy statements
- family member statements
Have Questions About Mental Health Benefits?
The attorneys at Hill & Ponton are here to support you in your claim and determining your PTSD disability percentage. If you are intending to appeal a denied claim, you can contact us for an evaluation.
If you are considering filing a claim, or even if you are interested in learning about the appeals process, we also offer a free ebook The Road to VA Compensation Benefits, to help break down the claims process from start to finish. Click the link below to learn more.
