When a veteran files claim for PTSD the VA will require the veteran undergo a Compensation and Pension Examination to verify PTSD diagnosis assess severity of symptoms, and determine if the condition is related to service.
Post-traumatic stress disorder (PTSD) is a mental health condition that is commonly misunderstood and underestimated by the VA.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) classifies PTSD as a trauma and stressor-related disorder.
PTSD is described by the DSM-V as "re-experiencing an extremely traumatic event (called the stressor), usually accompanied by increased arousal, nightmares, flashbacks, and difficulty sleeping, concentrating, and remembering."
PTSD is diagnosed based on criteria that look at different types of symptoms. There are four different groups of symptoms that PTSD diagnostic criteria take into account. These four groups and examples of each type of symptom include:
There are three elements to establishing service connection for PTSD.
Let's take a closer look at each of these elements:
Whenever a veteran files a claim for PTSD, the VA will require the veteran undergo a Compensation and Pension Examination (C&P exam) in order to verify the PTSD diagnosis, assess the severity of symptoms, and determine whether the condition is related to service. It is important for veterans to be as honest and forthright with the C&P examiner as possible. Because of the weight the VA places on C&P exams it is also important to be prepared for the exam. The following are tips for getting the most out of a PTSD C&P exam:
Once a veteran receives service connection for their PTSD, the VA will assign a rating. This rating represents the average impairment in earning capacity resulting from the veteran's PTSD symptoms. PTSD is rated under the criteria set forth in the General Rating Formula for Mental Disorders, which can be found here. PTSD can be rated at 0, 10, 30, 50, 70, or 100% disabling. VA regulations provide that "where there is a question as to which of two evaluations shall be applied; the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned."
When evaluating the severity of a veteran's PTSD, the VA will consider symptoms including, but not limited to the following:
The VA should assign a rating based on all of the evidence in the veteran's record. During its evaluation, the VA must consider the following:
Additionally, the purpose of VA disability benefits is to compensate veterans for impairment in earning capacity. Therefore, it is important to emphasize how your PTSD symptoms affect a veteran's ability to work and maintain gainful employment. Making sure there is evidence of how PTSD symptoms affect a veteran's ability to work is important because the VA must assign a rating percentage based on social AND occupational impairment.
The ultimate goal for many veterans is to get a 100% disability rating. Even if a veteran's PTSD symptoms don't meet the rating criteria, it is still possible to get to a 100% rating another way: total disability based on individual unemployability (TDIU). According to the Code of Federal Regulations, a total disability rating (100%) may be assigned "if a person who fails to meet the schedular rating is, nevertheless, unable to obtain and maintain a substantially gainful occupation."
As explained above, it's important to have evidence showing the level of occupational impairment due to PTSD symptoms. This is especially important when trying to get TDIU. Make sure the VA has evidence of how PTSD symptoms affect a veteran's ability to find a job, and how those symptoms impact their ability to keep a job. Do so by providing medical opinions, buddy statements, and treatment records discussing things such as:
The VA will issue a rating decision (RD) either granting or denying a veteran's claim. If the veteran disagrees with the VA's decision, they have 1 year from the date on the letter notifying the veteran of the VA's decision to file their appeal. This is done by submitting a notice of disagreement (NOD) using VA Form 21-0958.
If a veteran was denied service connection for PTSD, they should look closely at the RD to determine what element was missing. For example, did the C&P examiner say there wasn't a diagnosis of PTSD? In that case, getting an opinion from a different doctor may prove extremely valuable. If the VA granted service connection, it is still important to look closely at their decision. Oftentimes the VA makes a mistake assigning the rating and/or the effective date. Again, this is a situation where getting a medical opinion is extremely helpful to show the VA that a higher rating, or earlier effective date, is necessary.
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