Post-Traumatic Stress Disorder (PTSD) is a condition that many veterans have heard of, but not everyone fully understands. Some veterans may experience PTSD without realizing it, and the condition is often underestimated—both by veterans themselves and the VA.

This PTSD Claim Guide will walk you through key aspects of PTSD and the VA claims process, including:

• Understanding PTSD
• How to Establish Service Connection for PTSD
• What to Expect from a Compensation & Pension (C&P) Exam
• How the VA Rates PTSD Claims
• Qualifying for Total Disability Based on Individual Unemployability (TDIU)
• What to Do After Receiving a VA Decision
• Helpful Resources for Veterans

What Is PTSD?

PTSD is a mental health condition classified as a trauma and stressor-related disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It occurs after experiencing or witnessing a traumatic event, known as a "stressor," and is often accompanied by symptoms such as:

-Flashbacks or nightmares related to the trauma

-Difficulty sleeping or concentrating

-Avoiding places, people, or situations that trigger memories of the event

-Heightened alertness or an exaggerated startle response

-Negative changes in mood and thought patterns

For PTSD to be diagnosed, symptoms must cause significant distress or impairment in social or occupational functioning and meet criteria across four symptom categories: intrusion, avoidance, negative mood and cognition changes, and heightened arousal or reactivity.

Causes of PTSD in Veterans

PTSD can result from various traumatic experiences, including:

Combat exposure

Military sexual trauma (MST)

In-service personal assault or harassment

Serious accidents or life-threatening events during service

Not every veteran exposed to trauma will develop PTSD, but for those who do, it can be life-altering—impacting not only the individual but also their family. Many veterans struggling with PTSD may turn to self-medication through alcohol or drug use, further complicating their condition.

Unfortunately, stigma surrounding PTSD prevents many veterans from seeking help. Some may worry about being seen as weak or incapable, but PTSD is a medical condition that deserves proper care and treatment. Seeking help is a sign of strength, not weakness.

If you or a loved one is experiencing PTSD, know that support and treatment are available. In this next part of this guide, we’ll explain how to establish a service connection for PTSD and apply for VA disability benefits.

To receive VA benefits for PTSD, you must meet three key criteria:

• Diagnosis: You must have a current PTSD diagnosis from a qualified professional, such as a board-certified psychiatrist or licensed psychologist. The VA does not accept initial diagnoses from social workers or counselors.
• In-Service Stressor: You must provide credible evidence that the stressor occurred during your service.
• Medical Nexus: There must be a medical link between your PTSD symptoms and the in-service stressor.

PTSD Diagnosis Requirements:

A PTSD diagnosis must conform to the DSM-V criteria, which include stressor exposure, intrusion symptoms, avoidance, mood alterations, and reactivity changes, among others.

The VA may deny claims if they determine a veteran does not meet all DSM-V criteria.

If the VA rejects a competent PTSD diagnosis, it must provide a clear rationale and supporting medical evidence.

Proving an In-Service Stressor

The burden of proof varies depending on how the stressor occurred:

Diagnosed During Active Service: If PTSD was diagnosed while on active duty, your own statements may be enough to establish the stressor.

Fear of Hostile Military or Terrorist Activity: If diagnosed by a VA psychiatrist or psychologist, your statement may suffice if the stressor aligns with your service circumstances.

Combat Veterans: If your stressor is combat-related and aligns with your service records, your testimony can serve as evidence unless there is clear evidence to the contrary.

Military Sexual Trauma (MST) or Personal Assault: Alternative evidence such as medical records, statements from others, or behavioral changes may support your claim since official reports are often unavailable.

Special Considerations

Combat & MST Cases: The VA must consider alternative evidence and apply the "benefit of the doubt" rule when official records are lacking.

Appealing a Denied Claim: If the VA denies your claim due to insufficient evidence, you can challenge the decision with additional documentation or expert opinions.

Understanding these requirements can help you gather the necessary evidence to strengthen your PTSD claim. If you need assistance, consider consulting a VA-accredited attorney or advocate.

Once a veteran files a VA claim for PTSD, the Department of Veterans Affairs (VA) requires a Compensation and Pension (C&P) Exam to verify the diagnosis, even if a qualified medical professional has already diagnosed the condition. This exam serves several purposes:

• Confirms whether the veteran meets the criteria for PTSD under DSM-V guidelines.
• Determines if the PTSD is service-connected.
• Evaluates the severity of the condition for disability rating purposes.

What to Expect During the C&P Exam:

• The C&P examiner will not be your regular VA doctor.
• The examiner may not agree with an existing PTSD diagnosis from a treating physician.
• Veterans should be honest and thorough when describing symptoms, as the VA gives significant weight to the C&P examiner’s findings.
• If the examiner diagnoses a different psychiatric disorder, the VA may deny the PTSD claim or assign a rating based on the alternative diagnosis.

Documenting PTSD Symptoms to improve the likelihood of a successful claim:

• Write down all symptoms before the exam, including nightmares, anger, social isolation, and difficulty following authority.
• Bring a witness (spouse, family member, or close friend) who can describe how PTSD affects daily life.
• Request a copy of the exam report and verify the examiner’s conclusions.

How the VA Diagnoses PTSD

• The VA follows DSM-V criteria to diagnose PTSD. If the veteran does not meet all necessary criteria, the claim will be denied. Since many psychiatric disorders share symptoms, an examiner may diagnose a veteran with anxiety or depression instead of PTSD.
• The VA PTSD Disability Benefits Questionnaire (DBQ)
• The VA requires examiners to use the Disability Benefits Questionnaire (DBQ) to ensure claims are evaluated consistently. There are over 70 DBQs for different conditions, including PTSD.

VA PTSD Rating and Increase Requests

• PTSD ratings range from 0% to 100%, depending on the severity of symptoms and their impact on daily life. If a veteran requests an increased rating, the VA may schedule a new C&P exam, which could involve psychological testing. If the VA examiner suspects malingering (exaggerating symptoms), they may conduct additional psychological tests, such as:
• M-FAST (Miller-Forensic Assessment of Symptoms Test)
• MMPI-2 (Minnesota Multiphasic Personality Inventory-2)
• Personality Assessment Inventory (PAI)
• Trauma Symptom Inventory (TSI)

A high score on these tests may lead to a malingering label, making it harder to secure benefits. Veterans who receive this label may need an independent medical opinion to refute the allegation.

Contesting a Negative C&P Exam

If a veteran receives an unfavorable exam result, they can challenge it by:

• Documenting exam inconsistencies (exam length, examiner's demeanor, ability to discuss symptoms).
• Requesting a new C&P exam with a different examiner.
• Submitting additional medical opinions that counter the examiner’s conclusions.

Final Steps

If the VA denies the claim, the veteran can appeal the decision by providing new evidence, requesting a reconsideration, or seeking assistance from a VA-accredited attorney or advocate.

Understanding the VA PTSD claims process and being prepared for the C&P exam can significantly impact the success of a claim. Ensuring that all symptoms, supporting evidence, and witness statements are well-documented is crucial in securing the appropriate benefits.

VA Disability Rating for PTSD: Criteria, Eligibility, and Strengthening Your Claim.

Military service can expose veterans to traumatic experiences, leading to Post-Traumatic Stress Disorder (PTSD). The VA estimates that 7% of all veterans will experience PTSD, with rates increasing to 29% for those who served in Operations Iraqi Freedom and Enduring Freedom.

When a veteran establishes a service connection for PTSD, the VA assigns a disability rating based on symptom severity. Understanding the VA's rating system and how to strengthen a claim is essential for securing the correct benefits.

VA PTSD Rating System

The VA rates PTSD and other mental health conditions using a General Rating Formula, ranging from 0% to 100%, with ratings assigned at 0%,  10%,  30%,  50%,  70%,  and 100%.

• 100%: Total occupational and social impairment due to severe symptoms, including persistent delusions, hallucinations, or inability to perform daily activities.
• 70%: Significant impairment in work, school, and relationships due to symptoms like suicidal ideation, panic, depression, or difficulty adapting to stress.
• 50%: Reduced reliability and productivity, with symptoms including frequent panic attacks, memory impairment, or difficulty maintaining work and social relationships.
• 30%: Occasional work inefficiency, mild memory loss, chronic sleep impairment, anxiety, or depression.
• 10%: Mild symptoms that affect work only during high-stress periods or are controlled by medication.
• 0%: A PTSD diagnosis exists, but symptoms are not severe enough to impair function or require medication.

Securing the Right PTSD Rating

The VA often assigns ratings based on an average of symptoms rather than the most severe ones, which may result in an incorrect rating. The correct rating should reflect the highest level of impairment rather than a middle-ground assessment.

For example, if a veteran exhibits suicidal ideation, even if infrequent, this symptom alone qualifies for a 70% rating. If the VA assigns a lower rating by downplaying symptom severity, the veteran may need to appeal with additional medical evidence.

PTSD and Individual Unemployability (IU)

If PTSD prevents a veteran from maintaining substantially gainful employment, they may qualify for Total Disability based on Individual Unemployability (TDIU). This grants 100% benefits even if the PTSD rating is below 100%.

To qualify for TDIU based on PTSD:

• PTSD must be rated at 60% or higher, or at least 40% with a combined rating of 70%.
• Medical evidence must show that PTSD significantly impairs the ability to work.
• Supporting evidence, such as vocational expert reports or employer statements, can strengthen the claim.

Strengthening Your PTSD Claim

A successful PTSD claim requires three key elements:

• Current Diagnosis: A licensed psychiatrist or psychologist must diagnose PTSD following DSM-V criteria.
• In-Service Stressor: The veteran must provide evidence of a traumatic event during service.
• Medical Nexus: A medical professional must link the PTSD diagnosis to the in-service stressor.

Proving an In-Service Stressor

Evidence requirements vary based on service circumstances:

• Combat Veterans: VA accepts a veteran’s statement if records confirm combat service.
• Fear of Hostile Activity: If diagnosed by a VA psychiatrist, the veteran’s statement may be sufficient.
• Military Sexual Trauma (MST): Evidence may include medical records, behavioral changes, or statements from peers.

Appealing an Incorrect PTSD Rating

If a veteran receives an incorrect rating or denial, they can:

• Challenge the C&P exam findings by identifying inconsistencies or examiner bias.
• Request a new exam if the initial examiner dismissed symptoms.
• Submit additional medical opinions to counter the VA's evaluation.
• Seek legal assistance from a veterans’ disability attorney to navigate the appeal process.

Final Thoughts

Understanding how the VA rates PTSD and ensuring all symptoms are accurately documented can make a significant difference in securing benefits. Veterans who receive an unfair rating or denial should pursue an appeal to obtain the compensation they deserve. For personalized guidance, Chambers Law Firm, P.A. is available to assist veterans in securing their rightful benefits.

What if I Can’t Get 100% for PTSD?

For many disabled veterans, the goal is to receive a 100% disability rating. However, achieving this rating is not always possible, especially when it comes to mental health conditions like PTSD, which is often rated at 70%. One alternative to a 100% rating is Total Disability based on Individual Unemployability (TDIU). In this section, we will explain TDIU for PTSD.

What is Unemployability?

Under VA regulations, a veteran can receive a total disability rating if they are unable to obtain or maintain a job due to service-connected disabilities, even if they don’t meet the full schedular rating. TDIU is not a separate claim, but a part of the VA’s rating process. Veterans are assumed to seek the highest possible benefit, meaning the VA is required to consider unemployability if the veteran’s records show they are unable to work. To help ensure this, veterans should submit VA Form 21-8940, the formal application for TDIU.

What Can’t VA Consider for IU Based on PTSD?

The VA evaluates each case individually, focusing on the veteran’s own ability to work and manage PTSD, not the general public’s ability. The VA does not consider the veteran’s age, non-service-connected disabilities, or local job availability when determining eligibility for TDIU.

What Does VA Consider for IU Based on PTSD?

When determining eligibility for TDIU, the VA will consider factors such as:

• The severity of PTSD and how it affects daily life
• How often the veteran is unable to work due to PTSD
• Employment history and current employment status
• Education and training
• Annual income from employment (if any)
• Side effects of any PTSD medication
• Social Security Disability Insurance (SSDI) benefits, if applicable
• The VA may also schedule a PTSD C&P exam if the veteran’s PTSD appears to prevent them from working; The examiner will assess whether the veteran’s PTSD makes them unable to secure and maintain employment.

TDIU Two-Step Analysis

To qualify for TDIU, two conditions must be met:

• A service-connected disability rated at 60% or higher, or a combined rating of 70% with at least one disability rated at 40%.
• The disability must prevent the veteran from securing substantially gainful employment.

Can I Get IU if My PTSD Rating is Less Than 70%?

Yes. Even if a veteran’s PTSD rating is less than 70%, they may still qualify for TDIU if PTSD prevents them from maintaining a job. If the veteran has a lower rating, they can apply for an extraschedular rating, which will be reviewed by the Regional Office.

Can I Still Get IU if I’m Working?

Veterans can still receive TDIU if they are employed, as long as the work is not considered "substantially gainful" (e.g., earning less than the poverty threshold or working in a sheltered environment).

What is Sheltered Employment?

Sheltered employment refers to work situations where the veteran receives special accommodations, such as flexible hours or fewer work requirements, because of their PTSD. This includes jobs where the employer provides extra support, like a family business or work specifically created for the veteran.

Effective Date for TDIU

Determining the effective date for TDIU benefits can be complicated. The VA considers when evidence first shows the veteran was unemployable due to PTSD. This could include medical records or statements from the veteran or someone familiar with their condition.

What if VA Denies My PTSD Claim for IU?

If the VA denies TDIU or assigns the wrong effective date, the veteran has the option to appeal. There are three appeal tracks, and the appeal must be filed within one year of the decision to avoid it becoming final.

What if VA Tries to Reduce My PTSD Benefits?

The VA must provide clear and convincing evidence before reducing TDIU benefits. If a veteran’s condition improves, TDIU benefits can continue for up to a year. Before reducing benefits, the VA will notify the veteran and give them 60 days to submit additional evidence or request a hearing.

Once the VA makes a decision, the veteran will receive a rating that indicates whether PTSD is service-connected and, if so, the assigned rating. The veteran may also be granted or denied TDIU (see Part Five). At this stage, the veteran must decide whether to appeal all or part of the decision. Veterans have one year from the date on the notice letter to file a Notice of Disagreement (NOD). After receiving the NOD, the VA will send a Statement of the Case (SOC). The veteran then has 60 days from the date on the SOC notice letter to file VA Form 9, the formal appeal to the Board of Veterans’ Appeals (BVA).

What to Do if Service Connection is Denied?

If service connection is denied, the veteran should determine where the issue lies: is it the initial diagnosis of PTSD, the stressor, or the connection between the two (nexus)? If the issue is with the diagnosis, such as the C&P examiner not diagnosing PTSD, the veteran should seek another opinion from a PTSD expert. An Independent Medical Examination (IME) can be a valuable tool in the appeal process. The IME should clearly diagnose PTSD, link it to the stressor, and include a nexus statement that explains how it is at least as likely as not that the PTSD is related to military service. It’s helpful if the IME uses language directly from the regulations, such as “gross impairment in thought processes or communication” or “near-continuous panic or depression affecting the ability to function independently,” to give the VA clear guidance on where the veteran’s symptoms fall on the rating scale. The veteran should also try to gather more supporting evidence of the stressor, such as additional service records or statements from family and friends. This extra information can strengthen the appeal.

What If the VA Assigned the Wrong Rating?

If the VA grants service connection for PTSD but assigns the wrong rating, the veteran may want to appeal. The veteran should review the rating formula chart to see if a higher rating better reflects their symptoms. To support the appeal, the veteran should demonstrate that their social and occupational impairment is greater than described in the assigned rating, with an emphasis on how PTSD affects their ability to work, since the goal of VA benefits is to compensate for lost earning capacity.

Navigating the VA Claims Process

The VA claims process can be long and frustrating, with claims often moving through appeals and remands. While the process may feel overwhelming, we hope this PTSD Claim Guide has helped clarify the steps involved and will provide you with the information needed to navigate the system and secure the benefits you deserve.

National Center for PTSD

https://www.ptsd.va.gov/index.asp

Where To Get Help

https://www.ptsd.va.gov/public/where-to-get-help.asp

Veteran Crisis Line

https://www.veteranscrisisline.net/

RAINN Self Helpline

https://rainn.org/dod-safe-helpline

SAPRO (Sexual Assault Prevention and Response Office)

https://www.sapr.mil/