Post-Traumatic Stress Disorder or PTSD is a mental health issue that can be diagnosed and rated by the VA as a service-connected disability. If you are about to retire or separate from military service and suspect you may have a PTSD claim, it’s good to know how the VA reviews and rates this condition for compensation.
The Department of Veterans Affairs defines PTSD as “a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.”
Naturally, military service puts people in danger of experiencing traumatic events; a Time Magazine article from as far back as 2015 estimated some 500 thousand U.S. troops who served in wars in the decade or so prior have been diagnosed with PTSD. This condition may not develop immediately following the trauma; those who notice symptoms later should still seek help.
How the VA Describes Post-Traumatic Stress Disorder
The VA definition of PTSD seems to focus on the “life-threatening” part of the traumatic experiences thought to cause the condition, but the American Psychological Association takes a broader view, identifying “traumatic events” and not just “life-threatening” ones as potential causes of PTSD.
This difference in definition may inspire some to seek civilian review of their condition for a second opinion or to gather more supporting documentation to submit to the VA. Adding more evidence to a VA claim is always a good idea.
PTSD was commonly misidentified as “shell shock”, cowardice, or labeled as any number of mental disorders that share symptoms in common with PTSD.
Those who suffer from PTSD may relive the traumatic event, they may have strong feelings about things that remind them of the trauma, and suffer from anxiety they did not have before the event. While intrusive thoughts and other symptoms are common side effects of a traumatic experience, when they persist for more than a few months PTSD could be the reason.
If You Are a Veteran or Servicemember Suffering Due to PTSD
We’ll examine some important issues about VA compensation for PTSD below, but if you are a veteran and are having a crisis you think may be related to your condition, don’t wait for your VA appointments to seek help. You can call the Veteran Crisis Line at 1-800-273-8255 and press the number 1. You can also send a text message to 838255.
Again, it’s extremely important to seek help immediately if you are having a personal crisis, even if you aren’t sure it’s associated with PTSD. Your VA claims appointments are very important, but you should never delay care when it’s needed in favor of waiting for the appointment.
Can I Get VA Compensation for PTSD?
VA compensation for mental health issues, including PTSD, is possible but you are required to go through a similar review process as for any other type of VA-rated disability claim. To start this process you will need to submit to the VA:
- The type of claim you’re making (a specific mental health condition)
- Symptoms of the condition
- Military medical records
- Any applicable non-military medical or mental health care records
It helps to gather other supporting documentation such as “buddy letters” from friends, family, or coworkers describing you before, during, and after any observable symptoms. A letter from a counselor or therapist noting the same could also make an important difference in handling your claim.
How does the VA determine your condition and whether it is PTSD or not? The VA uses the DSM-5, an industry-standard guide to assigning “appropriate evaluations using the Mental
Disorder Criteria in the VA Schedule for Rating Disabilities” according to the VA official site.
Do I Need a VA Mental Health Exam to Apply for Compensation?
The VA does not typically require a performed-by-VA mental health exam for every single mental health-related claim, and VA regulations state that a VA-directed mental health exam is ordered only under certain situations which may include:
- When the VA needs to assign a “pre-stabilization” rating;
- When “the evidence of record” shows potential for the condition to improve
- When “sound medical evidence” is needed
The VA official site says with the exceptions of the list above, no “future exams” are permitted. But what happens when a mental health exam IS required, such as in cases where the VA needs to determine the future of your benefits?
Attending a VA Mental Health Exam
Some might be tempted to skip the mental health examination when required, but the Department of Veterans Affairs is firm about the need for this process. In the absence of the required exam, the VA will review the evidence currently in your records to decide which of the following applies to your case:
- Continue payment for the disability that was to be reviewed during the VA exam IF there is “no change in the severity of your disability(ies)” as supported by your records OR;
- Discontinue payment for the disability(ies) for which the examination was scheduled, OR;
- Reduce payment for the disability(ies) for which the examination was scheduled to the minimum evaluation established by law.
When you attend a VA claim exam for any issue, PTSD-related or otherwise, the examiner is only responsible for performing the review and does NOT assign a VA rating for the condition.
The reviewer is not responsible for the final determination of your claim, and only a representative from a VA Regional Office can answer questions about the ratings in your case. Don’t expect the claim reviewer to be able to share anything about the rating process at the time of your exam.
Caveats From the Department of Veterans Affairs
While the VA does accept claims for mental health issues, it advises veterans to take care to claim the right condition as many symptoms for certain conditions including PTSD may appear in other mental health issues, too. The VA advises that it only awards disability ratings for one mental health condition. It does so after having reviewed your claim, the medical evidence submitted, as well as any information about how your condition has affected your social interactions and career.
You should also know that your claim may be reevaluated if there is evidence or an error in the original diagnosis or if there are signs that your condition is improving. You could receive a change in diagnosis under the following circumstances:
- A progression in the mental health condition “resulting in the additional symptomatology better fitting the criteria of a different mental health condition diagnosis” OR;
- The evidence requires a correction of an error in the prior diagnosis, OR;
- There are signs of a new and separate mental health condition
Under the current system, the VA only permits one diagnosis for a mental health condition, which means “any change in diagnosis” should, for VA claims purposes, reflect “the most accurate diagnosis and symptomatology” according to the VA official site.
You should submit all claims for mental and physical issues related to your military service as soon as possible once you have decided to retire or separate. Mental health conditions may not be as easy to review and diagnose as some physical ailments; gather any appropriate supporting documentation as soon as you can and submit everything within the VA deadlines–you may be able to start submitting within 180 days of retiring or separating.
Not all VA claims are approved; some are denied and in such cases, you have the right to appeal the VA decision. You may be able to file a supplemental claim if there is new evidence to support your claim, and you could request that a senior reviewer take a look at your case. You’ll need to contact the VA directly the learn what it takes to file such appeals, and you may be able to get VA assistance locating certain medical records if you need help to support your case.