Proving Service Connection to PTSD and Securing the Right Rating
When it comes to disability claims in the VA system, hands-down, the most challenged relate to cases involving PTSD. This mental health issue makes life hell, affecting sleep, self-confidence, relationship stability, and the ability to join the workforce and maintain an income. So, it’s understandable how vet suffering from post-traumatic stress disorder feel personally outraged when the VA denies their PTSD claim.
But the system revolves around rules and procedures, and when they aren’t followed properly, you might have your claim denied or rated lower than you expect. So, what can you do in this situation? How can you ensure you get the treatment and compensation you deserve?
Step #1 Proving the Service Connection to Your PTSD
There’s three elements to filing a VA disability claim, and regardless of the nature surrounding your disability, you’ll need to go through each of these elements to get the rating and benefits you deserve.
- A current medical diagnosis.
- Proof of an in-service event, trauma, or stressor.
- A medical nexus linking the diagnosis and the proof.
The stressor and the nexus are the most crucial parts of your claim. Combat veterans usually find it more straightforward to validate the stressor element of the claim, their service records show combat engagement.
But non-combat vets might find the process a little more complicated, requiring their service records, alongside incident reports, and other supporting docs. The veteran can use behavioral changes, medical reports, transfer requests and disciplinary shifts to satisfy the Vas requirements, but the claim requires a high level of scrutiny and careful development to be successful.
Don’t assume that the VA will connect the dots, because they won’t. Your claim is vulnerable to rejection if you don’t give them a complete file.
Why The C&P Exam Makes or Breaks Your PTSD Disability Claim
After filing with the VA, they’ll likely schedule your “Compensation & Pension” (C&P) exam. During this consultation they evaluate the severity of your symptoms, along with the duration and frequency of PTSD episodes, functional impairment, and its social and occupational impact on your life.
The outcome of the C&P exam has a heavy weighting on the rating the VA gives you, and that’s important to the level of benefits you receive. The examiner could minimize severity of symptoms or fail to state your history properly, skewing the outcome against you with a rating that doesn’t accurately represent your condition.
Fortunately, you can challenge a poor outcome and submit private medical opinions to correct the record.
Understanding PTSD Ratings Set By the VA
The 38 C.F.R. § 4.130 rates the scale of PTSD experienced by veterans using a percentage scale ranging from 0%, 10%, 30%, 50%, 70%, or 100%. The rating you receive reflects the outcome of the C&P exam and the examiner’s opinion on how your condition relates to the occupational and social impairment you endure.
The difference in the rating you receive can end up costing you hundreds of dollars in lost compensation every month. The examiner doesn’t give you a rating based on how brave you were during the C&P, it’s based on the extent of your documented functional impairment. So, to get the best rating your documentation must be consistent and supported by medical evidence proving your condition. Without that, your rating suffers, and so do you.
Claim Value and Accuracy Are Affected By Secondary Conditions
PTSD usually accompanies several other physical and mental health disorders acquired during your service. SUD, sleep disorders, hypertension and other mental health problems are examples of secondary conditions.
Your full disability might not be seen by the VA if you don’t ensure they understand the extent of your secondary conditions. Secondary service connection requires the documentation to link your PTSD to secondary conditions, and medical opinions are valuable at this point in the claims process. Missing them in your evaluation can end up costing you dearly in the compensation owed to you.
What Can Veterans Do If Their VA Claim Is Denied?
Being denied a claim by the VA isn’t the end of the road for you. The Appeals Modernization Act gives you three ways to have the VA review your claim.
- Supplemental Claim
- Higher-Level Review
- Board Appeal
Which one of the three provides the best path for you is an individual case and depends on why they denied you. If the VA couldn’t find the nexus, you’ll need to get new medical evidence to support your claim.
If the C&P exam was not accurate and flawed a higher-level review of your exam may uncover these problems. If you feel your case is overly complex, calling for a board review can help. If you choose the wrong lane it does nothing but waste time, and you can’t afford that.
TDIU for PTSD Claims that Prevent You from Working
Veterans need to understand that they don’t need a 100% rating to receive full compensation for their claim. TDIU (Total Disability based on Individual Unemployability) gives vets with service-connected conditions 100% compensation if the issue prevents them from obtaining gainful employment.
You’ll need to collect the right evidence, including reports of employment history, its impact on your vocation, and medical support backing your claims. You’ll need to demonstrate your disability in this regard, the VA won’t just assume you’re unemployable.
Understand Your Rating with the Stonerose Law VA Disability Calculator
Understanding combined ratings often confuses vets, but you need to know that the VA uses a specific formula that can result in lower ratings. For instance, two 50% ratings won’t combine to 100%, the VA uses a diminishing scale.
Use the VA disability Calculator on the Stonerose Law website to get an accurate overview of the rating you can expect. The right rating helps you estimate the potential compensation you’re entitled to, the impact of adding secondary conditions to your claim, and if an increased rating changes your benefits.
The key to a successful claim lies in understanding how the VA evaluates your PTSD claim and how you build a record that supports the right rating. When the evidence supports the reality, you get an accurate outcome.
