Insider’s guide to PTSD and your VA claims

Insider’s guide to PTSD and your VA claims

Post-traumatic stress disorder (PTSD) is a condition that occurs in some people after witnessing a shocking, frightening, or dangerous event. According to the American Psychiatric Association, every year, approximately 3.5% of adults in the United States are affected by PTSD.

At the same time, the US Department of Veterans Affairs admits that PTSD occurs more often among Veterans than civilians. It is completely understandable, since, while in the military, you are more likely to witness combat or get exposed to life-threatening experiences than in civil life.

As a result, on average, 7 out of 100 (7%) Veterans will have PTSD. Statistically, this disorder is also more common among female Veterans who get diagnosed with PTSD in about 13% of cases. The data about PTSD among transgender and non-binary personas in the military is still insufficient to draw definite conclusions.

However, here at Veterans Claims United (VCU), we often come across the fact that, despite being pretty common and acknowledged among Veterans, PTSD often does not receive an adequate VA disability rating. And although it is said that 70% is the most common rating for PTSD, most Veterans struggle to receive this percentage, let alone 100% disability on their first claim.

In this article, we will talk about the essential parameters that will determine your VA disability rating based on the severity of your case of PTSD and provide some insider tips for increasing this rate and getting the maximum in the VA benefits that you have earned in years of service.


Factors that affect the VA disability rating for PTSD

The VA determines the disability rating for PTSD based on the following factors:

  • Symptomatology
    The frequency, intensity, and duration of PTSD symptoms are crucial in determining the disability rating. This includes factors such as recurrent intrusive memories, flashbacks, nightmares, hyperarousal, avoidance behaviors, and mood disturbances.
  • Occupational and Social Impairment
    The impact of PTSD on your ability to work and engage in social activities. The VA evaluates how the condition affects your capacity to maintain employment, interact with others, and function in different settings.
  • Functional Impairment
    The extent to which PTSD affects your daily functioning. This includes evaluating difficulties with activities of daily living, self-care, maintaining relationships, and managing responsibilities.
  • Frequency and Duration of Treatment
    The VA considers the frequency and duration of treatment that you have already received for PTSD, including therapy, counselling, medication, and hospitalizations, as well as the effectiveness of treatment in managing symptoms.
  • Occupational and Social History
    The VA may review your employment history, education, and social relationships to assess the impact of PTSD on your overall lifestyle and well-being. 

 

The VA Rating Official (RVSR) will make a subjective rating assessment after examining all your medical evidence and supporting statements, as well as the Compensation and Pension (C&P) examiner notes, on the electronic version of the Post-Traumatic Stress Disorder Public Disability Benefits Questionnaires (PTSD DBQ), which will be either the Initial PTSD DBQ (internal VA use only) or the PTSD Review DBQ.

The VA disability rating for PTSD is usually 70%, which makes it a so-called “high-value VA claim.” However, CFR PTSD ratings range all the way from 0% to 100%. That is why it is so important to make sure that you take all the necessary steps to receive an appropriate VA disability rating and improve Your VA PTSD claim if you believe that your case has been underestimated.


Filing for VA PTSD disability benefits: general procedure

The process and requirements of filing for a VA PTSD disability benefit may vary depending on individual circumstances and the specific regulations, which we shall also try to elaborate on in this article.

However, let`s take a general overview of the process:

  • Gather relevant documentation
    Collect any medical records, service records, incident reports, and other supporting documents that demonstrate your PTSD diagnosis, symptoms, and connection to your military service.
  • Complete the application
    Fill out the necessary forms to initiate your claim. The main form is the “Application for Disability Compensation and Related Compensation Benefits” (VA Form 21-526EZ). You can get this form from the VA’s website or by visiting your local VA office.
  • Submit your claim
    Submit the completed application form, along with any supporting documents, to the VA. You can file your claim online through the VA’s eBenefits portal or by mail. Make sure to keep copies of all documents for your records.
  • Attend a C&P exam
    In most cases, the VA will schedule a C&P exam to evaluate your PTSD. During this exam, a VA-appointed healthcare professional will assess your condition and provide a report to the VA for consideration.
  • Await the decision
    The VA will review your claim, along with the supporting documentation and C&P exam results. The processing time can vary, but you can check the status of your claim online through the eBenefits portal or by contacting the VA directly.
  • Receive the decision
    Once the VA reaches a decision, you will receive a notification letter detailing their determination of your eligibility for PTSD disability benefits. This letter will include information about your disability rating and any related compensation.
  • Appeal if necessary
    If you disagree with the VA’s decision, you have the right to appeal. The appeals process involves specific steps and deadlines, so it’s important to review the information provided in your decision letter and seek guidance from a Veterans Service Officer or legal representative.


To receive a higher rating, you need to be able to build a strong case and provide a sufficient amount of supporting documents and evidence, such as employment and financial history that demonstrate the effect of PTSD on your earning potential, nexus statements, and medical records. 

Having a vast network of credible independent medical professionals, here at VCU we help Veterans not only make informed decisions about their VA disability benefits claims but also support their applications with unambiguous evidence to increase chances for a higher rate from the first attempt or in case of an appeal. 


How to Increase a PTSD Disability Rating?

To increase a PTSD disability rating over time or in case you disagree with the VA’s decision, you would need to demonstrate that your symptoms and functional impairment have worsened significantly since your last rating decision or provide evidence that your claim has been underrated. Here are some steps you can take:

  • Review your decision letter
    Carefully review the decision letter you received from the VA. Pay attention to the reasoning provided for the assigned rating, as well as any evidence or information that may have been overlooked or misunderstood. Those are your clues for the further steps.
  • Get a second opinion
    Consider seeking a second opinion from an independent medical professional who specializes in PTSD. They can evaluate your condition and provide an expert opinion on the severity of your symptoms and functional impairment. Make sure to provide them with all relevant medical records and documentation to support your claim. 

    In many cases, if your PTSD DBQ has been reviewed by a private medical provider, there is a strong chance to receive a higher PTSD disability rating. VA uses Acceptable Clinical Evidence (ACE) to do assessments without an in-person examination when there is sufficient information in the record. You’ll almost certainly be given a C&P exam for PTSD to confirm that your symptoms meet the higher legal criteria.

  • File an appeal or request a re-evaluation
    Depending on the specific circumstances and the options available to you, you may choose to file an appeal or request a re-evaluation of your PTSD rating. This can involve submitting additional evidence, completing a new C&P exam, or engaging in a formal appeals process. 
  • Gather additional evidence
    Collect any additional evidence that supports your claim for a higher PTSD rating. This may include medical records, treatment notes, therapy reports, and statements from family members, friends, or coworkers who can attest to the impact of your symptoms on your daily life and functioning.
  • Consult with a Veterans Service Officer (VSO)
    Reach out to a VSO affiliated with a veterans’ service organization or state agency. They can assist you in navigating the VA system, reviewing your claim, and providing guidance on the best course of action to challenge your rating decision.
  • Consider legal assistance
    If you feel unsure about the appeals process or have questions about the procedure, it is best to consult with professionals who specialize in Veterans’ benefits law. They can provide legal advice, review your case, and advocate on your behalf to help you secure a higher PTSD rating.

Even following those steps, challenging a VA decision can be a pretty complex and lengthy process. That is why we would strongly recommend you and your family be patient and use all the qualified assistance you can get to ensure a successful resolution of your case.


Insights and tips for the C&P Exam for PTSD

The purpose of the C&P exam is to evaluate the severity of your PTSD symptoms and their impact on your daily functioning. By providing clear, accurate, and detailed information during the exam, you can help the examiner understand the true extent of your condition and potentially increase your VA disability rating.

Unfortunately, many Veterans may exaggerate their symptoms, and in the process, may miss some crucial information that may affect the final decision about their VA PTSD disability rate.

Here are some guidelines that will help you get the most out of this crucial evaluation phase, whether you are applying for PTSD VA disability benefits for the first time or challenging a previously made decision:

  • Be prepared
    Study your medical and military service records, as well as any supporting documentation you have related to your PTSD. If you feel confused or unsure, consult a professional who will explain to you some crucial terms and their possible effect on your VA PTSD rate. Review these documents before the exam so that you can provide accurate and detailed information about your symptoms and their impact on your daily life.
  • Be honest and thorough
    Describe your symptoms and their effects on your everyday life. Be honest about the severity, frequency, and duration of your symptoms, including any changes since your last evaluation. Be as honest as you can to describe how your symptoms interfere with your work, relationships, and daily activities. 
  • Provide specific examples
    Illustrate your symptoms with examples from your life. Explain situations or triggers that worsen your symptoms, as well as any coping mechanisms you have developed to manage them. Don’t be afraid to share uncomfortable truths: Mention risky behaviour, alcohol, and substance abuse if this applies to you, as well as divorce, broken friendships and relationships. Be brutally honest about your situation. This helps the examiner understand the true impact of your condition.
  • Don’t downplay or minimize your symptoms
    Sometimes Veterans may downplay their symptoms out of habit or a desire to appear strong and independent. However, your PTSD C&P exam is when you to need to be open and forthright. Provide an honest assessment of how your symptoms truly affect you. Make sure that the examiner understands the full extent of your impairment.
  • Don’t forget to mention physical symptoms 
    If you experience physical symptoms such as headaches, stomach aches, and muscle tension, and believe that they are related to your PTSD, make sure to mention them during the exam.
  • Bring someone for moral support
    You can bring a trusted support person, such as a family member or close friend, to accompany you during the exam. Except for support during such stressful moments, they can provide additional perspective, and help ensure that you don’t forget any important details.

 

PTSD Support and Resources for Veterans

Here, at VCU, we know that PTSD disability cases can be more challenging. In addition to dealing with the bureaucratic hurdles that are inevitably associated with the procedure of filing for VA disability benefits, Veterans have to face the deep emotional wounds and challenges associated with these complex conditions every day.

That is why, in addition to qualified assistance from legal experts, we strongly recommend you reach out to support groups and organizations that can help you on your journey to recovery.

  • Department of Veterans Affairs (VA) Medical Centers
    You can receive counseling, therapy, and medication management through these facilities. To find the nearest VA Medical Center or Vet Center, visit the VA website or call the VA’s toll-free number at 1-800-827-1000.
  • National Center for PTSD
    This is a specialized center within the VA that provides resources, information, and research on PTSD. Their website (www.ptsd.va.gov) offers valuable information on PTSD, treatment options, and coping strategies.
  • Crisis Hotlines
    You can also call the Veterans Crisis Line at 1-800-273-TALK (1-800-273-8255) and press 1. This 24/7 helpline provides immediate support, counseling, and assistance.


Remember, reaching out for assistance whether in a legal or psychological crisis is is a sign of strength, and an acknowledgment of your situation and which is always the first and most important step towards overcoming it!

If you have any questions about filing for VA PTSD disability benefits, doubts about the procedure and evidence that you need to submit, believe that your condition was underrated, or think that you deserve a higher rate today since your symptoms and their impact on your life have worsened since you got your last evaluation, don’t hesitate to book a 30-minute free evaluation with a VCU Veteran Specialist here.  

Our team of experienced and qualified professionals will gladly answer your questions, educate and coach you about the procedure, its pitfalls, and demands, and make sure that you and your family will get peace of mind knowing that, at the end of the road, you get the maximum VA disability rating you are entitled to.

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