Everything You Need to Know About PTSD and VA Disability

According to the American Psychiatric Association, post-traumatic stress disorder (PTSD) is a psychiatric disorder that may cause individuals who have been traumatized to experience feelings related to the traumatic event long after it’s over. Traumatic events can vary, including:

War
Terrorist acts
Combat
Natural disasters
Serious accidents
Rape
Threats of death, injury, or sexual violence

An individual may relive the traumatic event through nightmares or flashbacks. The intensity of the thoughts can often be overwhelming enough to make the individual sad, scared, angry, or isolated from other people. Those with PTSD typically avoid any situation that could remind them of the event, but sometimes even an accidental touch or loud noise can cause strong negative reactions.

During World War I, PTSD was nicknamed “shell shock,” and after World War II it was addressed as “combat fatigue.” However, it soon became evident that combat veterans were not the only individuals to experience this disorder. Roughly 3.5 percent of U.S. adults are affected by PTSD annually, and it’s predicted that 1 in 11 people will be diagnosed with it in their lifetime. Women are twice as likely to be diagnosed with PTSD. U.S. Latinos, Native Americans, and African Americans also have disproportionately higher rates of PTSD than non-Latino whites.

When it comes to filing a disability claim to the U.S. Department of Veterans Affairs (VA), an individual must first prove that they are experiencing symptoms of the disorder.

Symptoms of PTSD

The symptoms associated with PTSD are divided into four categories, and each can vary in severity. The four categories are as follows:

Intrusion — This includes any intrusive thoughts such as repeated memories, dreams, or flashbacks of the traumatic event. These intrusive thoughts may become so vivid that individuals feel they are reliving the event.
Avoidance — Resistance to talking about an event or how they feel about it characterized by avoiding reminders or “triggers.” This could include places, activities, objects, and people that did not previously generate such a reaction.
Alterations in cognition and mood — Occurs when an individual cannot remember certain important aspects of the traumatic event which leads them to believe distorted truths. This includes conclusions such as “no one can be trusted,” and “I am a bad person.” This combination leads to many real-world consequences like wrongly blaming others, ongoing negative feelings, less interest in activities, and/or a void of happiness.
Alterations in arousal and reactivity — A general change in temperament; angry outbursts or irritability, acting inappropriately, being overly observant of surroundings in a suspecting way, or having difficulty sleeping.

Many people experience these symptoms in the days following a traumatic event, but for an individual to be diagnosed with PTSD the symptoms must last for longer than a month. The issues must also cause the individual distress or problems in his/her daily life. PTSD commonly occurs with other physical and mental health problems such as depression, memory problems, and substance use.

Proving PTSD

If you believe you have the symptoms related to PTSD, you may be eligible for VA disability benefits. To receive compensation an individual’s situation must meet all of the following requirements:

The stressor happened during time of service
The individual cannot function at same level as before due to the symptoms
A doctor has diagnosed the individual with PTSD

The VA will only offer compensation to veterans, but not dependents.

For more information on filing a claim, visit the US Department of Veterans Affairs for the full claim process.

Service Connection

Having PTSD alone is not evidence enough to receive compensation. As with any VA disability claim, there must be sufficient proof of connection to time in active service. PTSD is not presumed to be related to being in the military, and an individual with PTSD that is not service connected will not be a candidate for VA compensation. Along with the current diagnosis a veteran must provide documents to show they were in combat and detail the traumatic in-service event.

If the veteran was in combat, they may only need a formal statement to prove the stressor. If there is any reason to doubt the veteran’s statement, it can be corroborated with medals, awards, unit records showing assignments, buddy statements from fellow veterans, or statements from people who knew them before and after their time in the military.

This in-service stressor in combination with a diagnosis from a VA-approved medical professional must also be supported by a nexus. A nexus will typically come as an opinion from a qualified doctor or from a social worker at a Vet Center. If the nexus states that the stressor and diagnosis are more likely to be connected than not, then the veteran may move forward with receiving a VA rating.

PTSD VA Rating

The VA assigns a percent value to individuals based on their situation and the severity of their condition. This number is called a VA rating, and determines how much, if any, compensation a veteran will receive to deal with their disability. These ratings can only be given out in increments of 10, such as 0, 10, 20, etc. When it comes to PTSD, here is the general rating formula that is used for mental health problems depending on daily hinderance:

0% — A diagnosis is present, but the symptoms are not severe enough to require medication or affect the individual’s professional or social functioning.
10% — The veteran experiences mild PTSD symptoms that can cause problems at work, home, or in social situations when exposed to extreme stress, but are typically controlled by continuous medication.
30% — The veteran experiences impairment in social situations or at work and occasional decreases in productivity. The PTSD symptoms of depression, panic attacks, sleep impairment, or anxiety can result in an inability to perform daily duties.
50% — The veteran may sometimes experience a significant lack of productivity while working due to symptoms such as panic attacks, difficulty speaking, memory problems, or trouble understanding complex commands. The veteran struggles with work and social relationships.
70% — The veteran is experiencing problems in most social and professional areas. This includes relationships with friends and family, trouble with their job, and problems with their mental health. Obsessive thoughts, lack of impulse control, and suicidal ideations can also be indicative of this level of severity.
100% — The veteran is wholly incapable of performing their work or social duties as a result of the symptoms they’re experiencing.

Additionally, if an individual is sent home from active duty because of their PTSD and meet certain requirements, they will receive a 50 percent rating for six months until they can be reassessed.

To receive their rating, the veteran will have to attend a PTSD-specific Compensation and Pension (C&P) examination. This exam must be performed by a medical professional with significant experience working with veterans who have PTSD in a clinical setting, and who has doctoral-level training in psychopathology, diagnostic methods, and interview techniques.

VA Response

Among veterans, PTSD is the third most common disability to be claimed for benefits. As of 2018, over 800,000 veterans are receiving compensation for some level of PTSD symptoms, 65,000 of which made claims in that year. It is estimated that roughly 50 percent of military personnel with PTSD do not receive treatment for it.

According to recent data from the VA, a typical claim will take roughly 154 days to be reviewed and returned with a decision. When the claim is either approved and benefits are distributed, or denied. Even with the current number of veterans receiving PTSD benefits, it’s not as easy as one might think to get a PTSD claim approved. Many claims get denied initially and must be appealed within one year of the initial decision.

Appeals

Due to the size and scope of the VA, it’s very possible that a mistake will be made on an individual’s disability claim. Whether this means receiving a lower rating than you deserve or potentially being denied compensation altogether, there is a way to appeal these claims and fight for a new decision. For information on appealing a claim, visit the US Department of Veterans Affairs Decision Reviews and Appeals.

Compensation

The amount of money an individual receives monthly depends on their VA rating. As of December 1, 2020, those numbers are as follows:

0% — $0 (free health care and other benefits)
10% — $144.14 per month
30% — $441.35 per month
50% — $905.04 per month
70% — $1,444.71 per month
100% — $3,146.42 per month

There are also other compensatory benefits that individuals may be eligible to receive from separate government programs such as Medicare, Medicaid, and Social Security. Veterans with dependents can also receive extra compensation if their rating is above 30 percent.

A 100 percent rating usually indicates total unemployability. Unemployability means that the symptoms present debilitate the veteran beyond being able to work or earn a wage in any capacity. This rating can be from PTSD alone but typically factors in a multitude of comorbid mental health problems.

Beyond money, veterans who file a VA disability claim can also qualify for other benefits such as discounted or free health care and PTSD treatment. These non-monetary benefits are also often available for individuals who may receive a disability rating of zero percent.

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The VA disability compensation system can be complicated, especially for someone who is already struggling with a mental health condition. Contact a member of our team today for a case evaluation.

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