How VA denies your PTSD Claim

Veterans and PTSD

Post-traumatic stress disorder, or PTSD, is a condition that’s both underestimated and misunderstood, especially when it comes to the Veterans Association. PTSD is actually a common condition. The Mayo Clinic estimates that more than 3 million Americans are diagnosed with PTSD every year — and that doesn’t take into account those individuals who never receive a diagnosis.

PTSD develops when an individual has witnessed or experienced a traumatic or terrifying event. Unsurprisingly, it’s a condition that’s particularly prevalent among veterans. Although the VA estimates that 10-15% of veterans will develop PTSD at some point following their military service, it’s entirely possible these numbers might actually be much higher in reality.

PTSD is classified as a trauma and stressor-related disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, the condition is characterized as a repetitive re-experiencing of an extremely traumatic event (or stressor), usually accompanied by increased arousal, nightmares, and flashbacks. Those who have PTSD often have trouble concentrating, remembering, and sleeping.

But a PTSD diagnosis is not always easy to come by. The manifestation of the condition is not always straight-forward and doesn’t appear in the same way from person to person. It may take months or even years to develop, and symptoms may shift or appear over time. To diagnose a case of PTSD, physicians will look at specific criteria for symptoms. There are four distinct groups of criteria, all with different symptoms. These groups are:

  • Intrusion Symptoms—Nightmares, intrusive memories or thoughts, or psychological and physical reactions to memories of the event.
  • Avoidance Symptoms—Avoiding situations, thoughts, or feelings that you associate with the traumatic event.
  • Negative Changes in Cognitions and Mood—Memory issues, negative thoughts about themselves or others, severe emotions like shame or sadness, lack of interest in activities they once enjoyed, or feelings of detachment, isolation, or disconnection.
  • Changes in Arousal and Reactivity—An easy startle response, or feeling constantly jittery or alert.

It’s easy to see how these symptoms could easily disrupt a person’s life and take a significant toll on their mental health, as well as their personal and professional life. If you or someone you love may be suffering from PTSD, it’s important to seek out help. Because PTSD presents itself differently in every patient, treatment must be sought and tailor-made for each individual. Although there is no cure for PTSD, treatment has proven to be very effective for the majority of patients. Typically, this treatment includes psychotherapy — including cognitive and exposure therapy, as well as regular appointments with a psychiatrist — and in some cases, medication.

If you are a veteran who has been diagnosed with PTSD, you may be entitled to receive benefits and compensation from the VA. There are many things that you need to know to get the benefits that you deserve, and the veterans advocates at Hill & Ponton have published a PTSD guide covering everything regarding a PTSD claim. In years past, veterans were required to provide evidence of the traumatic event that led to the development of their condition. Below are some of the important points in the guide on how to establish service connection and get the proper rating.

The first thing is to establish a service connection for your PTSD in order to be eligible for benefits. The three things the VA requires are:

  1. Current Diagnosis: you must have a current PTSD diagnosis that was given by professionals who the VA has deemed “qualified to perform PTSD Compensation and Pension examinations.” These professionals have doctoral-level training in diagnostic methods, clinical interview methods, and psychopathology. They also need to have a working knowledge of the DSM-V and have extensive clinical experience with both the diagnosis and treatment in veterans with PTSD. Typically, these are board-certified psychiatrists and licensed psychologists, but may also include psychiatric residents and psychology interns as long as they’re under close supervision of an attending professional in the field. Essentially, if you’ve received a current PTSD diagnosis from a licensed professional, that analysis satisfies this requirement. Please note: most VA hospitals and clinics employ licensed mental health social workers to treat veterans. Their diagnosis of PTSD alone is not enough to meet this requirement.
  2. In-Service Stressor: This might be the most difficult requirement to satisfy. Sometimes, trauma is easy to determine, but other times, proving its occurrence can be challenging. There are a lot of different regulations regarding the type of trauma you experienced. For example, the rules for determining fear of terrorist activity are different from veterans who engaged in combat or sexual trauma. It’s recommended that you consult with your psychiatrist or psychologist, as well as a qualified lawyer, to address this requirement.
  3. Nexus: Basically, this is the link between the first two requirements. It’s what connects the traumatic event you experienced with your current diagnosis of PTSD. A medical expert is required in order to explain how your symptoms are a direct result of your in-service stressor — which is especially important if you have multiple stressors. It’s vital you establish that the traumatic event is the definitive link to your diagnosis and cannot be explained by any other events that took place outside of your military service.

Once these requirements have been satisfied, you can then file a claim through the VA. If you file a claim, you’ll need to undergo a Compensation and Pension Examination (sometimes called a C&P Exam) to verify your diagnoses, assess symptom severity, and definitively determine whether your PTSD is directly related to your military service. The VA treats the C&P exam with a lot of weight and it will determine the amount of compensation you receive.

When you go to your exam, remember to be as honest and as forthcoming as possible. You should bring written statements from family or friends that say how your PTSD has impacted your life. You should also bring a list of symptoms you’ve experienced to help you when being questioned during the exam.

After the exam, you will be assigned a disability percentage rate. This percentage reflects how severe your condition is and how much the symptoms affect your ability to work and maintain social relationships. Depending on the severity of your PTSD, you could potentially receive a disability rate of 0%, 10%, 30%, 70%, or 100%.

Overall, the compensation you receive will be related to your estimated impairment of working ability. Above all, it’s important to demonstrate evidence of occupational impairment due to PTSD. Even if your symptoms don’t constitute a 100% disability rating, you may still be able to receive one through a TDIU, which stands for total disability based on individual unemployability. A TDIU may be assigned if an individual fails to meet the criteria for 100% disability but is still completely unable to obtain and maintain employment.

Because the way the VA determines disability percentages can be highly confusing and complex, working with a lawyer who specializes in VA claims may be to your benefit. The various rules and regulations for determining physical disability can be hard to navigate, but mental conditions like PTSD can be even more difficult to prove. That’s why having an expert on your side can be vital.

If you or someone you love may be suffering from PTSD as a result of military service, seek out assistance from an attorney who specializes in veterans’ issues. Alternatively, if you are dissatisfied with a disability rating you have received and aren’t receiving the benefits you need, there may be other options at your disposal.

This guest post was written by Matthew Hill from Hill & Ponton, P.A, a veterans disability law firm. In addition to representing the disabled, Mr. Hill is a recognized authority on VA law. He has authored several books on VA service connected benefits gives presentations across the nation on VA disability compensation. He is the treasurer for the board of directors of the National Organization of Veterans Advocates (NOVA).

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Posted by on November 8, 2016, With 0 Reads, Filed under Benefits, Military, PTSD, Veterans Affairs (VA). You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.

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