Post Traumatic Stress Disorder (PTSD), is a disorder that many people develop after experiencing or witnessing a traumatic event which makes it difficult for them to recover. Veterans are more likely to develop this disorder than civilians and it is estimated it can affect 11–30% of returning service members. If you have PTSD from a traumatic event you experienced during service, you may be eligible to receive VA Disability. In this blog, we will go over step-by-step how to navigate through the VA Disability claim process for PTSD.
Step 1: Understanding PTSD Eligibility Criteria
The standard for diagnosing PTSD is a structured clinical interview such as the Clinician-Administered PTSD Scale (CAPS-5). To meet the VA’s evaluation criteria, a veteran must have a current diagnosis of PTSD, a confirmed in-service stressor; and medical evidence linking the PTSD diagnosis to the stressor. Often, it can be difficult to prove service connection to PTSD. Typically, evidence to prove this can be found in the same treatment note or examination report in which a clinician has diagnosed a veteran.
Step 2: Gathering Necessary Documentation
Detailed medical records are essential for filing a successful VA Disability claim. One essential document is a diagnosis from a healthcare provider, particularly from psychologists or psychiatrists. They must clearly establish a direct link between the veteran’s PTSD signs and symptoms and the in-service stressor. Combat veterans may find personal statements sufficient, while non-combat veterans require stronger evidence such as buddy statements or detailed service records.
In addition to medical records, you will need to submit:
- Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (VA Form 21-0781): Required for claims based on general PTSD.
OR
- Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Secondary to Personal Assault (VA Form 21-0781a): Required for claims based on personal assault.
These forms are very important for providing specific details about the start and impact of PTSD, ensuring your claim is well-supported.
Step 3: Filing the Initial Claim
The initial application for VA Disability you will need to fill out is the VA Form 21-526EZ, which is the Application for Disability Compensation and Related Compensation Benefits. This form goes over your personal details, military service history, specifics about claimed disabilities, and information about dependents if applicable. It is important to make sure you read each section thoroughly and provide accurate responses in each section as it is essential to receiving your benefits. The statements stated in the section above will serve to support this initial form. You are able to submit your claim online, by mail, or in person. If you are filing online, you will need to create an account on the VA’s official website and create a secure account. For filing by mail, you will need to download all necessary forms and mail them to the appropriate VA regional office along with any other supporting documentation. You may also visit your nearest VA regional office and fill out forms while at the regional office where staff may assist you in completing the forms if needed.
Tips for for all submission methods:
- Keep Copies: Make copies of all forms and documents submitted for your records.
- Follow Up: Monitor the status of your claim online through the VA.gov portal or by contacting the VA regional office.
- Seek Assistance: Consider consulting with a VA attorney for guidance and assistance throughout the claims process.
Step 4: Attending a Claim Exam
After you file your disability benefits claim, the VA may ask you to have a claim exam. This exam will help determine if you have a service-connected disability and give you a rating of your disability. Your rating is based on how severe your disability and will affect how much disability compensation you’ll receive.
During your exam, the provider may do any or all of these things:
- Perform a basic physical exam.
- Ask you questions based on the medical records in your claim file. These may include questions from the Disability Benefits Questionnaire for each service-connected condition you’re claiming.
- Review the Disability Benefits Questionnaires (DBQs)
- Ask you to get other tests (like X-rays or blood work), at no cost to you.
Step 6: Responding to the VA’s Decision
If you are approved, the VA will send you a Rating Decision Letter detailing the decision on your claim. This letter will include:
- Your assigned disability rating, expressed as a percentage (30%, 50%, 100%).
- The effective date of your disability rating, which determines when your benefits will begin.
- A breakdown of the conditions or disabilities you are approved for and their ratings.
Your disability rating represents the severity of your service-connected disabilities. It determines the amount of compensation you will receive monthly and the level of healthcare benefits you are eligible for through the VA. The VA uses a specific formula based on your rating and to calculate your payment. You may also be eligible for healthcare benefits such as access to VA hospitals, clinics, and medical services for treatment related to your service-connected disabilities.
If you believe the VA made an error in your rating decision or if your condition worsens, consider filing an appeal to seek a higher rating or additional benefits.
Seeking Legal Assistance
The VA Disability claim process for PTSD can be stressful, as it requires careful attention to detail and thorough documentation. PTSD affects a significant number of veterans, impacting their daily lives. The benefits from a VA Disability claim could help a veteran live a more fulfilling and less stressful life. We want to help you achieve these benefits. If you’re preparing to file a VA Disability claim for PTSD or need assistance with an existing claim, contact Unruh Law today for a consultation. We will be there to help guide you and support you through the entire process.