Getting the VA PTSD rating you are entitled to can be a challenge in a VA disability claim.
Five Reasons it is a challenge to get the right VA PTSD rating.
1) Veterans facing the limitations of PTSD condition are already at their mental limits, meaning it is next to impossible to keep track of the VA red-tape and evidence needed to establish the right VA PTSD rating.
2) PTSD is a latent condition – meaning it doesn’t always arise on the battlefield. My own grandfather didn’t experience this condition – it was known as shellshock – until years after he fought at the Battle of the Bulge. Because it often arrives later in life after service, it can be hard to convince the VA to service connect PTSD, no less give you the correct VA PTSD rating.
3) The VA regulations governing VA PTSD ratings and PTSD claims are rewritten frequently.
Many of these “rewrites” are pitched as being “Vet Friendly” or “liberalizing” rules to make the process easier. When they are put into practice, it turns out that new VA PTSD rating or service connection rules or regulations make the claims harder and are anti-veteran.
4) The VA has created a “bottleneck” in VA PTSD claims, by finding PTSD cannot be service-connected until a doctor – whose bread is buttered by the VA – concludes that there is the requisite nexus.This can dramatically delay the amount of time it takes you to get the appropriate VA PTSD rating.
5) There is still a HUGE stigma associated with mental health conditions. Even today, with all the advancements in medical science, if a Veteran has a disability that affects her from the neck down, she is a “hero”. But if a veteran’s disability affects the brain or “Brain Housing Group”, he is treated like a blithering moron by folks that haven’t got a clue.
So how does the average Veteran get the VA PTSD rating he or she deserves?
I believe there are 4 Focal Points in achieving your goal of the proper VA PTSD rating.
While they are not the ONLY thing that a Veteran needs to focus on in their claim for service connection, perfecting these aspects will more often than not yield a better experience with the VA Claims Process.
Focal Point #1: PTSD, the C-File and 5-Star Evidence.
If every Veteran with a PTSD claim picks up a copy of their C-File, and finds out which of the 4 Pillars of their VA claim(eligibility, nexus, rating, effective date) was lacking “5-Star Evidence,” they could drastically accelerate the time it takes to get to the VA PTSD rating phase of their claim.
The 2 most important “stars”? Competent Evidence and Credible Evidence. While important in EVERY claim, we need to approach competency and credibility of PTSD evidence a bit differently to have a better experience at the VA.
Knowing how much evidence the VA Claims Evidence Thermometer needs in a PTSD claim is also vital. Some elements of a claim only need enough evidence to get you to the “at least as likely as not” level. But other elements – like insulating your claim from a VA rebuttal of a legal presumption – will require more evidence.
Knowing the 4 Piillars of the PTSD claim, and how much evidence is needed to solidly build each of the 4 pillar is the number one thing that Veterans should know.
Focal Point #2: Proving the PTSD Stressor Event.
If I had a nickel for every-time a Veteran didn’t know which TYPE of stressor event he/she was claiming, I could probably buy myself a seat in Congress. Seriously, not knowing what TYPE of stressor you are proving up is one of the biggest reasons for wrongful VA denials of PTSD, and one of the biggest causes of delay in a military PTSD claim.
If your stressor occurred during combat, do you know what evidence you need to prove that the stressor occurred?
What if the stressor occurred in a combat zone, but not during actual combat?
If your stressor event occurred during a friendly fire casualty situation, will the VA consider this combat?
How much 5-star evidence do you need for a non-combat stressor?
Focal Point #3: The PTSD Diagnostic Exam.
A good Diagnostic exam is like a bowling ball that hits squarely between the #1 and #2 pins: everything falls right into place.
A good Diagnostic Exam follows – RIGOROUSLY – the diagnostic criteria of DSM-V. (New decisions should NOT use GAF scores, but older appeals may still involve them)
It can establish your rating, and when done properly, can help to corroborate certain stressor events. It also will largely ignore the GAF Score if your VA or private psychologist or psychiatrist assigned one.
Done properly, it can also be a very strong piece of evidence that a VA C&P Examiner cannot attack or rebut when making the ultimate nexus determination.
Focal Point #4: The VA PTSD Rating.
In any mental health claim, there are only a handful of impairment ratings available: 0% – 30% – 50% – 70% – 100%.
Knowing what limitations and diagnostic criteria apply to the various levels can effectively streamline even the most challenging of claims. Take a look at each of the different claims levels in the excerpt of 38 CFR §4.130 showing the VA PTSD rating criteria. Notice how there are 3 components to each level of rating:
Component 1: Every stage of the VA PTSD rating table lists certain “symptoms” or areas of functioning. You do not need to have ALL of those listed to get a particular rating level. You do not need to have all the 10% symptoms to get a 30% rating. And, you can have symptoms that are LIKE those listed for each level but do not actually appear in the VA PTSD rating table. The point is, as one CAVC Judge famously wrote, to conduct a “holistic analysis” by looking at the precise ways the PTSD, or any mental health condition, has on a veteran’s ability to function in social and occupational settings.
Component 2: This section of the VA PTSD Rating criteria looks to the degree of impact your PTSD has on your social or occupational functioning. If it has NO impact on either social or occupational functioning, you are looking at a 0% for your VA PTSD Rating. If your PTSD totally impairs your social and occupational functioning, you are likely going to have a 100% VA PTSD Rating. All the other ranges between NO and TOTAL impairment of social and occupational functioning fall in the 10, 30, 50 or 70 rating criteria.
Component 3: for those remaining VA PTSD rating criteria – 10, 30, 50, 70 percent levels – you are going to look at the degree of impact that your PTSD has on your social and occupational impairment in the context of symptoms LIKE those listed in the VA PTSD rating table.
The point to this analysis is to show that you should not pigeon hole yourself into proving particular symptoms in trying to establish the maximum VA PTSD rating. Focus, instead, on showing how your PTSD affects your social and occupational functioning, and argue that your impact more closely approximates a particular level of the VA PTSD rating criteria.
Understanding how the VA PTSD ratings are established can give you a critical advantage and move your PTSD claim or appeal along more quickly.
However, the BVA still denies VA PTSD claims for service connection and increased VA PTSD rating claims with surprising frequency. If the BVA has denied your VA PTSD rating increase or service connection claim, you should strongly consider hiring an attorney who has the experience to appeal the BVA denial to the US Court of Appeals for Veterans Claims.
On the other hand, if you just need help appealing a VA Rating Decision in PTSD claim or appeal, I want you to take a look at this attorney – he’s one of the best Veterans advocates out there, and has forgotten more about VA PTSD ratings than most folks at the VA know.
Summary of the Focal Points in a PTSD Claim.
If you can “nail” these aspects of a PTSD claim, you will maximize your VA PTSD rating. Get out in front of your VA PTSD claim or appeal and don’t wait for the VA to assist you in developing these elements:
2) Know how to prove up your UNIQUE type of Stressor Event.
3) Get a solid Diagnostic Exam.
4) Learn how to provide 5-Star Evidence to get you the Impairment Rating you deserve in a PTSD claim.