Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can affect anyone, especially those who have experienced trauma during their military service. Yet, too many veterans have their PTSD Claim Denied after applying for compensation.
Filing a claim for Veterans Administration (VA) disability benefits is one way for veterans dealing with PTSD to get the help and support they need, but many veterans find their PTSD claim denied. It can be challenging to cope with the aftermath of such events, and seeking help is crucial for veterans dealing with PTSD.
The PTSD VA rating measures the severity of a veteran’s post-traumatic stress disorder symptoms to determine the level of disability compensation they’re entitled to receive.
The rating ranges from 0% to 100%, with breaks at 10%, 30%, and VA PTSD increase from 50 to 70%. The higher the rating percentage, the higher the veteran’s compensation level. It’s important to note that the rating can be increased or decreased based on the severity of the symptoms, and veterans can appeal the rating decision if they believe it’s incorrect.
To avoid the pitfalls of claims leading to denials, you must understand why claims are denied and how to overcome them. Here are the seven most common reasons for a PTSD claim denied and what you can do to ensure your claim is successful.
Reason #1: You Missed the Submission Deadline
Submitting your PTSD claim on time is crucial to the claims process. If you miss the deadline for submitting the necessary evidence related to your PTSD claim, it can lead to a denial by the VA.
To avoid missing the deadline, gather the necessary evidence for your disability claim as soon as possible since the application process can be time-consuming. The VA may require additional proof or forms to support your claim, and there may be deadlines for submitting them. They may also require you to schedule appointments for medical exams within a specific timeframe to prove your condition.
To ensure all deadlines are met, stay organized and keep track of all the necessary documentation. Consider using a calendar, planner, or reminder app to help you stay on top of important dates. Additionally, you can reach out to an Accredited VA attroney like VetsForever or a Veterans Service Officer (VSO) for assistance in staying ahead of deadlines.
Reason #2: Failing to Show Up for the Compensation and Pension Exam
The Compensation and Pension (C&P) exam is a crucial part of the VA’s decision-making process, and the results can significantly impact your disability rating and compensation. The exam is designed to evaluate your mental and physical health and to assess the impact your disabilities have on your daily life. Therefore, it’s imperative that you attend your C&P exam at the scheduled date and time.
In some cases, the VA may schedule appointments for veterans without proper notification, leaving you unaware of the appointment. Nevertheless, missing your scheduled C&P exam can lead to a denied claim, even if you were unaware of it!
If you cannot attend the exam for any reason, contact the VA immediately at 1-800-827-1000 to notify them that you can’t make it and reschedule the appointment. This ensures that the VA is aware of the situation and that you didn’t intentionally miss your appointment, preventing your claim from being denied.
Reason #3: Missing Medical Records
Missing or incomplete medical records are a common reason for a VA denied PTSD claim. Begin by requesting medical records from any healthcare provider you’ve seen for your symptoms. If you’ve received treatment from the VA, you can order your documents through the VA’s online portal, MyHealtheVet. Be sure to follow up with any providers who do not respond promptly.
In addition to medical records, collect any other relevant documentation supporting your claim. This may include statements or “Buddy Letters” from family members, friends, or colleagues who can attest to the impact of PTSD on your daily life. You can also provide evidence of any medications you’ve taken to manage your condition.
Reason #4: Insufficient Medical Evidence
The VA requires medical evidence to support your PTSD claim, which may be the most critical step missing in the process. You must provide enough information and evidence to show that your PTSD is directly related to your military service. To support your claim, obtaining a Nexus Letter and DBQ from a doctor or mental health provider is essential for establishing a direct link between your PTSD and your military service.
A Nexus Letter is written by a medical professional and details the connections between current medical conditions and a veteran’s military service. A DBQ is a form used by VA clinicians and contractors to provide specific information about a veteran’s disability obtained during C&P Exams.
It’s important to note that the VA doesn’t require a formal diagnosis of PTSD to file a claim. However, you must have medical evidence demonstrating that you have a current diagnosis of PTSD, and the VA must confirm that the event(s) that caused your PTSD occurred during your military service.
Reason #5: Inaccurate DBQ Reports
Believe it or not, sometimes the examination doctor needs to correct the DBQ form being submitted to the VA. If the information in the report is inconsistent with the disability symptoms being claimed, you may find your PTSD claim denied.
Usually, the VA will notify you of any discrepancies in the reports that weaken your claim, giving ample opportunity for your physician to correct any errors. Such notifications typically arrive by mail, so make sure to promptly open and carefully read all correspondence from the VA because there’s always a deadline by which you must respond. If you miss the window, they’ll automatically deny your claim.
Reason #6: Problems with Eligibility
To be eligible for VA disability benefits, you must satisfy certain conditions. First, you must have served on active duty in one of the U.S. Armed Forces, Reserve Forces, or the National Guard. Moreover, your disability must be directly linked to your military service.
It’s important to understand that being eligible for VA disability benefits doesn’t necessarily guarantee approval of your claim. The VA will review your application and determine if your condition meets the criteria for compensation. If you need clarification on whether you meet the eligibility criteria or have questions about filing a claim, it’s best to reach out to a VSO for guidance.
Reason #7: Your Condition Isn’t Service Connected
Another reason your PTSD claim may be denied is if the VA doesn’t consider your condition service-connected. In other words, if the VA determines that your military service didn’t cause your PTSD, you may be denied benefits. This can happen if you didn’t experience a traumatic qualifying event or if there’s insufficient evidence to show a connection between your PTSD and your military service.
However, service connection isn’t restricted to combat-related incidents. Military Sexual Trauma Disability Rating (MST) is an example of non-combat PTSD, which refers to sexual harassment, assault, or abuse during a person’s military service. The symptoms of MST are similar to combat-related PTSD and may include flashbacks, nightmares, anxiety, and depression.
You must provide as much evidence as possible to demonstrate how your military service led to the development of your PTSD. If your claim is denied due to a lack of service connection, it may be beneficial to appeal the decision with the help of an Accredited VA attorney like VetsForever.
How to Avoid Getting a PTSD Claim Denied Notice
Although the VA provides benefits and support to veterans with PTSD, it’s not uncommon to experience a denied PTSD claim for various reasons. To increase your chances of a successful claim, be sure to meet all deadlines, attend all required appointments, and provide as much evidence and documentation as possible to support your case.
With perseverance and support, veterans can get the benefits and compensation they deserve to manage their PTSD.
FAQs
How Often Do PTSD Claims Get Denied?
According to the VA, roughly 12% of all PTSD claims were denied in 2020. However, this percentage can vary based on a variety of factors, including the severity of the condition, the amount of evidence provided, and the reviewer’s experience.
What Percentage of PTSD Claims Are Approved?
The VA found that approximately 68% of all PTSD claims were approved in 2020. This number has increased in recent years as the VA focused more on improving mental health services and support for veterans.
How Do You Win A PTSD Claim?
To win a PTSD claim, it’s crucial to have a strong case supported by medical evidence and documentation. This includes records of your diagnosis and treatment and any relevant military records that demonstrate the connection between your PTSD and your military service. It’s also essential to meet all deadlines and attend all required appointments, such as the Compensation and Pension exam.
What to Do If Your PTSD Claim Is Denied
If your PTSD claim is denied, don’t lose hope; several steps can be taken to appeal the decision. First, request a decision review by a Decision Review Officer (DRO). The DRO will conduct a comprehensive review of all evidence and information used to make the initial decision and either approve the claim, deny it, or send it back for further consideration.
If the DRO denies your claim, you can appeal to the Board of Veteran Appeals (BVA). The BVA is an independent agency responsible for reviewing decisions made by the VA. You must file a Notice of Disagreement (NOD) with the VA to initiate the appeal process.
To increase your chances of success on appeal, you should gather additional evidence and documentation to support your claim. This evidence can include medical records, letters from mental health providers, and a Statement in Support of a Claim for Service Connection for PTSD from friends, family, and coworkers who can testify to the impact of your PTSD on your daily life.