As discussed above, it is always a good idea to obtain a service representative to help you present your claim to the VA. VA rules and procedures are very complicated. It can be frustrating and hazardous to go it alone.

 Veterans service organizations, as well as state and county departments of veterans affairs offer their services without charge. No matter whom you select to represent you, it is important that you be personally involved in your case and make certain that everything that should be done, is done.

 Although it can be a difficult task, shop around for the best advocate. Talk to the prospective representative; ask if there are any limits on his or her representation; get a feel for the person who will be working for you before you sign a power of attorney appointing the person as your representative.

Back to top:

  When to Apply: You should notify the VA of the benefits you want at the earliest possible time. From anywhere in the U.S., you can call the nearest VA Regional Office (VARO) by using the following number: 1-800-827-1000. Do not wait until you have gathered all of the evidence that you think you will need. Every day you delay can mean another day of benefits lost forever.

Warning: Do not be discouraged by a VA employee who says you are not entitled to benefits. Put your claim in writing and insist on a written reply from the VA.

How to Apply: To apply, send the VA a letter stating that you have a problem with your nerves, emotions, etc., that arose out of your military service. This is called an informal claim and will count as an application (although you will eventually be required to submit a formal application on VA form 21-526). If you have not heard from the VA within one month, you should call to confirm that your application has been received. If you have applied before, been denied and did not file a formal appeal, send a letter that states that you wish to reopen your claim with new and material evidence.

What to Apply For: The VA offers monetary benefits to veterans with service-connected disabilities (under its disability compensation program) and to veterans with serious nonservice-connected disabilities (under its pension program). Survivors may be entitled to benefits if the VA determines that the veteran had a service-connected disability that caused, or substantially contributed to cause, the veteran’s death. (See below).

Who Can Apply: A claim for PTSD is not limited to veterans who participated in combat with the enemy. For example, sexual assaults, vehicular accidents, being a victim of a crime or other sufficiently traumatic events during service can support a diagnosis of PTSD for VA claims purposes. Merely being in stressful situations, or being “stressed-out” generally will not be sufficient.

Sometimes a veteran’s survivor, including spouses, children and dependent parents can apply for service-connected death benefits (Dependency and Indemnity Compensation or DIC program) or for the nonservice-connected death benefits (pension program). A survivor might be able to show that a veteran with service-connected PTSD died as a consequence of a disease that was secondary to PTSD, e.g., cardiovascular disease, substance abuse (in certain cases).

 WARNING: If you have applied in the past and were denied, you may have a hard time reopening your claim. There is no specific VA application form to use to reopen your claim, but there are specific rules you must follow in terms of the evidence required in order for the VA to reopen the claim. Consult your service representative for details on what kind of "new and material evidence" you need to present.

Back to top:

  The VA regulation that governs the adjudication of PTSD claims is title 38, Code of Federal Regulations, section 3.304(f) (formally cited as 38 C.F.R. �� 3.304(f)). Essentially, the regulation provides that service connection for PTSD requires medical evidence of a current, clear diagnosis of PTSD, a link between current PTSD symptoms and an in-service stressor that is established by medical evidence, and credible supporting evidence that the claimed stressor actually occurred. If the evidence establishes that the veteran engaged in combat and the claimed stressor is related to combat, the veteran’s lay testimony alone can establish that the claimed stressor occurred. The same applies to stressors related to captivity where the evidence demonstrates that the veteran was a prisoner-of-war. If the claimed stressor is not related to combat, the veteran must prove its existence with evidence, such as service medical or personnel records, unit records, morning reports, or buddy statements.

 Where the claimed stressor is a personal or sexual assault, evidence from sources other than the veteran’s service record may be used to corroborate the veteran’s account. Such sources include records of law enforcement authorities, rape crisis or mental health counseling centers, physician or hospital records, tests for pregnancy or sexually transmitted diseases, statements from family, friends or fellow service personnel, evidence of changes in behavior or performance, and requests for transfers.

Back to top:

  You cannot be awarded service connection for PTSD if you do not have a current, clear diagnosis of PTSD. That diagnosis should come from a mental health professional (psychiatrist, psychologist, psychiatric social worker or therapist). If at all possible, work with a private mental health professional who has had experience with treating PTSD, who understands the requirements for a clear diagnosis and is willing to provide a detailed medical opinion letter or report that explains exactly the reasons he or she concludes you have PTSD. If you have records that document the in-service stressor, let your doctor review them prior to writing his or her report. It is even better to provide your doctor with a copy of your service medical records. You can request a copy of your service medical records from the National Personnel Record Center in St. Louis, Mo., using a Standard Form 180, Request Pertaining to Military Records. This form is available from your representative or any VA office. You can also apply for a copy of your service records online ( http://vetrecs.archives.gov ).

 Frequently, veterans with PTSD may have other diagnoses, e.g., personality disorder or substance abuse. It is very important that your doctor explain how your current diagnosis of PTSD relates to any other psychiatric disorder that you might have. If there is a history of alcohol or drug abuse, the doctor should state whether it preexisted PTSD or not and whether substance abuse developed because of PTSD (i.e., self-medication).

 You can expect the VA to contact you for evidence or for permission to request copies of your medical records. If the VA has treated you for your PTSD, make sure to ask that the VA obtain all records from the treatment center.

 The VA may schedule you for an examination by one of its doctor at a VA hospital or clinic. This examination (called a compensation or pension (or C&P) examination) is intended to confirm a diagnosis of PTSD and, if present, to describe the nature and severity of its symptoms. Bring copies of any prior psychiatric treatment records to the examination with you. If you do not have records of recent treatment for PTSD, you can specifically request that the VA provide you with a C&P examination.

 If you do not already have a private doctor's report, you should expect the VA doctor to ask many questions about what symptoms you have, when you began to have them and how often and how long you have had them. Some of the hardest questions will be about the stressful experience you had. You will need to be able to describe in detail (and sometimes painful detail) exactly what you experienced. You might also be asked to take a written, standardized diagnostic test.

Back to top:

  To prevail in a PTSD-based claim, you must establish that you have undergone a traumatic event or events (called a stressor) during your military service that would support a clinical diagnosis of PTSD. Unless your military records document that you were in combat with the enemy, your claimed stressor must be documented. A combat-related military occupational specialty (MOS) or combat-related awards or decorations (e.g., Combat Infantryman’s Badge or a Purple Heart) are examples of documented combat experience. However, if your service records do not demonstrate a combat-related MOS or decorations and you assert that you had experienced combat or enemy fire or attack, the VA is required to assist you in obtaining documentation that supports your claim (including researching government records) that could place you in a documented area of attack or an isolated hostile incident.

 You are entitled to one copy of your entire VA claims file (or C-file) without charge. If you have ever had any official contact with the VA that relates to a claim for benefits, your claims file should contain all of the service and post-service medical records that the VA has, as well as any correspondence to or from the VA and adjudication-related documentation.

Back to top:

HOW THE VA EVALUATES LEVELS OF DISABILITY

  Once the VA has awarded service connection or PTSD, it will then review the most current clinical evidence of record to determine how the severity of your symptoms impairs your social and industrial (ability to work) capacity. The VA has a schedule of rating disabilities, located in title 38 C.F.R., Part 4. The VA has established “Diagnostic Codes” (DC) for various medical and psychiatric disorders, which include a description of the severity of related symptoms and a corresponding disability percentage (called a “rating” or “evaluation”). Although there are different DCs for covered psychiatric disorders, the VA evaluates the level of disability due to psychiatric disorders under the same criteria, regardless of the actual diagnosis. 38 C.F.R. §4.130, DC 9411, governs PTSD ratings. This regulation provides graduated ratings of 0%, 10%, 30%, 50%, 70% or 100%. A 0% rating is noncompensable, This means that you have service-connected PTSD, however, there is little or no impairment as a result. VA compensations payments begin at 10% and increase at each rating level.

 The VA has adopted the criteria established in the DSM-IV as the basis for its psychiatric ratings, including PTSD. There is also a diagnostic matrix called the Global Assessment of Functioning Scale (GAF) that is used to determine your level of disability. The lower the GAF score, the higher the level of social and industrial impairment. Section 4.130 is reproduced below. You can share this with your psychiatric provider of care, who can prepare a report or opinion letter for submission to the VA that describes your level of impairment.

 Bear in mind that even if the severity of your symptoms do not satisfy the diagnostic criteria for a 100% (or total) evaluation under the rating schedule, if your rating is high enough, another VA regulation (38 C.F.R. § 4.16) allows the VA to pay you at the 100% level if medical evidence demonstrates that your are unable to obtain or maintain substantially gainful employment as the result of your service-connected PTSD. The technical term for this is a total rating on the basis of individual unemployability due to service-connected disability

 (TDIU or IU).

38 C.F.R. § 4.130, DC 9411

General Rating Formula for Mental Disorders: