Filing A Claim For Ptsd: The Basics
As a former rating specialist for the US Department of Veterans Affairs, I can tell you firsthand that a claim for PTSD is one of the most complicated and time-consuming claims the VA handles. As a result — an unfortunate result — many veterans wait years for decisions on these claims. This article provides a brief overview of the process in the hope that veterans will be equipped to better understand the process and deal with its challenges.
To obtain a disability rating for PTSD, a veteran must demonstrate three elements:
What Each Rating Means
100% rating: Completely unable to function socially or at work with symptoms such as severely inappropriate behavior, ongoing hallucinations or delusions, consistent threat of harming self or others, unable to remember basic information such as names of close relatives, severe confusion and disorientation, and/or inability to care for self.
70% rating: Unable to function in most social and work areas with symptoms such as obsessive behaviors, illogical speech, depression and panic so persistent that it interferes with ability to function, suicidal thinking, inability to control impulses , neglecting self-care such as hygiene, inability to handle stress, and/or inability to maintain relationships.
50% rating:Some impairment in ability to function socially and at work with lack of reliability and productivity, due to symptoms such as trouble understanding, memory loss , poor judgment, mood disturbances, trouble with work and social relationships, and/or having one or more panic attacks weekly.
30% rating: Some trouble functioning socially and at work, occasionally inefficient with work or unable to perform work tasks, but generally able to care of self and speak normally. Symptoms can include depression, anxiety, chronic difficulty sleeping, mild memory loss, suspiciousness, and panic attacks .
10% rating: Mild symptoms creating work and social impairment when under significant stress, or mild symptoms managed successfully with continuous medication.
Risk Factors For Sleep Apnea Who Gets It And Why
PTSD A study involving Iraq and Afghanistan veterans who visited a VA outpatient PTSD clinic found that 69% percent of them had a high risk for sleep apnea, and this risk increased with PTSD symptom severity.
Obesity greatly increases the risk of obstructive sleep apnea, due to excessive weight constricting the airway.
Being male increases your risk factor two-fold.
Smokers are 3 times as likely to have sleep apnea, due to the inflammation of the upper airway smoking causes.
Substance use Alcohol, sedatives, and tranquilizers can worsen obstructive sleep apnea, while prescribed pain medicines can interfere with brain signals, causing central sleep apnea.
Existing medical conditions asthma and other lung diseases, congestive heart failure, high blood pressure, type 2 diabetes Parkinsons disease, polycystic ovary syndrome, hormonal disorders, and a prior stroke can all increase your risk.
Genetics could also be a factor. A naturally narrow airway, nasal congestion, a deviated septum, or a family history of sleep apnea can all increase your risk.
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Have A Qualified Medical Professional Write Your Nexus Letter
A nexus letter, also known as an independent medical opinion , establishes the service connection for your disability claim. While you are allowed to have a nurse practitioner prepare your letter, its best to seek out a more credentialed expert. A psychiatrist with extensive experience treating Veterans with PTSD will be better able to elaborate on the cause of your condition.
Submit Applicable Private Medical Evidence
If youve consulted healthcare providers outside of the VA medical system, these records can help support your claim for benefits by showing what PTSD treatments youve tried and how your PTSD has led to secondary service-connected disabilities such as migraines or gastroesophageal reflux disease . Private medical evidence should be submitted with your original application if possible but can be added to your file for up to one year or submitted with your Notice of Disagreement to begin the appeals process.
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What Are The Symptoms Of Sleep Apnea
When you hear the word sleep apnea you probably think of someone who snores loudly in their sleep, not someone who experiences chronic heart failure. But complications from sleep apnea can be that dire. Some of the symptoms of sleep apnea include:
- Loud snoring
- Episodes in which you stop breathing during sleep
- Waking up gasping for breath
- Morning headaches
- Waking from a full nights sleep feeling unrested
Two quick notes on these symptoms. 1) Not all people with sleep apnea snore, and not all people who snore have sleep apnea. 2) Many people who have sleep apnea dont know it. Unless you wake up gasping for breath, you might not be aware that you stop breathing during your sleep.
Ready To Make A Claim 3 Steps To Presenting A Strong Va Ptsd Claim
Now that you know how the VA rates PTSD, its important to understand some best practices for making a claim. Keep in mind that PTSD claims can complicate the already confusing and murky claims process. Even with the new regulations passed in 2010 that make it easier for veterans with PTSD to qualify for VA benefits, a veteran with a PTSD claim will face unique challenges.
There are three requirements that make up a claim for PTSD:
So, you can make a strong claim by presenting these three requirements.
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Compensation And Pension Exams
After filing a VA disability claim for PTSD, VA typically schedules the veteran for a compensation and pension exam. VA uses C& P exams to determine if a nexus exists and to evaluate the severity of a veterans symptoms to decide a disability rating.
It is essential to go to every scheduled C& P exam, as VA may deny a veterans claim if they fail to attend an exam. If a veteran is unable to attend an exam, they should inform VA as soon as possible. If they accidentally miss an exam, they should be sure to contact VA to try to reschedule.
Records To Have Available
It can help to have both military records and records of your own communications to help jog your memory. You can request a copy of personnel records and service medical records from the military, and these records will help you remember dates and other details of what happened. Read Nolo’s article about how to obtain your records.
Ask friends and family members for any letters you sent them while in the service, and check your email account for any messages you sent describing what you experienced. If you keep a diary, it can be helpful to refer to it.
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Role Definition In Compensation Examination
VA compensation examiners complete online training to become credentialed to conduct compensation examinations. In this training videotape, the compensation examiner explains to a veteran that the purpose of the examination is not to conduct counseling but to document your experiences. VA regulations further reinforce this boundary between the evaluator and the clinician by noting that the evaluation should be conducted by someone who is not providing clinical care to the claimant. The Automated Medical Information Exchange worksheets for conducting the compensation examination require a directive interview to elicit the plethora of specific information that is requested, and there is no recommendation in the worksheets that treatment be offered.
The agency affiliation of the examining clinician may not be clear to veterans filing claims. Qualitative data suggests that veterans who undergo compensation examinations report not understanding the distinction between an evaluative examination and a treatment examinationafter all, both are conducted by mental health professionals.* Veterans may not make the distinction between the VHA staff who conduct examinations and the VBA staff who decide claims and dispense benefits. Both are VA staff.
Watch: C& p Exam For Ptsd Secrets
WATCH: C& P Exam for PTSD SECRETS!
#4. Do NOT have your best daythis does NOT mean you shouldlie or stretch the truth. Its against Federal Law to file a false claim. Whatthis means is you need to tell the C& P examiner how you are on your veryworst days. And be prepared to discuss how often you have those bad days.
#5. Be UNFOMFORTABLY VULNERABLE.This means that ifits awkward or hard for you to discuss, especially with someone you dontknow or trust, youre probably on-the-right-track. This is your one chance totell your uncomfortable truths. Maybe youve been abusing drugs or alcohol tocope with your PTSDtell the examiner. Maybe youve driven another caroff-the-road and got into a fighttell the examiner. Maybe youre divorced andstruggling to maintain healthy relationshipstell the examiner.
#6. PTSD claims comes down to severity of symptoms, specificallyyour level of Occupational and Social Impairment. Are you prepared to talkabout HOW your PTSD is negatively impacting your work, life, and relationships?
#7. Know your true story coldand potential in-servicestressors that caused or made your VAPTSD claim worse.
#8. You must be prepared to talk about your life in detail.Before joining the military. During the military. And after your active dutyservice. How long have you been suffering from PTSD? Have you ever soughttreatment? Why or why not?
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B Medical Conditions Which Are To Be Included In Entitlement/assessment
NOTE: If specific conditions are listed for a category, only these conditions are included in the entitlement and assessment of Posttraumatic Stress Disorder. If no conditions are listed for a category, all conditions within the category are included in the entitlement and assessment of Posttraumatic Stress Disorder.
- Other Trauma- and Stressor-Related Disorders
- Anxiety Disorders
Should I Submit An Intent To File Form
If you plan to file for disability compensation using a paper form, you may want to submit an intent to file form first. This can give you the time you need to gather your evidence while avoiding a later potential start date . When you notify us of your intent to file, you may be able to get retroactive payments .
Note: You dont need to notify us of your intent to file if you file for disability compensation online. This is because your effective date gets set automatically when you start filling out your disability compensation form onlinebefore you submit it.
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Ptsd Va Claim Rating Criteria
PTSD claims are rated on a scale from 0% to 100%. The level of occupational and social impairment is what determines your overall rating under the law.
0% Rating Criteria for PTSD:
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.
10% Rating Criteria for PTSD:
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.
30% Rating Criteria for PTSD:
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks , due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks , chronic sleep impairment, mild memory loss .
50% Rating Criteria for PTSD:
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect circumstantial, circumlocutory, or stereotyped speech panic attacks more than once a week difficulty in understanding complex commands impairment of short- and long-term memory impaired judgment impaired abstract thinking disturbances of motivation and mood difficulty in establishing and maintaining effective work and social relationships.
70% Rating Criteria for PTSD:
100% Rating Criteria for PTSD:
So How Does Ptsd Cause Sleep Apnea
There are a few theories out there, but the one that has a most traction takes into consideration the difficulty veterans with PTSD encounter when they are prescribed a Continuous Positive Airway Pressure therapy to treat their sleep apnea.
A CPAP machine is VAs go-to treatment plan for veterans with sleep apnea. Diet, exercise, and stress reduction are also recommended. If youve never heard of it, a CPAP machine is basically a mask connected to a machine that you wear at night. If worn properly, the CPAP machine produces a continuous flow of air that keeps interruptions to your breathing to a minimum, allowing you to get a better nights rest.
To be frank, CPAP machines arent hugely popular with veterans with PTSD. A survey found that only about half of veterans with PTSD use their CPAP machines at night, compared to 70% of veterans who arent battling with PTSD. The most common reasons vets gave for not using their CPAP machine, or only using it some of the night, were discomfort, nightmares, and feelings of claustrophobia.
Other researchers point out that people with PTSD often experience insomnia or frequent awakenings, which can reduce the secretion of growth hormones that help us fall asleep and stay asleep.
Teasing out cause and effect is a little tricky here, but these are the basic causes of the high prevalence of sleep apnea we see among the veteran population with PTSD.
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How To Claim Sleep Apnea Secondary To Ptsd
Do you need help or advice? Contact us now.
Have you even wondered if the sleep apnea that causes you to wake up feeling exhausted despite having had a full nights sleep could be connected to your PTSD? New research suggests there is a strong connection. A recent study found that 69% of Vietnam veterans with Post-Traumatic Stress Disorder also had some form of sleep apnea. PTSD and sleep apnea would seem to go hand in hand. But does PTSD actually cause sleep apnea?
This article examines the relationship between PTSD and sleep apnea in depth. We also cover how veterans with service-connected PTSD can get benefits for sleep apnea, whether the sleep apnea was caused by PTSD or another health condition.
By way of introduction, we are The Rep for Vets, a national disability firm proudly advocating on behalf of veterans with PTSD and other service-connected disabilities. Weve helped countless veterans across the country navigate the claims process and get the benefits they earned.
First, lets cover the basics of sleep apnea what sleep apnea is, why its considered a disability, what other health issues are associated with it and then well consider the connection between PTSD and sleep apnea.
How Do I Talk To Someone Right Now
If you’re a Veteran in crisis or concerned about one, connect with our caring, qualified Veterans Crisis Line responders for confidential help. Many of them are Veterans themselves. This service is private, free, and available 24/7.
To connect with a Veterans Crisis Line responder anytime day or night:
- Call , then select 1.
- If you have hearing loss, call TTY: .
You can also:
- Call .
- Go to the nearest emergency room.
- Go directly to your nearest VA medical center. It doesn’t matter what your discharge status is or if you’re enrolled in VA health care.Find your nearest VA medical center
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Proving A Service Connection
Once you have an official PTSD diagnosis, youll need to be able to prove a service connection for your condition. In essence, a service connection is a specific incident or set of circumstances that could have caused your condition. In the case of PTSD, almost any aspect of military service is enough to be a service connection.
If you served in a combat zone, were taken prisoner, or lost friends in the service, those can all qualify as service connections. Harsh service conditions, such as poor hygiene conditions or inhumane discipline can also qualify. The incident you use as your service connection will need to be something documented in your military records.
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Can Ptsd Rating Be Reduced
Home » FAQs » Can PTSD Rating Be Reduced?
Yes, your PTSD rating can be reduced. The U.S. Department of Veterans Affairs can lower your disability rating and reduce your monthly benefits for PTSD if it finds evidence that your condition has improved. But it must follow certain guidelines in doing so.
If the reduction will reduce your monthly compensation benefit, before VA can reduce your disability rating for PTSD , it must send you a notification letter explaining the VAs proposal to reduce you. Upon receipt of this letter, you have the right to request a hearing, where you and your attorney if you choose can argue against a rating reduction, but you must request the personal hearing within the time frame specified on the notice letter. Upon receipt of this letter, you also have the right to submit evidence to the VA but again you must submit the evidence within the time frame specified on the notice letter.
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Tip #: Be Patient Throughout The Va Process
Do not expect your PTSD VA Disability benefits claim to be approved quickly. Weve heard this rumor several times: the squeaky wheel gets the grease. That isnt true in the VA process. Everyone has to wait their turn when applying or appealing a PTSD VA disability benefits claim. The wait times are unfair to veterans but unfortunately, there isnt much you can do but take a number. Most veterans wait years to obtain PTSD VA disability benefits.
How To Apply For Ptsd Claim
We should start by discussing what is PTSD. First what it is not, is only combat related. According to the American Psychiatric Association, Post Traumatic Stress Disorder is simply a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape, or other violent personal assault.
In simple terms, PTSD can develop when someone experiences an event in their life that has a permanent negative impact. For example, you were in a car accident and ever since that accident, you are terrified to drive. It really is that simple. Now just because you witnessed a traumatic event, does not mean that you will automatically have PTSD. The other side of the mental health coin is resiliency. That is our ability to cope and deal with events we witness and or are a part of.
There are many misconceptions about PTSD that you can get clarification about here.
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