Post-Traumatic Stress Disorder (PTSD) is one of the most common—and often most misunderstood—conditions facing Veterans who seek VA disability compensation. While the psychological toll of military service can be profound and lasting, many Veterans find the process of securing benefits for PTSD far more complicated than expected.

The key to a successful claim or appeal lies in understanding what the VA requires, how PTSD is evaluated, and what evidence is needed to establish service connection.

Understanding PTSD in Veterans

PTSD is a mental health condition triggered by exposure to a traumatic event. For Veterans, this often stems from combat experiences, military sexual trauma (MST), or other service-related incidents involving threat, injury, or death.

Common symptoms of PTSD include intrusive memories, nightmares, hypervigilance, flashbacks, emotional numbness, irritability, avoidance behaviors, and difficulty with relationships or employment. These symptoms can significantly disrupt daily life and may persist long after service has ended.

Not all trauma leads to PTSD, and not all PTSD manifests in the same way. Because of this variability, the VA requires a specific process to diagnose the condition and evaluate its impact.

How the VA Diagnoses and Rates PTSD

Before the VA can assign a disability rating for PTSD, it must confirm that the Veteran has received a formal diagnosis from a qualified medical professional. This typically involves evaluation by a VA or private psychiatrist, psychologist, or licensed mental health provider. The diagnosis must follow the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Meeting DSM-5 Criteria for PTSD

To meet the VA’s requirements, the diagnosis must demonstrate that the Veteran was exposed to a traumatic event during service and continues to experience persistent symptoms related to that trauma. These symptoms must include re-experiencing the event through flashbacks or nightmares, as well as ongoing efforts to avoid reminders of the trauma. In addition, the Veteran must show negative changes in mood or cognition, such as persistent guilt, isolation, or emotional numbness.

Increased arousal—manifested as irritability, hypervigilance, or difficulty sleeping—is also a core component. Most importantly, these symptoms must cause significant disruptions in the Veteran’s daily functioning, such as in their work life, relationships, or ability to manage everyday responsibilities. Without a diagnosis that aligns with these DSM-5 criteria, the VA will not consider a PTSD claim valid.

How PTSD Ratings Are Determined

Once a diagnosis is confirmed, the VA evaluates the severity of the condition to assign a disability rating. Ratings are granted in increments of 10%, 30%, 50%, 70%, or 100%, depending on how the condition affects the Veteran’s psychological and social functioning.

For instance, a Veteran with occasional anxiety or mild social impairment may receive a lower rating, while someone with persistent panic attacks, depression, or suicidal thoughts may receive a higher one. Veterans who cannot maintain relationships or adapt to stressful environments often fall within the 70% range.

A 100% rating is reserved for those experiencing total occupational and social impairment, meaning the Veteran is unable to function independently in daily life due to the severity of their PTSD symptoms.

The Role of Evidence in Rating Decisions

The VA reviews a range of evidence to make this determination, including medical records, Compensation and Pension (C&P) exams, and personal statements. Because these ratings directly impact monthly compensation and access to further benefits, it’s critical that Veterans present a complete and accurate picture of how PTSD affects their lives. Appealing a low rating often involves submitting new medical evaluations or challenging the findings of an initial VA assessment.

Establishing Service Connection for PTSD

To qualify for VA disability compensation for PTSD, a Veteran must prove that the condition is connected to their military service. This process involves satisfying three essential elements: a current medical diagnosis of PTSD, credible evidence of an in-service stressor that triggered the condition, and a medical nexus linking the PTSD to that stressor. Each element must be clearly documented, and the type of service connection being pursued will shape the type of evidence needed and the overall standard of proof.

Direct Service Connection

The most common route for establishing service connection is through a direct link between a traumatic event during active duty and the current PTSD diagnosis. This can include experiences such as direct combat exposure, encountering improvised explosive devices (IEDs), surviving ambushes, witnessing serious injury or death, or being involved in military accidents or disasters. For many Veterans, these experiences left lasting psychological scars, even if they were not formally reported at the time.

To support a direct service connection, Veterans can submit military records that document their deployments, involvement in combat, or presence in hazardous environments. Awards such as the Combat Action Ribbon or Purple Heart, along with deployment logs or incident reports, often serve as strong indicators of exposure to trauma. When these documents clearly align with the onset of PTSD symptoms, the VA may accept the stressor without requiring additional corroboration.

PTSD Related to Military Sexual Trauma

Another form of direct service connection involves PTSD resulting from Military Sexual Trauma (MST). These cases can be especially difficult because MST is frequently underreported, and the absence of official documentation can complicate the claims process. However, the VA recognizes that a lack of formal reports does not invalidate a Veteran’s experience.

In the absence of service records detailing the incident, the VA allows the use of indirect evidence, commonly referred to as “markers.” These may include sudden requests for a change in duty assignment, a decline in work performance, disciplinary actions, or the onset of substance abuse following the incident. Diagnoses of anxiety or depression shortly after the trauma occurred may also support the claim.

Additionally, personal statements from friends, family members, or fellow service members who noticed behavioral changes or were confided in at the time can strengthen the case. These statements help establish that something significant occurred, even if it was not officially recorded.

Secondary Service Connection

PTSD can also be linked to other service-connected disabilities through what is known as secondary service connection. In these situations, the Veteran does not claim that the PTSD began during active duty, but rather that it developed as a consequence of another service-connected condition. For example, PTSD may arise following a traumatic amputation, permanent disfigurement, or ongoing chronic pain resulting from a combat injury. The emotional and psychological toll of these physical conditions can be profound and may evolve into full-fledged PTSD over time.

To establish a secondary service connection, the Veteran must provide medical evidence that clearly explains how the primary service-connected condition either caused or aggravated the PTSD. A medical nexus opinion is essential in this scenario. This opinion should come from a qualified mental health provider who has reviewed the Veteran’s history and can credibly link the development or worsening of PTSD to the already service-connected physical or mental health condition. Without this professional medical link, the VA is unlikely to recognize the connection.

Common Reasons PTSD Claims Are Denied

Despite the seriousness of PTSD and its prevalence among Veterans, many claims are denied due to missing documentation, procedural errors, or insufficient medical evidence. Understanding the most common reasons for denial can help you avoid preventable mistakes and improve your chances of success—especially when preparing an appeal.

No Verified Stressor

One of the most common obstacles to approval is the VA’s inability to verify the in-service stressor that caused the PTSD. This issue frequently arises in non-combat claims where traumatic events, such as training accidents or personal assaults, were not officially documented. If the stressor is not clearly supported by service records, incident reports, or credible lay evidence, the VA may conclude that the event did not occur.

For non-combat PTSD claims, the VA requires corroboration of the stressor unless the Veteran’s service records establish exposure to inherently traumatic conditions—such as combat. In the absence of this documentation, Veterans must submit alternative forms of evidence, including personal statements, buddy letters, or behavioral “markers” such as requests for transfer, disciplinary actions, or treatment for psychological issues shortly after the event.

Inadequate or Improper Diagnosis

Another common reason for denial is an inadequate diagnosis—or one that fails to meet the VA’s strict requirements. The VA only accepts diagnoses that conform to DSM-5 standards, which must be made by qualified mental health professionals such as licensed psychologists or psychiatrists. A diagnosis from a general practitioner, counselor, or unlicensed provider may not be considered sufficient.

Additionally, the VA evaluates whether PTSD symptoms result in functional impairment—not just whether the condition exists. If the evidence does not demonstrate that PTSD significantly disrupts the Veteran’s ability to work, maintain relationships, or manage daily activities, the VA may assign a lower rating or deny the claim altogether.

No Nexus Opinion Linking PTSD to Service

Even with a verified stressor and a proper diagnosis, the claim can still be denied without a medical nexus opinion linking PTSD to military service. The VA requires medical evidence that clearly states the condition is “at least as likely as not” caused by or aggravated by an in-service event or a service-connected condition.

This connection must be made explicitly in writing by a qualified medical professional. Without it, the VA may determine that the PTSD is due to non-service-related factors and deny service connection. This is one of the most frequently overlooked requirements, particularly in self-filed claims.

Negative or Inconclusive C&P Exam

The Compensation and Pension (C&P) exam carries significant weight in the VA’s decision-making process. If the examiner determines that PTSD is not related to service, attributes the symptoms to another source, or concludes that the condition is not severe enough to warrant compensation, the claim is likely to be denied or underrated.

Common issues during the C&P exam include examiners attributing PTSD symptoms to non-service-related causes such as childhood trauma, substance use, or stressful post-service life events. In some cases, the examiner may not adequately document the Veteran’s symptoms or fail to consider relevant evidence.

When this happens, it’s crucial to challenge the findings during the appeal process, ideally with new medical evidence or an Independent Medical Opinion (IMO) that directly addresses the inaccuracies in the original evaluation.

Strengthening a PTSD Appeal

If your claim for PTSD has been denied or rated too low, the first and most important step you can take is to seek experienced legal representation. The VA appeals process is complex and highly technical, and small errors or missing documentation can lead to lengthy delays or another denial. A lawyer who focuses exclusively on VA disability appeals—like those at Veterans Law Group—can help you avoid these setbacks and build a stronger, more effective appeal.

Why Getting a Lawyer First Matters

A lawyer who understands the VA system can immediately identify the weaknesses in your prior claim. They will review your denial letter, service records, medical evaluations, and any evidence you’ve already submitted. Based on this review, they can determine exactly what the VA found lacking—whether it was a missing nexus opinion, an inadequate diagnosis, or insufficient proof of the in-service stressor. With this insight, your attorney can create a tailored strategy designed to address those gaps directly and efficiently.

Legal representation also helps ensure your appeal is properly filed under the right option within the Appeals Modernization Act (AMA)—whether that’s a Supplemental Claim, a Higher-Level Review, or a Board Appeal. Filing in the wrong lane or with incomplete evidence can delay your case or reduce your chances of success. An experienced VA disability lawyer can make sure you choose the most effective route.

Developing a Strong Medical Nexus

Once representation is secured, your lawyer will begin gathering the strongest possible evidence to support your case. This often includes securing a medical nexus letter from a qualified provider. A well-crafted nexus letter links your PTSD to your military service and provides an expert opinion that the condition is “at least as likely as not” related to a specific in-service stressor. It should include a detailed review of your records, a clear explanation of the stressor, and a reasoned medical conclusion. This letter can carry significant weight—especially if the original C&P exam was flawed, brief, or dismissive.

Strengthening Your Claim with Lay Evidence

Your lawyer may also assist in collecting or refining lay statements from people who witnessed your behavior during or after service. These statements—from fellow Veterans, commanding officers, friends, or family members—can help establish key details such as the onset of symptoms, changes in mood or behavior, or the impact PTSD has had on your daily life. When these accounts are clear, consistent, and specific, they can serve as powerful support for your appeal.

Challenging a Flawed C&P Exam

If your original VA Compensation and Pension (C&P) exam was inadequate, your attorney may recommend obtaining an Independent Medical Examination (IME). An IME is performed by a private mental health provider who can offer a more thorough and unbiased evaluation. This is especially helpful in cases involving Military Sexual Trauma (MST) or complex trauma histories that were not properly addressed during the initial VA assessment.

Addressing Secondary Conditions and TDIU

Finally, your lawyer will help ensure that secondary conditions related to your PTSD are included in the appeal. These can include depression, anxiety, insomnia, substance abuse, or other mental health issues that have developed as a result of your PTSD.

In more severe cases, your lawyer may argue for Total Disability Individual Unemployability (TDIU) if PTSD prevents you from maintaining consistent employment. Including these secondary impacts not only increases your chances of a favorable outcome—it also ensures you receive the full level of compensation you’ve earned.

You Fought for Your Country. Let Us Fight for You.

If your PTSD claim has been denied or underrated, don’t give up. With the right legal support and documentation, many Veterans succeed on appeal—even after years of frustration.

Veterans Law Group offers free case reviews and strategic legal representation tailored to your unique history and needs. Contact us today to take the next step toward securing the compensation you’ve earned through service.

Reach out now—and let us help you fight for the benefits you’ve earned.