What VA disability claim documentation is needed for schizophrenia?
Published July 3, 2023
Are you or a loved one a veteran suffering from symptoms that may be schizophrenia? People with schizophrenia interpret reality in an abnormal fashion, sometimes having hallucinations, delusions, extremely disordered thinking and behavior, all of which can significantly impact daily life. Suicidal thoughts and action are also common. Have you filed (or are you considering filing) a psychiatric disability claim for schizophrenia?
Don’t wait for a formal diagnosis. If you or your loved one are a danger to themselves or others, get immediate help. Then you may explore whether the veteran is eligible to receive additional services and/or VA disability compensation if their schizophrenia is connected to their military service.
If you need immediate help, call 911 or you can reach the VA’s Veteran Crisis Line by dialing 988 then pressing 1. This is available 24/7, confidential, and you don’t have to be enrolled in VA benefits or health care to connect.
Also, as of January 17, 2023, veterans in suicidal crisis can go to any VA or non-VA health care facility for free emergency health care at no cost – including inpatient or crisis residential care for up to 30 days and outpatient care for up to 90 days. Veterans do not need to be enrolled in the VA system to use this benefit either.
After addressing any emergency needs, you can then consider applying for VA disability compensation. This article provides guidance on VA disability claims for schizophrenia in veterans, what documentation is needed, and how VA disability appeals work.
What does the VA consider when evaluating schizophrenia claims?
Schizophrenia can be aggravated (or sometimes caused) by military service. If you have been diagnosed with schizophrenia and think that it may have a connection to your service, it’s worth seeing if you are eligible for VA disability benefits, monthly tax-free payments that can help you financially.
The VA disability process starts with filing an initial claim (VA Form 21-526EZ – Application for Disability Compensation and Related Compensation Benefits). Free help is available from VSO (veteran service officers) throughout the country, including through your local DAV or VFW locations.
VA claims for schizophrenia are reviewed by the VA for three things – (1) did something happen to you during military service? (2) do you have a current diagnosis of schizophrenia? (3) is there a connection (or nexus) between the two? If they find all three elements, they will make a determination of “service-connection” for your schizophrenia. Most of the time the VA will then schedule a Compensation & Pension Exam (also known as a C&P exam) with a local VA medical office or medical professional contracted with the VA to evaluate you and get more details.
Having collected all their documentation (discussed in the section below) the VA will then compare your symptoms against a standard rating schedule. (see Schizophrenia rating schedule here). The VA has a single rating schedule for all psychiatric disability claims, including schizophrenia, and it looks at symptoms and impacts on your ability to care for yourself and interact with others.
VA disability ratings for schizophrenia range from 0% (diagnosis but no significant symptoms), 10%, 30%, 50%, 70% or 100% based upon how closely your symptoms match their rating schedule. No veteran has all of the symptoms at any one level, but the VA looks for the closest match. There is no average VA rating for schizophrenia.
What documentation do I need for a VA disability claim for schizophrenia?
For VA disability claims for schizophrenia, the VA first looks for a current condition (and at some point, a formal diagnosis) of schizophrenia, evidence that something happened in service, and then a nexus (connection) between what happened in service and the current schizophrenia. The evidence of these three elements comes in different forms and will be unique to your case.
Types of evidence that the VA reviews will include your official military personnel file (OMPF), service treatment records (STR) and medical records from after your discharge (VA or civilian). The VA is looking for something that happened in service, such as a report of injury or symptoms, and a current diagnosis that is connected to that.
Sometimes these records do not fully demonstrate the whole story of what your condition is or what caused it. Other records can be used to supplement the evidence, including records from battle buddies, family, close friends, sometimes even clergy or civilian therapists who have first-hand knowledge of what happened to you. Employment records may also be used to show that your condition and symptoms are affecting your daily life, at work, at home, or in social situations.
What happens if your claim is denied? Or if the rating is lower than expected?
Sometimes an initial VA disability claim for schizophrenia is denied. Sometimes it is granted, but at a lower disability rating than you think it should be. Don’t give up! You can appeal the decision; there are three different types of VA claim appeals available. You can appeal a denial of service-connection, too low of a disability rating, an incorrect effective date for the start of benefits, or other errors.
The three review options are Supplemental Claim, Higher-Level Review, or Board Appeal. If you don’t agree with the outcome of the first option you choose, there are opportunities for further review after that.
A Supplemental Claim appeal may be chosen if you have new relevant evidence that wasn’t part of the initial claim file. A Higher-Level Review appeal may be chosen if you want a more experienced examiner to review the file again. A Board Appeal may be chosen if you want an expert Veterans Law Judge at the Board of Veterans’ Appeals in Washington, D.C. to review the file.
You have one year from the date of your ratings decision to file an appeal so mark that on your calendar as soon as you receive it. If you think you might want to appeal the decision, start looking for help with that process. If you choose to appeal, you can hire an experienced VA disability claims appeal attorney to help you with your case. They often work on a contingency basis, meaning they don’t get paid unless and until you succeed in getting more money from the VA.