PTSD denied due to no diagnosis - what now?

by Deborah Miller, PhD, HSPP - Owner and Lead Psychologist for vetnexusletter.com

Every day, I work with veterans who have mental health symptoms due to stressful and traumatic events that occurred during service, but have never sought mental health treatment. This is very common due to military culture, which encourages self-reliance and creates stigma around mental health disorders. This leaves veterans in a difficult situation when they finally reach the point where they can't deny symptoms any longer and reach out for help through the VA, often through filing for disability benefits as a first step toward treatment.

Veterans with no mental health treatment records in service or post-service often find themselves being denied for PTSD due to "no diagnosis." This can happen because the VA did not even schedule a C&P exam and simply denied the claim based on lack of evidence, or because the VA examiner did not diagnose PTSD during the C&P exam.

There are a few things you can do before your file your claim to ensure you are given a C&P exam, and also after you've been denied based on the C&P exam. I'll go through these step by step.

** First though, I must recommend that you take this information with a grain of salt - as a psychologist, I'm not an accredited agent, like a lawyer or a Veteran Services Officer - they've been authorized by the VA to provide official advice and guidance about YOUR particular claim. The information I'm presenting is based on my extensive experiene with the VA as a C&P examiner, and through my independent work with veterans every day who are claiming for PTSD benefits. These are some things I've learned through my work, but trying to work with a good VSO is always a great first step in the process. Here is a link where you can find an accredited agent in your area: LINK

How to make sure you are scheduled for a C&P exam for PTSD/other mental health

If your mental health symptoms began during or after service due to a specific or multiple traumatic events, and you believe you meet some or all of the symptoms for PTSD (see here), you should file a claim for PTSD. "Traumatic events" are defined like this for PTSD:

Exposure to real or threatened death, serious injury, or sexual violence either directly, witnessing it happen to someone else, learning that this happened to a family member or close friend (in this case, the death/injury of the other person must have been accidental or violent), or, repeated exposure to details of traumatic events that happened to others (this pertains to first responders, military police, or other military positions in which you are regularly either responding to traumatic situations or required to view materials like video/photo/audio evidence that involves death, serious injury, or sexual violence).

This is first step of a solid PTSD claim - making sure your "traumatic event" meets the criteria described above. While most service-members routinely go through intensely stressful situations, not all of those situations rise to the level of "trauma." This does not negate or minimize your experiences - but it does mean that you would need to pursue a different type of mental health claim that is not related to PTSD. This is possible - PTSD is not the only mental health disorder you can claim, but the processes are different for mental health disorders that were not caused by trauma. Please read this blog I wrote about non-PTSD mental health disorders: LINK

When filing your PTSD claim, make sure the VA has all of the details it needs to be able to verify your traumatic event occurred. The best way to do this is by filling out VA Form 21-0781 with as much detail as you can. Include dates, times, locations, and other people who may have been involved or witnessed the events. Include a detailed personal statement describing when your PTSD or other mental health symptoms started, how those symptoms were related to your trauma from your perspective, and how they have affected your daily life. This is an important part - SPECIFICALLY REQUEST in your personal statement to be examined for PTSD and other psychiatric disorders related to trauma.

Following these steps when filing your initial claim will trigger a VA rule called "duty to assist," based on case law (McClendon v. Nicholson). Now that the VA has received your credible statement about your trauma, your symptoms over time, and a specific request to be examined, then they have a duty to help you develop your claim further. If you leave out these important details and just assume the VA will schedule you for an exam, then an overworked VA rater may simply decide your case is an easy one to deny right off the bat.

What to do if you are denied for "no diagnosis" after your C&P exam

Sometimes, veterans may have symptoms of PTSD but not meet the full requirements to actually qualify for this diagnosis. PTSD is a pretty complex diagnosis, and there are many symptoms across many categories that must be present for a psychologist to be able to give you that diagnosis. Not every person who experiences trauma will develop PTSD, but that doesn't automatically kill your claim. Here are a couple of things you can do to gather further evidence for a successful supplemental claim.

1. Look closely at your rating decision letter. Sometimes veterans won't have PTSD, but they DO have other mental health disorders based on their traumatic experiences, such as "Other trauma/stress related disorder" (which is kind of like saying 'PTSD Light'), depression, anxiety, etc. If the VA C&P examiner diagnosed you with a different, non-PTSD disorder, and the VA confirms an in-service stressor event, then the VA has a duty to consider those diagnoses for service connection as well. Look at your "Favorable Findings" section in the PTSD denial - if it says "A stressor is conceded based on X, Y, Z..." - this means the VA confirms that you did experience trauma during service. If is says "You have been diagnosed with a disability. Your VA examination shows a current diagnosis of..(depression, anxiety, or other disorder)." - then that means your C&P examiner diagnosed you with something other than PTSD. Those are the two elements you need. If the VA denied you for PTSD due to "no diagnosis", and your denial letter does NOT mention that your examiner stated your non-PTSD diagnoses are NOT caused by your military service, then this is a legal error by the VA and you can request a Higher Level Review asking that the rater examine service-connection for the non-PTSD diagnoses under case law called "Clemons vs. Shinseki." This case established that a veteran does not file a claim to receive benefits for a specific diagnosis; they file a claim for the symptoms and the condition causing them. So, while you may have filed for PTSD, the VA is required to investigate ANY diagnoses that may have been a result of your trauma.

   
   

2. If your rating decision letter does not confirm that your traumatic stressor occurred (e.g. no favorable finding where the VA concedes the stressor), then your job is to gather more evidence about your stressor event. This may be through more details about when/where it happened, lay statements from witnesses or people you told about the event at the time, or other forms of evidence. This is where a VSO or accredited agent will be very helpful, as a psychologist or mental health professional cannot provide confirmation that you trauma did occur - they can only provide your diagnosis of PTSD or other mental health issues. This is also the case for PTSD caused by Military Sexual Trauma (MST) - while a psychologist can provide an opinion about whether your MST likely occurred, you have to provide the psychologist evidence to review. This is called "marker evidence" - while I won't go into that now, you should research this if you are dealing with an MST case.

   
   

3. If your denial letter says that you have no PTSD diagnosis after your C&P exam, and the "Favorable Findings" do not include any diagnoses that were confirmed during the C&P exam, then you will need to consult with a mental health professional to establish any mental health diagnoses through private channels. While VA examiners often do a fine job, they are also human and can make mistakes or even simply perform a poor evaluation. We know this is the case especially with the VA's contract examiners - they are often poorly paid and overworked, leading to rushed exams and low-quality diagnoses. If you had a particularly poor exam, it is essential to immediately file a complaint and submit a personal statement form through your VA claim portal stating the details of the exam, why you feel it will not be representative of your true symptoms, and request a different examiner/exam (if you feel confident that the exam was inferior).

   
   

   If you have already been denied, some options are to seek treatment through a private mental health provider who can establish record of your diagnoses, or, if you are not interested in treatment, you can hire a specialist (like me) to perform an independent examination to establish any diagnoses and investigate their relation to your military service. This type of evidence, either through a treatment provider or through an independent examiner, can be submitted within a year of denial as a supplemental claim, and should be enough for the VA to either re-evaluate you with a new C&P exam, or, if you provide a thorough DBQ and nexus letter, to provide a positive result and decide the claim in your favor without the need for another C&P exam.

Again, I want to stress - it is ALWAYS advised to contact a good VSO in your area who can work through the specific details of your claim with you. PTSD claims are some of the most complex that the VA decides, and there are many factors to consider when submitting your claim and evidence to support your claim.

If you are at the point where you need an independent exam, DBQ, and/or nexus letter to support your PTSD claim, I would love to help. If you have past denials, I will analyze them as part of our work together and make sure we tailor your documents to address the specific reasons that your claim was denied. Please reach out if you are interested in working with me, by filling out our contact form - we will get back with you quickly during our business hours (M-Th, 10am - 4pm EST, 10am - 3pm EST on Fridays). I look forward to helping in any way I can!

• Dr. Miller, PhD, licensed psychologist