Is it possible to increase my VA Disability Rating for PTSD?
Yes, it is possible to increase your VA disability rating for PTSD. VA disability rating disputes actually have a relatively high success rate on appeal. If you are hoping to increase your VA disability rating, this article will help you understand how to use the VA disability process and the VA claim appeals to get the outcome you are looking for.
What is a VA Disability Rating and what does it mean?
There are two kinds of VA disability ratings – individual disability ratings and overall ratings. Percentage numbers are assigned to each service-connected disability during the VA disability claim process. If there is more than one disability, those individual ratings are combined through a complicated VA process to reach an overall disability rating. That overall rating (or combined rating) determines how your monthly benefit payments are calculated.
The individual percentages assigned to each disability claim, such as PTSD, are based on a series of criteria for that condition. The VA maintains lists of rating levels and the corresponding symptoms for PTSD and other conditions. Those lists are used as the reference for VA raters and also for examiners who evaluate veterans during a C&P Exam (Compensation & Pension Examination). Your symptoms and conditions are matched against those criteria. Whichever percentage matches most closely will be the assigned individual disability rating for that condition.
In the case of PTSD, the general rating formula includes six levels (0%, 10%, 30%, 50%, 70%, and 100%) and descriptions of symptoms and levels of impairment for each. A one-page rating sheet for your reference can be downloaded here. For the lowest level, 0%, a mental condition (such as PTSD) has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. The next level up, 10%, reflects more impact on your life. It references 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. At 30%, there is a decrease in work efficiency and intermittent periods of inability to perform work tasks, panic attacks (weekly or less), and other symptoms. At 50%, there is more work and social impairment and symptoms such as difficulty understanding complex commands, impaired judgment, and more. The 70% and 100% levels describe even more serious impairment and severe symptoms. The VA examiners will compare your medical records and other evidence to determine which level is closest to your condition. It is not a precise science, so it is not uncommon for you to disagree with their assessment and VA disability rating assigned to your PTSD.
If you have more than one disability rating, those ratings will be combined together through a complicated process (not simple addition) to arrive at an overall VA disability rating.
Is my VA Disability Rating permanent?
No, a VA disability rating is not “permanent” unless and until the VA deems it permanent. You, the veteran, have options for asking for an increased rating through an appeal or a later request for re-evaluation, for example, if your PTSD worsens. Sometimes the VA will change either your individual or overall VA disability rating, including your PTSD rating.
Between the second and fifth year after the effective date of your VA disability rating, the VA is allowed to ask for a re-examination to see if your condition has changed. This is done often, though not all of the time.
Unless your condition is in sustained improvement, the VA can’t reduce the disability benefits if you have been rated at that level for five years or more, and you won’t have to continue to be re-examined. Sometimes this limitation is referred to as the “5 Year Rule.”
After 20 years of a continuous rating, the VA cannot reduce your individual VA disability rating; this is sometimes referred to as the “20 Year Rule.”
Additionally, once you have reached the age of 55, your VA disability rating generally would not get set up for a future examination. This is the “55-Year Rule.”
Is it possible to increase my VA disability rating for PTSD?
Yes, your VA disability rating for PTSD can increase if the VA initially made a mistake or later if your condition worsens. There are several ways to do that.
One option is to try to increase your schedular rating. The term schedular rating refers to the list of symptoms the VA maintains for each type of disability and what they compare your condition against. If you believe that your PTSD claim was underrated initially, you have one year from the date of that rating decision to file an appeal. There are three different types of appeal – Higher Level Review, Supplemental Claim, or an appeal direct to the Board – and any of them could, in the right circumstances, result in an increased rating for your PTSD claim.
You can also request an increase in your schedular rating after one year passes if you have evidence that your condition has gotten worse. This process is similar to the initial claim process, but you won’t have to re-establish the fact that you have PTSD.
Remember that the overall VA disability rating determines your monthly benefit amount, so if you have multiple disabilities, an increase in just your PTSD individual rating may not make any difference in your benefit amount.
Another way to increase your VA disability rating for PTSD if you struggle to maintain a job because of your condition is to ask for a TDIU (total disability individual unemployability) finding. Sometimes even with a lower schedular rating, the effect of your PTSD is interfering with your ability to work so much that the VA will acknowledge that a TDIU finding is appropriate. With TDIU, you will be paid as if you have a 100% schedular disability rating.
How to appeal my VA Disability Rating?
You have one year from the date of your VA disability claims decision to file an appeal (also known as a Request for Decision Review). You can appeal your VA disability rating(s) or any other aspect of the VA’s decision. There are three types of appeals to choose from, based upon the details of your individual case and the reasons for a denial or underrating. You can file a Higher Level Review, Supplemental Claim, or Board Appeal. The first is just a second look by a more experienced decision officer, and the second looks at additional evidence, but importantly it is just by the same individuals that made the last decision. A Board Appeal is when other lawyers are actually looking at the case, you can request an actual live hearing (often by videoconference) or request for them to just look at the evidence already in the record. If you disagree with the outcome of the first option you choose, there are opportunities for further appeals after that.
You will likely want the assistance of a VA disability attorney. An experienced VA disability claim attorney will know how to ensure that your claims file has all of the necessary evidence and how to line up the evidence in a way that makes it easy for the VA to agree that the outcome you want is correct. The VSO that helped you prepare your initial claim may have been trained to fill out forms, but an attorney has been trained to advocate on your behalf.
Veterans Law Group exclusively handles VA disability appeals and many PTSD claims, often obtaining increased VA disability ratings. Are you considering an appeal for an underrated PTSD rating? Let us give you a free evaluation of your case.
