Our PTSD Guide will explain what PTSD is (Part 1), what is needed to get PTSD service-connected (Part 2), what to expect from a Compensation & Pension (C&P) exam for PTSD (Part 3), how PTSD is rated by the VA (Part 4), how to receive Total Disability Based on Individual Unemployability (Part 5), what to do after the VA decision (Part 6), and helpful resources (Part 7).
What happens if a Veteran does not qualify to get a rating of 100% for PTSD?
When a Veteran is severely disabled their goal is to reach an overall 100% rating with the VA. Sometimes this is not possible because of the VA rating schedule and due to the individual Veterans specific conditions. It can be particularly difficult for a Veteran to receive a mental health rating of 100% for the Veterans severe PTSD. When a Veteran has severe PTSD it is more then likely that the VA will assign the Veteran 70% for their PTSD. If the Veteran is not able to hold down a steady job that can financially support them (gainful employment) then they might qualify for Total Disability based on Individual Unemployability (TDIU).
What does unemployability mean?
Per VA regulations, a total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to hold down a steady job as a result of service-connected disabilities:
Provided That, if there is only one such disability, this disability shall be ratable at 60% or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40% or more, and sufficient additional disability to bring the combined rating to 70% or more.
In other words, a TDIU rating can be assigned to a Veteran when they do not meet the requirements of a regular 100% on the schedular rating chart. The Veteran can file for TDIU by submitting a VA Form 21-8940.
Their are two things that have to be confirmed before the VA can officially grant a Veteran TDIU benefits. The first thing is to make sure that the Veteran's overall service-connected disabilities meet a certain percentage. The second thing it to verify that the Veteran is unable to hold down a steady job because of their service-connected disabilities.
What is the VA not allowed to consider for TDIU based on PTSD?
TDIU based on PTSD is decided on a personalized basis. The VA bases their decision on TDIU within the context of the Veteran's individual qualifications are. The availability of work in the local economy or national economy has nothing to do with the consideration of the VA when deciding on a Veterans TDIU based on PTSD claim. It does not matter if an average person could get a job under the same conditions as the Veteran. The age of a Veteran or any of their non-service-connected disabilities can be taken into account when a decision is made on the TDIU. Even if a Veteran was recently employed, had a long career, is highly educated or is young the VA can not use any of those to rationalize a denial for TDIU based on PTSD.
What can the VA consider for TDIU based on PTSD?
When the VA is making their decision on TDIU based on PTSD they can take into considerations the Veterans daily life struggles when managing their PTSD.
- How often and how long the Veteran is incapacitated
- How much work time the Veteran has lost because of their PTSD
- What the Veteran's employment history and current employment status
- What the Veteran's educational history is
- Does the Veteran have any annual income from any employment, if so how much
- Does the Veterans PTSD medications have any side effects that affects their employability, if they take any medication
The VA will schedule a C&P exam for a TDIU claim. During the TDIU C&P exam if the VA decides that the Veteran us unable to hold down a steady job or work at all, then the VA has to decide if it is the Veteran's service-connected PTSD that is making the Veteran unable to work. The C&P examiner has to describe, in as much detail as possible, how the Veteran's PTSD is impacting their ability to work and their daily life struggles. See Part 3 for tips on C&P exams.
What PTSD rating does a Veteran need to get TDIU?
Remember the first thing that a Veteran must meet to receive TDIU benefits is to have one service-connected issue that is 60% or higher. In lieu of the one issue at 60% the Veteran needs to have an overall rating of 70% or more, with at least one issue that is rated at 40% or higher.
What does the VA mean by substantially gainful employment?
The second thing that a Veteran must meet to receive TDIU benefits is being incapable of maintaining substantially gainful employment. What does the VA consider as maintaining substantially gainful employment or marginal employment? Basically, maintaining substantially gainful employment or marginal employment is when a Veteran's does not earn more the the poverty threshold in a year. The poverty threshold changes almost every year per the U.S. Department of Commerce, Bureau of the Census.
What happens if the VA denies a Veterans PTSD claim for TDIU?
If the VA denies a Veterans claim for TDIU based on PTSD there are a few options the Veteran can choose from. The Veterans Appeals Improvement and Modernization Act has set up three different options per the VA.
Option 1 - Higher-Level Review, which means the Veterans claim will be review by a senior claims adjudicator and it involves the following:
- A higher-level de novo review (new look) of the decision
- No submission of new evidence allowed
- The possibility of overturing the decision based on
- A difference of opinion
- A clear and unmistakable error
The senior claims adjudicator identifies or learns of a duty to assist error, they can return the claim to the regional office for correction. When the Veteran or their representative files the appeal they can request an informal conference to identify the errors of law or the fact in the decision.
Option 2 - Supplemental Claim where the Veteran or their representative can submit new and relevant evidence to support the claim. The VA will also provide assistance in developing the evidence.
Option 3 - Appeal to the Board of Veterans' Appeals (BVA), this will allow the Veteran or their representative to appeal directly to the BVA. When going to the BVA they would have to choose between the three different options:
- Direct review: You do not want to submit additional evidence or have a hearing.
- Evidence submission: You want to submit additional evidence without a hearing.
- Hearing: You choose to submit evidence and have a hearing with a Veterans Law Judge.
If a Veteran wins their appeal by using any of the three options their effective date will still be the date of the original claim they appealed. An appeal has to be filed within one year from the date the original claim decision was made. If the appeal is filed after that one year date then the VA's decision will become final.
If your a Veteran or you know a Veteran that is suffering with PTSD, remember that there is nothing shameful about PTSD. PTSD is a disease that can be treated with proper care and treatment. Continue to Part Six, what to do after the VA decision, to learn more about how to get PTSD service-connected in order to receive the VA disability benefits you have earned.
PTSD Guide
