Most PTSD denials I read have nothing to do with whether the veteran is suffering. The rater, the VA employee who decides the claim, does not doubt it.

The short version

• VA looks for three things: a PTSD diagnosis, the event in service that caused it, and a link between the two.
• Most PTSD claims are won or lost on proof of the event, called the stressor.
• In combat, or when you feared hostile military or terrorist activity, your own statement can be enough in some cases.
• Go to your C&P exam. Tell the truth about your worst days.
• If VA says no, find what was missing. You usually have one year to act.

A claim usually fails because one specific piece of proof was not in the file. And nobody told the veteran which one.

PTSD claims are not a mystery. VA is looking for three things. If you know what each one is and what proves it, you can see your own claim the way a rater sees it.

The three things VA is looking for

• A current diagnosis of PTSD.
• An in-service stressor. This is the event in service that caused it.
• A nexus. This is the link between the stressor and the diagnosis.

That is the whole structure. Everything else is detail about how you prove each piece.

1. The diagnosis

You need an actual PTSD diagnosis in a medical record. It has to come from a qualified provider. These do not count:

• "Anxiety."
• "Sleep issues."
• Your own description of what you are going through, even if it is accurate.

This trips up veterans who have been treated for years without anyone writing the word down. Maybe you have been going to counseling, and the notes say "adjustment disorder" or "depression." You may still have a valid claim. But it will not be a PTSD claim until a provider makes that diagnosis.

Good to know: If your records show a different diagnosis, that is not a dead end. Claim the condition you actually have. VA uses the same rating rules for mental health conditions no matter which diagnosis is on your chart.

2. The stressor

This is where most PTSD claims are won or lost.

The stressor is the event. It might be an ambush, an IED, a crash, the recovery of remains, an assault, or a mass casualty event. As a starting point, VA usually wants some other proof that the event happened. It does not want to rely on your statement alone.

Things that can back up a stressor:

• Unit records, after-action reports, morning reports, and deck logs.
• Award citations, mainly ones that describe what happened.
• Service treatment records or personnel records from around that time.
• Buddy statements from people who were there.
• News stories or official records of a documented incident.

Be specific when you describe the event. A statement that says "I saw combat in Iraq" gives VA nothing to check. A better statement names a two-month window, a place, a unit, and what happened. That gives a records researcher something to actually search.

Write dates as closely as you honestly can. If you do not remember the day, give the month and the year. Do not guess at a date you are not sure of. A wrong date is worse than a range.

When the stressor rule is relaxed

This is the part that changes outcomes. It is also the part most veterans have never heard.

In some situations, your own statement can prove the stressor. You do not need unit records to back it up.

Combat

Say you fought the enemy in combat, and your stressor is related to that combat. Then your own account can be enough. It has to fit the circumstances and conditions of your service. VA is not supposed to make you produce paperwork for the firefight.

Fear of hostile military or terrorist activity

This one is broader than combat. It reaches a lot of people who do not think of themselves as combat veterans. It covers being in a place where you faced the threat of hostile action.

This rule answered a real problem. Mortar attacks on a base, convoys, IED threats, and rocket fire are hard to tie to one specific event years later.

In these cases, VA usually requires a few things:

• A VA psychiatrist or psychologist confirms the stressor is enough to support a PTSD diagnosis.
• That expert also confirms your symptoms are related to the stressor.
• The stressor fits the places, types, and circumstances of your service.

What you can do: If you served somewhere you were under threat, say so plainly in your statement. Use those words. Do not play it down because you were not the one returning fire. Almost every veteran has that urge to downplay. In this system, it costs you.

There are also separate evidence rules for personal assault and military sexual trauma claims. Those deserve their own article, not just a paragraph here.

3. The nexus

The nexus is the medical opinion that links the stressor to the diagnosis. It usually says the condition is "at least as likely as not" related to service.

In many PTSD claims, the nexus comes from the VA exam, not from a private doctor. That is because the examiner is asked to answer that question directly.

But a private opinion can carry real weight. This is true when the provider has actually read your service records and your treatment history. It helps most when the exam report is thin, or the examiner never dealt with your history.

The exam is part of the evidence

VA will almost certainly set up a C&P exam for you. C&P stands for Compensation and Pension. It is the medical exam VA uses to check your claim. Go to it. Missing the exam without notice can end a claim that was otherwise strong.

Then tell the truth about your worst days, not your best ones.

I have sat on that side of the desk as a veteran. I know what the reflex is. You square yourself away. You say you are managing. You do not want to look weak in front of a stranger with a clipboard.

That answer gets written down and rated.

Instead, describe how often, how bad, and how it affects what you can do. For example:

• How many nights a week you do not sleep.
• How many jobs you have left.
• Whether you can be in a crowded store.
• What your spouse has stopped asking you to do.

That is the information the rating rules actually turn on.

If VA says no

Read the denial. Find the sentence that says what was missing. It is almost always one of the three pieces. The fix depends on which one.

• If VA did not find proof of the stressor: A Supplemental Claim on VA Form 20-0995 is usually the way to go. You send new and relevant evidence and ask VA to decide again.
• If VA had everything but applied the law wrong: A Higher-Level Review on VA Form 20-0996 puts your case in front of a senior reviewer.

Either way, you usually have one year from the date on the decision letter. That deadline ends more claims than any argument ever will.

You do not have to prove you were broken. You have to prove three specific things, in writing.

The Jacks Law Group represents veterans nationwide and worldwide from offices in Henderson and Las Vegas, Nevada. David R. Jacks, Jr. is a VA-accredited attorney and a 100% permanently and totally disabled U.S. Army veteran. If you want help with a claim or an appeal, call to set up a consultation.

Disclaimer: This blog is general information only. It is not legal advice. Reading it does not, by itself, make us your lawyers. Every VA claim depends on its own facts. Rates, rating rules, and program rules change over time. For advice about your own situation, talk with a VA-accredited attorney.