At VA Claims Insider, we’re dedicated to providing you with the tools you need to navigate the VA system. Today, we’re tackling a topic that’s close to many of your hearts: Post-Traumatic Stress Disorder (PTSD). PTSD is a reality that too many of our nation’s heroes face, often in silence. But we’re here to say—you’re not alone. We want to give you the insights and understanding to confidently file your VA disability claim for PTSD.
This Ultimate Guide on PTSD criteria is designed to be your roadmap. It’s all about empowering you to understand, take control, and win your claim. We’re committed to helping you get the benefits you’ve earned and deserve. So, let’s demystify the PTSD criteria together, making your journey toward a successful VA disability claim a little bit easier.
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What is PTSD?
Post-Traumatic Stress Disorder, or PTSD, is a mental health condition that can develop after experiencing or witnessing a life-threatening event. These events can include combat exposure, military sexual trauma (MST), training accidents, or other traumatic incidents. Medical providers will look at your symptoms to determine if you meet the PTSD criteria.
Symptoms can include flashbacks, nightmares, severe anxiety, and intrusive thoughts about the traumatic event.
Is PTSD an Anxiety Disorder?
This is a common question, and the answer is a bit complex. PTSD is related to anxiety disorders, but it’s unique in many ways.
While it does include elements of anxiety-like intense fear and stress, PTSD also includes other symptoms such as reliving the traumatic event (like through flashbacks or nightmares), avoiding things that remind you of the event, and having negative changes in beliefs and feelings.
Therefore, PTSD is categorized separately, but it’s crucial to remember that everyone’s experience with PTSD is unique, and it might look different from one veteran to another.
The Unique Experience of PTSD in Veterans
In the civilian world, PTSD can arise from a variety of traumatic events. For veterans, combat is often the first thing that comes to mind. But it’s important to know that not all military-related PTSD comes from combat.
Combat-related PTSD can come from experiences that are unique to war. This can include exposure to improvised explosive devices (IEDs), hostile fire, witnessing the death of fellow servicemen and women, or feeling that your life was in danger.
On the other hand, non-combat PTSD in veterans can result from training accidents, military sexual trauma, or the psychological toll of being in a high-stress, life-threatening environment. Non-combat veterans can face unique challenges because their PTSD isn’t linked to a specific war event, but their experiences are just as valid and deserving of recognition and treatment.
Read our article on non-combat PTSD to learn how to file a successful non-combat PTSD claim.
DSM-5 PTSD Criteria
One of the most important concepts to understand when filing your VA claim for PTSD is the criteria for PTSD the VA looks at to evaluate your PTSD. The VA uses the DSM-5 criteria to determine whether or not you have PTSD and to what extent it affects your daily life. This directly impacts your VA disability rating and potential benefits.
Understanding the world of psychiatric diagnoses can feel a bit like learning a new language. DSM-5 and ICD-10 codes are part of this language.
The DSM-5, or Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, is the go-to guide for many mental health professionals. It’s what your doctors probably use to officially diagnose PTSD and other mental health conditions. The DSM-5 PTSD criteria are crucial in your VA disability claim because they show whether or not you qualify for a PTSD diagnosis in the first place. The VA will use these criteria to assess your condition.
DSM-5 PTSD Criteria
The DSM-5 lays out a very specific set of criteria that must be met to diagnose a veteran with PTSD. All criteria must be present for a diagnosis of PTSD. These PTSD diagnostic criteria include:
Being exposed to a life-threatening event or witnessing one
You’ve been through a dangerous, harmful, or life-threatening event. This could be during combat, a training exercise, or even during peacetime. This might include:
- Being in a battle, an ambush, or a dangerous situation yourself
- Seeing these events happen to your fellow soldiers
- Learning that a close military buddy experienced a violent or accidental event
- Constantly being exposed to reminders of the event in your military duties, like seeing or handling human remains or being part of medical or cleanup operations.
Having symptoms like flashbacks, nightmares, or anxiety related to the traumatic event
After this event, you have had one or more of the following experiences:
- Unwanted and upsetting memories of the event keep coming back
- Bad dreams related to the event
- Feeling or acting as if the event is happening again (flashbacks)
- Getting upset when something reminds you of the event
- Physical reactions like a fast heartbeat, sweating, or shakiness when something reminds you of the event
Avoiding reminders of the trauma
You might find yourself trying to avoid things that bring back memories of the event, such as:
- Avoiding conversations about the event or your military service
- Staying away from crowds, fireworks, or other things that could remind you of combat
Changes in feelings and beliefs after the trauma
Your thoughts and feelings have changed in a negative way since the event. This can include:
- Forgetting key parts of the event
- Having negative thoughts about yourself or others, like feeling you can’t trust anyone or feeling guilt about actions during combat
- Blaming yourself or others for the event
- Constantly feeling bad, scared, guilty, or angry
- Losing interest in activities you used to enjoy
- Feeling distant or cut off from people
- Finding it hard to have positive feelings like love or happiness
Symptoms last more than a month and affect your daily life
If these changes have lasted for more than a month, and they’re really affecting your life – like your job, your relationships, or your peace of mind—then it’s possible you’re dealing with PTSD.
Changes in how your reactivity
You might also notice changes in how you react to things:
- Getting angry or irritated easily, maybe even becoming aggressive
- Acting recklessly or taking unnecessary risks
- Being overly alert or watchful – the “on guard” feeling common in combat zones
- Being easily startled or frightened
- Having trouble focusing or thinking clearly
- Having problems sleeping or relaxing
Your symptoms are not a result of another condition or medication
You experience significant impairment in your social life, work life, or both areas of your life.
Lastly, sometimes these symptoms don’t show up right away. It might be six months or more before you start to feel this way, which is why full diagnostic criteria may not be met until at least six months have passed from when you first experienced the event.
If a mental health diagnosis, like PTSD, doesn’t match what’s outlined in the DSM-5, or if the results from a medical exam don’t support the diagnosis, the VA may send the report back to the doctor who performed your Compensation & Pension (C&P) examination. In other words, the VA needs strong evidence from your medical records and the doctor’s examination to agree with the PTSD diagnosis.
ICD-10 for PTSD
The ICD-10 is another coding system you might encounter, or International Classification of Diseases, 10th Edition. The ICD-10 is used around the world to code and classify diseases and health conditions. In the case of PTSD, the PTSD ICD-10 code is F43.10, F43.11, and F43.12. These codes may appear on your medical records related to your PTSD diagnosis and treatment.
F43.10: Post-traumatic stress disorder, unspecified. This code is used when you’ve met the PTSD criteria, but it’s a bit unclear when the symptoms started and how long they’ve been going on.
F43.11: Post-traumatic stress disorder, acute. This means that the PTSD symptoms have been there for one to three months. To be diagnosed with PTSD, symptoms need to have been present for at least a few weeks.
F43.12: Post-traumatic stress disorder, chronic. If you see this code, it means the PTSD symptoms have been lasting for more than three months.
For the purposes of your VA claim, if you’ve been diagnosed under ICD-10, you’ll want a chronic diagnosis of F43.12, meaning your PTSD symptoms have been going on for over three months. If you’ve been given an F43.10 diagnosis code, you can continue to record symptoms to clarify your diagnosis and show that your condition is chronic.
PRO TIP:
Try not to focus on the technicalities of your diagnosis too much. Instead, focus on your symptoms and the severity of your symptoms.
Filing a Winning PTSD Claim
If you meet the PTSD criteria listed above, the next step is applying for a VA disability rating for PTSD. PTSD is rated at 0%, 10%, 30%, 50%, 70%, and 100%; however, the average PTSD rating for veterans is 70%.
The VA will look at your symptoms to decide how much your PTSD affects your daily life and how much disability compensation you should receive. This rating considers factors like how often you have PTSD symptoms, how severe they are, and how they impact your work and relationships. The longer your symptoms have been going on and the more severe, the higher your VA rating will likely be.
To learn more about how your symptoms translate to the VA rating scale, read our guide on the VA PTSD rating scale.
When filing a VA claim for PTSD, you need three elements to win your claim to show you meet PTSD criteria:
- You have a current diagnosis of PTSD
- The PTSD came from a stressor event during your service – read this article to learn more about PTSD stressors
- There is a medical link, or “nexus,” connecting your PTSD to the stressor event
To prove all three elements, you’ll want to include all medical evidence. You’ll also have to fill out some specific forms:
- The Statement in Support of Claim form (VA Form 21-4138). This form lets you share your personal story about your PTSD.
- To verify the stressful event that led to your PTSD, you’ll need to fill out the PTSD Stressor form (VA Form 21-0781). For PTSD resulting from personal trauma or sexual assault, use VA Form 21-0781a.
Once you’ve turned in these forms and your stressor is confirmed, along with a current diagnosis and evidence of a nexus, the VA will schedule you for a Compensation and Pension (C&P) exam.
The Importance of the Compensation & Pension Exam
During your C&P exam, your examiner will ask you about your PTSD criteria using these 31 symptoms the VA uses for PTSD ratings. Understanding the PTSD criteria listed above will be a huge help in completing your C&P exam to ensure all forms (specifically, the PTSD Disability Benefits Questionnaire) are accurately and comprehensively completed to get the VA rating you deserve.
Take Action to Get the Support You Deserve for Your PTSD
It’s important to remember the vital role understanding PTSD criteria plays in your VA disability rating. The more informed you are about what PTSD is, how it’s diagnosed, and how it relates to your VA claim, the better positioned you’ll be to navigate the process effectively. Knowledge is power, and in this case, it can also be the key to getting the support you’ve earned.
Experiencing PTSD isn’t easy. But remember, you’re not alone in this fight. There’s a whole community of fellow veterans who’ve walked this path before you and countless resources available to help.
If you believe you’re experiencing PTSD, don’t hesitate to reach out for help. It takes courage to confront these challenges head-on, but that’s something we, as veterans, know all about. You’ve served our country, and now it’s time to ensure you get the care you deserve.
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Most veterans are underrated for their disabilities and, therefore, not getting their due compensation. At VA Claims Insider, we educate and support you to understand and take control of the claims process, so you can get the rating and compensation you’re owed by law.
Our process takes the guesswork out of filing a VA disability claim and supports you every step of the way in building a fully-developed claim (FDC)—so you can increase your rating FAST! If you’ve filed your VA disability claim and have been denied or have received a low rating—or you’re unsure how to get started—reach out to us! Take advantage of a FREE VA Claim Discovery Call. Learn what you’ve been missing—so you can FINALLY get the disability rating and compensation YOU DESERVE!
