How to Combat VA's Claim That You Don’t Have PTSD

How to Combat VA's Claim That You Don’t Have PTSD

Without VA benefits to cover proper therapy and treatment, veterans suffering from post-traumatic stress disorder (PTSD) are facing a future of personal and professional hardships. But just because the Department of Veterans’ Affairs has denied your PTSD claim doesn’t mean you’re out of luck.

As a veterans’ disability lawyer, I’ve helped numerous veterans fight for previously-denied VA compensation for PTSD – and win. One winning VA compensation for PTSD understands why the VA denies these important benefits.

Two Reasons VA Denies PTSD Claims

Typically, the Department of Veterans’ Affairs denies PTSD claims for two reasons:

  1. Absence of a verified stressor, or
  2. Absence of a PTSD diagnosis

Denials based on the absence of a verified stressor are common with non-combat VA claims when the veteran doesn’t have combat theater service or other exposure to direct combat stressors. Since many events during service are never reported, non-combat veterans can have a hard time verifying that stressful incident took place.

If the veteran can verify a stressor, the VA may then try to deny the claim for the absence of a bona fide PTSD diagnosis. They may argue that the veteran is “malingering,” and doesn’t have all the symptoms required for true PTSD diagnosis. The VA may also claim a veteran is malingering when he or she is seeking a higher disability rating, saying the veteran is exaggerating their PTSD symptoms.

VA Errs in Assuming Veterans Fake PTSD

A psychological study called the “Rosenhan Experiment” helps explain the VA’s error in denying claims based on what they feel is malingering. In this study, Stanford University psychologist David Rosenhan had imposter patients (with no mental illness) visit a psychiatric hospital over a three-month period. The “malingerers” would tell doctors they were suffering from mental illness and should be admitted to the psychiatric ward – faking it of course.

During the study, researchers asked the doctors to rate every incoming patient as either a malingerer or a legitimate patient suffering from mental illness. Out of 193 patients, doctors labeled 83 as potential malingerers (roughly 45%).

At the end of the study, Dr. Rosenhan informed hospital administration that there were no imposter patients at all. All 193 patients were legitimate patients with true mental illness. Just because doctors were told to be looking out for malingerers, they assumed that nearly half of the patients who walked through the door were faking their illness.

Rosenhan’s experiment concluded that "any diagnostic process that lends itself too readily to massive errors of this sort cannot be a very reliable one.” Applying this to the VA’s claim approval process, if the VA is looking for veterans who may be providing false or unreliable information, they will almost certainly label quite a few as malingerers.

Citing this study and other studies like it has successfully aided me in fighting for my veteran clients. When the VA’s reason for the denial centers on the PTSD diagnosis or its symptoms, attacking the VA's tendency to accuse veterans of faking it has great value in the arsenal of a good advocate.

VA Wrongly Decides Treatment Gap Means No Illness

Even if a veteran has an official diagnosis of PTSD, the VA may try to say a veteran doesn’t have true PTSD because he or she lacks consistent mental health treatment during the time between discharge from service and their official diagnosis. They assume if you aren’t being treated, you aren’t sick.

Of course, this is not the case. Reports show that over 70% of people with mental illness never receive treatment. In fact, few mental health patients are treated. Many take years to admit they are struggling. Others simply don’t have access to treatment. This treatment gap illustrates the difference between “true prevalence” and “treated prevalence,” – concepts the VA tends to confuse.

True prevalence means the condition exists, but healthcare professionals don’t document it because veterans aren’t reporting problems. When the VA sees the absence of treatment, it wrongly assumes the absence of the illness altogether. They fail to understand the concept of true prevalence, and they fail to consider the data regarding mental health treatment rates versus mental illness rates.

There is extensive research that explains why we have such a significant treatment gap and the principle factors behind it. For example, people suffering from mental illness don’t want to admit they have a problem due to the negative stigma around mental illness. Indeed, a very negative stigma surrounds mental health therapy in the military population. Many military personnel view seeking therapy as weak and contrary to their ubiquitous machismo attitude.

Some patients even have extreme paranoia and distrust of mental health professionals – often as part of the mental illness itself. Yet the VA universally fails to recognize that it is quite common for veterans with PTSD to go years without formal treatment. The VA wrongly concluded, if they aren’t getting treatment, they don’t have PTSD.

Using Mental Health Research to Win PTSD Benefits

To combat the VA's erroneous denial of PTSD benefits, veterans and their advocates must be familiar with the medical and scientific data that illustrates problems with the assumption of malingering and the normalcy of a treatment gap for veterans seeking mental health therapy.

An experienced veterans’ disability lawyer will be familiar with the scientific literature, understand these concepts, and be able to adequately explain them in order to mitigate the VA's objections. In some cases, medical expert testimony regarding the scientific literature can help clear up any discrepancies with the VA.

Don’t give up. If you or someone you know has been denied VA benefits for PTSD, we can help. Our Veterans’ Disability Benefits Law Firm specializes in handling difficult, hard to prove cases that have been on appeal for years. Contact us today at 888.878.9350 or Use This Online Form.

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Related topics: ptsd (20) | VA denials (6)


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