The long-term effects of service-related injuries can take unexpected forms. Some veterans experience disabling symptoms that make up a condition called spatial disorientation. Spatial disorientation causes vertigo, clumsiness, confusion, and tinnitus. It can severely limit daily activities.
The causes of spatial disorientation are not always clear, but the VA associates it with both PTSD and TBI. In addition, presenting symptoms of spatial disorientation could make you eligible for the higher rating criteria if service connected for certain conditions like PTSD. Learn more about how the VA addresses claims that include spatial disorientation.
What Is Spatial Disorientation?
Spatial disorientation usually refers to feeling like you cannot physically orient your body to your surroundings. You may feel off balance or dizzy for no reason. You might be excessively clumsy or need to hold the wall or furniture to maintain posture or navigate walking around a room.
Spatial disorientation can also be accompanied by confusion or brain fog. You might also experience other symptoms of vertigo, like nausea, ringing in the ears, or altered visual perception. The symptoms may be intermittent or can go on for prolonged periods, disrupting regular activity.
What Causes Spatial Disorientation?
Most of the scientific literature on spatial disorientation has to do with symptoms in pilots and scuba divers. Both airplane flight and underwater diving can cause a disconnect between what the body feels and what the eyes see. That disconnect can lead to temporary feelings of spatial disorientation.
The causes of spatial disorientation in other situations are less clear. Sometimes people experience spatial disorientation during daily life, even where there is no apparent reason for the symptoms. Experts believe that vestibular dysfunction is part of the cause. The vestibular system comprises the delicate structures of the inner ear that aid in balance. If those structures are damaged or unable to communicate properly with the central nervous system, it can result in spatial disorientation.
Research indicates that PTSD can trigger symptoms of vestibular dysfunction, including spatial disorientation. The exact link is unclear, though some researchers believe it has to do with the effects of trauma on the brain's structure. In addition, spatial disorientation symptoms can appear after a traumatic brain injury (TBI). The damage to the brain can affect the vestibular system or the ability of the nervous system to properly interpret sensory information.
Does the VA Consider Spatial Disorientation a Disability?
The VA does not treat spatial disorientation alone as a disability. Instead, the VA lists spatial disorientation as a symptom of PTSD, TBI, or other mental illnesses. For the VA to consider spatial disorientation in a disability claim, you would need to show that it is connected to an injury or mental health condition that you acquired because of your military service. In other words, it should be viewed as a symptom of a service-connected disability, such as PTSD or TBI.
What Is PTSD?
Post-traumatic stress disorder (PTSD) is a common mental health condition that affects veterans. As many as 15% of combat veterans exhibit some degree of PTSD.
According to the Mayo Clinic, PTSD is a mental condition caused by the trauma of experiencing or witnessing a terrifying event. For example, many veterans experience or witness trauma in combat, sustain traumatic injuries with lasting emotional impacts, or experience sexual assault. All these events can lead to PTSD.
PTSD symptoms can be emotional or physical. In addition to spatial disorientation, veterans with PTSD might experience:
- Being easily startled or frightened
- Difficulty maintaining close relationships
- Feeling emotionally numb
- Irritability, angry outbursts, or aggressive behavior
- Memory problems
- Negative thoughts
- Sleep changes
- Trouble concentrating
For the VA to consider a diagnosis of PTSD, symptoms must be present for one month or longer, get worse over time, and/or interfere with daily life.
What Is a Traumatic Brain Injury?
According to the CDC, a traumatic brain injury (TBI) is any injury to the brain that affects brain function. TBI is often caused by a blow to the head or body that causes the brain to move in the skull, damaging brain tissue. Any object that penetrates the skull and brain, such as a bullet wound, is also considered a TBI.
The risk of TBI is high for military personnel, and many veterans have changes to mental and physical abilities after a head injury.
The VA recognizes a wide array of residual effects from TBI and considers them when evaluating disability claims. Some of the residual effects of TBI include elements of spatial disorientation such as vertigo, tinnitus, impaired motor control, inability to orient oneself, and confusion or brain fog.
How Does Spatial Disorientation Affect Disability Claims?
If you are experiencing spatial disorientation, you should include it as a symptom in your disability claim. The VA recognizes spatial disorientation as one of the most severe symptoms of PTSD and rates it accordingly. Thus, if you have spatial disorientation and are seeking a higher PTSD rating, make certain you have this documented.
The VA places greater weight on symptoms documented in your treatment records than it does on statements you make purely in connection with a claim for appeal for VA benefits. Accordingly, it is best to visit your treating doctor or therapist often and tell your treating provider about the existence of these symptoms. The goal is to get the mental healthcare provider to document your complaints in the treatment records. The next step, then, is to make sure your treatment records get into your VA file. This way, when VA reviews your claim or appeal for VA benefits, it will see the symptoms that match the higher rating criteria.
This is a much better way to effectively communicate your symptoms than simply writing a statement in support of your claim or appeal. Statements in your treatment records carry more weight because, historically, judges believe that statements you make for treatment purposes are inherently accurate. It is premised on the idea people are seeking medical help and want to be as accurate as possible with the doctor or therapist to facilitate proper treatment and care.
Turning back to spatial disorientation associated with PTSD, if your claim is for disability benefits because of PTSD, and you are seeking either a 70 or 100 percent rating, you will need to demonstrate that spatial disorientation, along with other symptoms of PTSD cause, total occupational or social impairment or occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.
Additional disabling effects of PTSD might include:
- Difficulty in adapting to stressful circumstances
- Impaired impulse control
- Inability to establish and maintain effective relationships
- Near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively
- Neglect of personal appearance and hygiene
- Obsessional rituals which interfere with routine activities
- Speech intermittently illogical, obscure, or irrelevant
- Suicidal ideation
In the VA's General Rating Formula for Mental Health Disorders, conditions that include spatial disorientation as a symptom are rated at a 70% disability rating or higher.
When evaluating the effects of a brain injury, the VA separates the symptoms associated with spatial disorientation. If your injury resulted in a set of spatial disorientation symptoms that affect daily living, you would need to list each symptom rather than saying you experience spatial disorientation.
For example, if you experience a combination of dizziness, ringing in the ears, difficulty orienting yourself in your environment, and clumsiness, you will need to report each symptom separately. The VA examiner would then assess how each individual symptom affects your ability to live, work, and care for yourself.
Your disability rating for spatial disorientation related to TBI will be based on the cumulative effects of the symptoms on your life. The effects of each symptom are considered when deciding your disability rating.
What If I Don't Know if Spatial Disorientation Is Caused by PTSD or TBI?
Many veterans have both PTSD and TBI. The symptoms of the two conditions can be similar, and it may not be possible to know which condition causes any particular symptom. This should not prevent the VA from approving your benefits claim.
This is where the benefit of the doubt rule can kick in. The standard of proof in these VA disability cases is “as likely as not.” What this means is that if you can demonstrate that it is at least 50 percent probable that the service caused your problem or that the symptoms are coming from service-connected PTSD, then VA should attribute the symptoms to the PTSD—assuming you are service connected for the PTSD. Phrased differently, if a service-related cause and a non-service-related cause both equally cause your symptoms, VA is required to attribute the symptoms to the service-related condition.
How Will the VA Evaluate My Symptoms?
The VA categorizes PTSD as a mental health disorder. PTSD claims are rated on the scale called "General Rating Formula for Mental Health Disorders." Benefits are assigned based on what symptoms a veteran displays and the degree of "occupational and social impairment" they cause. Spatial disorientation is explicitly listed as a symptom of severe PTSD. Thus, if you are trying to maximize your VA rating for PTSD, it is crucial that you be explicit in documenting the presence of the spatial disorientation symptom.
Unlike spatial disorientation with PTSD, the VA considers TBI a neurological condition but treats each symptom as a separate condition. The VA evaluates veterans with TBI on the injury's cognitive, emotional/behavioral, and physical effects. Some TBI symptoms are rated according to a VA scale titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." Other symptoms are classified as mental conditions and are rated according to the criteria on the general mental health rating scale. Physical symptoms of TBI are rated as discrete physiological symptoms.
The distinct aspects of TBI-related spatial disorientation will be evaluated individually.
Qualifying for VA Benefits for Spatial Disorientation
To reiterate, there is no separate VA disability for spatial disorientation. Again, it is a symptom of severe PTSD or TBI. So, when you are asking about VA benefits for spatial disorientation, you must look at the issue as being merely a symptom of a service-connected condition. If you are not service connected for anything, and you have this symptom, then you need to get accurately diagnosed to determine what condition is causing this symptom. Then, to get disability benefits, veterans need to apply to the VA. Your claim must demonstrate three elements:
- You will need to show that you have a current disability. You will need to show that you have a condition that impacts your well-being and ability to work. It must be a chronic condition, not just a temporary one that healed without lasting chronic residuals.
- You will need to provide evidence that something happened in service that caused the development of the diagnosed condition. You will need copies of service medical records detailing symptoms, treatment, or complaints. Or, in cases of PTSD, an event that can serve as a PTSD stressor.
- You must establish a connection between in-service injury or disease and your present disability. You must be able to demonstrate that the cause of your disability was "incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein." Your service records may contain information about the pertinent events or injuries that led to PTSD or TBI during active duty. If you have proof that something happened in service, and you have a current diagnosis, often the missing link is the nexus letter or report. You can learn more about how to obtain a nexus letter here.
In addition to service records and medical records, statements from people in your life can support your claim involving spatial disorientation. So-called "buddy letters" from spouses, friends, or colleagues can help describe incidents where your spatial disorientation has affected your activities and how it limits your ability to work or care for yourself. Your friends and family may not be doctors so they can give professional opinions on the cause and diagnosis of spatial disorientation, but they can document witnessing you experiencing things or complaining about the symptom. Most importantly, your friends and family should discuss in their written statements how these symptoms impact your ability to work or have social relationships.