Anxiety disorders are very common mental health conditions. Experts estimate that 30% of American adults experience anxiety disorder. One study suggests that 15% of active-duty personnel experience anxiety disorders. While often manageable, in some cases, anxiety disorders can be so severe that the symptoms prevent veterans from engaging in normal activities.
If you or a loved one is a veteran who has debilitating anxiety symptoms, you may be entitled to disability benefits from the VA.
What Is Anxiety?
The American Psychological Association defines anxiety as “emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” Most people experience occasional anxiety that passes without disrupting their lives. However, anxiety can also become so persistent that it affects daily life. This is called an anxiety disorder.
Anxiety disorder is characterized as intense, excessive, and persistent worry and fear about common situations. Symptoms of an anxiety disorder may include:
- Feeling nervous, restless, or tense
- A sense of impending danger, panic, or doom
- Increased heart rate
- Rapid breathing
- Feeling weak or tired
- Difficulty concentrating or thinking about anything other than subjects of worry
- Difficulty sleeping
- Gastrointestinal (GI) problems
- Difficulty controlling feelings of worry
- Urge to avoid things that trigger anxiety
Anxiety disorders can cause panic attacks, which are episodes of sudden, intense feelings of anxiety, fear, or terror. Both persistent anxiety and panic attacks can be debilitating.
The Mayo Clinic notes that there are multiple anxiety disorders. Some of the most common anxiety disorders include:
- Generalized anxiety disorder: Persistent and excessive anxiety and worry about activities or events. Worry is difficult to control and causes physical symptoms.
- Panic disorder: Characterized by panic attacks, which are sudden feelings of intense anxiety, fear, or terror that reach a peak within minutes. Panic attacks can cause feelings of impending doom, shortness of breath, and rapid, fluttering, or pounding heart.
- Social anxiety disorder: High levels of anxiety, fear, and avoidance of social situations. It may cause feelings of self-consciousness and concern about being judged by others.
- Anxiety disorder due to a medical condition: You may develop severe anxiety or panic as a result of a physical health condition.
- Agoraphobia: Fear of places or situations that might cause you to panic or make you feel trapped, helpless, or embarrassed. Agoraphobia can be so severe that you avoid any situation that might trigger anxiety.
- Substance-induced anxiety disorder: Certain illicit or prescription drugs can lead to symptoms of intense anxiety or panic. In addition, withdrawal from drugs can trigger anxiety symptoms.
- Other specified anxiety disorder and unspecified anxiety disorder: This term refers to anxiety symptoms that are significant enough to be disruptive but but don’t meet the exact criteria for any other anxiety disorders.
There is no single cause of anxiety disorders. Experts are not certain what predisposes some people to anxiety disorder. There are some factors that can increase the risk of developing an anxiety disorder.
- Trauma: People who experience a traumatic event may develop anxiety disorders.
- Stress due to an illness: Experiencing a health condition or serious illness can cause significant worry.
- Stress buildup: Tension about stressful life situations – such as a death in the family or job loss – may trigger excessive anxiety.
- Other mental health disorders: People with other mental health disorders, such as depression, may also have symptoms of anxiety disorder.
- Family history: Anxiety disorders can run in families.
Anxiety disorder can be treated. Most people can manage their symptoms with a combination of therapy and medication. However, some people may have symptoms that are debilitating and don’t respond to treatment. They may have short or long periods where they cannot engage in normal activities due to severe anxiety.
Anxiety VA Ratings
The VA recognizes several anxiety disorders as a disability under section § 4.130:
- Generalized anxiety disorder
- Specific phobia: social anxiety disorder (social phobia)
- Other specified anxiety disorder
- Posttraumatic stress disorder
- Panic disorder and/or agoraphobia
- Unspecified anxiety disorder
- Illness anxiety disorder
Benefits for anxiety disorder are awarded based on how significantly symptoms affect a veteran’s daily life. Anxiety VA ratings are:
10: Occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or symptoms controlled by continuous medication.
30: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).
50: Occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.
70: Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.
100: Total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.
Service Connection for Anxiety Disorder
For veterans to qualify for VA disability benefits for an anxiety disorder or any health condition, they must be able to prove service connection. This means demonstrating a link between their condition and their military service. There are three elements required to prove this connection:
- A current diagnosis of an anxiety disorder
- An in-service incident or circumstance that caused or aggravated the anxiety disorder
- A medical nexus connecting the current diagnosed anxiety disorder to the in-service incident or circumstance
Anxiety Disorder Onset During Active Duty
One way to prove service connection is to demonstrate that your anxiety disorder started or got more severe while you were on active duty. Any records you have regarding anxiety symptoms experienced before you joined the military can demonstrate that the condition was well managed before your service. If you got treatment during the service, you can use those records to show that you were dealing with those symptoms at the time. In addition to medical records, you can ask people who knew you at the time to share their memories. These “buddy letters” can act as another record of your mood and symptoms during your service. But keep in mind that the VA favors service medical records above lay statements as evidence of in-service events. VA is often inclined to view some buddy statements as biased, and your own lay statements as self-serving. However, it is important to obtain them and submit them to VA anyway.
You may also be able to show that your anxiety disorder started as a result of a trauma that occurred during active duty; military records can show evidence of an injury, combat situation, or other service-related trauma. Military sexual assault is another type of trauma that may precipitate an anxiety disorder. You do not need to have pressed charges or gotten treatment after the assault to include it as a trigger of an anxiety disorder.
Military Service Aggravating Anxiety Disorders
Events during military service are not always the originating cause of a disability. Sometimes, military service makes an existing health condition worse than it would have been if you had not served. When military service aggravates a condition, the VA may consider it a military-connected disability.
You can show that service aggravated a mental health condition by presenting evidence of a prior diagnosis. Your medical records and enlistment records should contain information about pre-service health conditions. If you can show evidence that your anxiety disorder grew more severe during or after service, this can prove that the aggravation of the conditions is service-connected.
You can use your military and medical records, as well as letters from family, friends, and colleagues, to corroborate the connection between your time in the military and your anxiety disorder.
Anxiety and Other Mental Health Conditions
Anxiety disorders can co-occur with other mental health conditions, such as depression or PTSD. However, the VA doesn’t look at each diagnosed mental health condition as a separate issue. They don’t evaluate depression as one disability and anxiety disorder as a second disability. This is because in most cases, the symptoms overlap.
Instead, they look at the cumulative effects of all your symptoms. They base your rating on how all of the symptoms taken together affect your ability to function. Adding more diagnoses will not result in a higher disability rating.
However, we once represented a veteran who was the victim of an MST, military sexual trauma. He was seeking higher ratings for his service-connected mental disorder that was due to the MST. The veteran retained us to represent him on appeal at the U.S. Court of Appeals for Veterans Claims. In analyzing his file, we realized that he did have more than one mental health diagnoses. In addition, one of the disorders appeared to cause severe gastrointestinal symptoms.
Accordingly, we argued the case of Amberman v. Shinseki, which was a 2009 opinion from the Federal Circuit. In Amberman, the veteran suffered from two service-connected mental disorders, which were rated together, and she argued that the disorders were not the same disability as contemplated by 38 C.F.R. § 4.14 and should receive separate ratings. The Federal Circuit recognized that some mental disorders could have different symptoms and it would be improper in some instances for VA to treat the separately diagnosed conditions as producing the same disability. For example if a veteran has somatization disorder that produces stomach problems, it would not overlap with the PTSD symptoms such that the veteran could receive a separate rating. It is our professional opinion that for Amberman’s holding to be successful, a veteran must have a unique mental health diagnoses that produces symptoms that are beyond the scope of the rating criteria.
Anxiety as a Secondary Condition
Anxiety disorders can occur as the result of another health condition that is linked to your military service. When this happens, you can add your anxiety disorder diagnosis to your overall disability claim as a secondary condition.
For example, anxiety disorders such as panic attacks or PTSD can develop as a result of a traumatic brain injury. If you sustained a TBI due to a combat injury, that is your primary service-linked disability. If your doctor confirms that you developed an anxiety disorder because of the TBI, then the anxiety disorder is a secondary disability caused by the first disability.
Another example is if you have anxiety caused by a medical condition. The stress of managing health issues – including treatment, recovery, financial costs, and the effects on family life – can lead to an anxiety disorder. A veteran who suffered a disability due to limb loss or developed cancer due to burn pit exposure will be subject to tremendous medical stress. If that stress triggers a newly occurring anxiety disorder, the anxiety would be a secondary disability.
Examples of medical problems that can be linked to anxiety include:
- Heart disease: Heart disease is very common among veterans. According to one study, 9.2% of veterans report coronary heart disease, 7.1% of veterans have experienced heart attacks, 4.9% of veterans have experienced stroke, and 11.3% of veterans report other heart conditions.
- Diabetes: Type 2 diabetes is a common condition among veterans. Some estimates suggest that 25% of veterans develop type 2 diabetes. In addition, diabetes is linked to exposure to Agent Orange.
- Thyroid problems: Thyroid conditions can affect mood and behavior. Thyroid disease is linked to Agent Orange exposure and may affect veterans who served in Vietnam.
- Respiratory disorders: Veterans may experience respiratory disorders, particularly if they are exposed to certain chemicals. Burn pit exposure is known to cause lung disease, including COPD, lung cancer, constrictive bronchiolitis or obliterative bronchiolitis, emphysema, and interstitial lung disease (ILD).
- Drug misuse or withdrawal: The Substance Abuse and Mental Health Services Administration estimates that as of 2020, over 5 million veterans had substance abuse disorders. Research shows that substance abuse is often correlated with anxiety disorders; as many as 80% of individuals seeking treatment for substance abuse had at least one co-occurring anxiety disorder.
- Chronic pain: Chronic pain is a prevalent issue for veterans. Veterans are more likely than civilians to experience chronic pain, and the pain is more severe. Pain can be due to severe injuries that occurred during service, including limb loss, spinal injuries, or broken bones. In addition, veterans are prone to repetitive motion injuries like degenerative disc disease. Joint disorders like osteoarthritis can also be linked to military service.
- Irritable bowel syndrome: New research shows that irritable bowel syndrome is more common among veterans than previously known. In one survey, 28% of respondents reported IBS symptoms such as chronic constipation or diarrhea. The respondents also reported high levels of anxiety and decreased quality of life.
- Cancer: Any cancer diagnosis can provoke anxiety, and for some people, the anxiety can be debilitating. The incidence of cancer among veterans is very high, with nearly 50,000 veterans receiving new cancer diagnoses every year. Exposure to radiation, burn pits, and contaminated water at Camp Lejeune are all linked to certain cancers in veterans, including:
- Adult leukemia
- Bladder cancer
- Kidney cancer
- Liver cancer
- Multiple myeloma
- Non-Hodgkin’s and certain other lymphomas
- Brain cancer
- Gastrointestinal cancer of any type
- Head cancer of any type
- Kidney cancer
- Lymphatic cancer of any type
- Neck cancer
- Pancreatic cancer
- Reproductive cancer of any type
- Squamous cell carcinoma of the larynx
- Squamous cell carcinoma of the trachea
- Adenocarcinoma of the trachea
- Salivary gland-type tumors of the trachea
- Adenosquamous carcinoma of the lung
- Large cell carcinoma of the lung
- Salivary gland-type tumors of the lung
- Sarcomatoid carcinoma of the lung
- Typical and atypical carcinoid of the lung
- Respiratory (breathing-related) cancer of any type
- Bone cancer
- Breast cancer
- Colon cancer
- Esophageal cancer
- Cancer of the gallbladder
Another example: we once had a client who suffered from service-connected hepatitis C. He made a claim for service connection for anxiety secondary to his service-connected hepatitis C. The hepatitis C was very well controlled and produced very little effects on his day-to-day life. For that reason, the VA denied the claim, believing that it was not likely that a health condition that did not impact the veterans day-to-day life would produce anxiety. However, we dug deeper into the matter and realized that the genesis of his anxiety was not linked to the physical impairments that he experienced as a result of the hepatitis, but rather out of a fear that his condition would inadvertently infect his wife and grandchildren. We hired a medical expert, a forensic psychiatrist, who examined this matter and was able to bring out that distinction. Ultimately, we prevailed in the case and obtained for the veteran a very high anxiety VA rating secondary to hepatitis C.
Combined Rating for Anxiety Disorder and Other Disabilities
If you have another disability and also have anxiety disorder as a secondary condition, the VA may increase your overall disability rating. The VA will assign a disability rating to each condition and apply the Combined Disability Rating formula to the total. This process involves several steps:
- The disabilities are arranged in the order of their severity, beginning with the greatest disability.
- The ratings are combined with the use of a Combined Rating Table to determine the total rating.
- This combined rating value is rounded to the nearest 10%
- If there are more than two disabilities, the combined value for the first two is found but not rounded yet. That combined value is combined with the rating degree of the third disability.
- This process continues for any subsequent disabilities, and the final number is rounded to the nearest 10%
As an example, if a veteran has a 50% disability rating for one condition and a 30% disability rating for a second condition, the combined value, according to the Combined Rating Table, will be 65%. The 65% value must be rounded up to 70%. That veteran’s combined disability rating would, therefore, be 70%.
How to File a VA Disability Claim for Anxiety Disorder
To file a disability claim with the VA, you must first confirm that you are eligible to receive benefits. Eligible individuals must have served on active duty, active duty for training, or inactive duty training, must have been discharged honorably, and must have a current condition that affects their mind or body.
In addition, you must meet at least one of the following criteria:
- You got sick or injured while serving in the military.
- You had an illness or injury before you joined the military, and serving made it worse.
- You have a disability related to your active-duty service that appeared after completing your service.
You will need to fill out VA Form 21-526EZ either as a hard copy or online.
You may choose to file just the claim form, or you can file a fully developed claim that includes the following:
- All private medical records related to the claimed condition
- Any records of medical treatment for the claimed condition while serving in the military
- Any military personnel records related to the claimed condition
- Information about any related health records that you don’t have. The VA can request them on your behalf from a federal facility like a VA medical center or clinic.
- Letters from family members, friends, clergy members, law enforcement personnel, or fellow service members can add information about the claimed condition and how and when it happened.
When collecting medical records or other evidence of anxiety symptoms, look beyond mental health care records. Some symptoms of anxiety have physical manifestations, such as:
- Skin conditions: Skin issues can be an unrecognized symptom of anxiety. Sometimes called “psychogenic itch” experts define anxiety-related skin issues as “an itch disorder where itch is at the center of the symptomatology and where psychological factors play an evident role in the triggering, intensity, aggravation, or persistence of the pruritus.” In other words, periods of high stress or anxiety can trigger itching, hives, rash, or other persistent skin discomfort. Service members may have sought treatment for psychogenic itch without realizing it was a symptom of anxiety disorder. They and their doctors might have assumed it was a dermatological problem or an allergy causing the condition. In-service medical records that show treatment for psychogenic skin issues can be helpful in identifying episodes of anxiety during active duty.
- Hair pulling: Trichotillomania, or hair-pulling disorder, is a form of compulsive behavior where an individual pulls out their own hair. It causes frequent, irresistible urges to pull out hair from the scalp, eyebrows, eyelashes, or other areas of the body. It can cause visible hair loss and skin damage. Trichotillomania is linked to anxiety disorders and may be one symptom of anxiety. However, doctors may not note the link to anxiety disorder or think it’s a skin issue causing hair loss. Evidence of trichotillomania that started during active duty, including photos that show you with missing hair, can support a claim of service-linked anxiety disorder.
- Picking at skin: Dermatillomania, also known as excoriation disorder or skin-picking disorder, causes an individual to compulsively pick or scratch their skin, causing injuries or scarring. Like hair-pulling disorder, this condition can be linked to anxiety disorders or mental health conditions like obsessive-compulsive disorder. Active duty personnel are prone to minor skin injuries, so frequent scratches or sores might not raise concerns about mental health issues. However, medical records of dermatillomania-related skin infections or photos showing persistent scratches and sores can demonstrate that anxiety-related dermatillomania started during military service.
Another area that could be evidence of anxiety is enuresis. Enuresis is the medical term for bed wetting at night. This is a rare condition, and in all of my 25-plus years of practice, I have only seen it twice. Veteran made a claim for a mental disorder secondary to a personal assault in service. This personal assault was not sexual in nature, but it nevertheless caused severe chronic mental health issues that affected his life for decades after service. In this particular case, the veteran was anyone able to complete the physical training and as a result his entire unit was given extra work to do. That night, in the barracks, they held a blanket over his bunk and pinned him down something called a blanket party, and they beat him with bars of soap inside socks. They beat him severely.
As a result of this incident, the veteran, who was about 19 years old at the time, started wetting the bed. He ended up getting discharged from the service for bed wetting. However, he never reported the assault. Later, the VA denied his claim on the grounds that there was no evidence of an in-service event or trigger for the onset of his mental health issues. The veteran had to file an appeal, and retained our law firm. As an aside, it is extremely important if you are denied for anxiety disorder that you consult with an attorney for possible appeal. In cases where there is complexity, there is rarely a situation where a veteran would not benefit from the advice of a very experienced veterans benefits attorney. In this case, we hired a forensic psychiatrist who was able to delve into the underlying issues for the development of this condition. Through the forensic analysis, and the research of the scientific literature, we were able to establish that the in-service bed wetting was the early manifestation of an undiagnosed anxiety disorder that was not formally diagnosed until years after service. This was helpful because there was no report to sick call for anxiety or mental health symptoms.
In most cases involving mental health issues, there is rarely an explicit reporting of the symptoms in the service treatment records. Military personnel are loathe to admit to any mental health issues and so the skill of the advocate in trying to find alternative ways of proving the event is invaluable.
We had another case where a veteran claimed service connection for a mental disorder as a result of a personal assault during service. In this example, the veteran was not particularly injured or harmed in the incident, but nevertheless, it proved to be a very powerful trigger for him. The veteran was in the shower one day and he had shampoo in his hair and was washing his hair when somebody came along and turned the water all the way on hot, trying to scold him. He jumped out of the way before he suffered any burns. He did not suffer any skin injuries or anything else of that nature. However, after this incident the veteran started developing hives in something called angioneurotic edema that affected his lips. There were never any explicit psychiatric symptoms reported or noted in his service treatment records.
The veteran’s claim was denied repeatedly for many years until he finally hired our law firm. In our research, we discovered that the veteran grew up in a neighborhood in Bronx, New York where he was the only Jewish kid in an all Irish neighborhood. He grew up being bullied and had a fear of being bullied since childhood. Although he did well in school and had no further problems in his childhood, the incident in service brought back to life the old feelings of being bullied. In addition, we discovered that this veteran typically broke out in hives when under extreme stress. From that information we were able to determine that the hives and angioneurotic edema that he suffered during Service were his body’s stress reaction to various events. The forensic psychiatrist was able to establish that those noted symptoms in his service treatment records were the early signs of an anxiety disorder and that those symptoms tended to corroborate his report of the personal assault in the shower.
We obtained over $360,000 in retroactive pay for this veteran, and we used the evidence of hives and angioneurotic edema in service to prove the earliest manifestations of anxiety during active duty. Results of this nature are difficult to obtain without the assistance of an experienced veterans’ disability lawyer. In addition, these results were also only obtained because of a willingness to take his case to the US Court of Appeals for Veterans Claims. To get to the US Court of Appeals, a veteran must file an appeal with the Board of Veterans Appeals and be willing to take his case to the highest levels of the appellate process within the federal agency. Too often, veterans continue just to refile claims over and over again at the local regional level. Although most veteran service officers are excellent at what they do, there are some that rarely take cases to the Board and feel that it is not necessary. In complex cases, a case should be taken to the board, and if denied there, taken on appeal to the US Court of Appeals. That’s where the experience of a veterans’ disability attorney with extensive appellate experience at the federal appeals court could mean the difference between winning and losing and potentially winning significant sums of back pay.
There is a saying amongst many in the veterans bar that says, if you’re going to get a decent decision out of the VA, it’s going to come from the Board. I know many readers of this article probably dispute this insight to many instances where cases have been granted right away at the regional office level. And that is true. Most of the easy cases with good proof are granted relatively easily, leaving many in the veterans advocate community to think that lawyers are unnecessary. However, lawyers are very necessary in cases that are complex and difficult. We’re talking about the cases that are not easily granted on the first try, and cases that cannot be won without a high-powered medical expert. In addition, if you receive a Board denial, it is essential that you consult a lawyer to get advice on your appeal options. Only a veterans’ disability attorney who is licensed to practice before the US Court of Appeals for Veterans Claims is able to represent you on an appeal to the federal appeals court following a Board denial.
If you need help gathering supporting documents, staff at the VA can assist you and so can a veterans’ service officer.
C&P Exams for Anxiety Disorder
The VA may ask you to get a Compensation & Pension (C&P) Exam to assess your claim of military-connected anxiety disorder. The VA uses C&P exams to determine if there is a medical nexus between the diagnosed condition and their time in service. If a C&P exam is ordered, you must attend or contact the VA immediately to tell them if you are unable to do so. Failing to attend a C&P exam will likely result in your claim being denied.
During a C&P exam, the veteran will see a VA doctor (or a doctor contracted by the VA). The doctor will ask about medical history, time in service, and current condition, including symptoms of anxiety disorders. If your anxiety is linked to another health condition, a physical exam may be part of the process as well.
If you want to bring your spouse or another support person to your C&P exam, you should request permission in advance. They may not participate in the exam. There is other strategic advice we offer our clients before they attend the exams to maximize the chances of a favorable outcome. And this advice is given to our clients on a case-by-case basis depending on their circumstances.
After the C&P exam, you are entitled to a copy of the examiner’s report. The VA will not give you this report automatically. They will only provide it if you request it.
You will not receive any new diagnostic information or treatment plans after a C&P exam. It is not a medical exam for treatment purposes, but rather a process to assess your existing health and disability claim.
What if My Anxiety Disorder Claim Is Denied?
The VA may deny your initial disability claim. This is disappointing and frustrating. If your initial claim is denied, you have options to appeal the decision. There are several options for initiating an appeal.
- Higher Level Review Appeal: This option asks the VA to submit your existing application to a higher-level reviewer. You cannot submit any additional evidence to support your claim.
- Supplemental Claim Appeal: With this option, you can add new relevant evidence to your initial claim and submit that for review.
- Notice of Disagreement with the Board of Veterans Appeals: If you want to file a Board appeal, you can use three different processes or lanes; the options are evidence submission, direct review, or a hearing.
- Appeal to the US Court of Appeals for Veterans Claims (“CAVC”): You have 120 days following the denial by the Board to file an appeal with the US Court of Appeals. You absolutely must consult with an attorney at this point.
Working with a VA law firm can improve your chances of having a successful appeal.
Experienced Legal Help
If you need assistance with your VA disability case for anxiety disorder, we can help. Our team of experienced lawyers can help you get all the benefits you deserve for your anxiety VA rating. To learn how a VA benefits lawyer from our law firm can help with your anxiety disorder disability benefits appeal, give us a call at 888-495-5774 or visit our site to schedule a free case evaluation.