How to Win Disability Benefits for PTSD

Post-traumatic stress disorder (PTSD) is a very real disability that is often misunderstood. Living with PTSD becomes more devastating when sufferers find they can no longer do their jobs. Getting much-needed disability benefits for PTSD can be particularly frustrating. 

If you are struggling with PTSD and cannot work, we can help you obtain the benefits you deserve. Marc Whitehead & Associates is a national law firm advocating for the rights of those who have been disabled by PTSD.  The disorder can afflict anyone exposed to dire stress or trauma, from veterans in combat to individuals who experience or witness a horrible or life-threatening incident. 

Some people are disabled by PTSD alone, while others with PTSD struggle with additional impairments. Research has linked traumatic stress exposures and post-traumatic stress disorder to such conditions as cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, chronic fatigue syndrome, musculoskeletal disorders, eating and sleep disorders, and other diseases.

We work with people across the U.S. whose disability benefits for PTSD were wrongly denied by the Social Security Administration (SSA) or by their long term disability insurance carriers such as Unum, Cigna, Prudential and the others. Our accredited veterans’ claims lawyers represent veterans disabled by PTSD, who now are fighting for their disability compensation owed them by the Department of Veterans Affairs (VA). 

PTSD disability claims are often given a skeptical or unfair review and are denied without proper cause. The reasons are many, perhaps the main reason is that the severity of any mental illness can be difficult to prove objectively. 

Contact our PTSD lawyers or call 800-562-9830, and we’ll do everything we can to optimize your chances of getting maximum disability benefits for PTSD. We are familiar with the complex array of symptoms associated with PTSD, both psychological and physical. We know the medical and vocational evidence the Social Security, insurance, and VA examiners are looking for, and how to present all evidence most effectively.

The Many Causes of PTSD

To qualify for disability benefits for PTSD, you should provide sufficient medical documentation of a stressor event. Some cases of PTSD involve experiencing traumatic events such as physical assaults or muggings, terrorist attacks such as 9/11, natural disasters such as tornados, civil conflicts, or catastrophic events like car crashes or explosions.

Complex cases of PTSD may also involve traumatic and long-term physical, psychological, or sexual abuse, such as: 

The Disabling Symptoms of Post-Traumatic Stress Disorder

PTSD can be acute or chronic, with a broad scope of severity. Once the threat is gone, intense, adverse emotions leave sufferers with a jumble of imagery, sounds, smells, and other vivid memories of the event. PTSD symptoms can include:

• Flashbacks – Reminders of past events that trigger flashbacks, where the person suddenly relives the event as though it is happening again, without control. Triggers can be physical surroundings, smells, sounds, certain people, or other reminders of the painful experience.
• Dissociation – Emotional numbness, a sense of being disconnected from yourself and detached from others. The person can lose awareness of what’s going on around them, being taken totally back mentally to the traumatic event.
• Nightmares – Intrusive memories of the event can be in the form of dreams and night terrors. 
• Intense fears – Episodes of intense, debilitating fear memories may be accompanied by periods of horror and helplessness, also referred to as emotional paralysis.

Further common symptoms of PTSD include:

• Anxiety and depression 
• Difficulty concentrating
• Confusion
• Angry outbursts, exaggerated startle response
• Avoidant behavior  

Symptoms normally begin soon after the traumatic event; however, PTSD can also suddenly be triggered years later. 

Winning Social Security Disability Benefits for PTSD 

The SSA defines post-traumatic stress disorder as “recurrent and intrusive recollections of a traumatic experience, which are a source of marked distress.”

You may qualify for Social Security Disability benefits for PTSD if you satisfy several criteria specified in the SSA’s medical Listing of Impairments. 

PTSD is categorized as a Trauma and Stressor-Related Disorder, under SSA Listing 12.15. The medical requirements are spelled out in three parts, A, B, and C. Your symptoms must satisfy the requirements of paragraphs A and B – OR – A and C.  

Part A is about medical evidence and documentation. Part A specifies five characteristics to diagnose a stress or trauma-related disorder, and all must be present. 

1. Exposure to actual or threatened death, serious injury, or violence
2. Further involuntary re-experiencing of the traumatic event 
3. Avoidance of external reminders of the event
4. Disturbance in mood and behavior, and
5. Increases in arousal and reactivity

Part B, which requires the extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:

1. Understand, remember, or apply information
2. Interact with others 
3. Concentrate, persist or maintain pace
4. Adapt or manage oneself

Part C of the medical listing for Trauma and Stressor-Related Disorders requires that post-traumatic stress disorder is “serious and persistent;” that is, you have a medically documented history of the existence of PTSD for at least 2 years, and there is evidence of both:

1. Medical treatment, mental health therapy, psychosocial support, or a highly structured setting that is ongoing and that diminishes the symptoms and signs of your mental disorder 

AND

1. Marginal adjustment, that is, you have limited potential to adapt to changes in your environment or to demands that are not already part of your daily life.

As you can see, winning Social Security Disability benefits for PTSD can be very technical and medically complex. Our experienced legal team can guide you through this process, whether you are preparing to file your initial claim, or you need to appeal a wrongful claim denial. 

What if you cannot meet the medical listing? You must not give up, because you have a further and often more attainable option, which is to qualify for benefits through SSA’s medical-vocational allowance. 

The Medical-Vocational Allowance begins by establishing your Residual Functional Capacity (RFC) – the physical and/or mental level of work you can perform as an impaired person.

To qualify under these standards, the post-traumatic stress disorder must be severe enough that you are considered disabled from performing your previous job, or any other type of substantially gainful work. SSA will look at the physical and mental demands of the work you have done in the past 15 years.   

If you can still do this kind of work, SSA will find that you are not disabled. If SSA finds that you cannot do your past work, the next step is for SSA to determine whether there is work available in the national economy that you can do.  

These last two steps of the SSA’s evaluation process are where disability benefits for PTSD are often won. While Social Security is interested in your diagnosis of post-traumatic stress or other mental disorder, it is just as interested (if not more) in determining your degree of functional loss. 

SSA has specific mental and physical RFC forms that your treating doctor will complete and submit in support of your post-traumatic stress disorder claim. We work closely with your doctors to get their appropriate and complete documentation. Our attorneys will make sure your limitations that result from PTSD are specified distinctly and in the vocabulary of SSA disability. 

Winning Long Term Disability Benefits for PTSD from the Insurance Company

Convincing the insurance company that PTSD is a disability can be an uphill battle. What does it take to show an insurance carrier that you are unable to work because of your disorder and its complications?

Your first action is to read the policy and understand any limitations and exclusions. Here are a few common restrictive provisions written into most long term disability (LTD) policies:

• Insurance policies often take a hard line and limit coverage of “mental and nervous” conditions.” This umbrella term generally limits PTSD and other mental health disorders to 24-months coverage. If you are awarded short-term disability (STD) benefits, just as the 24-months of benefits expire the insurer will say you do not qualify for long-term disability, and disability payments will end. 
• LTD policies often have an “act of war” exclusion upon which insurers may try to base denials of disability benefits for PTSD.
• Most insurance policies will require that you also apply for Social Security disability benefits. The reason is, any disability payments the insurance company pays you will be offset (reduced) by the amount of your Social Security disability payments. And just because Social Security approves your disability claim for PTSD, this has no bearing on whether your insurance company will approve your claim for long-term disability benefits for PTSD.

One of the most important elements of a successful LTD insurance claim is having the support of your doctors. We work in close collaboration with physicians and mental health professionals so that your claim satisfies an insurer’s threshold of evidence required to prove you are disabled due to post-traumatic stress disorder.

We welcome the opportunity to discuss your long-term disability claim and how we may be able to help. Whether your coverage is under a group disability or an individual disability policy, we can help you file an initial application for disability benefits for PTSD and manage your case from start to finish, or handle all phases of your disability appeal. 

Disability Compensation for Veterans with PTSD 

The VA will acknowledge PTSD is a service-related disability provided you can verify that your PTSD symptoms are directly linked to your military service. The VA considers the following scenarios to be traumatic events, or “stressors,” in a veteran’s claim for disability benefits based on PTSD:

• you sustained serious injury, personal  or sexual trauma, or sexual violation, or
• you were threatened with injury, sexual assault, or death

The VA reports that PTSD is the leading mental health issue suffered by troops returning home from combat. As stated by the VA’s National Center for PTSD, many veterans of recent combat operations experience PTSD, including:

• 11 to 20 out of every 100 veterans (11-20%) who participated in Operations Iraqi Freedom (OIF) or Enduring Freedom (OEF)
• 12 out of every 100 Gulf War Veterans (12% ) who participated in the Gulf War (Operation Desert Storm)
• 30 out of every 100 Vietnam veterans (30%) who participated in the Vietnam War had PTSD in their lifetime.
• PTSD can relate to a traumatic sexual event. A distressing number of veterans have suffered sexual assault, abuse, and harassment while serving in the armed forces, referred to as military sexual trauma (MST).

Criteria For Getting Disability With PTSD

Eligibility for disability benefits for PTSD from the VA is based on the following:

• You have symptoms related to a traumatic event, or stressor, or your experience with the stressor is related to the PTSD symptoms
• The stressor happened during your military service
• You can’t function as well as you once could as a result of your symptoms
• You’ve been diagnosed with PTSD 

Many veterans seek our help when they disagree with the PTSD ratings the VA has assigned. VA is known to often rate at a percentage that does not consider the veteran’s actual disabilities and extent of impairment. To this end, we have prepared in-depth articles to help you understand your PTSD rating and what you can do to increase your PTSD rating. 

Remember, if you are a veteran diagnosed with PTSD, you may qualify for VA compensation, Social Security Disability Insurance (SSDI) benefits, or both.

If you are a veteran of any branch of the U.S. Military and need help obtaining disability benefits for PTSD, contact Marc Whitehead & Associates for a free consultation. We will help you verify the stressor, establish nexus, and communicate the extent of your disability to the VA, making certain your case is properly developed and presented.