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Some history. I was a VA psychologist for 22 years, 1974 to 1996. The PTSD diagnosis didn’t exist until 1980, when the existing DSM (DSM II) was revised into DSM III. I worked with countless veterans both in treating PTSD and conducting C&P exams, The exam you go through when applying for disability compensation. When I retired from the VA in 1995 we were up to DSM IV, with DSM V soon to follow. I continued doing both ends of the work in private practice until about 2020.. The diagnosis has changed somewhat throughout these revisions, but the basic criteria have remained.

It is essential to know a few things: First, the VA has always used the existing DSM to make diagnoses; This is not new.

Second, VA psychiatrists and psychologists, among many others, have been involved from the start in defining the criteria for PTSD, and the combat veteran experience has been a part in defining the condition. For the revision of DSM III, the DSM III-R, I was on the PTSD committee myself. The committee was heavy with VA people who had been involved, like me, in treatment of vets for years.

Third, the process of determining VA disability has two basic steps: the diagnosis comes first, by a clinician, who writes up a clinical evaluation; and second the disability determination, by a different person, based on the outcome of the exam. The psychiatrist you see for the exam does not decide on disability.

Disability determination depends on a number of criteria mostly which relate to post-trauma functioning: not only symptoms of post-traumatic anxiety but also problems in various domains of functioning. I don’t have DSM-5-tr but from DSM 5, the key criterion for disability is this: “The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning,” A statement like this has been included in every rendition of the diagnosis. The only thing new that you may be encountering is the wording in DSM5tr.

To be clear, it may sound cold, but the compensation is for this loss of functioning, ie disability to function, not simply for the pain and suffering that goes with it. Hope this helps.

That’s good data, but slightly off.

The award is a 3 step process. Not 2. First, a current diagnosis, which you listed. The 3rd step you also listed, an evaluation of extent.

The 2nd item is nexus. There has to be an evaluation that the diagnosis derives from active duty service. In most cases of all disability, not just PTSD, there would need to be evidence of ongoing issues (though some issues are intermittent and need not prove this).

Nexus is in the form of an evaluation by someone, maybe . . . often . . . the C/P examiner that “the current diagnosis is at least as likely as not” derived from active duty events.

The linkage of diagnosis can be less than 50% likely derived from active duty, 50/50 likely linkage (as likely as not), or certainly linked (an amputation for example occurring at a battlefield hospital).

As I said above, it is a difficult process. Cheating is not a trivial thing to do.