How to file a VA PTSD claim — the foundational mental-health claim for combat veterans + MST survivors

Step 1: Confirm DSM-5 PTSD diagnosis from a qualifying provider

PTSD diagnosis must come from: (a) VA mental health provider; (b) Vet Center counselor; (c) licensed civilian psychologist, psychiatrist, LCSW, or LMFT trained in PTSD assessment. DSM-5 PTSD criteria: (A) exposure to actual or threatened death/serious injury/sexual violence; (B) intrusion symptoms (nightmares, flashbacks, distress at reminders); (C) avoidance (people, places, conversations, thoughts); (D) negative cognitions/mood (memory loss for trauma, persistent negative beliefs, detachment, inability to feel positive); (E) arousal/reactivity (hypervigilance, exaggerated startle, sleep disturbance, irritability, recklessness, concentration); (F) duration >1 month; (G) significant distress or impairment. If you don't have a current diagnosis: (1) request VA mental health intake (free, no enrollment needed for combat veterans first 5 years post-discharge); (2) walk into any Vet Center (free, no documentation, OTH-welcome) — see /api/v1/howto/access-mst-counseling.json + /api/v1/howto/find-vet-mental-health.json. The VA may also schedule a Compensation & Pension exam covering PTSD diagnosis after you file.

Step 2: Document your stressor (combat-zone auto-verification OR MST lay evidence)

For COMBAT-ZONE STRESSORS (38 CFR 3.304(f)(3)): if you served in a combat zone (Iraq, Afghanistan, Vietnam, Korea, Persian Gulf, Bosnia/Kosovo, Somalia, Lebanon), VA cannot require objective documentation of specific traumatic events. Your sworn statement on VA Form 21-0781 describing the type of stressor (mortar attacks, IED exposure, witnessing casualties, combat firefights, MEDEVAC missions, body recovery, force protection incidents) is sufficient. Combat awards (CAB, CIB, CMB, CAR, Purple Heart, Bronze Star with V, Air Medal with V) auto-establish combat exposure. For MST/PERSONAL ASSAULT STRESSORS (38 CFR 3.304(f)(5)): file VA Form 21-0781a + lay evidence. MST does NOT require: prior reporting, investigative records, perpetrator identification, or witness corroboration. Acceptable evidence: behavior changes (sudden requests for transfer, deteriorating performance ratings, increased absences, substance use onset, relationship breakdowns), lay statements from family/friends describing pre/post-incident change, civilian records mentioning the assault any era, treatment records from civilian providers. The "marker" doctrine specifically allows VA to find behavior changes as evidence the assault occurred even without direct witness/report.

Reference: https://www.va.gov/find-forms/about-form-21-0781/

Step 3: File VA Form 21-526EZ + VA Form 21-0781 (or 21-0781a for MST)

Submit VA Form 21-526EZ listing "PTSD secondary to [combat/MST/personal assault]." Attach VA Form 21-0781 (combat) OR VA Form 21-0781a (MST/personal assault) with detailed stressor narrative. CRITICAL: do NOT minimize. List EVERY traumatic incident you can recall, even if seemingly minor. Include: dates (approximate), locations, what happened, who was involved, your role, the impact on you. Include lay statements from spouse/family/battle buddies separately on VA Form 21-10210 — these supplement your account + describe your post-event behavior changes. File via va.gov/disability/file-disability-claim-form-21-526ez/ OR through your CVSO. PACT Act: if your combat-zone deployment + PTSD timeline coincides with PACT-presumptive era, you may also have additional presumptive claims — file together where logical.

Step 4: Attend C&P exam — DO NOT MINIMIZE symptoms (examiner notes drive the rating)

VA will schedule a Compensation & Pension PTSD exam. Examiner is typically a VA-contracted psychologist or psychiatrist using DSM-5 + the Clinician-Administered PTSD Scale (CAPS-5) or PTSD Checklist (PCL-5). CRITICAL TACTICAL ADVICE: (a) BRING a written list of your symptoms — frequency, severity, triggers, impact on work + relationships + sleep + concentration. Do not rely on memory under stress. (b) DO NOT MINIMIZE — many veterans default to "I'm fine" / "managing OK" because of cultural conditioning. The examiner will rate based on what you say + observe. Specific descriptions matter: "I have nightmares 4-5 nights/week" (not "sometimes"); "I cannot tolerate fireworks at all" (not "I avoid loud noises"); "I have panic attacks weekly" (not "anxiety"); "I haven't slept more than 4 hours in 6 months" (not "trouble sleeping"). (c) DESCRIBE work + relationship impact specifically — missed work days, lost jobs, divorce, social isolation, anger episodes affecting family. (d) BRING a family member or close friend if possible — they can corroborate your account + describe what they observe.

Step 5: After grant — pursue secondary claims (this is where PTSD compounds)

Once PTSD is service-connected, MULTIPLE secondary claims become available under 38 CFR 3.310: (a) SLEEP APNEA secondary to PTSD — extremely common pathway; CPAP-dependent rated 50% (38 CFR 4.97 DC 6847); sleep architecture disruption from hyperarousal causes obstructive + central sleep apnea. Get a sleep study + nexus opinion from sleep medicine physician. (b) DEPRESSION secondary to PTSD — very common; rated 30-70% range often. (c) GAD/Anxiety secondary to PTSD. (d) Substance use disorder secondary to PTSD self-medication. (e) Erectile dysfunction secondary to PTSD (medication side effect or condition itself); ED also qualifies for SMC-K under "loss-of-use of creative organ" — see /api/v1/howto/file-smc-claim.json. (f) IBS / GI conditions secondary to chronic stress. (g) Hypertension secondary to PTSD — recognized pathway. (h) Headaches/migraines secondary to PTSD. Each secondary requires medical nexus opinion linking the secondary to PTSD. See /api/v1/howto/file-secondary-condition-claim.json. Properly-claimed secondaries can compound a 50% PTSD into a combined 80-100% rating.