VA Permanent and Total Disability (TDIU) for PTSD
Permanent and Total disability (P&T) has some benefits that not everyone on VA disability receives. Some are practical, such as freedom from periodic reviews of their medical conditions. Others are actual VA benefits, such as educational and healthcare benefits for dependents and survivor benefits. Here’s what you need to know about getting a permanent and total disability designation for PTSD.
“Permanent” and “Total” are Separate Considerations for VA Disability
Although the terms “permanent” and “total” are often discussed together, it is possible to have a permanent disability that is not totally disabling. “Permanent” means that the VA does not expect the condition to improve. “Total” means that the person is considered completely disabled, either with a 100% VA disability rating or a TDIU designation. Either can be assigned without the other. For example, a veteran may have a permanent disability (such as PTSD) at 70%. Her PTSD is not “Total” because it is less than 100%. Likewise, it is possible to have a total disability that is not permanent. For example, the same veteran’s PTSD may be temporarily rated at 100% during hospitalization for a suicide attempt, but not be designated as permanent because the VA expects that the condition may improve.
Permanent and Total disability requires both a 100% rating or TDIU designation and an expectation that the condition will not improve.
VA Disability Rating Schedule for PTSD
PTSD is rated according to the General Rating Formula for Mental Disorders. If the veteran also suffers from other service-connected mental health disorders such as depression or anxiety, the symptoms of PTSD and the other disorders will be considered together.
To receive a 100% VA disability rating for mental health conditions alone, the veteran must meet the following criteria:
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.
As you can see, that’s a high bar. And it will be up to you to provide sufficient medical documentation and supporting statements from people in your life to establish the level of severity of your condition.
If you are preparing to file for VA disability for PTSD or seeking to increase your VA disability rating, you should know that efforts are underway to change the rating formula for mental health conditions. Those changes were expected in 2025 and have not yet been implemented, but are still anticipated. Most experts believe the new rating formula will benefit veterans, so it’s a good idea to talk to an experienced VA disability benefits advocate about your options.
Other Ways to Secure a Total Disability Rating
If you don’t meet the criteria for a 100% VA disability rating for PTSD alone, there are other ways to qualify for a Permanent and Total disability rating.
One way is to combine your PTSD rating with disability ratings for other service-connected or secondary conditions. You should be aware, though, that the VA uses a formula for combined disability ratings. For example, a 50% VA disability rating for PTSD and a 50% rating for a physical condition don’t add up to 100% as you might expect. Instead, they combine to 75%.
The other way is a TDIU designation, also known as individual unemployability. A TDIU designation is assigned when a veteran has a VA disability rating of less than 100%, but is nonetheless considered unemployable due to the limitations of one or more service-connected conditions. A minimum VA disability rating is typically required for this designation (at least 60% of one condition or at least 70% for a combination of conditions with at least one rated at 40% or higher), but occasionally the VA makes an extraschedular determination of TDIU.
If one of these three conditions is met, you meet the “total” prong of the test for P&T disability.
Determination of Permanent Disability for PTSD
Whether a total VA disability rating for PTSD or a combination of conditions is “permanent” is a medical question for the veteran’s treating doctor. Will this condition ever improve during the veteran’s lifetime? If the doctor’s answer is no, then the veteran should submit the doctor’s written opinion to VA, with documentation of the reasons for that belief.
The VA may or may not accept the treating physician’s assessment. In some cases, they may require a C&P exam or additional information to make their determination.
Can a Permanent and Total Disability Rating Ever Be Changed?
A Permanent and Total disability rating is considered permanent, and the veteran is not subjected to periodic rating reviews. However, there are unusual circumstances in which a P&T rating can be altered. For example, if you were considered permanently disabled but a new treatment later emerged that cured or significantly mitigated your disability, your rating could be altered to reflect that.
The VA Will Award Permanent and Total Disability (P&T) for PTSD
- The veteran’s PTSD meets the criteria for a 100% rating, and
- Medical evidence shows that the PTSD is not likely to improve during the veteran’s lifetime.
Case Study 1: Permanent and Total Disability (P&T) for PTSD
A 40 year-old Gulf War combat veteran filed a claim for PTSD in 2011. In 2012, VA denied the claim despite the Combat Action Ribbon noted on his DD Form 214. After significant development, DHG representatives won the case on appeal. The medical evidence proved that he met the criteria for a 100% rating. His symptoms included unprovoked irritability with periods of violence, impaired impulse control, and audio hallucinations. They were so severe that he could not hold a job. In addition, his doctor wrote that his symptoms would only get worse throughout his lifetime. Consequently, VA awarded a Permanent and Total disability for PTSD.
Case Study 2: Permanent and Total Disability (P&T) for PTSD
A 45 year-old Peacetime veteran received a 70% rating for his PTSD. After service, he worked in a Ford Motor Company manufacturing plant for 15 years. After a workplace injury to his back, he was medically retired. A VA medical exam found that his PTSD was unlikely to improve. However, there was no medical evidence to support a 100% rating. But for his workplace accident, he would be able to work. VA decided to keep his rating at 70%, which is less than total. Consequently, he was not entitled to Permanent and Total disability for PTSD.
Case Study 3: Permanent and Total Disability (P&T) for PTSD
A 22 year-old Air Force veteran witnessed a deadly parachute accident. It happened 3 months into his active duty service. As a result, he was diagnosed with PTSD and anxiety disorder. Unfortunately, he turned to drugs and alcohol to self-medicate his symptoms. Within 2 years of his discharge, he was homeless. When he filed a PTSD claim, VA denied it for insufficient evidence. At the local VA hospital, he met another veteran who referred him to DHG. DHG then developed medical evidence, a lay statement from the veteran, and legal arguments. In response, VA scheduled a PTSD medical examination. VA’s own examiner recommended a permanent 100% rating. Shortly afterwards, VA awarded a Permanent and Total disability rating for PTSD.
FAQs On Permanent and Total Disability for PTSD
What is the difference between Permanent and Total?
Permanent means the condition is not expected to improve. Total means the veteran is considered completely disabled, either with a 100% rating or a TDIU designation. When both apply, the veteran is considered Permanent and Total (P&T).
Can I qualify for P&T if my disability rating isn’t 100%?
Yes. Veterans who cannot work because of their service-connected conditions may qualify for Total Disability based on Individual Unemployability (TDIU), which counts as “Total.”
Can the VA change a Permanent and Total rating?
It is rare, but possible. A P&T rating can be changed only if new medical evidence or treatment shows the condition has significantly improved.
Call for a Free Case Review
If you’re unsure whether your condition qualifies as Permanent and Total, our accredited advocates can review your case, gather evidence, and fight for the benefits you’ve earned. Are you eligible for Permanent & Total disability? For a FREE CASE REVIEW, call 800-800-3332 or click here.
