PTSD and depression: what the Board looked for

Why PTSD and depression claims get denied

We read 164 PTSD, depression, and other mental health denials from the 1,721 Board rulings in our 2022 to 2026 study. The main reason the Board gave:

• 51% No current diagnosis, including none that met the standard mental health criteria (DSM-5) (84 of 164)
• 15% The Board found the VA’s own exam or opinion more convincing (25 of 164)
• 9% Nothing in the file linked the condition to service (14 of 164)
• 7% The event behind the PTSD wasn’t backed up in the record (11 of 164)
• 5% No event in service on record (9 of 164)
• 4% A legal rule ruled it out, mostly because a mental health condition was already service-connected (6 of 164)

Mental health is the one area where a missing diagnosis leads. The Board also often said the veteran’s own view of the cause wasn’t medical evidence (112 of the 164), and faulted private opinions for a wrong or incomplete history in 19. For PTSD, the record has to back up the event in service (19 denials noted it wasn’t). A medical opinion can’t do that by itself.

Counts come from what the Board wrote in each decision. None were Anchorpoint cases. How we counted

Where the VA exam and private letters fell short

These come from the decisions themselves.

• The VA exam points to no mental health treatment in service. In one 2025 appeal, the Board called a VA opinion resting on that alone “impermissible.”
• The VA exam gives a different diagnosis, such as alcohol use disorder, or says today’s symptoms don’t match what happened in service.
• The VA exam leans on assumptions, such as past substance use.
• Private letters fall short when they repeat your account with no reasoning, give a blanket statement, or only say a link is possible.
• For PTSD, the Board also needs support in the record that the event in service happened. A few denials turned on that, not on the letter.

What the Board looked for

“Probative” is the Board’s word for convincing.

What the opinions that won had in common

In 100 grants, the Board credited a veteran’s private medical opinion. Here is how often the Board said that opinion:

• 82% Explained its medical reasoning (82 of 100)
• 70% Came from a clinician who examined or interviewed the veteran (70 of 100)
• 69% Named the clinician’s profession or specialty (69 of 100)
• 65% Used the VA’s standard, “at least as likely as not” (65 of 100)
• 65% Considered the veteran’s own account (65 of 100)
• 64% Showed the clinician reviewed the records (64 of 100)
• 24% Cited medical studies (24 of 100)
• 15% Took on the VA examiner’s opinion (15 of 100)
• 8 of 34 Addressed whether a service-connected condition made it worse (secondary claims only)

Counts come from what the Board wrote in each decision. None were Anchorpoint cases. How we counted

What a strong nexus letter for PTSD or depression does

From the opinions the Board found convincing:

• Rests on an interview, testing, and a full review of your records, and says so.
• Gives a diagnosis and explains which standard criteria you meet.
• Connects your symptoms to specific events in service, or to a service-connected condition such as chronic pain.
• Explains why there’s no treatment record from service, when there isn’t one.
• Addresses other explanations the VA raised, like alcohol use or life stress.
• Takes a clear position using the VA’s standard, “at least as likely as not,” which means a 50 percent or better chance. “Possible” isn’t enough.