Panic Attacks: VA Disability Claims, Ratings, and Appeals

CCK Law: Our Vital Role in Veterans Law

Panic disorder is a type of anxiety condition that causes frequent panic attacks—sudden feelings of intense fear and terror when there is no real danger. Panic attacks can happen anytime, anywhere, and without warning.

VA recognizes that panic attacks, panic disorder, and other anxiety conditions are common among veterans. One study showed that “panic disorder has been diagnosed in 6.1 to 8.3 percent of veterans across epidemiological studies.”

Service-connected panic disorder may entitle a veteran to monthly compensation and other benefits, depending on their VA rating for panic attacks. As a mental health disorder, a panic attack VA rating can be as high as 100 percent—total disability. However, for a veteran to receive a panic attack VA rating, the veteran must provide evidence that their panic disorder is directly or indirectly connected to their military service.

Highlights of this article include:

• How to establish service connection for panic disorder
• How VA ratings are assigned for panic attacks
• What the monthly VA compensation is for panic disorder
• How to appeal or increase a panic attack VA rating

What are Panic Attacks?

Panic attacks are sudden episodes of intense fear or discomfort that typically peak within minutes. These episodes can occur without warning and may involve symptoms such as the following:

• Sense of impending doom or danger
• Fear of loss of control, going crazy, or death
• Rapid, pounding heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or tightness in your throat
• Chills or hot flashes
• Nausea
• Chest pain
• Headache
• Dizziness, lightheadedness, or faintness
• Numbness or tingling sensation
• Feelings of unreality (depersonalization or derealization)

Many people mistake panic attacks for heart attacks or other serious medical conditions, further intensifying the experience.

Panic disorder, a type of anxiety disorder, involves recurrent and unexpected panic attacks. People with this disorder often live in fear of when the next attack will happen, which can lead to significant disruptions in their daily lives.

They may avoid certain places, activities, or situations to prevent triggering an attack, leading to agoraphobia in severe cases. This can interfere with employment and other daily activities. As a mental health condition, panic disorder can even be totally disabling.

Panic Disorder and Veterans

Veterans are a population particularly vulnerable to panic attacks and panic disorder, due to the psychological impact of their service experiences, including exposure to trauma, combat situations, and high-stress environments. These experiences often increase the risk of anxiety disorders like panic disorder and other conditions like post-traumatic stress disorder (PTSD).

Facts about Veterans and Panic Disorder:

1. Prevalence of Panic Attacks in Veterans: A study of VA medical centers found that 8 percent of veterans reported having panic attacks. This is significantly higher than the general population, where estimates range between 2 percent and 3 percent.
2. Comorbidity with PTSD: Veterans with PTSD—a common mental condition among veterans—are particularly prone to panic attacks. Research has indicated that 37.5 percent of veterans with PTSD also experience panic attacks. The symptoms of PTSD—such as flashbacks, hypervigilance, and intrusive thoughts—can contribute to the development of panic attacks or exacerbate existing anxiety conditions.
3. Gender Differences: Research shows that female veterans may report panic disorder at twice the rate of men. This could be partly due to higher rates of trauma exposure, including military sexual trauma (MST), which can trigger anxiety disorders.
4. Suicide Risk: Panic disorder, especially when co-occurring with PTSD, significantly raises the risk of suicide among veterans. One study about panic disorder in veterans found that “veterans with panic disorder reported significantly more suicide attempts than veterans with posttraumatic stress disorder or neither diagnosis.”
5. Impact on Quality of Life: Veterans with panic disorder frequently experience significant impairment in employment, social relationships, and daily functioning.

Addressing panic disorder in veterans requires a multifaceted approach, often involving cognitive behavioral therapy (CBT), medication, and peer support programs tailored to the unique experiences of veterans. VA offers specialized treatments, but barriers such as stigma and lack of awareness about mental health services still exist, making it crucial to continue outreach and education efforts.

How to Establish Service Connection for Panic Attacks

In order to receive VA disability for panic attacks, a veteran must first prove service connection. There are a number of ways to demonstrate a link between panic attacks and military service.

Direct Service Connection for Panic Attacks

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Veterans can prove direct service connection for panic attacks if they can prove their insomnia resulted from or was aggravated by their military service:

• A current diagnosis of panic disorder. Typically, the easiest way to show proof of a diagnosis is through medical records. It is important to note that a condition must be ongoing in order to qualify for VA disability benefits.
• An in-service event. The best forms of evidence to prove an in-service event are service treatment records as they will have documented any injury or illness, including panic disorder or panic attacks, for which you were treated while on active duty. This is very beneficial in proving a condition arose during service or shortly after service. Unfortunately, not all veterans have this type of evidence available to them.
  • In this case, lay statements from the veteran and/or their family members can be particularly effective. These statements can be used to describe both the onset and progression of the veteran’s disorder, as well as how it relates back to their service.
• A medical nexus between the panic disorder and the in-service event. This is commonly a statement from a qualified healthcare professional affirming that they believe your condition was “at least as likely as not” caused by your military service. (Learn more about nexus letters.)

Preexisting Panic Disorder: What Is “Aggravation”?

VA also allows veterans to receive compensation if their military service made a preexisting condition worse. This is referred to as “aggravation.”

Here is how aggravation works in a VA claim:

1. Preexisting condition: A veteran has a medical condition that existed before they joined the military. If this condition was noted during their entrance medical examination, it is considered a pre-existing condition.
2. Aggravation during service: If the condition worsens beyond its natural progression because of military service, the VA may award disability compensation based on the degree to which the service worsened the condition. The veteran must provide evidence that the condition worsened beyond the natural progression of the condition during their time in service.
3. Burden of proof: VA presumes that a preexisting condition noted at entry was aggravated by service unless there is clear evidence that the worsening was due to the natural progression of the condition rather than military service.
4. Compensation: If VA determines that a condition was aggravated by service, they will assign a disability rating for the aggravated portion of the condition. In other words, the compensation is only for the increase in severity directly attributed to military service, not for the entire condition.

Secondary Service Connection for Panic Attacks

Veterans can also receive VA disability for panic attacks that were caused by a service-connected condition (as opposed to caused directly by an in-service event). This is called secondary service connection.

For example, service-connected PTSD often leads to panic attacks and panic disorder. In this case, the panic disorder is now service connected through the PTSD claim, which means that a VA rating for panic attacks may now be possible, even though the panic disorder surfaced after service.

Secondary disabilities can be especially challenging to prove. If you need assistance, contact CCK Law for a free case evaluation.

Tips for Proving Service Connection

Lay Evidence for Panic Disorder

Lay evidence is often overlooked as a way to support a panic attack VA rating. These are personal statements written by someone familiar with the veteran’s situation. There are several types of lay statements.

Examples of lay statements that would support a panic attack VA rating might include:

• a letter from a spouse who can attest to the veteran’s attacks
• a letter from a coworker who can vouch for how the veteran’s panic attacks affect their ability to work
• a letter from a veteran’s friend about how the panic attacks impair their ability to have social relationships

C&P Exams for Panic Disorder

Before considering whether to grant a panic attack VA rating, VA will use a mental health Compensation and Pension (C&P) examination to gather more evidence.

The exam usually takes place at a VA hospital or with a VA-contracted provider. The examiner will most likely conduct psychological testing that could identify any of several different conditions. They may also ask questions about your panic attacks to better understand how your panic disorder connects to your service.

Before the exam, the examiner should review the veteran’s c-file. The exam then usually lasts about 15 to 20 minutes but can range between 5 minutes to several hours.

Importantly, VA does not give the veteran a copy of their report based on the C&P exam unless the veteran asks for it. Therefore, CCK recommends that veterans request a copy of the exam report. That way, the veteran will know if they disagree with the examiner’s assessment, allowing them to challenge unfavorable C&P exams.

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VA Presumptions for Panic Attacks or Panic Disorder

Some medical disabilities are automatically presumed to be service connected, which can greatly simplify the claims process.

As of 2024, the only presumptions that apply specifically to anxiety disorders like panic attacks are for former prisoners of war (PDF).

VA’s Duty to Assist and Burden of Proof

A panic attack VA rating usually relies on a combination of subjective and medical evidence, which can be intimidating to veterans unfamiliar with the VA claims process. But veterans should keep in mind that the VA disability claims process is intended to be non-adversarial. Two ways this is supposed to be reflected are:

1. VA has a legal duty to assist (e.g., with compiling records, adding claims that the veteran might have overlooked, etc.).
2. VA must grant a veteran’s claim if the evidence shows that they are “at least as likely as not” (i.e., at least a 50-50 chance) that they are entitled to the benefit they are seeking.

When VA rating for panic disorder is denied, VA often has not abided by at least one of these rules. Consider contacting a VA-accredited lawyer or advocate promptly to appeal the decision.

How VA Rates Panic Disorder

Chronic panic attacks are a mental health disorder. Mental health conditions receive disability ratings of 0, 10, 30, 50, 70, or 100 percent using the criteria found in 38 CFR § 4.130 – Schedule of ratings—Mental disorders.

The ratings criteria for mental health disorders like panic attacks are based on the level of social and occupational impairment that a veteran experiences. For example, a veteran experiencing mild symptoms, or whose symptoms are well controlled by continuous medication, may receive a 10 percent disability rating.

Veterans with more severe symptoms, such as near-continuous panic affecting the ability to function independently, may receive a 100 percent VA rating. Self-injurious behaviors and suicide attempts are also consistent with a 100 percent rating.

Below is a summary of the criteria for the mental disorder ratings:

• 100 percent—Presents total occupational and social impairment
• 70 percent—Occupational and social impairment, with deficiencies in most areas

• 50 percent—Presents occupational/social impairment with reduced reliability

• 30 percent—Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks

• 10 percent—Occupational or social impairment due to mild or transient symptoms

• 0 percent—If diagnosed but symptoms are not severe enough to interfere in occupational or social settings

Due to the overlap in symptoms and impairment, VA usually gives a single rating to all of a veteran’s mental health conditions. For example, a veteran who has both service-connected posttraumatic stress disorder and service-connected panic disorder would typically receive a single mental health rating.

Total Disability Based on Individual Unemployability (TDIU) for Panic Disorder

Chronic panic attacks can be debilitating. Even if a veteran’s panic attack VA disability rating is less than 100 percent, they may be unable to work.

When a veteran is unable to secure and maintain substantially gainful employment as a result of their service-connected conditions, they may be entitled to Total Disability based on Individual Unemployability (TDIU). TDIU allows veterans who are not rated as 100 percent disabled to be compensated at a 100 percent disability rate anyway.

There are two ways in which a veteran can receive TDIU benefits:

• Schedular TDIU—To be eligible for “schedular” TDIU, a veteran must have either 1) a condition rated at least 60 percent, or 2) a combined rating of at least 70 percent and at least one rating of 40 percent or above.

• Extraschedular TDIU—Even if a veteran with insomnia does not meet these conditions, they may still qualify for “extraschedular” TDIU if the Director of Compensation Service makes a determination that their service-connected insomnia is still somehow preventing them from holding substantially gainful employment.

TDIU claims can be highly complex and time-consuming, so utilizing the services of a VA-accredited law firm or agent may prove beneficial.

VA Disability Compensation for Service-Connected Panic Attacks

If a veteran proves service connection and receives a compensable (greater than 0 percent) panic attack VA rating, they are entitled to monthly compensation. Note that dependents and other factors can increase monthly compensation.

As of December 1st, 2024, the VA disability rate benefit amounts are as follows:

• 0 percent disability rating: $0.00 per month
• 10 percent disability rating: $175.51 per month
• 30 percent disability rating: $537.42 per month
• 50 percent disability rating: $1,102.04 per month
• 70 percent disability rating: $1,759.19 per month
• 100 percent disability rating: $3,831.30 per month

How to Appeal or Increase Your Panic Attack VA Rating

Veterans may wish to appeal or file to increase their VA rating for panic disorder. Some potential reasons for doing so could include:

• VA denied their claim incorrectly
• The veteran believes their rating should be higher
• An existing condition worsened
• A secondary condition developed

In these types of situations, veterans have options for appealing their rating.

Note that a VA-accredited lawyer or advocate may be able to recommend which path to take, related claims to add, pitfalls to avoid, and other ways to accelerate the process.

Call CCK Law Today

Appeals can be difficult and time-sensitive. Also, veterans have likely already experienced lengthy delays waiting for their initial rating. Veterans should also consider that appeals may benefit from continuing into the federal court system, particularly after recent Supreme Court decisions. For these reasons, the law permits VA-accredited law firms or advocates to assist veterans with appeals.

If you are appealing an unfavorable decision related to your claim for VA disability for panic attacks, contact CCK Law, the most experienced veterans law firm in the U.S. You may call 800-544-9144 or contact us online.