Mental Health Decompensation & How It Affects Your Benefits

Mental Health Decompensation & How It Affects Your Benefits

Mental health conditions affect millions of Veterans and are not always static. Mental health disabilities like PTSD, Alzheimer’s disease, and more can change over time. Sometimes, they get better. In other cases, they get worse.

When that happens, your disability benefits from the VA may change. Today, let’s explore mental health decompensation, what it means, and how it can affect your benefits in the long term.

What Is Mental Health Decompensation?

Mental health decompensation is any instance in which a diagnosed mental health condition worsens over time. For example, if you have PTSD and your symptoms are relatively stable for several years but become worse after being re-exposed to one of your triggers, you could be described as having experienced mental health decompensation.

According to the Social Security Administration, an “episode of decompensation” is any period of significant and rapid deterioration in mental health, like a panic attack, some memory loss, or reversion to previous negative symptoms. Technically, episodes of decompensation aren’t recognized in the Blue Book listings used by the SSA for mental disorders. Still, these developments can impact your VA benefits and other disability compensation you may receive.

Mental health decompensation is oftentimes thought of as sporadic. Many people believe they may have temporary timeframes where their symptoms worsen, then return to a normal or baseline state. But this isn’t always true.

In some cases, mental health decompensation can permanently decrease overall stability or safety. Some Veterans who get older experience greater levels of mental health decompensation. General age-related mental health problems might combine with service-connected mental health disabilities, resulting in severe decompensation episodes and additional living difficulties.

In these cases and more, it’s important to know how to file for increased disability benefits from the VA.

What Are the Causes of Decompensation in Mental Health?

Decompensation episodes can occur in anyone with one or more mental health conditions for various reasons.

For example, those struggling with mental health disabilities already face a more challenging day-to-day existence. A stressful, unexpected, or negative situation can be a proverbial tipping point or cause mental health symptoms to worsen.

Sometimes, a person experiencing a mental health disability capably might find themselves suddenly spiraling or in a negative behavioral loop that makes it difficult to recover stability.

In other cases, a person’s medication might stop working because they miss a dose or something about their neurochemistry changes. In these situations, their mental health deterioration could directly result from medication mismanagement or misunderstanding.

Regardless, the reasons for decompensation in mental health don’t usually matter when it comes to VA disability benefits. All the VA cares about is whether you have a service-connected disability and, if so, how severe your symptoms currently are.

How Does Mental Health Decompensation Affect VA Benefits?

If you have a service-connected mental health disability, like PTSD, an episode of decompensation can affect your VA benefits. Specifically, you may be able to file a claim for a higher disability rating to reflect your new, more severe symptoms.

For example, say that you had a disability rating of 30% for PTSD. Your service-connected PTSD symptoms were noticeable and sometimes severe but generally manageable. Over the last few months, you’ve noticed that your PTSD symptoms have become much worse. You require more meetings with your therapist and more expensive medication.

Therefore, you decide to file a claim for increased benefits. The VA reviews your new symptoms and recommendations from your therapist, then decides to increase your disability rating to 50%. This new rating should stay at the 50% rate until the VA reviews your case later down the road.

Mental Health Decompensation – Direct and Secondary Service Connections

Regarding mental health decompensation, direct and secondarily service-connected disabilities may receive higher disability ratings.

Direct service connection is awarded if your mental health condition is directly related to your military service or an in-service event, illness, or injury. For instance, if you witness a comrade fall in battle and develop PTSD. As a result, you could receive service connection for that mental health disability.

Secondary service connection is awarded for conditions that developed or worsened because of a direct service-connected disability. If you develop PTSD because of your military service, then develop sleep apnea because of the PTSD, you may receive secondary service connection for that sleep apnea.

If you have a secondary service-connected mental health disability and experience decompensation, you could still apply for increased benefits.

Proving That Your Disability Has Become Worse

To recover increased disability compensation for your service-connected disability, you should prove that your disability has become noticeably worse. There are many ways in which you can do this.

For example, you can gather lay statements from friends, family members, coworkers, and fellow servicemembers. All of these individuals can substantiate claims that your mental health disability has become worse over the last few weeks or months. 

Furthermore, you can get an optional new nexus letter from a licensed mental health care practitioner, like a therapist or psychiatrist. A nexus letter is a medical document representing the official opinion of a licensed medical professional. If you choose to include this optional document, your nexus letter should state:

  • That you still have your diagnosed, service-connected or secondary service-connected mental health disability
  • That your mental health disability has become worse in the opinion of your medical practitioner

Your medical practitioner can cite factors like increased appointment requirements, more or higher medication dosages needed to counteract symptoms, and beyond. Combined with lay statements, this may help convince the VA that you have experienced mental health decompensation and need additional disability benefits.

Filing a Claim for a Higher Disability Rating

Filing a claim for a higher disability rating is similar to filing an initial disability benefits application. You will likely need to fill out Form 21-526. You’ll also need to attach the above-mentioned evidence and a nexus letter from your licensed medical professional.

The VA should review your case and determine whether you qualify for increased disability benefits. You may need to sit for another Compensation and Pension Exam, so a VA-appointed examiner can determine what level of disability rating you qualify for.

In this process, you should work with knowledgeable Veterans law attorneys. Veterans law attorneys can:

  • Help you understand what you need to do to file a successful benefits increase claim
  • Gather evidence on your behalf and ensure that you have the necessary paperwork to strengthen your claim
  • Help you file an appeal if needed
  • Negotiate with the VA on your behalf
  • And more

Other Benefits Effects for SSDI and SSI

In addition to VA benefits, SSDI and SSI benefits may be affected by episodes of decompensation for mental health disabilities.

You may qualify for SSDI or SSI benefits if you cannot work because of your mental health disability. For example, if your PTSD is so debilitating that you can’t hold down a job, you could qualify for these benefits in conjunction with your VA disability benefits to give yourself enough money to live on.

For both of these benefits types, you’ll need to produce documentation that shows:

  • Your mental health disability symptoms have worsened for a demonstrable period of time
  • You, the claimant, were unable to adapt or respond to stress or normal changes because of the mental health decompensation
  • You are severely limited during decompensation episodes and are unable to perform any normal activities of daily living

The bar of evidence is very high to increase your disability benefits from these programs. But it could be well worth the effort. If you don’t know where to start, your Veterans law attorneys may also be able to help you secure additional benefits or compensation from SSI or SSDI.

Contact Berry Law Today

Ultimately, mental health decompensation could result in you getting a higher disability rating than you initially received. Depending on the new symptoms you experience and the proof you can provide to the VA, your disability rating could increase temporarily or permanently.

Filing for increased disability benefits can be difficult without the right legal representatives. At Berry Law, our knowledgeable team will help you through the process from start to finish and make sure you know what to expect. If you need to increase your disability rating or appeal a disability benefits decision, contact us today.


Recognising Signs of Deterioration in a Person’s Mental State | Australian Commission on Safety and Quality in Health Care

Types Of VA Disability Claims And When To File | Veterans Affairs

Chapter 2 Service-connected Disabilities | Office of Public and Intergovernmental Affairs

Types Of VA Disability Claims And When To File | Veterans Affairs

Berry Law

The attorneys at Berry Law are dedicated to helping injured Veterans. With extensive experience working with VA disability claims, Berry Law can help you with your disability appeals.

This material is for informational purposes only. It does not create an attorney-client relationship between the Firm and the reader, and does not constitute legal advice. Legal advice must be tailored to the specific circumstances of each case, and the contents of this blog are not a substitute for legal counsel.

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