Service connection for PTSD requires three things under 38 C.F.R. § 3.304(f): a diagnosis that meets VA's diagnostic standard, credible supporting evidence that the in-service stressor happened, and a medical link between that stressor and your current symptoms. A denial means VA found at least one of them missing. Your decision's favorable findings show which elements VA already accepted, and the "Reasons for Decision" show which one is still open. How you support the stressor depends on which of five rules fits your service.

A denial is a decision about evidence, not a judgment about whether your distress is real. If you are in crisis or thinking about harming yourself, contact the Veterans Crisis Line: dial 988 then press 1, text 838255, or chat online, 24 hours a day.

The five stressor rules in § 3.304(f)

SituationWhat the rule says about proving the stressor
(f)(1) PTSD diagnosed during serviceYour own testimony alone may establish a stressor related to that service, if it is consistent with the circumstances of your service and there is no clear and convincing evidence to the contrary
(f)(2) Combat with the enemySame as above, for a stressor related to that combat
(f)(3) Fear of hostile military or terrorist activityYour testimony alone may establish the stressor if a VA psychiatrist or psychologist, or one VA contracts with, confirms the stressor is adequate to support a PTSD diagnosis and your symptoms are related to it, and the stressor fits the places, types and circumstances of your service
(f)(4) Former prisoner of warYour testimony alone may establish a stressor related to that experience, on the same conditions as (f)(1)
(f)(5) In-service personal assault, including military sexual traumaEvidence from outside your service records can corroborate the account: police, rape crisis center, counseling or medical records, tests, and statements from family, roommates, fellow service members or clergy. Behavior changes, such as a transfer request, declining performance, substance use, or unexplained depression, panic or anxiety, can also count. VA may not deny the claim without first telling you about these sources and giving you a chance to provide them

Other stressors need credible supporting evidence. By statute, 38 U.S.C. § 1154(a) requires VA to give "due consideration" to "the places, types, and circumstances" of your service, using your service record, unit histories, medical records and "all pertinent medical and lay evidence." VA's military sexual trauma page covers care and support available whether or not you file a claim.

A PTSD claim covers more than the PTSD label

In Clemons v. Shinseki (2009), the Court of Appeals for Veterans Claims held that a PTSD claim "cannot be a claim limited only to that diagnosis, but must rather be considered a claim for any mental disability that may reasonably be encompassed" by your description of the claim, the symptoms you describe and the evidence in the file. If a clinician diagnosed depression or an anxiety disorder instead of PTSD, VA should consider that condition as part of the same claim. If a mental health condition is already service connected under another name, check the issue heading carefully. VA avoids rating the same disability under different diagnoses (38 C.F.R. § 4.14), so a second label does not automatically mean a second rating. The PTSD condition guide covers how PTSD is rated once it is service connected.

Start with the decision's own headings

For the PTSD issue, copy the favorable findings, evidence list and the exact denial reason. Then read the mental health exam or opinion, if you have it. Does VA accept a diagnosis but dispute the stressor? Accept the stressor but question the medical link? Does one clinician diagnose PTSD while another uses a different diagnosis? Each answer points to a different task.

Fictional example: "A clinician diagnosed PTSD. VA accepts that diagnosis. Service connection is denied because the decision did not find sufficient support for the claimed stressor." This notice does not ask for the diagnosis again. It asks which stressor rule applies, what evidence VA considered, and whether a relevant source was missing. If the notice instead accepts the stressor but says the exam did not find PTSD criteria met, the exam and any other qualified assessment become the center of the dispute.

Keep a private index of records rather than copying a traumatic account into any shared tool: "decision, page 4, stressor finding"; "exam, date, diagnostic discussion"; "service record, date, relevant entry." A witness should describe only what they saw, without being asked for intimate details.

A real remand: stressor accepted, diagnostic report missing

In Board decision A25094419, October 30, 2025, the Board of Veterans' Appeals (the Board) did three things with a denied PTSD and insomnia claim. First, it broadened the claim to any psychiatric disorder, citing Clemons. Second, it accepted the veteran's hearing testimony about an event he witnessed during his ship's port calls in Kenya in 1961. Personnel records confirmed those port calls, and the Board found his account consistent with "the types, places and circumstances of his military service" under § 1154(a), making a favorable finding that binds VA going forward.

Third, it found the October 2024 VA exam inadequate. The examiner had not completed a PTSD questionnaire showing which diagnostic criteria were or were not met, and a later addendum raised new, unexplained conclusions about insomnia and generalized anxiety disorder. The Board remanded for a new exam, told the examiner to complete the PTSD questionnaire whether or not PTSD was diagnosed, and asked the examiner to address a private evaluation that found the PTSD criteria met. It did not grant service connection.

The lesson for your own file: an accepted stressor, a diagnosis and a medical explanation are separate entries. If the problem is a missing report or conflicting clinical findings, sending the stressor account again will not answer it.

PTSD decision worksheet

ElementExact notice or opinion passageWhat the file containsSpecific question to resolve
Diagnosis under VA's standardQualified assessment and date
Stressor, and which § 3.304(f) rule appliesService or other permitted evidence, without private details here
Medical link to current symptomsClinician's reasoning and records reviewed
Other mental health diagnoses (Clemons)Any depression, anxiety or other diagnosis in the file
Favorable findingsDecision language
Missing or disputed itemEvidence list, report, date, page

Keep identifying and traumatic information off any shareable worksheet. A record title and location is enough to find the source later.

PTSD appeals in Claim Raven's Board data

Claim Raven's analysis of 2024 to 2025 Board decisions counts 1,609 decided PTSD condition records: 45.4% favorable, 28.2% denied and 26.4% remanded. Where the Board quoted lay evidence, such as the veteran's or a witness's statements, 53.3% of 537 PTSD records were favorable, compared with 32.9% of 413 where it did not. Claim Raven's data does not classify enough PTSD denials to report their reasons. The label mixes service-connection and rating issues, and these are appeals of already-disputed claims, so the figures describe patterns, not your odds or a cause. Claim Raven's PTSD study looks at what the Board credited across many decisions, and this case breakdown of one PTSD denial follows a single decision from stressor to medical link.

Choose a review path after the evidence question

If the missing piece is a record VA did not have, such as a corroborating statement, a treatment record or a new diagnostic evaluation, that is new evidence for a Supplemental Claim. If VA misapplied a stressor rule, ignored a diagnosis already in the file, or relied on an incomplete exam, a Higher-Level Review looks at the same record for that error. Check your letter and VA's decision review FAQ for deadlines. When the diagnosis itself is the gap, this guide to no-diagnosis denials covers the records to check. If PTSD is already service connected and the dispute is the rating, see the PTSD rating increase worksheet instead. A veterans service organization representative can review a contested stressor rule with you at no charge.

Raven Eye, a tool Claim Raven sells and offers on this page, can explain the stressor or diagnosis passage in your notice beside the original text. It does not diagnose PTSD, provide treatment or establish a stressor.

Sources and scope

Checked September 23, 2026: 38 C.F.R. § 3.304(f) (eCFR, current through August 27, 2026); 38 U.S.C. § 1154(a); Clemons v. Shinseki, 23 Vet. App. 1 (2009); the Veterans Crisis Line; VA's decision review pages; and Board decision A25094419. No real trauma history or medical conclusion appears in the fictional example.