This topic thread is to discuss filing a successful PTSD claim. It is not a medical advice thread.

In filing a claim for PTSD you need a diagnosis from competent medical authority. That would be a psychologist, or psychiatrist. Your diagnosis must be linked to your verifiable stressor. The stressor must be an active duty situation described as a traumatic event out of the normal realm of human emotion. If your stressor does not meet the criteria establish the claim will not be well grounded.
The Diagnostic Criteria set forth in the DSM IV is: The person has been exposed to a traumatic event in which both of the following were present: the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and the person's response involved intense fear, helplessness, or horror.
This to say is the bottom line required.
Legislation known as the Veterans Claims Assistance Act 2000 changed the well ground issue in the year 2000; however, we still need to properly present a claim. For service connected disability we need the following:
• a condition that manifested itself on active duty, or within the first year from separation
• the condition must currently exist and be diagnosed by competent medical authority
• a nexus, or link of the current condition and the condition from active duty.
What you need to do is to build support for your claim by never missing a doctors appointment. Always be on time and be extremely careful of what you say and/or don’t say. When you go to the doctor follow these simple rules: When you see a medical doctor or any nurse, you should respond to How are you today? by saying "my nightmares bother me, the flashbacks are nearly unbearable " then discuss what else bothers you.
This issue is first and foremost, then you can complain about other things that bother you. You always respond with your service connected issue first. Never say fine, never say OK.
In development VA will ask a veteran if they were treated on active duty. This is a suggested response to a VARO duty to assist (DTA) letter asking for treatment in service. “In regard to your DTA letter in regards to my service connected issue: PTSD. The VA treatment records will link my current condition to my service.
You ask for “proof of treatment in service of this condition.” That is not possible. First, the reason it is called post is due to the fact it appears later, or after the factual happening of the traumatic event. If it had appeared while I was in service it would have been acute, unless a long duration which would be in my service medical records in your possession. Second, PTSD was not recognized as a mental disorder, until DSM III was published in 1980. The condition was not recognized by the VA until a year later. This was after the information was released by the American Psychiatric Association and reviewed by the then Veterans Administration Administrator.
Today we find many current OEF and OIF veterans claims, show Failure in some VA offices. Recent reviews of claims files forwarded to the VSC Front Office for evaluation by the JSRRC Coordinator have exposed a trend, specifically a failure to comply with the procedures outlined in M21-1-1MR IV.ii.1.D.13j concerning the use of Military Occupational Specialty (MOS) as evidence for corroboration of a claimed in-service stressor.
According to an article published by the U.S. Army Logistics Management College, "all logistics convoys on Iraq’s nonlinear battlefield of necessity are combat patrols. CLPs (combat logistic patrols) are susceptible to attack by improvised explosive devices, small arms fire and complex ambushes every time they leave their operating bases."
Motor Transport Operator, Wheeled Vehicle Repair, Light Wheel Vehicle Mechanic, and Combat Engineer are all examples of MOS’s which we may expect to see listed on a DD214 or in a personnel file which would signify the claimant’s assignment to a logistics convoy.
As detailed in M21-1MR, Part IV, subpart ii, 1D. 13j, a veteran’s MOS as specified on his/her DD Form 214, or in the personnel folder, may be used as evidence that he or she engaged in combat or to otherwise corroborate a claimed in-service stressor. Therefore, consideration should be given to claims exhibiting the following characteristics:
Army or Marine Corps OEF/OIF veteran, whose DD214 or personnel file shows a logistics related MOS;
Veteran reports a specific combat-related stressor (including date/location) such as an attack by improvised explosive devices, small arms fire or ambush;
Personnel file confirms that he/she served in the immediate area and at the particular time in which the stressful event is alleged to have occurred.
If the three requirements outlined above are met, the veteran’s reported combat-related stressor(s) may be conceded and a VA examination may be ordered if a diagnosis of Post-Traumatic Stress Disorder (PTSD) has also been provided.
In absence of concise information concerning the veteran’s reported combat-related stressor (ex: missing date/location, or his/her personnel file does not confirm that he/she served in the immediate area and at the particular time in which the combat event is alleged to have occurred), development should continue.
Please note that in all cases requiring stressor verification, the VSR/RVSR should carefully and thoroughly follow the established procedures for researching PTSD Stressors
Ultimately, if all established procedures have been followed and efforts to verify the claimed stressor prove futile, the case should be forwarded for review by the JSRRC Coordinator.
Resources for Research of Posttraumatic Stress Disorder (PTSD) Stressors
CFR 3.304(f)
38 C.F.R. 3.102
38 C.F.R. 4.3
38 U.S.C. 1154(b)
M21-1MR, Part IV, Subpart II, 1.D.13.j
“1st Infantry Division Movement Control Operations in Iraq” by Capt. Henry C. Brown (www.almc.army.mil)
Suozzi v. Brown, 10 Vet.App. 307 (1997)
Pentecost v. Principi, CAVC, No. 00-2083 (05/24/02)
Moran v. Principi, CAVC, No. 99-754 (06/20/03)
Sizemore v. Principi, No. CAVC, No. 02-1012, (09/03/2004)
VAOPGCPREC 12-99
http://www.almc.army.mil/alog/...05/move_conrtol.html


What is the post-traumatic stress disorder (PTSD)? Here is a description from the APA for your review:
Post-traumatic stress disorder (PTSD), as such, has been a part of organized psychiatry only since 1980. The concept of PTSD, however, has been well known for over a hundred years under a variety of different names. Certainly, Freud thought that traumatic events experienced as a child, had an effect on an the child's subsequent emotional development. Actually, however, it was his contemporary, Pierre Janet, who wrote most brilliantly and eloquently on traumatic stress. In fact, he was really the first person to describe the full syndrome (group of symptoms) of post-traumatic stress disorder.

During World War I, a similar state was called shell shock, and during WW II, it was referred to as combat fatigue. However PTSD is not shell shock, nor is it combat fatigue. After the Vietnam War, it was often mistakenly called the Post Vietnam Syndrome. Indeed, the understanding and effective treatment of PTSD were actually described in the psychiatric literature well before the Vietnam War. A psychiatrist from Harvard Medical School, Dr. Eric Lindemann at Massachusetts General Hospital in Boston, was the first to report on the systematic management of PTSD. He did this work after the Coconut Grove fire and tragedy in the 1940's.

Post-traumatic stress disorder is defined in terms of the trauma itself and the person's response to the trauma. Trauma occurs when a person has experienced, witnessed, or been confronted with a terrible event that is an actual occurrence. Alternatively, the person may have been threatened with a terrible event, perhaps injury (physical or psychological) or death to themselves or others. Then, the person's response to the event or to the threat involves intense fear, helplessness, and/or horror.

It is important to note, however, that having strong reactions to trauma is normal. What's more, there is a range (spectrum) of expected reactions depending on a person's prior exposure to trauma and even on hereditary (genetic) factors. Most importantly, you should understand that there are efficient and effective treatments for PTSD.

What are the symptoms of PTSD?
In general, post-traumatic stress disorder can be seen as an overwhelming of the body's normal psychological defenses against stress. Thus, after the trauma, there is abnormal function (dysfunction) of the normal defense systems, which results in certain symptoms. The symptoms are produced in three different ways:
Re-experiencing the trauma
Persistent avoidance
Increased arousal
First, symptoms can be produced by re-experiencing the trauma, whereby the individual can have distressing recollections of the trauma. For example, the person may relive the experience as terrible dreams or nightmares or as daytime flashbacks of the event.

Furthermore, external cues in the environment may remind the patient of the event. As a result, the psychological distress of the exposure to trauma is reactivated (brought back) by internal thoughts, memories, and even fantasies. Persons also can experience physical reactions to stress, such as sweating and rapid heart rate. (These reactions are similar to the "fight or flight" responses to emergencies described by Dr. Walter Cannon.) The patient's posttraumatic symptoms can be identical to those symptoms experienced when the actual trauma was occurring.

The second way that symptoms are produced is by persistent avoidance. The avoidance refers to the person's efforts to avoid trauma-related thoughts or feelings and activities or situations that may trigger memories of the trauma. This so-called psychogenic (emotionally caused) amnesia (loss of memory) for the event can lead to a variety of reactions. For example, the patient may develop a diminished interest in activities that used to give pleasure, detachment from other people, restricted range of feelings, and a sad affect that leads to the view that the future will be shortened.

The third way that symptoms are produced is by an increased state of arousal of the affected person. These arousal symptoms include sleep disturbances, irritability, outbursts of anger, difficulty concentrating, increased vigilance, and an exaggerated startle response when shocked.

How is the diagnosis made and what is the initial approach to PTSD?
Anyone can normally have any combination of the above-described symptoms during the first month after a significant trauma. If, however, the duration of these symptoms is more than one month and causes significant distress, or the symptoms impair the person's ability to function, then the diagnosis of PTSD can be made. In addition, if the duration of symptoms is more than three months, a diagnosis of chronic (long duration) PTSD is made. In some cases, oddly enough, the onset of symptoms is not until six months after the stressful events. This situation is referred to as delayed onset of PTSD, for which the outcome (prognosis) is often worse.

Research has shown that an immediate reduction of symptoms can be harmful in terms of the long-term outcome and persistent psychological illness. In other words, allowing an early peaking of the symptoms of depression and other PTSD problems is appropriate and preferable. Therefore, many of the treatments that psychiatrists have adopted are under the category (rubric) of what is referred to as stress debriefing (reviewing) of the critical incident (traumatic event). That is, we meet with the victims as soon as possible after the traumatic event. The purpose of the meeting is to discuss (debrief) the traumatic event in detail primarily with those most involved, and secondarily with those individuals who are involved at some distance. The specific goal is not to push the trauma away, but to get the people to talk about all aspects of the trauma and how it is affecting them.
Clinicians need to inquire very quickly about all aspects of the trauma and the person's response to it. This information will lead to a more rapid, specific diagnosis. We have found that with early management (intervention) techniques, we are able to reduce the number of patients who go on to develop full-blown acute (early) post-traumatic stress disorder and chronic (long duration) post-traumatic stress disorder. The question then is, once PTSD has been diagnosed, what are the most successful ways to treat it?

What are the tools to treat PTSD?
The basic tools for the treatment of post-traumatic stress disorder are:
Individual psychotherapy that is targeted at symptom clusters;
Peer group support, especially for chronic PTSD ;
Medication.

Various clinicians and clinics have their own methods for treating PTSD. A survey of PTSD experts, however, seems to conclude that for milder acute (early) PTSD, stress debriefing and early individual psychotherapy are especially important. For more severe acute PTSD, medication, critical incident stress debriefing, and group and individual psychotherapy should be started in combination. For mild, chronic PTSD in children, adolescents, and geriatric (senior) patients, the treatment is psychotherapy. For milder, chronic PTSD in adults, combination treatment is again used with stress debriefing, medications, and group and individual psychotherapy.

What are the types of psychotherapy for PTSD?
The next question is, what kind of psychotherapy should be used for PTSD? An example would be a person with a history of previous severe trauma as a child, such as sexual or physical abuse. People that have had these experiences may be particularly sensitive (vulnerable) if they are re-traumatized by the therapy itself. That is to say, with review and discussion of the traumatic event, they may develop a more severe and perhaps chronic (long duration) variant of PTSD. So, for these patients, longer-term psychodynamic psychotherapy is usually indicated. In psychodynamic psychotherapy, there is a focus on past traumas and how they are rekindled by the present experiences. For most suffers of PTSD, however, a combination of cognitive and behavioral strategies (psychotherapy) that focus on the symptoms would usually be recommended.

For example, intrusive (unwelcome) thoughts, flashbacks, panic, and avoidance (actions to avoid emotional pain) are best treated by exposure therapy, anxiety management, and cognitive therapy (see below). Exposure therapy consists of education about common reactions to trauma, breathing retraining, (such as breath counting and deep breathing), and repeated exposure to the past trauma in graduated doses. As a result of exposure therapy, the traumatic issue or event can be remembered without the anxiety or panic resulting.

Cognitive therapy involves separating the intrusive thoughts from the associated anxiety that they produce. Additionally, it involves changing the sequence of thought patterns that occurs whenever the patient is exposed to the traumatic stimulus. Cognitive therapy also helps patients that have avoidance because with this therapy, these patients no longer need to avoid situations or places that may be reminders of the trauma. You see, cognitive therapy seriously diminishes the power of these reminders to cause severe reactions. What is more, patients can work on these issues outside of the doctor's office by using audiotapes and/or videotapes and by keeping a journal.

In addition, stress inoculation training, a variant of exposure therapy, can be used for the management of anxiety. This therapy includes relaxation. It also involves carefully monitoring the patient's thoughts that follow from thinking about the traumatic event. Then, when thoughts of the trauma do occur, the patient uses a script that was created in therapy to attempt to change their thoughts that follow thinking about the trauma. At first, the patients may even need to imagine themselves as someone else (role playing) to bring about this change in their thought pattern. But then, the role-playing gradually becomes the reality.

Other types of therapy that are useful for anxiety are visualization techniques and confidence builders, such as positive self-talk and social skills training. In visualization techniques, patients train themselves to recall and visualize a particularly peaceful or pleasant place or situation whenever thoughts of the trauma occur.

Other avoidance symptoms, referred to as numbing, include emotional unresponsiveness, detachment from others, and loss of interest in life's pleasures. For the treatment of numbing, most experts recommend the cognitive therapies, psychodynamic psychotherapy, and peer group support. In fact, numbing symptoms are among the most difficult symptoms to treat. For these symptoms, peer group support is extremely important.

What are the results of treatment and the follow-up of PTSD?
Most people suffering from a posttraumatic syndrome should expect a good response to treatment within 3 months, as long as they do not have another severe psychiatric illness, substance abuse, depressive disorder, bipolar disorder (manic depressive), or other maladaptive personality disorders, such as antisocial personality disorder.

After the initial 3 months of treatment, acute PTSD can be treated with group or individual psychotherapy booster sessions every 2 to 4 weeks. Chronic PTSD patients should be seen regularly for at least six months with booster sessions. However, a small percentage of patients with PTSD, especially those with another associated psychiatric disorder, remain quite symptomatic for longer periods of time. For acute PTSD, the duration for continuing medication before considering tapering is 6 to 12 months. For chronic PTSD with a good response, we can consider tapering medication at 1 to 2 years. However, patients with chronic PTSD with residual symptoms need to continue treatment for at least 2 years.

Edited for readability only, no content changes.

This message has been edited. Last edited by: DaveBarker,

Feel free to ask questions, we will give you the best possible answers. There is no magic trick to get rated service connected for PTSD. You either have PTSD, or you do not. If you have PTSD it is either related to your service, or it is not. When you speak with competent medical authority and you tell them how your mean parents, siblings, school kids, or teachers mistreated ,or beat you senseless do not expect the diagnosis to match VA criteria.
Watch what you say. Keep on track. Do not lie, 99% of the lies are uncovered the first day, the rest a little later. Often a veteran tells of a stressor and VA does not believe it. Why? If it is not a reasonable stressor, you need evidence to show the event was real. You need supporting documents, statements from comrades.
About the worst thing you can do, while trying to impress your PTSD clinician is to describe unlawful body mutilations you were a part of, these are illegal in the first place and the medical records will be reviewed by VARO personnel. I do know of one case where the veteran was reported to authorities for commission of a war crime. He claimed cutting off VC ears and wearing them around his neck. Not the smartest thing he said.

MST Military Sexual Trauma!
The essential feature is the development of characteristic symptoms following a psychologically traumatic event that is generally considered to be outside the range of usual human experience. Sexual trauma is outside the range of usual human experience.
The developed characteristic symptoms involve reexperiencing the traumatic event; numbing of responsiveness to, or reduced involvement with, the external world; and a variety of autonomic, dysphoric, or cognitive symptoms. The stressor producing this syndrome would evoke significant symptoms of distress in most people, and is out of the range of such common conflict.
Some stressors frequently produce the disorder (e.g. torture) and others only occasionally (e.g. car accident). Frequently there is a concomitant physical component to the trauma which may even involve direct damage to the central nervous system (e.g. malnutrition, head trauma). This disorder is apparently more severe and longer lasting when the stressor is of human design. The severity of the stressor should be recorded by professionals.
The traumatic event can be re experienced in a variety of ways. Commonly the individual has recurrent painful, intrusive recollection of the event, or recurrent dreams or nightmares during which the event is re experienced. In rare instances there are dissociative like states, lasting from a few minutes, to several hours, or even days, during which components of the event are relived and the individual behaves as though experiencing the event at that moment. Such states have been reported in persons exposed to the criteria found in DSM IV 309.81 Posttraumatic Stress A Disorder. Diminished responsiveness to the external world, referred to as psychic numbing or emotional anesthesia, usually begins after the traumatic event. A person may complain of feeling detached or estranged from other people, that he or she has lost the ability to become interested in previously enjoyed significant activities, or that the ability to feel emotions of most types, especially those associated with intimacy, tenderness, and sexuality, is markedly decreased.
After experiencing the stressor, many develop symptoms of hyper-alertness, exaggerated startle responses, and difficulty falling asleep. Recurrent nightmares in which the traumatic event is relived and which terminal sleep disturbance may be present. Some have impaired memory and difficulty concentrating. Symptoms are often intensified when activities resemble the actual trauma.
Associated features: symptoms of depression and anxiety are common, and in some instances may be so severe as to be diagnosed as an anxiety or depressive disorder. Increased irritability, unexpected explosions of aggressive behavior, with minimum or no provocation. Impulsive behavior also can create problems such as unexplained trips, unexplained changes in life styles. Symptoms may begin immediately or soon after the trauma. It is not unusual, however, for the symptoms to surface months or years later following the trauma. Impairment may be mild or affect every aspect of life. Phobic avoidance of situations or activities that resemble the trauma are common and often create occupational or recreational impairment. Psychic numbing often interferes with interpersonal relationships, such as family life. It often leads to self defeating behavior sometimes including suicide. Substance disorders are common .
The appearance of apparent psychotic symptoms are interpreted by many professionals as psychosis; but, are actual symptoms of PTSD in a normal person.

From the Charleston Gazette November 11, 2008
Recent rural vets at high risk
Income, employment, mental health suffer
By Eric Eyre
Staff writer
More than half of all West Virginia soldiers who live in the state's most rural counties and recently served in Iraq and Afghanistan show signs of post-traumatic stress disorder or depression, according to a recent analysis of data from a survey of the state's war veterans.
About 56 percent of returning soldiers from West Virginia's rural counties suffer from mental health problems compared to 32 percent who live in urban areas, and 34 percent residing at out-of-state military bases.
"It's very unsettling," said Hilda Heady, associate vice president for rural health at West Virginia University. "I've been working on this issue for quite some time, but I wasn't expecting it to be quite so high."
West Virginia's rural veterans were more likely to be unemployed, to be physically and mentally disabled, and to have lower incomes than their urban counterparts. They're also at greater risk for suicide.
"They're having trouble sleeping," Heady said. "They're losing their jobs. There's a tremendous impact on these folks."
West Virginia's returning soldiers from rural counties were more likely to serve in combat in Iraq and Afghanistan, according to the recent analysis. Veterans exposed to combat suffer from post-traumatic stress disorder and depression at higher rates, Heady said.
Also, returning soldiers from rural areas have a difficult time finding mental health services, the survey found.
"We just do not have enough mental health providers in rural areas," Heady said. "The military does an excellent job training these guys, getting them ready to go, but when these folks come back, we just don't have enough tools to help them."
Part of the problem: The Department of Defense's managed-care TRICARE health insurance program won't reimburse doctors in some rural areas.
"A lot of the rural physicians cannot get credentialed in TRICARE," Heady said.

Rural veterans also have to drive long distances to the state's Veterans Administration hospitals - in Huntington, Martinsburg, Clarksburg and Beckley.
"The biggest problem is the general lack of access to care in rural areas," said Sen. Ron Stollings, D-Boone, a primary care physician in Madison.
The recent analysis is part of the ongoing West Virginia Returning Soldiers Study, which has surveyed more than 930 veterans who applied for benefits through the state Veterans Affairs office.
In the survey, veterans answered questions about their mental state. Researchers used the responses to calculate scores that suggest whether the soldiers suffered from PTSD, depression, or both.
The study, which was spearheaded by WVU psychology professor Joseph Scotti, also showed that members of the West Virginia National Guard were more likely to show signs of PTSD and depression than active-duty soldiers from West Virginia.
"The stress of these multiple deployments, both on the vets and their families, is taking a tremendous toll," Heady said. "They go. They come back. They go again."
To help returning veterans with PTSD and depression, Heady recommended increasing the number of mental health practitioners in rural areas and providing additional training for those who already work there.
"We need to be doing all we can to help the next generation of these vets and their family members know how to cope, how to get services and how to help each other," Heady said.

Some how this topic was closed, by whom I do not know. It is now open. Please ask questions here regarding PTSD claims.

The Three Elements of a Successful PTSD Claim

There are three separate and distinct elements of a claim for S/C for PTSD that are set forth and defined by law and regulation. ALL THREE must be present in order for a claim for S/C to be successful. The absence of any one (or more) of these elements inevitably lengthens the time needed to process the claim, and generally doom the claim to failure. PTSD, like most of the other disabilities subject to the presumptive provisions of the law, often is not diagnosed in service, so it will not be shown specifically in the SMR’s (unless it WAS diagnosed in service). The three elements that must exist for any claim for S/C to be successful. That is, a) an in-service event; b) a current diagnosis of the disability; and c) a nexus (or link) between the in-service event and the diagnosis. The same is true for PTSD claims.



In-Service Event (Stressor)

The first element of a successful PTSD claim is the existence of an in-service event (stressor) that precipitated the PTSD. This event, or stressor, must be documented by official records in most cases, or at least be supported by a preponderance of the evidence. In PTSD claims, even more so than in other claims for presumptive disabilities, the “who, what, why, when, and where” surrounding the stressor is vital to the success or failure of the claim. The best thing that the SO can provide in these claims is assistance to the veteran in providing as full and completes a description of the in-service event; particularly in cases where the stressor is not conceded (such as in combat situations). The veteran’s statement should include, in addition to a full and complete description of the event, full names of all persons involved, date(s) {at least month and year}, unit(s) of assignment {to at least the company or battalion level}, and places {at least city or province, and state or country}. VA has a specific form for use in this instance – VA Form 21-0781 (“Statement in Support of Claim for PTSD”) and VA Form 21-0781a (for use in claims for PTSD relating to personal assault or sexual harassment). While their use is not mandatory, the forms are designed to elicit the necessary information from the claimant in a logical format; thus, you should use them.

The most common stressor would involve either a serious threat to one's life or physical integrity; a serious threat or harm to one's children, spouse, or other close relatives and friends; sudden destruction of one's home or community; or seeing another person who has recently been, or is being, seriously injured or killed as the result of an accident or physical violence. In some cases the stressor may be learning about a serious threat or harm to a close friend or relative, i.e., that one's child has been kidnapped, tortured or killed.

The trauma may be experienced alone (rape or assault) or in the company of groups of people (military combat). Stressors producing PTSD include natural disasters (floods, earthquakes), accidental disasters (car accidents with serious physical injury, airplane crashes, large fires, collapse of physical structures), or deliberately caused disasters (bombing, torture, death camps). Some stressors frequently produce PTSD (torture, being a POW) and others produce it only occasionally (natural disasters or car accidents). Sometimes there is a concomitant physical component of the trauma, which may even involve direct damage to the central nervous system (malnutrition, head injury). PTSD is apparently more severe and longer lasting when the stressor is of human design.
Sexually related traumatic events may be considered stressors. Conclusions that rape, sexual assault, or other personal assaults are stressors are easier to make since, obviously, these events are considered stressful to almost anyone. On the other hand, sexual harassment as a stressor may be less obvious and more difficult to corroborate. However, sexual harassment should not be ruled out as a stressor. For example, repeated incidences of sexual harassment collectively may be considered a stressor.

Sometimes the duty assignment itself can be considered a stressor. Examples of this could be assignment to a burn ward in a hospital, assignment to graves registration details, or assignments relating to the transportation of the dead or wounded.

There are claims where PTSD was actually diagnosed in service and shown in SMR’s. VA still requires in this circumstance, there still must be a verified stressor shown by official records and a nexus between the two drawn by the examiner before S/C could be established. The in-service diagnosis itself is NOT sufficient to establish S/C.

The most important element is that the in-service event, or stressor, is a particular event or situation that resulted in the symptoms of the disability. Generalities such as “I was in Vietnam” or “I was sent to Iraq” are of little value in the establishment of a stressor, because they do not describe a particular event or situation.

The second element of a successful PTSD claim is a current diagnosis. If the veteran has a stressor, but is not diagnosed with PTSD, the claim cannot be successful for that reason. Thus, you should be sure that medical evidence showing the diagnosis accompanies the claim, or at least the veteran provides completed and signed VA Forms 21-4142 for private physicians or medical facilities, or the full names of VA medical facilities where treatment was provided. It is important to understand that, while VA cannot establish S/C for PTSD on the basis of private medical evidence alone, it is important that ALL available medical evidence be of record to enable a fair and impartial decision be reached. A VA examination will seldom be ordered in PTSD claims until the stressor is confirmed or verified (more about how this is done will follow in a subsequent topic in this lesson). The claims folder will be reviewed by the examiner prior to the examination, so it is important that the file contain all available medical evidence in support of the claim. If the examiner does not diagnose PTSD, then the claim is almost certain to be denied on that basis.

Third element is nexus This element of the PTSD claim is vital in order for the claim to be successful. The law requires that the examiner, and NOT the RVSR, must relate the diagnosed PTSD to the in-service event, or stressor. The RVSR has no latitude in this determination; only the examiner has this authority. This relationship establishes the nexus, or link, between the in-service event to the diagnosis, thus providing the third element necessary for a successful claim. For example, a veteran claims PTSD as a result of a gunshot wound he suffered in combat. SMR’s confirm the GSW, PTSD is diagnosed, and the examiner finds that the PTSD resulted from the GSW. All three elements are present, and the claim would be granted on that basis. However, if in the same scenario, the examiner found that the PTSD was unrelated to the GSW, but rather was related to a post-service motor vehicle accident, the nexus, or link, to the in-service event (the GSW) would NOT be established, and the claim would be denied on that basis. In the second scenario above, you have a combat veteran with a GSW who is diagnosed with PTSD, yet the claim is denied properly because the nexus was not established. Changing the scenario again, instead of PTSD being diagnosed by the examiner in scenario #1, say that the examiner diagnosed a personality disorder instead. Again, you a combat veteran with a GSW, yet the claim for PTSD would be denied because the disability was not diagnosed, and personality disorders are not disabilities for which S/C can be established. Remember personality disorders are often diagnosed in error, or even intentional by some who want to save the VA money, it does happen. Appealing a medical decision is not an option under VA regulations.

There are three principal types of PTSD claims. They are PTSD based on combat incidents, events, or trauma; PTSD based on non-combat incidents, events, or trauma; and PTSD based on personal or sexual assault or sexual harassment.

Edited for readability only, no content changes.

This message has been edited. Last edited by: DaveBarker,

quote:

There are three principal types of PTSD claims. They are PTSD based on combat incidents, events, or trauma; PTSD based on non-combat incidents, events, or trauma; and PTSD based on personal or sexual assault or sexual harassment.

Feel free to ask questions, or make comments.

Dave...thanks for outlining the process for claiming PTSD. Over the years, I've been left with not knowing what to do. The VSO's, shall I say, I've had no confidence in them. I was sexually assaulted in February 1988 by my gunnery sargeant. He was assigned to my unit 82nd Airborne Fort Bragg, after our "gunny" was promoted to first sargeant. This new gunny was openly racist. He hated the fact that all of the section chiefs were black, myself included. He would openly use the "n" word but not in the presence of the CO(who was white) or the first sargeant(who was black). On this February night, my friends and I went out drinking and I retired to the barracks around 2:30 am. Gunny acquired the master keys and broke into my room and sexually assaulted me. Granted, he's 6'5" around 245 lbs. I reported the incident to my CO and the first sargeant and they thought that I was making this up and that I needed to "straightened up and fly right". I didn't want this to become to public because of the embarrassment. Over the months, I became withdrawn, disorderly, not following orders, and later went AWOL and was discharged with less than honorable. The VA found out the circumstances and changed it to an Honorable discharge. I was diagnosed with PTSD by my psych doctor since 1996, and I was denied twice by the VA for PTSD, but they Service Connected me for having Generalized Anxiety Disorder at 0%. My SMR does not show the sexual assault because my CO nor the first sargeant reported it. My psych doctor is also a SA victim and he said that its going to be tough to prove. Over the years, it's been tough to live and I've attempted suicide. I've given the VA dates, names, time, the unit, etc. My psych doctor encouraged me to submit an increase for my GAD, since getting PTSD is close to impossible. I submitted for the increase for GAD, and right now I'm waiting for a decision. Dave, I find it hard to even discuss this, but what else can I do?

quote:

Over the months, I became withdrawn, disorderly, not following orders, and later went AWOL and was discharged with less than honorable. The VA found out the circumstances and changed it to an Honorable discharge. I was diagnosed with PTSD by my psych doctor since 1996, and I was denied twice by the VA for PTSD, but they Service Connected me for having Generalized Anxiety Disorder at 0%. My SMR does not show the sexual assault because my CO nor the first sargeant reported it. My psych doctor is also a SA victim and he said that its going to be tough to prove.

Strong symptoms indeed. Since you are service connected for generalized anxiety disorder, you are fortunate in that respect. So now we need to link your anxiety with the traumatic event. I will assist you in doing that. It will not be easy, but can be done. We need to review your service medical records, as well as your personnel records from the trauma date until separation from active duty. When the records show a sudden change, it often is the nexus needed.
Please go in my profile and request me as a friend. I will help you.
Dave

Dave, I'm having trouble requesting you as a friend. The instructions are not that clear.

Marvin I clicked 'Add Friend' to add you as a friend and sent you my direct e-mail.

To all who read my articles and commentary
A mighty big PS:
An unknown mysterious person complained about my DU article on my website, to our National Service Director, last week. He advised me as it was his rightful duty to do so. The unknown complainant cited the e-mail link on my website was to my VA e-mail address and thus implied I was using VA e-mail for 'personal business!' Wow helping veterans with a VA e-mail is personal business? Amazing, simply amazing. So whomever did it, shame on them for not complaining to me. However the problem was resolved, my webmistress changed the e-mail address to my personal e-mail address.
So bottom line my website still has the DU article and here we are still publishing facts!
Somebody is awful sad, somewhere in Mudslingingville tonight. Not me though.
If any desire to check out the evil site, that abused VA e-mail, paste this address minus the
> < into your search engine
>http://www.geocities.com/dave_barker_amvet/index.html<

If you do please leave a message. The messages will determine the future of the web site existance.
That reporting incident was really hitting below the belt. It reminds me of my former Director in 1984, who threatened my job over AO and PTSD articles. Some veterans simply hate it when someone wants to help other veterans. I may be somewhat stupid, but I just don't get it. I have had at least two different individuals try to bump me off Military.com in the past, but to report me to the National Service Director? That is bad, really bad.

Finally the VA reviewed the incident and completely dismissed the issue.

Bill for Vets with PTSD Moves Forward
June 17, 2009
PR Newswire

Hall Bill to Help Veterans with PTSD Passes House VA Committee

Washington, DC – This week the full House Veterans' Affairs Committee passed Congressman John Hall's (D-Dover) landmark legislation to increase access to treatment and benefits for veterans suffering from Post Traumatic Stress Disorder (PTSD), and other injuries. Hall's H.R. 952, Compensation Owed for Mission Based Activities in Theatre (COMBAT) Act, will remove the burden from disabled veterans who have to prove that a specific incident during combat caused his or her disability. Hall's COMBAT Act will make it so that any veteran who served in combat will automatically have the ability to get treatment and benefits for injuries incurred during service.

"Currently there is an onerous burden put on the veteran, especially those diagnosed with post traumatic stress disorder to prove combat zone stressors," stated Hall. "Instead of helping these veterans, the VA acts as an obstacle, inflicting upon the most noble of our citizens a process that feels accusatory and disbelieving. The current process is complex, legalistic and protracted, and particularly difficult for veterans because of the stresses and uncertainties involved while facing skeptical and cynical attitudes of VA staff."

The VA's current policy forces veterans to "prove" that a specific stressor during a war triggered their PTSD, even if they have already been diagnosed and been receiving treatment for the condition. Veterans must track down incident reports, buddy statements, present medals, and leap other hurdles to validate to the VA that their PTSD was a result from their war service.

"The current policy violates common sense," stated Hall. "A soldier who does not have PTSD before entering a war, who returns home from war with PTSD, should not have to prove that his PTSD is a result of a specific experience during war. Simply serving in combat can induce PTSD. The wars America is fighting right now have no front or rear lines. Danger can strike in any place, anywhere. It is clear that the current regulations are in need of change."

From Iraq and Afghanistan conflicts alone, over 100,000 veterans have been diagnosed with PTSD. Tragically, however, only 42,000 have been granted service-connected disability for their condition. The disability claims backlog at the Veterans Administration (VA) is topping 900,000. A great many of these claims are Vietnam Veterans seeking compensation for PTSD.

During the House VA Committee's debate on the COMBAT Act, Hall told his colleagues "We can pave the way for today's veterans to receive the same assistance that created the Greatest Generation. Otherwise, we run the risk of allowing veterans and their families to face mental illness, suicide, homelessness, divorce, and unemployment alone. I, for one, won’t let that happen. I hope you won't either."

The Committee favorably passed the COMBAT Act, which now goes to the full U.S. House of Representatives for further consideration.

Thanks for your posting. We always like to see members contributing.

I know that PTSD is a touchy subject and people have a lot of questions about it. All I can contribute is my story and how I was awarded 30 percent. I believe that your statement in support of claim is a key factor.

My statement in support of claim included a news article, and my description of the event to include smells, thoughts, and names of people that were KIA and MIA during the event. I also refered to my CIB and awards that I recieved for the event. Just tell your examiner the truth and usually a psychologist can get it right.

Hope this helps someone get the treatment and compensation that they deserve.

quote:

Just tell your examiner the truth and usually a psychologist can get it right.

Thanks for sharing. Always tell the truth, including verifiable event dates and name of KIAs and WIAs Really helps. Buddy letter from guy who were there and of course any medical records for treatments and awards should make the event and you involvement easier to verify.

RGR, we sish you the very best. Take care, and come back and see us soon and often,

Bruce

Good work Dave, Doing us all Proud!

Be Well and God Bless