PTSD and Your VA Claim

Raymond F. Gustavson, Jr.

Having your claim for service-connected post-traumatic stress disorder approved by the Department of Veterans Affairs (VA) doesn’t have to be an agonizing process. Simply put, you must have the following:

  • Evidence that your in-service stressor actually occurred.
  • A current diagnosis of PTSD.
  • Medical evidence of a causal nexus (or link) between your current symptoms and the in-service stressor.

Criterion #1: A Stressor

So, what is a stressor? Simply put, it is a condition, ­stimulus, or life event that causes or provokes a stressful response in someone. That is, you witnessed a stressful incident. The stressor can be combat- or non-combat-related.

Having your claim for service-connected post-traumatic stress disorder approved by the VA doesn’t have to be an agonizing process.

To determine if you have a stressor, the VA rating specialist will look, first of all, at your DD-214, and see if you were awarded the Combat Infantryman Badge (CIB), Combat Action Ribbon, or other medal.

If the stressor is not found on the DD-214, the rating specialist will look at your military 201 Claims File to see if you received one of the following:

  • Air Force Cross.
  • Air Medal with “V” Device.
  • Army Commendation Medal with “V” Device
  • Bronze Star Medal with “V” Device.
  • Combat Action Ribbon.
  • Combat Infantryman Badge.
  • Combat Medical Badge.
  • Combat Aircrew Insignia.
  • Distinguished Flying Cross.
  • Distinguished Service Cross.
  • Joint Service Commendation Medal with “V” Device.
  • Medal of Honor.
  • Navy Commendation Medal with “V” Device.
  • Navy Cross.
  • Purple Heart.
  • Silver Star.

Further evidence of stressors

Further supporting evidence of a stressor may be found in the 201 Claims File. This includes plane crashes, ship sinkings, explosions, rapes or assaults, duty on a burn ward or graves registration unit, and acceptable POW status.

Another source of information is the Purple Heart Registry, a database maintained by the Veterans Health Administration (VHA) as part of their enrollment criteria for healthcare in a VA hospital.

If your service medical records (SMRs) show treatment for gunshot or shell fragment wounds, proof of the stressor is also complete.

The Vietnam Service Medal is not among those decorations considered conclusive proof of the stressor.

You will note that the Vietnam Service Medal is not among those decorations considered conclusive proof of the stressor. This is because it was awarded to anyone who served in Vietnam, the waters offshore, or the airspace above. It was also awarded for service in Thailand, Laos, or Cambodia.

If you are not in receipt of one of the approved medals, the VA will send you what is called a PTSD development ­letter. This letter asks you to list specific details concerning the stressor. If the letter is returned with information such as specific incidents, dates, unit assignments, and names of witnesses, the VA will go out to the U.S. Armed Services ­Center for Unit Records Research (USASCURR) in an attempt to verify these statements. The VA will include a copy of your DD-214, your description of the stressor or stressful incident, and copies of any pertinent military information in your 201 Claims File. USASCURR researches Army, Navy, Air Force, and Coast Guard records. They do not research Marine Corps records. Those records are maintained by the U.S. Marine Corps Historical Center located in the Washington Navy Yard, Washington, DC.

USASCURR searches morning reports, unit and command histories, casualty records, etc. in an attempt to verify the stressor. Usually they will send back copies of these reports, with pertinent parts underlined in yellow, and state the ­reasons why or why not verification was made. A word of caution: USASCURR states that military records rarely list ­specific experiences of individual service personnel.

What about combat reports on the Internet?

The reason VA must contact USASCURR is because many combat histories are readily found on the Internet. An unscrupulous veteran may access these in an attempt to prove he has a stressor. Also, since these web sites have no official standing for the VA, or any other branch of the U.S. government, their authenticity is in doubt. This does not mean that people who post to these web sites are liars. To the contrary, there are many heart-rending and true accounts of combat on some web sites. However, for these accounts to be acceptable as proof to the VA, the stories must be verified by USASCURR or another such agency.

On the other hand, such Internet sites may prove helpful in locating witnesses to a stressful incident. Thus, your claim for post-traumatic stress disorder may be strengthened by the statement of a veteran with verified combat-related experience, or any other veteran who witnessed the stressful incident. Do look at these sites, and don’t be afraid to post to them if your are looking for military buddies.

If the letter from USASCURR does not show that the claimed stressor is verifiable, the rating specialist will deny the claim. One incident that I witnessed was a ­veteran who had a combat-related diagnosis of post-traumatic stress dis­order from a VA psychiatrist. The diagnosis was based on PTSD acquired as a result of combat in Vietnam, and was based on information which the veteran gave his doctor. Unfortunately, the veteran’s military personnel file showed he had never left the continental United States. As a result, his claim was denied.

For post-traumatic stress disorder as a result of personal assault, the rating specialist will review the service medical records and 201 file, looking for verification, either in the form of sick-call or hospital reports, or any other evidence that showed the stressful incident occurred. If no verification is found, the rating specialist will send a letter to the claimant asking for current medical evidence showing that a stressful experience had occurred.

Examples of such requested records would include the following:

  • Records from law-enforcement authorities.
  • Records from rape-crisis centers, hospitals, or physicians.
  • Pregnancy tests, or tests for sexually transmitted diseases.
  • Statements from family members, roommates, fellow ­service members or clergy.

The rating specialist also needs to take into consideration behavioral changes that may indicate the presence of a stressor. These may include, but are not limited to, the following:

  • Visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment.
  • Sudden requests for a change in occupational series or duty assignment without other justification.
  • Increased use or abuse of leave without an apparent reason, such as family obligations or family illness.
  • Changes in performance and performance evaluations.
  • Episodes of depression, panic attacks, or anxiety but no identifiable reasons for the episodes.
  • Increased or decreased use of prescription medications.
  • Increased use of over-the-counter medications.
  • Substance abuse, such as alcohol or drugs.
  • Increased disregard for military or civilian authority.
  • Obsessive behavior, such as overeating or undereating.
  • Unexplained economic or social behavior changes.
  • Breakup of a primary relationship.

As you can see, there is not always a clear-cut pattern of evidence showing that a personal assault occurred. Possibly, the claimant was too humiliated to report the incident to military authorities. Even if this was done, there are cases where the unit commander or other responsible person did nothing to investigate and punish the perpetrator. A resultant lack of record keeping is not uncommon. This makes the job of the rating specialist difficult, but not impossible. In such cases, the rating specialist will look for a pattern indicating some type of behavioral change. For example, a service person may have had an exemplary work record up to the time of the personal assault, but now it is considered marginal. That gives a pretty strong clue that an assault may have occurred.

Criterion #2: Current Diagnosis of PTSD

As stated above, there are three requirements for consideration of a claim for post-traumatic stress disorder. The second requirement is a current diagnosis of PTSD. Who can make a diagnosis of post-traumatic stress disorder? Usually, a licensed psychiatrist does this. VA regulations also stipulate that a VA psychologist at the GS-13 level, or a private psychologist holding a Ph.D. in psychology or a related field of study, may make such a diagnosis.

Criterion #3: Medical Evidence of a Link

The third requirement for consideration of a claim for post-traumatic stress disorder is medical evidence of a causal nexus (or link) between the current symptoms and the in-service stressor. To determine this, the rating specialist will schedule you for a VA examination. During the examination the examiner will ask you certain questions related to your PTSD claim. Based on these answers, and a review of your claims file, he will make a nexus (or link) between the current symptomatology and the claimed in-service stressor.

To do this, the examiner uses the current edition of the Ameri­can Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). It has been refined over the years with the latest one, DSM-IV-TR, issued in the year 2000. Some (but by no means all) of the DSM-IV-TR criteria include:

  • Experiencing an event that involved death or threatened death or serious injury, with the person’s response involving intense fear.
  • Recurrent and intrusive memories of the event.
  • Flashbacks related to the event.
  • Intense psychological distress or physiologic reactivity to internal or external cues that resemble the event.
  • Trying to avoid thoughts or feelings related to the event.
  • Inability to remember important aspects of the event.
  • Feeling detached from other people.
  • Troubles related to sleep, irritability, anger, concentration, hyper-vigilance, and exaggerated startle response.

The DSM-IV-TR is available at your local library, or you can read pertinent parts at behavenet.com/capsules/disorders/ptsd.htm.

After a link has been established, the VA examiner will determine the severity of your PTSD.

After a nexus (or link) between the current symptoma­tology and the service stressor has been established, the VA examiner will determine the severity of your PTSD. This is done with the use of a tool called the Global Assessment of Functioning (GAF).

A GAF is an indicator of your psychological, social, and occupational functioning. It is assigned by the examiner, and ranges in severity from 0 to 100. That is, the lower the GAF score, the more severe the symptoms.

Multiple GAFs can be assigned to show the progressive serious­ness of PTSD over a period of time. For example, on a certain date, a veteran was assigned a GAF of 54, which equates to an evaluation of 50 percent. Six months later his condition had worsened, and the evidence showed that he now had a 70 percent evaluation. His award was written to show two effective dates for the progression of the PTSD.

The occasion may arise where two opposite diagnoses exist. For example, one examiner states the veteran has PTSD, and the other says he does not. In this case the rating specialist will send a VA examination request to the VA Medical Center asking both doctors to agree in their diagnoses. This is ­usually phrased on the exam request as follows: “We have diametrically opposed diagnoses regarding PTSD. The two examiners are to review the claims folder and reach a con­sensus. If they can not, a panel of psychiatrists should review the claims folder and reach a decision.”

If additional mental disorders are present with a veteran who has post-traumatic stress disorder, the rating specialist is obligated to ask the VA or other examiner to separate these disorders from the PTSD diagnosis. The examiner will then assign one GAF for the PTSD and another for the secondary condition. The resultant GAF for PTSD is then used to determine the exact degree of disability for your PTSD.

In the event the veteran has a history of violence, the examiner will assign a much lower GAF. If the evidence then shows that the veteran is unable to perform “substantially gainful employment,” Individual Unemployability may be assigned. These benefits are payable at the 100 percent rate. If the GAF is extremely low, (e.g., 30 or under), and the veteran is unemployed, the rating specialist should simply rate the post-traumatic stress disorder at the 100 percent level, thus eliminating the need for an Individual Unemployability determination.

After your claim for post-traumatic stress disorder has been approved (e.g., the 70 percent rate), and you are still working, a routine future examination will be scheduled after two years. Your award letter will probably contain the following statement: “Since there is a likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future review examination.”

You must attend this examination when the VA requests it. If you fail to go to the examination, you will be sent what is called a predetermination letter. This letter gives you sixty days to tell the VA why your benefit should not be reduced. Failure to respond means your award will be suspended, and that means your monetary benefits stop.

After your claim for PTSD has been approved at the 100 percent rate, or it appears that you will continue to remain permanently unemployed and severely disabled, educational benefits for your spouse and children may be granted. These are called Chapter 35 educational benefits.

Recently the VA has received a number of claims for cardiovascular conditions resulting from PTSD. Currently, the VA states there is no acceptable link between cardiovascular conditions and post-traumatic stress disorder. This comes from the VA’s own National Center for PTSD.

I think, however, that the regulations will eventually change on this matter, as there is a growing body of scientific and medical evidence indicating a strong link between PTSD and cardiovascular conditions.

If your claim for PTSD is denied, do not lose hope.

If your claim for PTSD is denied, do not lose hope. First of all, read the letter the VA sent you, and look specifically at the reasons why your claim was denied. Next, send a one-sentence letter to the VA stating you disagree with the decision. This protects your appeal rights; however, your letter must be received within one year of the VA-denial letter. In your letter, you may submit any additional evidence you feel is relevant to your claim, or any information the VA re­quested but you failed to send.

Since the VA appeals process is a precise yet often difficult process to understand, I strongly advise contacting a local service organization for help. One of their service reps will explain exactly why your claim was denied and help you process your appeal. Sometimes it’s as simple as not sending in that one piece of information you thought was a waste of time. So, again, don’t lose hope.

The grant of a VA disability for PTSD is often a satisfying conclusion to a long, drawn-out struggle. The grant is satisfying to you, the veteran, but it is equally satisfying to the rating specialist. During my time as a Rating Specialist on the Appeals Team, nothing gave me greater pleasure than to prepare a rating granting this benefit. In essence, it helps fulfill the legacy of Abraham Lincoln when he said, “To bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan – to do all which may achieve and cherish a just and lasting peace, among ­ourselves, and with all nations.”

 

Raymond F. Gustavson, Jr.Retired VA Rating Specialist Raymond F. Gustavson, Jr. served with the U.S. Army in Vietnam, and is writing a self-help book to help veterans understand the complexities of the VA claims process. His first novel, “A Thirst for War,” was a semi-finalist in the 2009 William Faulkner Competition. The sequel, “In the Hands of the Wolf,” was a semi-finalist in the 2011 William Faulkner Competition, and won Third Prize at the 2012 Florida Writers Association convention.