The VVA Veteran — September/October 2011
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So You Think You Might Have A Claim For PTSD?
Lauren L. Kologe And Margo Lee Williams

Not sleeping? Fighting with everybody? Always checking the doors?You may want to file a claim for PTSD. This article goes over the basics of what you will need in order to file a VA claim for PTSD, as well as information on recent changes in how the VA approaches PTSD claims.

Becoming service-connected for PTSD may help compensate for the effects stress has on your work and quality of life, and may also move you up in the priority groups at the VA. It also could mean that you will not have co-pays for certain medications.

This is not a gift:You have already paid the price by your service to our country. Please remember that if you are filing any claim for benefits, we suggest that you get help from a VA-accredited veterans service officer, agent, or attorney.You can locate an accredited representative at www.va.gov/ogc/apps/accreditation A listing of VVA service officers arranged by state is available at https://benefitsforum.org/Rep.aspx

ELEMENTS OF A PTSD DISABILITY CLAIM

The VA will ask if you have three things: a current diagnosis, a stressful event (or events) that caused the PTSD, and the relationship between the current PTSD and those events (called a “nexus”).

Current diagnosis: If you are already being treated at a Vet Center or a VA hospital for PTSD, you have already met this requirement. It will be in your records.If you are being seen by an outside doctor, it is important to provide those records and to get a diagnosis of PTSD at a VA facility. If you have a different diagnosis, you should still ask your mental health provider to evaluate you specifically for PTSD. If your mental health provider indicates you do not meet the full criteria for PTSD but feels your condition is related to your military service, you should still consider filing a claim and speak with your local veterans service officer about how to proceed.

If you haven’t been seen for treatment or diagnosed with PTSD, call your local VA hospital and ask to be seen by their PTSD program. If the hospital doesn’t have a program, ask to be seen in the regular mental health program. Local Vet Centers also specialize in mental health treatment. If you are enrolled in VA health care, ask your primary care physician for a referral.

Stressors: Stressors are the event or group of events that caused your PTSD. If you want to get service-Connected compensation for PTSD, you will need to show that your traumatic experiences took place in the military, not in civilian life.We understand that it can be difficult to remember and rehash these events, particularly since you have spent time trying to distance them. If you already have talked about these events with a mental health professional, you can ask for these records and show them to your representative.

Your service representative and family can help.As painful as it may be, you must talk about the events for your claim to succeed. You will need your DD-214 and, if possible, your service records, including personnel records. The DD-214 verifies your service, shows your military occupational specialty, and may show you were in combat. Your personnel file may show where you were stationed, TDY orders, special orders including combat assignments, commendation letters, and medals. If you do not have your DD-214 or military personnel file, you can request them using form SF 180, www.archives.gov/research/order/ standard-form-180.pdf

In Section 2 of the form, check the boxes for “undeleted” DD-214, all documents in official military personnel file, and medical records. Hospital records are stored separately and indexed by the name of the hospital, so you will have to put that information down as well. If you don’t remember, there may be a notation in your records about which hospital you were sent to, and you can send for the hospital records later.

If you kept pay records, travel vouchers, or letters home when you were in service, submit copies of these records with your claim. There is a list of medals that provide immediate corroboration of combat duty at www.benefits.va.gov/WARMS/M21_1MR4.asp Click on SectionD: Claims for Service Connection for PTSD, which is under Subpart II (Compensation), Chapter 1 (Development).

There have been changes to the VA regulations making it easier to prove a stressor based on fear of hostile military or terrorist activity.However, providing VA with proof of your stressor will help your claim. If your stressor relates to someone’s death during service in Vietnam, it is possible to find a record of the death on the Virtual Wall, www.virtualwall.org For more recent veterans, check out the Virtual wall on CNN’s website: www.cnn.com/SPECIALS/war.casualties

You can leave a message for a family on these sites; men and women you have served with may have left messages and contact information. There are reports of airstrikes at different airbases and unit histories available online. For Vietnam War research, one good database is www.vietnam.ttu.edu/resources/operations/ There are records of campaigns detailed in reference books such as Where We Were in Vietnam by Michael P. Kelley, which covers the entire Southeast Asia theater of operations.

You might also find corroboration of stressors in line-of-duty determinations or investigative reports.You might even find articles from Stars and Stripes detailing an event. Looking for people you served with who also experienced the stressful events can help you and your fellow veterans. Military.com has listings of many units and unit histories and Hullnumber.com has listings ofmany ships and their rosters. Some units have reunions, newsletters, and even cruise books and histories online. Unit websites and VSO membership organizations have locator and reunion sections in their publications and online. The best example is the “Locator” section of The VVA Veteran.

The National Archives and Records Administration in College Park, Maryland, and the Joint Services Records Research Center in Alexandria,Virginia, also research stressors for VA claims. The VA will contact NARA or JSRRC if your records cannot be found in other databases. If you cannot verify your stressors through other locations, you should ask your representative to write to NARA or JSRRC to search for them.You must provide a time frame and as many specific details about the events as possible.

PTSD based on personal assault can be especially difficult to talk about, so there is a different stressor questionnaire for personal assault cases, the VA Form 21-0781a. If your stressor was related to a personal assault,VA now recognizes that there may be no official records about the stressor and will try to get information about these stressors from alternative sources such as family members, roommates, health clinics, crisis centers, civilian police reports or medical reports, chaplain or clergy members, and personal diaries or journals.

HOW HAVE THE STRESSFUL EVENTS AFFECTED YOUR LIFE?

Here are a few of the ways that stressors can affect someone: lack of job stability, lack of marital stability, poor relationships with children and other family members, lack of social life, sleep problems, reactions to loud noises, checking the perimeter, flashbacks, and anxiety. Even if you did not seek treatment until recently, you can have family members— including spouses, ex-spouses, or adult children—write letters about what they have observed.

You may have attempted to distract yourself from the trauma by filling every moment with work or other activities, or by numbing yourself through repetitive behaviors or substance use.You may have tried to hide the memories from everyone, but those closest to you most likely will have noticed behaviors such as your avoidance of crowds, reactions to loud noises, and withdrawing on anniversary dates. This is a natural reaction to the trauma.

The Claim Process: To submit a VA claim, you will have to file a VA Form 21-526. There also is a standard PTSD questionnaire to fill out,VA Form 21- 0781 or 21-0781a. Your representative can help with this. The PTSD questionnaire asks about your stressors: dates, places, units,medals, and any persons who were wounded or killed in the event. After you file the claim, the VA will send a letter confirming receipt of your claim. The VA may ask for additional information and may ask you to come to a compensation and pension examination.

The purpose of the exam is to confirm the three elements needed for service connection and to provide information about your specific level of disability, which is needed for rating purposes.Generally, a C&P exam will consist of talking with a VA psychiatrist or psychologist and completing some short oral and written evaluation tests.

It is important not to understate or overstate your symptoms in the C&P exam, so that you will obtain the most appropriate disability rating. A journal can be a useful tool to help you understand what triggers your stress and help you manage it. It also can be a great tool to show how your symptoms have been affecting you over a period of time. It is easy to feel like your whole life is falling apart on bad days and feel overly optimistic on good days.A journal shows how you are feeling each day and helps you recognize patterns and how frequently your trauma affects you. Bringing this record to a C&P exam enhances your credibility.

Unlike Social Security disability, which is an all-ornothing determination, VA service-connected compensation is paid on a scale, depending on the impact of your disability on your work and daily activities.You can be rated anywhere from 0 to 100 percent disabled.Different compensation rates are associated with each disability rating. Current compensation rates can be found at www.vba.va.gov/bln/21/Rates

Once all records have been obtained by you or the VA and you have had a C&P examination, your claim will be ready to rate. This means that the VA has certified all development is done and has sent it to be included with others that also are ready to be decided by a rater. The VA must work the oldest claims first, so even though everything may be done for your claim, you have to wait your turn, which can take several months. Once a rater has your claim, he or she will review the evidence and either grant, deny, or defer your claim. Deferring a claim means that the rater saw evidence that needed clarification or asked for additional evidence.You will receive a letter with the VA’s decision.

SHOULD I APPEAL?

If your claim for service connection for PTSD is denied, but you have distressing memories of combat or trauma in service, we urge you to contact a representative who can help with an appeal. If you are granted service-connected disability compensation for PTSD, you will be given a percentage disability rating and an effective date for payments. Even if your claim is granted, you can appeal the percentage disability rating and, in some cases, the effective date assigned.

Carefully read the reasons for the rating and the effective date assigned. If your rating decision does not mention certain events you have experienced—for example, if you quit or were fired from a job because of your PTSD, or if you have stopped socializing with friends—you may want to appeal. If your PTSD has worsened recently, you may want to file a claim for increased rating instead of an appeal.

It is important to remember that if you appeal and are granted a higher rating, it could go back, under certain circumstances, to when you first filed your claim. If you do not appeal, you can file a claim for an increased rating later, but any increased payments (with one exception) will go back to when you filed your new claim. The length of time an appeal may take can be daunting, but persistence often pays off. If you are unsure whether to appeal your claim, consult a veterans service officer or attorney.

The effective date of a claim for service connection is usually the day you filed your claim with the VA, with payments beginning the first day of the following month. If you filed your claim within a year of your discharge from the military, the effective date should be the day following discharge from active duty.

CHANGES IN ADJUDICATING PTSD CLAIMS

There are three main changes regarding how the VA approaches PTSD claims that you should know about, especially if you have filed a claim and it was denied. First, the manual that mental health professionals use to diagnose patients has been updated, and the VA has adopted the newest version of this manual (the DSM-IV TR). Second, the VA has made it easier to prove that a stressor happened to you. Third, federal courts have recognized that when a veteran files a claim for a specific mental health condition such as PTSD, the VA must consider whether other diagnoses based on the veteran’s traumatic military experiences may entitle the veteran to benefits.

Changes to Diagnosis of PTSD: There have been several updates to the Diagnostic and Statistical Manual since its first version in 1952. PTSD was first recognized as a diagnosis in the third version, DSM-III.At that time, a diagnosis of PTSD based on traumatic experiences could only be made if the person “experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.”

It is now recognized in DSM-IV that the same experience may affect people differently. The DSM-IV criteria require that the person “has been exposed to a traumatic event in which the person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others; and the person’s response involved intense fear, helplessness, or horror.” See www.ptsd.va.gov/ professional/pages/dsm-iv-tr-ptsd.asp

The VA has adopted the DSM-IV standards for deciding claims. If you filed a PTSD claim before 2000 and were denied because your stressor was deemed inadequate to cause PTSD, we encourage you to consider reopening your claim and to consult with an accredited representative or attorney. There will be more updates to the DSM; DSM-V is scheduled to be published in May 2013.

Changes to the VA Stressor Requirement: One of the most important changes to the way the VA approaches PTSD claims is the relaxation of the second requirement, proof that you experienced a stressor. If you have a diagnosis of PTSD by a VA psychiatrist or psychologist and your stressors were based on a fear of hostile military or terrorist activity, provided the stressor or stressors are consistent with the circumstances of your service, your own account of the event will establish the existence of the stressor.

“Consistent with the circumstances of your service” is a determination that theVA rater makes. For example, if a veteran states that he experienced sapper attacks inVietnam but his records placed him in Germany with no TDY orders, his claimed experiences are not consistent with his service. On the other hand, if the veteran’s MOS was supply clerk but his base was heavily attacked by mortars and rockets and he experiences PTSD due to those attacks, that would be consistent with the time and place of service.

These changes will mean that less processing time will be required to verify stressors, but they also require a diagnosis of PTSD by a VA psychiatrist or psychologist or a psychiatrist or psychologist contracting with the VA, even if you already have a diagnosis from a private doctor. This means wait times for C&P exams will continue to be lengthy.Also, this relaxed stressor requirement does not apply to stressors that are not related to fear of hostile military activity or combat, and those still have to be corroborated with some evidence other than the veteran’s testimony.

Changes in Defining a Claim for PTSD: If you do not meet the full criteria for a diagnosis of PTSD, there may still be profound effects on your work and quality of life from your military experience. The Court of Appeals forVeterans Claims has said that if a veteran files a claim for PTSD but is diagnosed with another mental health condition, VA must determine whether the diagnosed condition is related to the veteran’s military service. The VA cannot deny a claim simply because a veteran filed for the wrong mental condition, since the veteran is not amental health professional.

For example, when we see a claim denied just because a veteran has anxiety disorder rather than PTSD, we always ask for another C&P exam to determine whether the anxiety disorder is related to military service.

Lauren Kologe is Deputy Director of the Veterans Benefits Program at VVA. She can be contacted at lkologe@vva.org MargoWilliams is a National Service Officer for VVA at the Appeals Management Center.Her email is margo.williams2@va.gov
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