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COPD and the Gulf War

Like PTSD, Gulf War Syndrome is marching up the ranks in prevalence today, and has earned its own regulation in the VA federal and United States codes. Because it is multi-symptomatic, Gulf War Syndrome can be discussed in many different ways. In a previous post, we gave a general overview of Gulf War Syndrome and how to obtain service-connection by presumption. Here we will discuss a specific on-going issue: obtaining service-connection for COPD as related to the oil well fires of 1991.

With President Obama’s announcement on August 31, 2010, the US combat mission in Iraq (Operation Iraqi Freedom) had officially ended, and with that, the second phase of the Gulf War. The first Gulf War, led by U.S. and coalition troops in January 1991, followed the August 1990 Iraqi invasion of Kuwait. The war was over on February 28, 1991, and an official cease-fire was signed in April 1991. Fourteen years later, Operation Iraqi Freedom (2003-2010) and Operation New Dawn (2010-2011) created a new group of Gulf War Veterans.

From a legal and medical standpoint, the Gulf War presented a unique set of challenges. Veterans who served in these eras have experienced health issues commonly known as Gulf War Syndrome—with symptoms such as fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems. What makes Gulf War Syndrome unique is the inability of medical professionals to diagnose these symptoms. As a result, the VA established 38 CFR §3.317, which more clearly defines parameters of “undiagnosed illnesses” and the guidelines for receiving compensation for those illnesses. One of the respiratory illnesses that we are seeing more of is Chronic Obstructive Pulmonary Disorder (COPD).

COPD is an obstructive lung disease characterized by chronically poor airflow. It typically worsens over time. In contrast to asthma, medication does not significantly improve the airflow. While the primary cause of COPD is considered to be tobacco smoke, COPD can also be caused by occupational exposures and pollution from indoor fires (in some countries). Some of the characteristics of COPD include:

  • Shortness of breath, especially during physical activities
  • Wheezing
  • Chest tightness
  • Having to clear throat first thing in the morning, due to excess mucus in lungs
  • A chronic cough that produces sputum that may be clear, white, yellow or greenish
  • Blueness of the lips or fingernail beds (cyanosis)
  • Frequent respiratory infections
  • Lack of energy
  • Unintended weight loss (in later stages)
  • Exacerbations—severe episodes during which symptoms become worse and persist for days or longer

Servicemen who spent time in Kuwait in 1991 will remember the huge billows of smoke and the smog that hung over the ground as over 600 oil wells burned for seven months. Hundreds of US soldiers worked around those fires, breathing in the fumes with little or no protection. Years later, the breathing problems they developed in Kuwait have only gotten worse.While the Veterans Administration has declared that there is no evidence of long-term health problems from exposure to oil well fires at this time, the health problems of veterans who served in Kuwait tell another story. Since COPD is not on the list of presumptive diseases associated with Gulf War Syndrome, it is more difficult of veterans to get service-connection for conditions outside this list. However, in the news release dated September 28, 2010, the VA stated that, “for non-presumptive conditions, a Veteran is required to provide medical evidence to establish an actual connection between military service in Southwest Asia or Afghanistan and a specific disease”. Moreover, under 38 USC §1117(g)(8) and 38 CFR §3.317 (b)(8), “signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multisymptom illness include: […] signs or symptoms involving the upper or lower respiratory system”. The caveat to these regulations is that it is more difficult to prove service-connection “if there is affirmative evidence that the disability is the result of the veteran’s own willful misconduct or abuse of alcohol or drugs”. Or, in this case, willful misconduct or abuse might include the use of tobacco/cigarettes.

In order to be successful in establishing service-connection for conditions such as COPD, it is beneficial to get an outside medical opinion on the matter. The VA is required to consider the evidence of medical opinions outside of the VA. If the opinion of the independent medical practitioner is positive, the VA will be looking for the phrase “at least as likely as not”. If this phrase is not included in the report, or something to the equivalent, the VA will not make a favorable decision on the claim based upon that report.

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by Mary Klements, Veterans Advocate
July 31, 2014

PTSD & Self-Medication – Alcohol

Coping with Post Traumatic Stress Disorder (PTSD) is a challenge for most veterans as they return from service. Servicemen from Vietnam, Thailand, Afghanistan, Iraq, Kuwait and countless other war zones all deal with this very real aftermath of combat and war experience. And while many veterans address their PTSD with medication and therapy, there are many others who choose to cope by means of self-medication.

Self-medication usually takes form in alcohol or drugs, sometimes a combination of both. Veterans find that consuming alcohol dulls the symptoms of PTSD, such as:

  1. Reliving the event
  2. Avoiding situations that remind you of the event
  3. Negative changes in beliefs and feelings
  4. Feeling keyed up (hyperarousal)

This fourth symptom seems to be particularly prominent among veterans that have served within the last five to ten years. Symptoms of hyperarousal could include:

  1. Feeling jittery, or always alert and on the lookout for danger
  2. Suddenly becoming angry or irritable
  3. Having a hard time sleeping
  4. Having trouble concentrating
  5. Being startled by a loud noise or surprise
  6. Experiencing the need to have back to a wall in a restaurant or waiting room

While many veterans experience these symptoms, they might not think it necessary to seek out medical help. Why bother when you can dull the edge with whiskey or beer? And they do just that. They find that they can sleep better (as in, without nightmares) when they drink. Or that they are less irritable when they drink. They still have to sit with their back to the wall in a restaurant or other public places, but at least they aren’t feeling as jittery or on edge.

This approach to self-medicating their PTSD symptoms makes more sense to veterans than medical intervention, but the reality of this approach presents a darker future. A six-pack of beer might solve the problem for a night, but multiplied over the course of years will likely result in serious health issues.

While the VA recognizes the use of alcohol as a common method of self-medicating, the VA will not award benefits for conditions that developed due to misuse of alcohol. Conditions that result from sustained alcohol use include:

  • Liver disease, such as: alcoholic hepatitis and cirrhosis
  • Digestive problems
  • Heart problems, such as: high blood pressure, enlarged heart, heart failure, and stroke

Other problems could include: diabetes, erectile dysfunction, eye problems, osteoporosis, neurological complications, weakened immune system, and risk of cancer.

The VA may not directly grant benefits due to a condition caused by misuse of alcohol, but that does not mean that all hope is lost. Courts have interpreted 38 USC 1110 as permitting an alcohol abuse disability under one condition: when that disability (such as liver disease) arises secondarily a pre-existing or worsening service-connected disorder (one not caused by willful misconduct). Courts have reasoned that a secondary alcohol disability (such as liver disease) results from a line of duty disease (in this case, PTSD) or disability, rather than as a result of abuse of alcohol or drugs itself. In other words, the VA will grant service-connection for a condition caused by alcohol abuse if the alcohol abuse was due to a service-connected disability. In this case, the service-connected disability would be PTSD.

Cases like this are difficult to win, and could take years. The VA will look for every reason to deny compensation for alcohol-related conditions. However, with positive medical opinions and perseverance on the part of the claimant, it can be done.

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by Mary Klements, Veterans Advocate
July 30, 2014

Navigating Your C&P Exam.

C&P exams, or Compensation and Pension Exams, will be required by the VA in order to process your claim. Our blogs have dealt with this subject previously. But here’s a couple of reminders and a few Do’s and Don’ts to help you through this exam.

  1. Do be on time.
  2. Do take a list of your symptoms. Even the ones you’d really rather not talk about, or that may be embarrassing. Ask a spouse or friend to help you compile the list. Often, a spouse may notice that when you bend down to pick up something, you are always holding your back, or that at the end of the day, you check the locks on the house and window three or four times before going to bed.
  3. Do be polite. Being rude or profane will not help your claim at all.
  4. Do be honest and forthright. When you first walk in the room, and the examiner asks you how you are, this is the time your exam really starts. Tell the examiner exactly how you are. If your back hurts, say so. Most veterans are conditioned to not complain. If you have trouble stating how you are, it’s safe to say, “I’ve had better days.” After all, if you were “okay”, you wouldn’t be at a C&P exam.
  5. Don’t lie. Don’t embellish your symptoms. Referring to your list that you brought, explain to the examiner what your symptoms are, without resorting to exaggeration. Lying will just cause more problems.
  6. Don’t be afraid to tell the examiner when something hurts or if you have trouble with performing an exercise.
  7. Don’t complain about the VA system in general. Your C&P exam is not the time to air grievances. (For example, how long you waited, how long you’ve had this claim in, what the nurse said to you when you called…)
  8. Do remember that anything you say in the exam room may be written into your C&P exam. For example, if you are asked about your hobbies, it’s always safer to say that you can’t participate in them as much as you used to. Your C&P exam is not a social occasion where you are exchanging information with a friend.
  9. Do write down your impressions after the exam. If you felt ignored, or felt something did not go well, document it while it is still fresh in your mind.
  10. Don’t lose your cool with the examiner if you think the exam went badly. Again, document what you remember and what bothered you as soon as you can.

For more information on what will go on during your particular C&P exam, many find the disabilities benefits questionnaire that is provided by the VA to be helpful.

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by Lora Wentzel, Veterans Advocate
July 28, 2014

Multiple Sclerosis, the mystery disease

Multiple Sclerosis, or MS, is a crippling non-contagious autoimmune disease of the nervous system. It destroys myelin, our nerves protective covering, rendering nerves ineffective and diminishing communication between the brain and body. Symptoms vary among sufferers but include blurred vision, depression, fatigue, weakness, tingling or numbness in one or more limbs and extreme cases involve losing the ability to speak and walk altogether. According to the National Multiple Sclerosis Society, approximately 2.3 million people have MS worldwide.

While the exact cause and cure are unknown, numerous factors may contribute to developing MS including gender, genetics, age, geography and ethnic background. Scientists have suggested infection, stress, chemicals and a combination of genetics and external influences but no conclusive evidence exists. Interestingly, one study confirmed incident rates among military personnel are higher than other populations, with African Americans suffering the highest rates. This validates the correlation between military service and MS is substantial; we just have not yet identified the precise source.

Since preventing and curing MS is not possible, mitigating symptoms and progression is the only relief currently available to sufferers. Traditional treatment includes various medication, physical therapy and surgery whereas alternative treatment includes acupuncture, herbal remedies and the versatile yoga. The VA offers traditional treatment whether Veterans are service connected for this disease, or not. While treatment impedes the progression of MS, early diagnosis is preferable but somewhat problematic.

First, no medical test or examination definitively diagnoses MS. Further, initial symptoms surface then disappear for months effectively eliminating hopes of early diagnosis. Unfortunately, this unpredictable and unreliable symptomology frequently results in misdiagnosis among service members particularly during earlier generations when awareness was lower. Consequently, accurate diagnoses tend to occur years after symptoms first appear and often times long after military service.

The difficulties involved in diagnosing MS resulted in Federal law defining the presumptive period following military service as seven years, the longest among presumptive conditions. In 2007, Washington Senator Patty Murray championed an honorable but unsuccessful attempt to change the presumptive period from seven years to indefinitely. Such efforts deserve support and ultimately another endeavor after successfully identifying the cause.

If diagnosed with MS, obtain your C-file and investigate what medical treatment you received during your military service. Initial symptoms are usually very subtle and require medical expert review of the evidence to determine when the disease actually manifested. If manifestation occurred at least within seven years following service, you should pursue disability benefits.

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by Eric Cook, Veterans Claims Advocate
July 25, 2014

Cardiovascular disease secondary to PTSD

Despite increasing evidence and published medical studies that there is a link between Posttraumatic Stress Disorder (PTSD) and cardiovascular disease, the VA continues to deny veteran’s claims for heart conditions secondary to PTSD.

PTSD develops after exposure to particularly traumatic events. Its severity depends on the nature and intensity of the trauma. Recent studies have shown that it also depends on the susceptibility of the exposed person.

For instance, a study of a brain chemical called neuropeptide Y, which has been called the “resiliency hormone”, that is measured in blood or spinal fluid, suggest that Navy Seals and Green Berets tend to have naturally high levels of the hormone in the blood in response to acute stress. These high levels of the hormone could help explain their mental and emotional resilience. Lower levels of the peptide were found in people with PTSD, compared with those without the disorder. Interestingly, according to the study, the hormone is also implicated as a factor in heart disease, although its exact role is not yet clear. (Marine Resiliency Study, Dewleen G Baker M.D., VA San Diego Healthcare System, San Diego, CA, Funding Period: October 2009 – September 2012)

Veterans with PTSD experience many chronic symptoms that have been found to have a significant effect on physiological systems that over time have adverse effect on the body. There are four hallmarks of PTSD:

  1. Reliving the event
  2. Avoiding situations that recall the event
  3. Negative changes in beliefs and feelings
  4. Feeling keyed up also called hyperarousal

For veterans with PTSD, memories of the traumatic event can come back at any time, through flashbacks and nightmares. Memories are frequently triggered by sights, sounds and even smells. When they occur, people may feel the same fear and horror they did when the event took place. Those with PTSD may also feel on constant alert and on the look-out for danger. These reactions cause a “fight or flight” response, which is how the body responds to danger and threats. A cascade of hormones are secreted when this occurs, triggering changes throughout the tissues and organs of the body. The heart beats faster, arteries constrict, blood pressure increases. The body starts preparing for battle – glucose levels rise, platelets in the blood become sticker. It’s a normal life-saving miracle that is built within us if we find ourselves fleeing from imminent danger. But when this process happens many times over, in response to chronic emotional stress, the lining of the arteries gets damaged and the heart muscle weakens. It becomes more a destructive pattern than a protective one.

Although the association between PTSD and cardiovascular disease is complicated by health risk behaviors such as smoking, obesity, and family history, there are many studies independent of traditional cardiac risk factors associating PTSD and heart disease.

Many times the VA denies claims for heart disease secondary to PTSD stating that a heart condition is caused by plaque built-up in the artery, without any further reasoning. Do not deter from pursuing your claim for heart disease if you were denied. As the medical community continues to explore additional mechanisms linking PTSD and cardiovascular disease, all research seems to be moving in the direction of establishing a direct causal link between PTSD and heart disease.

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by Brenda Duplantis, Disability Advocate
July 24, 2014

Guide to Parkinson’s Service Connection without Agent Orange Exposure

Many veterans struggling with Parkinson’s Disease are also struggling with the VA. Parkinson’s Disease is one of the illnesses the VA presumes is related to Agent Orange exposure. However, many Vietnam-era vets are unable to prove they were exposed to Agent Orange, due to being stationed in Thailand, Korea, or even in CONUS. While a claim for Parkinson’s by a veteran with presumed Agent Orange exposure may be easier, all is not lost.

Several chemicals veterans are exposed to on a regular basis have been shown to cause Parkinson’s Disease and related neurodegenerative disorders.

Pesticides

Malaria was a common problem during the Vietnam War, and in order to reduce the levels of mosquitos, the United States Military launched “Operation Flyswatter.” 1.76 million liters of malathion concentrate was sprayed overhead from airplanes, often at dusk as soldiers were eating. Many bases in Thailand were fogged heavily with malathion every day in order to reduce mosquito population.

Organophosphate pesticides such as malathion have been shown to have a clear and consistent relationship to Parkinson’s Disease. In fact, the mechanisms that make pesticides so useful in killing mosquitos are similar to the mechanisms that cause Parkinsonian symptoms. Parkinson’s involves a loss of neurons that regulate the neurotransmitter dopamine in a specific area of the brain called the substantia nigra. This typically happens with Parkinson’s via either oxidative stress on the neurons, or by dysfunction of a gene that creates a protein in the brain called α-synuclein. In fact, Lewy bodies, one of the defining characteristics of Parkinson’s, are composed of α-synuclein.

Pesticides have been shown in many studies to cause both oxidative stress and errors in the expression of the α-synuclein gene, among other genes. One study found that those exposed to pesticides had a 5.66 greater incidence of faulty genes involved in transporting dopamine.

Another study found that those who sprayed pesticides or insecticides at least once a year for 5 years (not necessarily consecutively) had seven times higher odds for developing Parkinsonism.

While we still don’t completely understand how Parkinson’s begins, the evidence connecting pesticide exposure and Parkinson’s is strong. While some other pesticides, such as Paraquat and rotenone are even more likely to cause PD than Malathion, it may prove more difficult to show exposure in-service.

Jet Fuel

I’ve written previously about how much JP-4 veterans were exposed to regularly, and I’ve briefly written about damaging jet fuel exposure can be for the brain. JP-4 contains many chemicals that damage the brain, and a few of these have been shown to be related to Parkinson’s. The toluene, xylene and ethylbenzene found in JP-4 have been shown to cause dysfunction in dopamine transmission, specifically in the areas of the brain affected by Parkinson’s. A chemical called n-Hexane has also been shown in many studies to cause problems with dopamine transmission. There are even case reports of patients where the cause of their Parkinson’s was fully known to be exposure to n-Hexane. N-Hexane can not only cause Parkinsonian symptoms, but also seems to lead to an earlier onset of symptoms, and a more difficult to treat disease.

Trichloroethylene

Trichloroethylene, a solvent used as a degreaser and cleaner, causes Parkinson’s so severely that nearly 20% of Parkinson’s patients have been shown to have TCE exposure. Like n-hexane, it also causes an earlier onset of symptoms, and makes the disease more resistant to medication. Trichloroethylene causes dopamine transporter dysfunction as well as severe damage to the mitochondria in neurons.

TCE was widely used by veterans in a variety of specialties, however TCE environmental and water contamination such as the Camp LeJeune contamination means that many vets who wouldn’t normally use trichloroethylene in their duties can become exposed merely by being on base.

Just because the VA does not consider a veteran to have presumed exposure to Agent Orange doesn’t mean that your Parkinson’s wasn’t caused by your service, or that your claim is unwinnable. You just need the right research team on your side!

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by Chris Amidon, Veterans Advocate
July 23, 2014

Does the VA provide C&P exams for every case?

Unfortunately not and in many cases constitutes error.

This discouraging fact may potentially frustrate anyone navigating the VA claims process for the first time. Disappointingly, the VA frequently refuses to provide this fundamental medical assessment defying numerous obligating authorities. VA’s failure to provide exams is troubling because exams are critical in establishing the required “nexus” between your service and current disability. Although exams also serve other purposes to include providing a diagnosis and the disability’s severity level, you may read more about exams in this prior post.

For decades, veterans were at the VA’s relentless mercy to receive an exam. Despite the passage of the Veterans Claims Assistance Act on November 9, 2000, the controversy regarding when an exam was justified continued until June 5, 2006 when the US Court of Appeals for Veterans Claims decided the landmark case McLendon v. Nicholson. The Court, through this case, effectively lowered the threshold necessary to obligate the VA to provide an exam.

The McLendon case established three requirements to receive an exam, (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with service. In other words, a current diagnosis is no longer required rather only evidence of persistent symptoms and an in service event that feasibly could be responsible. In 2010, the VA also lowered the requirements to receive an exam regarding psychological disabilities by issuing internal guidance known as Training Letter 10-05. This directive authorizes an exam when evidence corroborates service in a hostile area and the veteran provides a statement.

However, despite an administrative directive, Federal law and even precedence established by a governing Court the VA continues to deny veterans exams, which constitutes a majority of errors identified during judicial review. This may not pose undue hardship for veterans with private insurance because the VA accepts exam reports, or Disability Benefits Questionnaires, for many conditions directly from private physicians. Conversely, this places significant financial burden on veterans seeking benefits they desperately need and deserve who rely solely on the VA for their healthcare.

In the event you receive notice that an exam was scheduled, be sure to read our post on how to prepare and what to expect at the exam. Additionally, do not be surprised if your VA examiner is not even a certified doctor as many examiners are only physician assistants. As frustrating as that sounds, this could actually be to your benefit because an Independent Medical Opinion or IMO easily counters the inferior medical opinion. If denied an exam and thus benefits, do not accept this at face value – rather seek legal advice from an experienced attorney immediately.

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by Eric Cook, Veterans Claims Advocate
July 22, 2014

Parkinson’s Disease and Chemical Exposure

Although veterans who served boots-on-ground in Vietnam are now presumptively service-connected for Parkinson’s, other causes of Parkinson’s are becoming more prevalent. This post is going to discuss Parkinson’s and how to show direct service-connection between Parkinson’s and exposure to chemicals.

Parkinson’s disease (PD) is a chronic and progressive movement disorder, and is the most common neurodegenerative movement disorder of aging. Parkinson’s affects the nerve cells in the substantia nigra area of the brain that produce dopamine. Dopamine is a chemical that sends messages to the part of the brain that controls movement and coordination. As Parkinson’s progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

Because Parkinson’s is a progressive disease, the symptoms vary in manifestation and duration. Listed below are signs of Parkinson’s at the initial/mild stage, the secondary/moderate stage, and advanced stage.

Initial/Mild Signs:

  • Resting tremor
  • Bradykinesia – slow movement
  • Rigidity – stiffness & inflexibility of the limbs, neck & trunk
  • Postural Instability – tendency to be unstable when standing upright
  • Change in posture and facial expressions

Secondary/Moderate Signs:

  • Freezing – the temporary sensation of one’s feet being glued to the floor
  • Micrographia
  • Mask-like expressions
  • Involuntary movements

Advanced Signs:

  • Great difficulty walking; in wheelchair or bed most of the day
  • Inability to live alone
  • Assistance needed with all daily activities
  • Cognitive problems, including hallucinations and delusions

Other Signs:

  • Stooped posture, a tendency to lean forward
  • Dystonia
  • Impaired fine motor dexterity and motor coordination
  • Impaired gross motor coordination
  • Poverty of movement (decreased arm swing)
  • Akathisia
  • Speech problems, such as softness of voice or slurred speech caused by lack of muscle control
  • Difficulty swallowing
  • Sexual dysfunction
  • Cramping
  • Drooling

In spite of decades of study, the causes of Parkinson’s have yet to be determined. Many experts say that Parkinson’s is caused by a combination of genetic and environmental factors, but these vary case by case. Certain environmental factors, such as occupational exposure to chemicals, have been linked to Parkinson’s. 

Of the chemicals that have been most suspected risk factors for Parkinson’s, TCE holds the most proof of causing Parkinson’s. A colorless, non-flammable halocarbon, trichloroethylene dissolves most fixed and volatile oils. It is a powerful solvent action for fats, greases, waxes, oils, and tars. Type 1 TCE is used in dry-cleaning and for general solvent purposes. Type 2 TCE is used for vapor degreasing of metals. Over 90 percent of TCE is consumed by the metal degreasing and dry-cleaning trades.Studies of discordant twins, as well as experiments in laboratories, have shown that people chronically (eight to 33 years) exposed to TCE were more likely to develop Parkinson’s than the those who had not.

Military veterans have been seeing these results more than most. For decades, TCE had a wide variety of purposes in the military—from paint thinner to parts cleaner— and involved constant handling. After months or even years of inhaling and handling this chemical with little or no protection, veterans see Parkinson’s symptoms appear. While chemical exposure resulting in Parkinson’s has not been officially recognized by the VA as a presumptive disease, it is still possible to get VA benefits. In order to increase chances of winning these kinds of cases, it would be advisable to get a medical opinion by a doctor or specialist in that field. The verbiage that the VA needs to see is that “it is at least as likely as not” that the veteran’s conditions were caused by (for the purposes of this post) constant handling of TCE, and thus are service connected.

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by Mary Klements, Veterans Advocate
July 21, 2014

PTSD and Verifying “Special Operations” Stressors

When a veteran files a claim for PTSD, the VA stipulates that the basis of the claim be established by the verification of an in-service stressor. In order to clarify how this can be accomplished, the VA updated the pre-existing CFR regulation 3.304(f) by giving detailed instructions for specific situations. This regulation states that service connection for PTSD requires three elements:

  1. Medical evidence diagnosing the condition
  2. A link, or nexus, established by medical evidence , between current symptoms and an in-service stressor
  3. Credible supporting evidence that the claimed in-service stressor occurred.

What we are going to talk about in this post is this last conditions—specifically, the burden of the VA to verify a veteran’s involvement in Special Forces classified missions, or to obtain related classified documents.

The VA defines “Special Operations” as small-scale covert or overt military operations of an unorthodox and frequently high-risk nature, undertaken to achieve significant political or military objectives in support of foreign policy. Special Operations units are typically composed of relatively small groups of highly trained, armed personnel, and are often transported by helicopter, small boats, or submarines, or parachute from aircraft for stealthy infiltration by land.

Under the Veterans Claims Assistance Act (VCAA) of 2000, and in particular under the new 38 U.S.C. § 5103A, the VA must make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate his/her claim. Such an obligation includes making “reasonable efforts” to obtain:

  • relevant records (including private records)
  • service treatment records
  • other relevant records held by any Federal department or agency

In the case of Special Operations, the VA must make reasonable efforts to verify circumstances and the situation that the veteran claims to have been his stressor.

Combat exposure is most frequently established based on the receipt of certain military decorations verified within service personnel records. Such decorations include the Medal of Honor, Navy Combat Action Ribbon, Combat Infantryman’s Badge, Bronze Star Medal with “V” Device, and Distinguished Service Cross.

However, many veterans were engaged in combat or in Special Operations and were not awarded the military decorations described above. In these cases, the VA will not establish combat exposure based on those criteria. Instead, the VA follows a procedure outlined in Fast Letter 09-52 to determine the combat-related stressor.

The VA will send the veteran a VCAA letter, requesting more information about the combat/Special Ops-related situations. The letter may have wording similar to the following: 

Tell us more about your participation in a Special Operations unit by providing the following information on the attached VA Form 21-4138, Statement in Support of Claim: 

  • To which branch of service and component were you assigned?
  • What were the dates of your Special Operations tour of duty?
  • Provide the location (city/province and country) where the incident took place and the approximate date (within a 60-day range).
  • If you were not assigned to a Special Operations unit but were attached to one, indicate to which unit and from what dates you were attached.

Please note that if you fail to respond or you provide an incomplete response, this may result in the denial of your claim.

Fast Letter 09-52 stipulates that the veteran is requested to respond to this letter within thirty (30) days. If the veteran fails to respond within that time frame, the VA will continue to process the claim according to standard procedures, and will make a decision based upon the evidence in the folder. It is important that claimants be as specific as possible with their response to this letter. If there is not enough information in the response, the VA will send a follow-up letter requesting what information is still needed. If the claimant does not respond within 10 days, or provide the necessary information, the VA will continue to process the claim as previously mentioned.

Once the VA has the information needed to verify the stressor, the folder will be taken to the Military Records Specialist (MRS). The MRS will:

  1. Complete the “Special Operations Forces Incident” report
  2. Send the report via encrypted mail to VAVBASPT/RO/SOCOM

The request will be processed by the U.S. Special Operations Command (USSOCOM). It takes a minimum of sixty (60) to process this request. A response from the USSOCOM will provide a “sanitized” summary of the research on the incident, or a negative reply if no information can be found. For certain incidents, USSOCOM may report that it cannot release any information. Classified service records received from USSOCOM will often be from a casualty report, and may be limited to:

  • the date of the injury
  • the location where the injury occurred, and/or
  • a brief description of the injury or illness, or

In some instances, the records may only confirm that the Veteran participated in Special Operations, because the operation is still considered classified.

Once the USSOCOM has completed the request, the VA will continue to process the claim and make a decision with the consideration of that new evidence.

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by Mary Klements, Veterans Advocate
July 18, 2014

The stigma of PTSD and mental illness.

Stigma, the “mark of disgrace associated with a particular circumstance, quality, or person”. This characterization befits criminals and cohorts alike, not disabled Veterans. Unfortunately, stigmas exist regarding Post Traumatic Stress Disorder (PSTD) and disabled Veterans who suffer mental illnesses. Sadly, these unjustified falsehoods discourage Veterans seeking treatment and compensation for their invisible disabilities.

The truth – there is no disgrace, not even one iota, in defending our Country and returning home with PTSD or any other mental illness. The best defense against negative stigma is learning the truth behind mental illness fallacies and responding appropriately. The most prevalent stigmas about PTSD include the cause being character weakness, an increased violence potential and malingering on psychological examinations.

Mental illness afflicts people at all levels within society, even sitting Presidents have suffered from mental illnesses. In fact, a Duke University study revealed forty-nine percent of Presidents suffered mental illnesses including bipolar disorder, depression, PTSD and social phobia. Abraham Lincoln suffered chronic depression and displayed suicidal ideation during periods of emotional distress. Lincoln endured heartless ridicule, but survived with earlier forms of expressive and psychotherapy. Further, an estimated eight percent of Americans who experience trauma will suffer PTSD at some point in their life. Therefore, suffering PTSD has absolutely nothing to do with character strength rather everything to do with experiencing traumatic events.

Another common misconception exists that Veterans who suffer PTSD are unpredictable and violent, which most likely stems from human nature to fear unknown conditions we do not understand. Research conducted at the National Center for PTSD actually reveals no conclusive evidence and minimal correlation between PTSD and increased violence. However, substituting professional treatment with drug or alcohol self-medication and introducing other risk factors such as comorbid mental illnesses certainly increase the propensity for violence among PTSD sufferers.

The most offensive misconception regarding PTSD sufferers is malingering, or exaggerating symptoms, occurs on psychological examinations in order to obtain disability benefits. April 10, 2012, the Department of Army concluded malingering only accounts for less than one percent of PTSD claims, presumably related to the relaxation of standards for psychological examinations found in VA’s Training Letter 10-05. Further, research conducted at the National Institutes of Health indicates over reporting PTSD symptoms during examinations are actually synonymous with “cries for help”.

The truth possesses immense strength and power, and empirical evidence substantiates the majority of Veterans do not prevaricate to obtain PTSD disability benefits. If you suffer from PTSD, or any other mental illness, do not permit stigma or disbelievers to dissuade you from pursuing disability benefits. Respond appropriately, contact an experienced Veterans Attorney and apply for the benefits you earned and deserve.

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by Eric Cook, Veterans Claims Advocate
July 17, 2014

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