As the medical world continues to evolve and improve with advancements in research and treatment, so also the realm of mental health has significantly improved in identifying and treating psychiatric disorders. With that, too, has come an increased awareness of mental health conditions, such as post-traumatic stress disorder (PTSD), that have been plaguing veterans for decades, largely undiagnosed or often misdiagnosed with ineffective treatment. The most common misdiagnosis we see as advocates is some form of a personality disorder (versus PTSD), and we see this most often with Viet Nam veterans. Recent updates to the Diagnostic Statistical Manual (DSM) have improved accuracy and clarity in diagnosing psychiatric conditions, along with treatment appropriate for the diagnosis. Clinicians now are identifying mental health disorders, previously misdiagnosed as personality disorders, as actually early stages of PTSD.
The heightened awareness of the psychiatric toll that the Viet Nam war took on veterans has led to increasingly prevalent mental health claims in the landscape of VA claims. In recent years, the VA has taken significant measures to ensure that PTSD claims are adjudicated sympathetically, especially those related to Viet Nam veterans.
To that end, the VA created a special presumption for PTSD claims. This presumption dictates that in order to obtain service connection for PTSD, the following is necessary:
- Medical evidence of a diagnosis of PTSD
- A link, established by medical evidence, between the current symptoms and an in-service stressor
- Credible evidence that the claimed in-service stressor occurred
If any of the above criteria are missing from the claim, the VA will be unable to grant service connection for the PTSD claim.
The VA has also recognized that, in light of criteria #2, it may be very difficult for a veteran to prove that the stressor actually occurred. In times of war, stressful events or circumstances were not always documented by the military, so there would be no way for a veteran to obtain any kind of proof that an event happened. To alleviate this difficulty, the VA established five scenarios in which a veteran would not be obliged to prove the occurrence of the stressor via service records. These are as follows:
- A veteran’s lay statement alone (i.e., his/her own testimony/description of the event) may establish the occurrence of the stressor if the evidence establishes a diagnosis of PTSD during service, and if the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service.
- A veteran’s lay statement alone may establish the occurrence of the stressor when the evidence establishes that the veteran engaged in combat with the enemy, and the stressor is related to that combat, provided that claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service.
- A veteran’s lay statement may establish the occurrence of the stressor if the stressor is related to the veteran’s fear of hostile military or terrorist activity. For the VA to recognize this, a VA psychologist or psychiatrist (or a VA-contracted clinician) must confirm that the stressor would be adequate (severe enough) to support a diagnosis of PTSD and that the veteran’s symptoms are related to that stressor.
For VA purposes, fear of hostile military or terrorist activity means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from:
- an actual or potential improvised explosive device
- vehicle-embedded explosive device
- incoming artillery, rocket, or mortar fire
- small arms fire, including suspected sniper fire
- an attack upon friendly military aircraft
The final criterion is that the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror.
- A veteran’s lay statement may establish the occurrence of the stressor if the veteran was a prisoner of war and if the stressor is related to the veteran’s experiences as a prisoner of war.
- If the veteran’s claim for PTSD is based on an in-service assault, evidence from sources other than the veteran’s service records may corroborate the veteran’s account of the stressor incident.
Thus we see the importance of a correct mental health diagnosis. The entire presumption for PTSD cases hinges on a diagnosis of PTSD. Very often we see that the VA compensation and pension (C&P) examiners will concede that a veteran’s stressor is adequate to support a diagnosis of PTSD, but they will diagnose the veteran with a mental health condition other than PTSD. This happens when the examiners find that the veteran does not meet enough of the symptoms of the diagnostic criteria for PTSD.
Therefore, it is important to seek a second opinion if you have the means to do so. While the regulations state that a VA psychologist/psychiatrist has to confirm that a stressor is adequate to support PTSD, the VA is required to consider the medical opinion of a qualified expert outside of the VA. If the C&P examiner provides an opinion that is unfavorable to your case, and the VA denies your claim, you can always obtain a second opinion. After all, C&P examiners are human, too; they can make mistakes. This is your case and your benefits. It is important to fight for your cause, to obtain the benefits that you deserve for serving our country.