Applying for Service Connected Disability for PTSD
(Post Traumatic Stress Disorder)

"Few veterans who have PTSD know they have it", says VA expert Dr. Matthew j. Friedman.

1. PTSD Directory, Listing of agencies who can help you with PTSD information and legal representation for filing a claim for compensation.
2. Cover Letter, Explains the process of appyling for Service Connected Disability Compensation for PRSD and what is expected from the veteran and his agent.
3. Tips for obtaining VA Service Connected Disability.
4. Collecting Evidence to win VA Benefits.
5. Diagnostic Criteria, 309,89, Post Traumatic Stress Disorder.
6. VA Programs for Veterans with PTSD,  Learn about VA programs for veterans with PTSD.

PTSD Directory

Dr. Alfanso Batres, Director, and VA Readjustment Counseling Services.
(202) 273-8967.

National Center for PTSD, Behavioral Science Division, and Boston VAMC.
(617) 232-9500 ext. 5923. National Center for PTSD Web Site.

Vietnam Veterans of America, Inc. (VVA) Service Officer Program
1-800-882-1316.

Disabled American Veteran (DAV) Service Officers Program
(617) 303-5675.

Veterans of Foreign Wars (VFW) Service Officer Program
(617) 565-2595.

The American Legion Service Officer Program
(617) 565-2591.

VA Help Line: 1-800-827-1000.

Back to Top

Filing a Claim for PTSD

Dear Veteran,

In order to understand the process of applying for, and winning a claim for service connected Post Traumatic Stress Disorder (PTSD), please read the attached information. By reviewing this information you will gain an understanding of what PTSD is and what the VA requires of a veteran when applying for Service Connected compensation.

The information in this packet was compiled to help you determine if you have PTSD, and if you qualify for a service connected disablity for it. By knowning and understanding what PTSD is, and the process you will be expected to traverse through the VA Health Care System, you enhance your chances of winning your cliam for Service Connected compensation.

PTSD is governed under VA regulations Title 38, Code of Federal Regulations (CFR) 3.304 and the M21-1 Part 3, section 5.14. The rating schedule is used by the VA to assign a percentage of disability rating of 0% to 100%, and is found in Title 38 CFR 4.130.

You can access these regulations and Diagnostic Codes online at http://www.access.gpo.gov/nara/cfr or they may also be found at http://www.4law.cornell.edu/uscode/38. For a complete listing of all code of federal regulations visit http://www.4law.cornell.edu/uscode/#TITLES. For those of you who do not want to use the Internet, most major libraries have a hard copy of Title 38, Code of Federal Regulations, and the Diagnostic Codes.

Note: It is suggested that you make copies of the Diagnostic Code, and review them to determine what you think is an honest evaluation of the percentage of disability from your PTSD. Under these regulations the severity of the symptoms as well as the ability of the veteran to seek and hold gainful employment are the factors used to rate your percentage PTSD. As the symstomoligy worsens, so does the percentage of disability. By doing this you can look through the various ratings code (0% to 100%) for PTSD and get some idea of the percentage of disability you are suffereing from, and may be granted compensation for.

You need to establish several factors before a Service Connected Disability rating is issued. The most important is that a competent psychological authority diagnoses you with PTSD.

In order to get a diagnosis of of PTSD you need to provide as much information about stressful event or events that caused the PTSD in the first place. You must establish these stressors for the VA. The very best evidence, which the VA accepts at face value as proof that a stressful event did occur are any Infantry MOS (11B or 0311) or any of the many varieties of infantry assignments. A Combat Infantryman's Badge (CIB) or Combat Action Ribbon, Combat Medic Badge, are sufficient proof that stressful experience occurred. The issuance of any valor awards or medals, Bronze Star with "V" device, Silver Star, Distinguished Service Cross, Purple Heart are all proof of a stressor. Any combat awards are in your personal military file that shows combat involvement are sufficient to prove a stressor under the presumption rule.

The next step is to establish a link or "nexus" between the present diagnosis and your service in a combat situation. If you have combat awards to justify presumption your claim should go forward without a problem. If you didn't have combat MOS and no awards or ribbons you may have a more difficult time in proving your claim. For veterans without a combat MOS or other documentation of combat, you will need to submit a stressor statement outlining what incident (s) caused the PTSD, and verification through military files and/or records that the incident(s) did occur.

After compiling the necessary information needed to submit your claim, you must fill out a 21-526 form, Application for Compensation and/or Pension and submit it to the VA. The VA will then compile all the documentation submitted alogn with any other information needed to process your claim. When all conditions come together the claim is sent to the Rating Board, which usually orders a Compensation and Pension exam.

When you report for a Compensation and Pension exam you will be asked many if not all of the questions in the Claimant Questionnaire that is included in this packet. The answers you give will be used to evaluate your condition and determine if you have PTSD, and if so to what degree or percentage of disability you should be compensated for.

For more information and or help with filing a claim for a Service Connected Disability for PTSD, please contact your local Veterans Service Officer or one of the service organizations listed in this packet.

Back to Top

Tips For Obtaining VA Service Connected Disabilities

Before the VA rates your disability, they require a medical examination. How can you get the highest rating possble? I suggest you follow this outline: Prepare for the exam. Review your medical history. Write down any important facts about your disability and any questions you want to discuss with the doctor. Include details such as how often it bothers you and how much it limits your daily activities. If you can, look up your disability in the VA's rating schedule, which will tell the symptoms the doctor will be looking for. Also bring any information such as civilian doctor's reports that would document your claim.

The rating schedules are found in Volume 38, Code of Federal Regulations (CFR) Part IV, Sections 4.1 through 4.132 Diagnostic Codes. These sections have tables with diagnostic codes. Most public libraries have a hard copy of the Code of Federal Regulations (CFR) and you can get some of them on the Internet at http://www.access.gpo.gov/nara/cfr. Click on Title 38, Part 4, Schedule of Rating Disabilities, or http://www.4law.cornell.edu/uscode/38/. - For a complete listing of all Codes of Federal Regulations (CFR) visit http://www.4law.cornell.edu/uscode/#TITLES.

Next, the VA will schedule you for a C&P (Compensation & Pension) exam with the doctor, who will evaluate your disability. Be on time and be prepared. Describe all your symptoms. If it hurts when the doctor moves your back, arm, or leg to test your range of motion, say so. Tell the doctor all about your medical problem, including your medical history; and most importantly, tell the doctor how much it is bothering you. Above all, be honest!

The VA adjudicators will review the doctor's report and assign a rating to your disability. You will be advised of your rating for each disability tested. The VA then takes that percent rating and determines your monthly disability compensation from a seperate table. Remember that veterans do not receive monetary compensation unless they are rated at 10 percent or higher.

Do you have to accept the VA's rating or do you fight? Actually, you can do both. The VA will begin paying you at the rate established, but you can still appeal to get the rating increased. Don't be afraid to ask for another exam. If you don't ask, they will assume you are satisfied.

Back to Top

Collecting Evidence to win VA Benefits

In order to obtain benefits you must have convincing evidence to support your claim. You should compile and submit as much evidence to support your application as you can obtain. Collecting good evidence and presenting it properly to the VA are the keys to wining a judgment in your favor.

Before you collect evidence, be sure you understand what is relevant to your claim. Review the VA regulations with our representative so you know what is important to your claim and what is not. Let's say you are making the claim that you're present condition is related to an injury or illness you had while on active duty. In order to substantiate your claim you need to do 3 things:

1. Establish and document that you have a current medical condition.
2. Establish that you had this same medical problem while on active duty. In some instances you may be experiencing a problem that can be medically related to the condition you experienced while on active duty. For instance: you injured your left leg and now your right leg is giving you problems. You would need a doctor's statement saying that because of the injury to your left leg you have favored your right leg, and now it is deteriorated with a certain percentage of loss of function. His statement would have to directly relate the injury to your military service.
3. Establish that you have continued to have this problem since you were discharged from active duty. In this instance you would need to provide medical records of treatment for the condition, and statements from employers or others that would validate your claim.

If the problem you are experiencing didn't appear until after your discharge, but did appear within one year of discharge, you may still be able to claim a connection. There are also other special cirumstances related to exposure to radiation, the herbicide Agent Orange, Golf War Syndrome. If you think your illness is covered under this type of circumstance, or being affected by such relationship, you should consult a VA Service Representative or your local Veterans Service Officer.

It is very important to provide this evidence; you can not skip over even one of these factors and expect to have the VA grant your claim.

Back to Top

Diagnostic criteria for 309.89 Post-traumatic Stress Disorder

1. The person has experienced an even that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e.g., serious threat to one's life or physical integrity; 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.
2. The traumatic event is persistently reexperienced in at least one of the following ways:
1. recurrent and intrusive distressing recollections of the event (in young children, repetitive play in which themes or aspects of the trauma are expressed)
2. recurrent distressing dreams of the event
3. sudden acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative [flashbacks] episodes, even those that occur upon awakening or when intoxicated)
4. intense psychological distress at exposure to events that symbolize or resemble as aspect of the traumatic event, including anniversaries of the trauma
3. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
1. efforts to avoid thoughts or feelings associated with the trauma
2. efforts to avoid activities or situations that arouse recollections of the trauma
3. inability to recall an important aspect of the trauma (psychogenic amnesia)
4. markedly diminished interest in significant activities (in young children, loss of recently aquired developmental skills such as toilet training or language skills)
5. feeling of detachment of estrangment from others
6. restricted range of affect, e.g., unable to have loving feelings
7. sense of foreshortened future, e.g., does not expect to have a career, marriage, or children, or a long life
4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:
1. difficulty falling or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilance
5. exaggerated startle response
6. physiological reactivity upon exposure to events that symbolize or resemble as aspect of the traumatic event (e.g., a woman who was raped in an elevator breaks out in a sweat when entering an elevator)
5. Duration of the disturbance (symptoms in B, C, and D) of at least one month.

Specify delayed onset if the onset of symptoms was at least six months after the trauma.

Back to Top

VA Programs for Veterans with PTSD

PTSD is an anxiety disorder resulting from exposure to an extreme traumatic stress involving direct or indirect threat of death, serious injury or a physical threat. The trauma may be experienced alone (rape or assault) or in the company of others (military combat). The events that can cause PTSD are called "stressors". They include natural disasters (floods, earthquakes), accidental man-made disasters (car accidents, airplane crashes, large fires) or deliberate man-made disasters (bombing, torture, death camps). Symptoms include recurrent thoughts of a traumatic event, rediced involvement in work or outside interests, hyper alertness, anxiety and irritability. The disorder apparently is more severe and longer lasting when the stress is of human design.

More than 150,000 veterans were service-connected for PTSD in 2001. Nearly 2,500 veterans in this group were not being compensated for PTSD because they declined disability compensation to receive a VA pension, which provided more income.

Vet Centers

VA readjustment counseling is provided through the 206 community-based Vet Centers located in all 50 states, Puerto Rico, the Virgin Islands, the District of Columbia, and Guam. Vet Centers are located outside of the larger medical facilities, in easily accessible, consumer-oriented facilities highly responsive to the needs of local veterans. The Vet Center mission features a holistic mix of direct counseling and multiple community outreach and education, and extensive social services and referral activities designed to assist veterans and improve general levels of post-military social and economic functioning.

Vet Centers are staffed by interdisciplinary teams that include psychologists, nurses, and social workers. Vet Center teams also reflect representative or higher levels of ethnic and gender diversity, as well as, high levels of staff having veteran status, most having served in a combat theater of operations.

Eligibility for Vet Center services includes veterans who served in any war or in any area during a period of armed hostilities. Eligibility for sexual trauma counseling at Vet Centers is open to any veteran regardless of period of service.

In 2001, Vet Centers saw more than 126,000 veterans and had more than 900,000 visits from veterans and family members. For many veterans who would not otherwise receive VA assistance, the Vet Centers make more than 100,000 referrals a year to VA medical facilities and another 120,000 referrals annually to VA Regional Offices for disability compensation, pensions, or other benefits. For the third consecutive year, 99 percent of veterans using Vet Centers reported being satisfied with services received. This is the highest level of veteran satisfaction recorded for any VA program.

VA Medical Center Programs

VA operates an internationally recognized network of more than 140 specialized programs for the treatment of PTSD through its medical centers and clinics. One notable program consists of PTSD clinical teams that provide outpatient treatment, working closely with other VA treatment programs, including Vet Centers and the community. In 2001, more than 77,300 veterans were treated for PTSD by VA specialists.

In addition to 86 PTSD clinical teams, VA operates eight specialized inpatient units around the country, plus five brief-treatment units, 18 residential rehabilitation programs, and nine PTSD day hospitals. There also are four outpatient Women's Stress Disorder and Treatment Teams. A special focus in the program has included underserved and minority populations, such as African Americans, Hispanics, and Native Americans. A specialized PTSD inpatient treatment unit serves women veterans at the Palo Alto, California, VA Medical Center's Menlo Park Division.

The Veterans Millenium Health Care and Benefits Act (Public Law 106-117) provided support for new specialized PTSD and Substnace Use Disorder treatment programs. The law also re-established the Under Secretary of Health's Special Committee on PTSD. The committee is to assess VA's capacity to diagnose and treat PTSD and to provide guidance on VA's education, research and benefits activities with regard to PTSD.

National PTSD Center

In 1989, VA established the National Center for Post-Traumatic Stress Disorder, with a mandate to promote research into the causes and diagnosis of the disorder, to train health care and related personnel in diagnosis and treatment, and to serve as an information resource for professionals across the United States and, eventually, around the world. The center consists of seven divisions with distinct, but complementary responsibilities: Behvaioral Science, Women's Health Sciences, Clinical Neurosciences, Education, Evaluation, Pacific Islands Ethnocultural, and Executive and Resource Center Divisions.

The center is commited to approaching PTSD through a focus on research, education, and consultation. These three threads weave the center's work together in a way that brings science into pratice and ensures that clinical concerns guide scientific priorities. The National Center has come to be viewed as a world leader in PTSD research. Current research at the center includes large-scale clinical trials, as well as studies on the epidemionolgy, diagnosis, psychobiology, and treatment of PTSD.

Among its many educational programs the center provides regular satellite broadcasts and publishes two newsletters, which highlight the latest developments in research and clinical practices for PTSD. The National Center also offers a monthly 5-day clinical training program free of charge to VA staff, and maintains a nationally recognized web site (http://www.ncptsd.org) with information about trauma and PTSD. THe web site includes a bibliographic database of more than 21,000 articles. Finally, the National Center provides consultation to clinicians, scienntists, and policy makers concerning treatment, research, and education regarding PTSD.

Back to Top