Post-Traumatic Stress Disorder (“PTSD”)
PTSD is probably the most common psychiatric disorder associated with military conflict. Yet, it can be the most difficult to prove. There are three elements to a PTSD claim. First, the claimant must have a present diagnosis of PTSD made by a psychiatrist, psychologist, licensed social worker or other mental health care practitioner.
Second, the veteran’s PTSD must have been caused by an in-service stressor(s). Very generally, a stressor is some traumatic event or incident likely to cause mental disorder. Examples of stressors are engaging in combat or a combat-related incident or witnessing fatal or near-fatal accidents. The evidence necessary to prove an in-service stressor depends upon whether the veteran engaged in combat or not. If the claimant can establish that he or she engaged in combat, then generally the veteran’s statement about the occurrence of the stressor will be accepted as sufficient proof. But, if the claimant is not a combat veteran, he or she must submit independent evidence corroborating or verifying the statement about the occurrence of the stressor. For most non-combat stressors claims, the in-service stressor requirement raises the most difficult proof problems. Military records are the best way to corroborate in-service stressors. For instance, if the claimant alleges that his unit came under missile and/or mortar attack, morning reports or daily logs may contain entries verifying these attacks. Proof of a stressor may come in the form of a “buddy statement,” a written statement from a fellow soldier who also witnessed the traumatic event.
The third requirement for a PTSD claim is the nexus requirement. Just like all claims, the PTSD claim must contain proof of a causal link between the in-service incident and the present disability. That means that a medical expert, (here, a medical health practitioner) must opine that the in-service stressor caused the claimant’s present PTSD.
Veterans who are struggling with PTSD symptoms should be aware of the available VA resources to get help. The following are some of the available facilities:
VA Medical Centers
VA Outpatient Clinics
VA PTSD Programs
VA Suicide Prevention Coordinators
How do you know if you have PTSD?
Some of the most common symptoms of PTSD include recurring memories or nightmares of the event(s), sleeplessness, loss of interest, or feeling numb, anger, and irritability, frequent emotional outbursts, feelings of isolation, feelings of guilt, feelings of hopelessness, easily startled or spooked, suicidal thoughts, avoidance of people (even family members), loss of memory, inability to concentrate, excessive drinking to ease anxiety or stress. Sometimes these symptoms show up months or years after the stressful event(s). They may also come and go. If these problems don’t go away or are getting worse—or you feel like they are disrupting your daily life—you may have PTSD.
Veterans & PTSD
It is no secret that many veterans coming back from a combat deployment are often plagued with PTSD symptoms. By some estimates, one in five vets returning from Iraq and Afghanistan experience symptoms of PTSD or major depression. (There are over 2.3 million American veterans of the Iraq and Afghanistan wars compared to 2.6 million Vietnam veterans who fought in Vietnam). Sadly many of these service members don't seek treatment because they fear it will harm their careers. Untreated, PTSD and depression can lead to cascading problems, such as drug use, marital problems, unemployment and even suicide.
What is Military Sexual Trauma (MST)?
Military sexual trauma (MST) refers to both in-service sexual harassment and sexual assault. Both men and women soldiers can be victims of MST. Sexual harassment, without assault, may involve offensive sexual comments, unwanted sexual propositions or attention, overt requests for sex, implied demands for sex through promises of reward (e.g. promotion) or threats of punishment (demotion). A sexual assault is a perpetrator’s sexual touching against a soldier’s will or consent. The sexual activity involved can include many different experiences including unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object, and/or sexual intercourse. People tend to think that only women experience sexual trauma, however, this is not the case. In 1995 the Department of Defense conducted a large study of sexual victimization among active duty populations and found rates of sexual harassment to be 78% among women and 38% among men over a one-year period. Rates of attempted or completed sexual assault were 6% for women and 1% for men. Rates of military sexual trauma among veteran users of VA healthcare appear to be even higher than in general military populations. In one study, 23% of female users of VA healthcare reported experiencing at least one sexual assault while in the military.
Special Rules for Adjudicating PTSD Claims Based Upon MST
Normally, PTSD claims require the veteran to submit contemporaneous documentation (usually service records) of an alleged in-service stressful event. However, for PTSD claims based upon military sexual trauma, the VA has relaxed the requirements. The VA’s regulation spells this out:
If a posttraumatic stress disorder claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. VA will not deny a posttraumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred.