To see more info and explore the links below, go to:

http://www.military.com/benefits/resources/ptsd-overview

Posttraumatic Stress Disorder can occur following a life-threatening event like military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. Most survivors of trauma return to normal given a little time. However, some people have stress reactions that don't go away on their own, or may even get worse over time. These individuals may develop PTSD.

People who suffer from PTSD often suffer from nightmares, flashbacks, difficulty sleeping, and feeling emotionally numb. These symptoms can significantly impair a person's daily life.

PTSD is marked by clear physical and psychological symptoms. It often has symptoms like depression, substance abuse, problems of memory and cognition, and other physical and mental health problems. The disorder is also associated with difficulties in social or family life, including occupational instability, marital problems, family discord, and difficulties in parenting.

If you are suffering from PTSD, or know someone who is, the following list of resources and information will help you find help in dealing with PTSD and related conditions.

Featured PTSD News

July 12, 2010

New Regulations on PTSD Claims

Quick Facts:

This new rule is for Veterans of any era.

The new rule will apply to claims:

* received by VA on or after July 13, 2010;

* received before July 13, 2010 but not yet decided by a VA regional office;

* appealed to the Board of Veterans' Appeals on or after July 13, 2010;

* appealed to the Board before July 13, 2010, but not yet decided by the Board; and

* pending before VA on or after July 13, 2010, because the Court of Appeals for Veterans Claims vacated a Board decision and remanded for re-adjudication.

QUESTIONS AND ANSWERS

“Stressor Determinations for Posttraumatic Stress Disorder”

1. What is Post-Traumatic Stress Disorder (PTSD)?

Post Traumatic Stress Disorder (PTSD) is a condition resulting from exposure to direct or indirect threat of death, serious injury or a physical threat. The events that can cause PTSD are called "stressors” and may include natural disasters, accidents or deliberate man-made events/disasters, including war. Symptoms of PTSD can include recurrent thoughts of a traumatic event, reduced involvement in work or outside interests, emotional numbing, hyper-alertness, anxiety and irritability. The disorder can be more severe and longer lasting when the stress is human initiated action (example: war, rape, terrorism).

2. What does this final regulation do?

This final regulation liberalizes the evidentiary standard for Veterans claiming service connection for post traumatic stress disorder (PTSD). Under current regulations governing PTSD claims, unless the Veteran is a combat Veteran, VA adjudicators are typically required to undertake extensive record development to corroborate whether a Veteran actually experienced the claimed in-service stressor. This final rulemaking will simplify and improve the PTSD claims adjudication process by eliminating this time-consuming requirement where the claimed stressor is related to “fear of hostile military 2 or terrorist activity,” is consistent with the places, types, and circumstances of their service, and a VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD.

3. What types of claims for VA benefits does the final regulation affect?

The final regulation will benefit Veterans, regardless of their period of service. It applies to claims for PTSD service connection filed on or after the final regulation’s effective date, and to those claims that are considered on the merits at a VA Regional Office or the Board of Veterans’ Appeals on or after the effective date of the rule.

4. Why is this final regulation necessary?

The final regulation is necessary to make VA’s adjudication of PTSD claims both more timely and consistent with the current medical science.

5. How does this final regulation help Veterans?

The final regulation will simplify and streamline the processing of PTSD claims, which will result in Veterans receiving more timely decisions. A Veteran will be able to establish the occurrence of an in-service stressor through his or her own testimony, provided that: (1) the Veteran is diagnosed with PTSD; (2) a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted confirms that the claimed stressor is adequate to support a PTSD diagnosis; (3) the Veteran's symptoms are related to the claimed stressor; and (4) the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service and the record provides no clear and convincing evidence to the contrary. This will eliminate the requirement for VA to search for records, to verify stressor accounts, which is often a very involved and protracted process. As a result, the time required to adjudicate a PTSD compensation claim in accordance with the law will be significantly reduced.

6. How does VA plan to monitor the need for examiners in various regions of the country, and how does VA plan to respond if is determined that more examiners are needed in a particular region?

The Veterans Health Administration (VHA) has written in to the FY11-13 Operating Plan the need for additional staff to support doing adequate, timely exams. VHA proposes: “A8. Increase mental health field staff to address the increase in C&P examinations and develop monitoring system to ensure clinical delivery of mental health services does not decrease in VHA.“ Specifically, VHA has requested 125 clinicians for FY11 with additional 63 staff in FY12 if the need exists. If the Operating Plan and the proposed budget are approved, VA proposes asking the Veterans Integrated Service Networks (VISNs) to develop plans for distributing the funds in order to ensure adequate coverage at sites based on number of claims being processed; the VISNs are well positioned to determine these regional needs.

7. How does the regulatory revision affect PTSD service connection claims where an in-service diagnosis of PTSD has been rendered?

The new regulation does not apply to the adjudication of cases where PTSD has been initially diagnosed in service. Rather, under another VA rule, 38 CFR § 3.304(f)(1), if a Veteran is diagnosed with posttraumatic stress disorder during service and the claimed 3

stressor is related to that service, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.

7. Is the new regulation applicable only if the Veteran's statements relate to combat or POW service?

No. The rule states that the stressor must be related to a “fear of hostile military or terrorist activity,” and the claimed stressor must be “consistent with the places, types, and circumstances of the veteran’s service.”

8. What circumstances will still require stressor verification through DoD’s Joint Services Records Research Center (JSRRC) , VBA’s Compensation &Pension Service (C&P Service), or other entity if a Veteran claims that his or her stressor is related to a fear of hostile or terrorist activity?

The regulatory revision will greatly lessen the need for undertaking development to verify Veterans’ accounts of in-service stressors. Now, stressor development may only need to be conducted if a review of the available record, such as the Veteran’s service personnel and/or treatment records, is inadequate to determine that the claimed stressor is “consistent with the places, types and circumstances of the veteran’s service.” In such circumstances, the Veterans Service Representative (VSR) will determine on a case-by-case basis what development should be undertaken.

However, it is anticipated that in the overwhelming majority of cases adjudicated under the new version of § 3.304(f), a simple review of the Veteran’s service treatment and/or personnel records will be sufficient to determine if the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service. We also believe that, in some cases, a Veteran’s separation document, DD-Form 214, alone may enable an adjudicator to make such a determination.

9. As the regulatory revision seems to require an enhanced role for the examining VA mental health professional, whose role is it to determine whether the claimed stressor is consistent with the Veteran’s service?

VA adjudicators, not the examining psychiatrist or psychologist, will decide whether the claimed stressor is consistent with the Veteran’s service.

10. Is a Veteran's testimony about “fear of hostile military or terrorist activity” alone sufficient to establish a stressor?

Yes, if the other requirements of the regulation are satisfied, i.e., a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a PTSD diagnosis and that the Veteran's symptoms are related to the claimed stressor, and the stressor is consistent with the “places, types, and circumstances of the Veteran’s service.”

11. Are the stressors accepted as adequate for establishing service connection under new § 3.304(f)(3) limited to those specifically identified in the new regulation?

No. The examples given in the revised regulation do not represent an exclusive list in view of the use of the modifying phrase “such as” that precedes the listed examples. Any 4

event or circumstance that involves actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, would qualify as a stressor under new § 3.304(f)(3).

12. How will the Veterans Health Administration (VHA) work with Veterans Benefits Administration (VBA) on the new regulation?

VHA was actively involved in discussion with VBA of the new regulation and fully supports the new regulation.

The new regulation will provide fair evaluation for Veterans whose military records have been damaged or destroyed, or for whom no definitive reports of combat action appeared in their military records, even though they can report such actions and it is reasonable to believe that these occurred, given the time and place of service.

This will be especially beneficial to women Veterans, whose records do not specify that they had combat assignments, even though their roles in the military placed them at risk of hostile military or terrorist activity.

This means that more Veterans will become eligible for VA care and thus be able to receive VA care for mental illness related to their military service, as well as receiving full holistic health care.VHA will work actively with VBA on implementing the regulation. VHA staff’s main role is as clinicians conducting C&P interviews to establish diagnoses and obtain other information to be used by VBA raters to determine the outcome of claims.

The new regulation will not change the diagnostic elements of the C&P interview, but may change what additional data are collected for use by VBA raters

Office of the Secretary

U.S. Department of Veterans Affairs

For Vets with PTSD, end of an unfair
process  By Eric Shinseki 

For 38 years, I was privileged to serve the men and
women entrusted with our nation's security. The
character of their service is reflected in something
called The Soldier's Creed. Most everyone I have met
who is familiar with its four key lines agrees that
they define the essence of uniformed service:

I will always place the mission first;

I will never accept defeat;

I will never quit;

I will never leave a fallen comrade.

Four simple, declaratory statements — promises that
form the foundation for trust within military
formations.

Especially in time of war, those who wear our
nation's uniforms and their families bear incredible

burdens for us. A new generation faces the demand
for courage, strength, dedication and stamina — as
daunting today as it has ever been. Failure is never
an option. Our service members have never failed the
nation, the mission, or their comrades.

But the toll for this kind of loyalty and dedication is
high. Troops are returning with invisible wounds
that can be as debilitating as any physical battlefield
trauma. As in every conflict in our nation's history,
today's warriors are suffering emotional injuries just
as they do physical ones.

The residual effects of combat manifest themselves
in every combatant's life. You have to be strong to
prevail. You must be loved, respected and
supported to weather the worst of the storms. You
must be patient, and it helps to be lucky. And you
must have the strong, unwavering support of the
nation that sent you on those missions.

At the Department of Veterans Affairs (VA) there is
only one goal — to ensure that veterans of every
generation receive the best possible health care and
the benefits they have earned.

Previously, veterans filing for health care and
disability benefits for post-traumatic stress disorder
(PTSD) were required to document in detail the
causes of their symptoms. These have traditionally
been called "stressors."

The rules stringently required veterans, who served
in the combat branches of the military, where the
likelihood of direct action against an armed enemy

was highest, to provide detailed documentation of
those engagements. For those not serving in the
combat branches, the burden of proof was even
higher. But in either case, these rules were neither
fair nor sustainable.

At VA, we're now moving to treat all veterans
equally. Today, VA begins simplifying the process
by which veterans with PTSD are able to access
health care and receive benefits.

Streamlining this process will help not just the
veterans of Operations Enduring Freedom and Iraqi
Freedom, but generations of veterans who have
previously "borne the battle" for our nation.

We're publishing a regulation today in the Federal
Register that simplifies the process for claiming
service connection for PTSD by reducing the
documentation needed for veterans to validate the
specifics of place, type and circumstance of
incident. From this point forward, VA will not
require corroboration of a PTSD stressor related to
fear of hostile military or terrorist activity, if a VA
doctor confirms a diagnosis of PTSD and the
stressful experience recalled by the veteran
adequately supports that diagnosis.

This decision to simplify the process has been
validated by an Institute of Medicine study, which
concluded that service in a war zone is inherently
linked to increased risk of PTSD.

As President Obama has said, "Just as we have a
solemn responsibility to train and equip our troops
before we send them into harm's way, we have a
solemn responsibility to provide our veterans and
wounded warriors with the care and benefits they've
earned when they come home. That is our sacred
trust with all who serve — and it doesn't end when
their tour of duty does."

In Profiles in Courage, President John F. Kennedy,
himself a combat veteran, noted, "Without belittling
the courage with which men have died, we should
not forget those acts of courage with which men ...
have lived. The courage of life ... is no less a
magnificent mixture of triumph and tragedy."

The courage to deal with the effects of battle is real,
and it takes courage and determination to mitigate
its effects once we return from operations. It has
been so for every generation of warriors.

Simplifying the documentation needed to receive
medical care and compensation for service
connected to PTSD upholds our commitment to
those who protect our freedoms — not just the
veterans of Afghanistan and Iraq, but all generations
of veterans, who proudly served and sacrificed in
their time.

Eric Shinseki is secretary of the U.S. Department of
Veterans Affairs.

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Week of January 19, 2009

• DoD Decides No Purple Heart for PTSD
• Life Changes and TRICARE
• TRICARE Payments to Change
• Navy Bonus Policy Changes
• VA Helps Financially Burdened Veterans

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