Manual Im His Part 2

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Persons with the requisite professional qualifications include board-certified psychiatrists and licensed psychologists, as well as psychiatric residents and psychology interns under the close supervision of an attending psychiatrist or psychologist. In addition, the diagnosis must conform to the diagnostic criteria in the DSM-V. After the stressor criterion, there are four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.


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The sixth criterion concerns duration of symptoms, the seventh assesses functioning, and the eighth criterion clarifies that symptoms are not attributable to a substance or co-occurring medical condition. Note that some criterions require only one symptom, while others require multiple symptoms. The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: one required. Examples: Combat participation, military sexual trauma, witnessing a roadside bomb go off a few vehicles ahead, learning that a family member was killed in a car accident, or being part of a burial crew.

Note that number three above may be the most difficult way to satisfy Criterion A. The traumatic event is persistently re-experienced in the following way s : one required. Persistent effortful avoidance of distressing trauma-related stimuli after the event: one required. Negative alterations in cognitions and mood that began or worsened after the traumatic event: two required. Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: two required.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:. Full diagnosis is not met until at least six months after the trauma s , although onset of symptoms may occur immediately. In addition, the VA cannot reject a competent diagnosis of PTSD without providing an adequate statement of reasons or bases for its decision.

If you have a current diagnosis of PTSD from an expert who is competent to diagnose the disorder, move on to step 2.


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This element of establishing service connection for PTSD is the stumbling block for many veterans, but even if you are doubtful that you will be able to corroborate your stressor, hope is not lost. Use the following flowchart to determine what evidence is needed for your claim. Was the veteran diagnosed with PTSD during a period of active military service?

If a veteran is diagnosed with PTSD during a period of active military service, there is a lower burden of proof for stressor corroboration evidence.


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The lower burden of proof applies to claims pending on or filed after October 29, Another important thing to note is that if a veteran is released from service because of a mental disorder that developed as a result of a highly stressful event in service , the veteran must be awarded a disability rating of not less than 50 percent and be scheduled for a reevaluation within 6 months.

Is the stressor related to fear of hostile military or terrorist activity? What is fear of hostile military or terrorist activity? This lower burden of proof applies to all veterans, regardless of where they experience the fear of hostile military or terrorist activity, but it does not include sexual assault or hostile criminal actions of US military personnel directed against other US military personnel. It also only applies to claims received on or pending after July 13, If a veteran has a previously denied PTSD claim, in order to reopen the claim under this lower burden of proof standard, he or she would need a lay statement of his or her fear of hostile military or terrorist activity and service records that show service in an area involving exposure to hostile military or terrorist activity.

Similar to veterans who were diagnosed with PTSD during service, there is a lower burden of proof for combat veterans when it comes to stressor corroboration evidence. Essentially, the VA admits that when a veteran is engaged in combat, his or her primary focus is going to be carrying out the mission, not taking notes on any and all injuries.

It includes presence during such events either as a combatant, or service member performing duty in support of combatants, such as providing medical care to the wounded. But, depending on the circumstances, it is important to note that the veteran may have an additional hurdle in proving that he or she was in combat. For some veterans, this is a simple task due to their military service records or military occupational specialty MOS and where or when they served.

Chapter 1 - Eligibilty for Services

But for other veterans, it may not be obvious at first glance that they served in combat. For these veterans, the VA will look to not only military service records and MOS, but also certain military decorations, buddy statements, letters home to family or friends, copies of newspapers or regimental or divisional newsletters, photographs, or any other credible supporting evidence that can help to establish whether the veteran was in combat or not.

If a veteran contends that he was in combat action that cannot be confirmed by his or her MOS or military service records, the VA must make a finding as to the credibility of his or her statement and provide reasons for its finding of whether the veteran engaged in combat, keeping in mind the benefit of the doubt rule. At this stage, if a veteran states that he served in combat and identifies a stressor that is not impossible to believe, and has a current diagnosis of PTSD see step 1 , then the VA must take steps to develop evidence.

The VA will look for evidence of both combat service and additional evidence that the combat stressor actually took place. It is usually a good idea for the veteran to request these records as well. Once it is established that the veteran served in combat, the VA must also accept lay evidence as proof that the alleged stressor happened during combat even in the absence of official records or supporting clinical evidence. Go to step 3. If a veteran suffers from PTSD as a result of an in-service personal assault or trauma such as rape, physical assault, domestic battering, robbery, mugging, stalking, or harassment, the stressor can be corroborated through alternative evidence if military records do not document that a personal assault occurred.

The VA has a special obligation to assist in these cases commonly referred to as Military Sexual Trauma or MST and must inform the veteran that evidence other than that found in service records may be submitted. Alternative sources for evidence may be things such as records from law enforcement, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy or STD tests; statements from family members, roommates, fellow service members, or clergy; a personal diary or journal; or evidence of behavior changes such as a request to transfer, deterioration in work performance, substance abuse, depression, panic attacks, or anxiety.

Unfortunately, these cases are frequently denied, partly due to the fact that VA has difficulty compensating for disabilities that are less obvious than a physical disability, and because due to the nature of MST cases it is rare for there to be a formal report or complaint in the record. The VA often must rely on the alternative evidence listed above, and typically fails to give that evidence the weight that is required. According to a June report from the Government Accountability Office, since , there have been 29, veterans who have sought disability benefits for problems related to MST.

PTSD is the most common disability claimed as a result of MST at 94 percent of claims, with major depressive disorder and anxiety disorder being the second and third most common. Also of note is the wide disparity among regional offices: in some ROs as few as 14 percent of claims were approved, while other ROs approved as many as 88 percent of claims. The GAO report found that regional offices are having ongoing difficulty applying broadened MST standards and may differ wildly in their interpretations of the evidence in the claim file.

This goes to show that there is still a lot of work and training that needs to be done on the VA side in regards to MST claims, which can be discouraging for many veterans. But just remember that while MST claims take time, they are not impossible to win. The key is to get the VA to look at the stressor evidence in the right context in order to show, for example, a behavior change that corroborates the occurrence of the stressor. Unless there is no reasonable possibility that assistance by the VA would aid in substantiating the claim, the VA must assist the veteran in developing evidence that supports the existence of a stressor.

Unintuitive Things I’ve Learned about Management (Part 2)

In addition, credible supporting evidence can come from lay sources such as buddy statements. An example of a situation in which a veteran would need stressor corroboration evidence is if he or she was in a bad car accident during service, the car accident was not related to combat, and the veteran was not diagnosed with PTSD until after leaving service. In this situation, the veteran would need to be able to corroborate that the car accident happened. Binge-worthy Streaming TV Series.

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