“Fear-Based” PTSD Criteria Explained

June 03, 2011 | Benjamin Krause

A recent VA Compensation Service Bulletin sought to eliminate processing ambiguity relating to PTSD claims. Regional Offices nationwide have been largely critiqued because of erratic application of rating criteria. The current bulletins are intended in part to decrease the overall 23 percent of botched claims processing.

Anyone paying attention to veterans’ issues has heard horror stories from veterans who attempted to gain service connection for PTSD despite possessing medals and records showing their unit came under hostile fire in Iraq and Afghanistan. My friend Jim is one of these. Once denied, many of these veterans give up on the appeals process because it forces them to revisit the trauma every time the issue is revisited.

If you are one of these veterans or know one who is, here’s what you need to know about the bulletin and how it can affect your claim for disability compensation.

First, the 2010 change to the VA regulation governing PTSD disability claims is intended to encompass all PTSD situations from military service. This means veterans who were assaulted, either sexually or physically, while on active duty may be eligible for this benefit if the stressor is documentable or contained somewhere within their service medical records. The regulation, 38 CFR 3.304(f)(3) also allows for the veteran’s lay statement to satisfy the establishment of an “occurrence” under specific criteria. The occurrence must be:

  • “related to fear of hostile military or terrorist activity, and
  • a VA psychiatrist or  psychologist, or contract equivalent, confirms that the claimed stressor is adequate to support a diagnosis of PTSD,  and
  • the veteran’s symptoms are related to the claimed stressor.”

This solution seems relatively straightforward; however, the jury is out as to how well the VA is implementing the criteria.

Second, the process may prove lengthy because the VA has implemented a case-by-case review of the facts surrounding each claim. The VA claims representative will need to verify that the facts given by the veteran are true, including duty locations and service or campaign medals, prior to the veteran being scheduled for an exam. Thus, certain medals are now sufficient to schedule a PTSD examination. For example, VA Compensation has concluded that a veteran’s receipt of the Vietnam Service Medal or Vietnam Campaign Medal is sufficient proof that the veteran service in a hostile military environment. This also includes veterans aboard ships in “blue water.” Therefore, veterans with either of these medals should be able to pass the first threshold of proving the occurrence. Once the claim is verified, an examination should be scheduled.

Third, veterans who have already been denied service-connection for PTSD, but who have evidence similar to that discussed above may wish to re-evaluate their initial claim and/or denial. Those veterans with old disabilities may want to revisit their condition for an increase. Either way, the process starts by knowing what is within your claims file. See “Beat Denials & Lowball Ratings” to begin researching your own claim. The first step is filing a Freedom of Information Act (FOIA) request for your file. The second should be finding a quality Veterans Service Officer or Veterans Law attorney in your area who you trust.

About Benjamin Krause

Benjamin Krause is a Veterans Benefits Attorney and journalist who investigates problems veterans face with the Dept. of Veterans Affairs. He regularly reports on veterans' benefits news and analysis on the website DisabledVeterans.org.

Comments

  1. john david davis says:

    Finaly after 10 years of Denials and Appeals, you have given me hope. I am one of the fortunate(lucky) ones who made it thru VN. It is good news to me that the
    VA is recognising the VCM and VSM medals.This was always puzzling to me that the Army could put a combat veteran thru such s—. Scuse my bad English,please. All replies welcome. Americal Division Veteran

    a

    • What was your job in VN?? Are you a Combat Veteran? Do you have the CIB or just the VCM and VSM Medals?

      • namleatherneck says:

        Or Just a VCM or VSM medals?? I have to say that without the folks that back in the rear send the guys out in the bush the supplies & what ever else they needed you would have been fighting with sticks and rocks!!
        It was not for trying, they just put me in the rear and that is were I did my TIME.

        Namleatherneck

        • OKNightOwl says:

          NamLeatherNeck – great comeback! Welcome Home!

          • 0369DevilDog says:

            NamLeatherNeck – Yeah great comeback. I sa"w 122's" and Motars slam into Freedom Hill, Da Nang and the" rear with the gear" from Charlie Ridge. Thanks for the Beans, Bandages and Bullets supplies. Welcome Home!

  2. lilsuej says:

    What medals qualifies from Desert Storm?

    • USAF Vet says:

      I would think the South west Asia metal would or the expeditionary medal possibly but this is just a guess.

  3. Jose R, Gonzalez says:

    According with C7P and P.R. Veterans Contact Div. I don't qualyfying for PTSD c ompesantio because I have depress disorder already approved, so what i did send my claim to Washingto D.C. on appela to see what happed.

  4. GEORGE ANN HARPER says:

    HELLO, I AM THE WIFE OF A VIETNAM VETERAN WHOM VA HOSPITAL HAS
    DIAGNOSISED HIM WITH PTSD BUT WILL NOT SAY THAT IT IS COMBAT
    RELATED.

    THEY ARE CONSTANTLY GIVING HIM THE RUN AROUND. THIS IS GETTING TOO STRESSFUL FOR ME. I HAVE TO KEEP A WATCH ON
    HIM AND KEEP HIM QUIET WHEN HE'S AT HOME. HE TRIES TO WORK
    BUT HAVE OTHER ILLNESSES, STEMMING FROM THE VIETNAM WAR.

    HE SERVED 19 MONTHS IN VIETNAM, 1968-1970.
    SOMEONE NEEDS TO CHECK INTO WHAT THESES SO CALLED VA REPS.
    ARE WRITTING IN THE SOILDERS EXAM PAPER WORK. HOW CAN YOU
    HAVE ALL OF THE CRITERIA FOR PTSD BUT BE DENIED COMPANSATION?

    • 0369DevilDog says:

      I am so sorry to hear what you and your husband are going through. Please know I was in country the sametime as your husband, but not as long. God bless him for having coped with a 19 month tour. I guess he may have extended. However, I hope you get a Disabled Veterans (DAV) Rep or another good Service Organization. Good Luck

    • GoldenGhost says:

      "How can you have all of the criteria for ptsd but be denied compensation?" Easy, none of the symptoms of PTSD are specific to PTSD. There is great overlap between PTSD, other anxiety disorders, depressive disorders and personality disorders. Also a few folks flat out lie about their symptoms as well. Read: http://www.beforeyoutakethatpill.com/2009/3/spitz

    • Don Stafford says:

      I have PTSD and am paid at the 100% level. I got my determination in about 1998. Here is the problem: The VA counselors look to gain your confidence so you will think you are just chit chatting. What they are looking for is to dig anything out of you that suggests that you had a disfunctional or problem childhood. With this info they can claim that the problem stems from your childhood and not the military. good luck, Don

    • mike baechle says:

      You don't have to have been in combat to get compensation for PTSD. You do, however, have to meet very specific criteria. A PTSD claim is complex. You need help. Get in touch with the Disabled American Veterans in your area.

  5. Roland Bradby says:

    My wife passed away four years ago to breast cancer after serving 22 years in The United States Air Force. I have shyde away from the VA since her death but I need to know if I am still entitled to a Dependent ID Card. I only received the one time death benefit at the time of her death because I had been really ill myself. Can someone help steer me in the right direction to get specific information on what I can and cannot get. Thanks for any help you can give.

  6. I am in the midst of my comp application process. First off my local doc said I had PTSD so I went to VA, they have me scheduled for inpatient 8 week program that I find I cannot attend because their regs require I be narcotic free, and I am on high dose narcotics for extreme back pain from a Line of Duty accident on a PD. Not sure what I will do about treatment that is pending. I went for my comp exam, not sure how that went either, of course the shrink never says what she will say in report however her comments during the exam sort of point to her doubts that I had flash backs, however believes they were extreamly real dreams of the events I saw in nam back in 70-71 during Lam Som 719. Getting back on the meds now as I went through hell trying to get off the drugs to attend the treatment.

  7. I am very concerned with the way people claim that VA shuts down claims, I am an active Duty Officer about to that had serve for over twenty years and had served in Desert Shield Storm, one 1998 Bosnia rotation, Invasion of Iraq "Operation Iraqi Freedom", Afghanistan Twice. I saw Iraqi Republican Guard Bodies when I crossed the border of Kuwait to Iraq. I felt SCUD misiles flying over me. I was always scared when I went to Afganistan in 2008 and we were on constant alert due to rockets attack to Camp Phoenix in Kabul, I went in total depression went I found out that a Soldier that I used to talk with and became a friend was killed in Iraq by a Sniper, I met a German Interpreter and she was permanently injured in an explosion in Takhar Afghanistan and I was totally affected when I heard the Hungarians Nurses saying that due a big hole in her her head they had to burn her brain to prevent further bleeding, I have nightmares and guilty feelings because of these people being reservist with a normal life and me being active duty and not being in their place…, I suffer from terrible depression because of the way my past Military culture treated me during my upbringing and it affected my self confidence an the way I interacted with my peers…., Please advice.

  8. i cannot get compensation for my ischemic heart disease or my parkinsons disease. although i was aboard ship on 4 different occasions. i have a vietnam service medal and a campaign medal. also was in the gulf of tonkin in hostile territory and even received combat pay at the time my question is , why no comp for ischemic heart disease and parkinsons disease?

  9. joe jones says:

    I am a vietnam veteran and i was in the 173/th airborne light infantry in may 67thrmay68. i fought from ben hoa,seeing my comrades get their heads getting blown off all the way down to their toes.the biggest battle i was in was hill 875.my co. started out to dig in on the next hill over from hill 875.we dug our foxholes about 2or3inches deep,when the north vietnam soldiers openned fire on us.snipers were in the trees,they were already dug in under the ground. we were overan when we first hit the ground.in the first hour iran out of bullets.the comander called in a500pound bomb on top of us.we ran out of water food and bullets.72% of the whole unit was wiped out.this is not hard to prove.look it up on the internet.20yrs. later,I went to at least 15 treatment centers and i found out that I sffer from ptsd and agentorange.after all this time,all I have to show, is a bcd,and a cabinet full of pills.who can help me.