Post-traumatic Stress Disorder
Post-traumatic 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.
1. How to file a claim.
File VA Form 21-526, Veteran’s Application for Compensation and/or Pension. You must file a claim to begin the process. If you do not file a claim, you cannot be granted a disability – even if you deserve one.
Seek help from a Veterans Service Organization so that the proper forms are submitted to the Department of Veterans Affairs (VA). A national service organization (American Ex-POW’s, American Legion, AM VETS, DAV, Military Order of the Purple Heart, PVA, VFW, VVA, etc), a State Veterans Affairs Office, or a County or Local Veterans Affairs Office can help you through the process. These organizations can provide you the correct forms, give you information and assistance in preparing these forms, and even submit your information to the appropriate Regional Office of the Department of Veterans Affairs. You need to be sure, however, that they will submit the documents you may leave with them, or you will need to do so yourself.
If you feel that a particular organization is not being responsive to your needs, talk with the person working with you, or, alternately, go to a different Veterans Service Organization for help.
2. Diagnosis
First step in starting the claim process is to be seen by a medical professional and be clinically diagnosed with Post Traumatic stress disorder. The diagnosis can come from a private physician or from a VA physician.
Your service officer can help you to make a decision to file the claim before receiving an official diagnosis or after receiving a diagnosis. I would suggest that if you truly believe you have PTSD and and are certain to receive a diagnosis of the illness, go ahead and file for PTSD.
A warning would be that it is more difficult to re-open your claim if denied. It does not matter how many people believe you have PTSD, a diagnosis from a medical professional is the only thing the VA accepts as proof of illness. Again, ask the opinion of your service representative.
When filing a claim the VA will ask for any or all medical evidence regarding you in-service health and health after leaving the military. This includes any medical treatment from private physicians, military physicians, or VA treatment centers. Your service officer will give you a form to fill out that will ask you for all the doctors you have seen. The VA will take care of requesting the information from these physicians. But, it may be important for you to have copies of these documents just in case any information is not received by the VA.
4. What evidence do I need to prove my claim?
Proof of that the stressor occurred. Get a copy of your military records if you don't already have them. If not get VA Form SF-180 to request your records. Your service officer may already have the form if not down the form here:
5. How to document your military experiences.
For a military-related disability to be recognized, the VA must verify that you were exposed to a severe or life-threatening stressor. Your military experience(s) can be documented using:
* VA Form 21-4138, Statement in Support of Claim (Stressor Letter)
* DD 214, and DD 215 if you have this
* original award documents of medals or awards
* newspaper articles about a traumatic event
* letters to or from loved ones, regarding traumatic events
* statements from fellow service personnel
* photographs relevant to traumatic experiences
Document military stressors in a Stressor letter. [VA Form 21-4138, Statement in Support of Claim - on which a Stressor letter may be written, or to which a Stressor letter can be attached.]
Submit a Stressor letter – (Save file and open in MS Word) from you, the veteran, if possible, or with others’ help, if needed. Writing a Stressor letter can take weeks, months or years to accomplish. It is important to get this done and submitted for consideration, as soon as you can, despite possibly stirring up painful memories and feelings. You do not have to go into extreme detail when writing down information about stressful events. Provide what information you can, however, about your stressors, including the unit in which you served, approximate date(s), location(s) where you were, who was with you, name and rank of individual(s) killed or wounded, what happened, etc.
Bring in a copy of your DD 214. Your DD 214 will show in which campaigns you served, the individual medals you were awarded, and if you were awarded the CAB, CAR, CIB or CMB. Sometimes, the DD 214 may not list all the individual medals and awards that you were given.
Bring in copies of the original award documents for any individual medals or awards that you received. Any medals or awards you received in the military are important. Those that show you were wounded or acted with bravery include the Purple Heart Medal, Air Medal with V Device, Soldier’s Medal, Bronze Star Medal with V Device, Silver Star Medal, Commendation with V Device, Distinguished Flying Cross, etc. Those that show you were in combat include the CAB, CAR, CIB or CMB.
Your DD 214, DD 215, medals, and awards verify whether you were wounded, performed with valor, and/or were exposed to a life-threatening stressor. The VA accepts the CAB, CAR, CIB or CMB as confirming exposure to a life-threatening stressor (i.e., combat), as well as any award for valor or a Purple Heart.
Also, bring in a copy of newspaper articles which document a traumatic event, and letters to and/or from loved ones about this having happened – if you have either of these. This documentation is especially important if your DD 214 and/or DD 215 does not confirm exposure to a life-threatening stressor.
6. How your family, friends, fellow service personnel, and care providers can help.
Provide current letters from loved ones, friends, fellow service personnel or people (including co-workers and employers) who have known you and observed problems. Remember that a former spouse, estranged relative or friend may be willing to provide useful information.
Individual letters can be attached to or written on VA Form 21-4138, Statement in Support of Claim, and need to include the veteran’s full name, social security number, and the date of the correspondence. In addition, the person writing the letter should also include their name, address, and how the veteran is known to them.
Ask family members, friends or people who have known you to write letters regarding changes they have observed in you. Ask them to describe changes in overall attitude and behavior, emotional state, including fluctuations; ability to get along with, and to work with, others; etc. How are you different now from how you were before military service? How do the changes observed impact your relationships with family, friends and people at work?
"Buddy letters" from military friends who have served with you in your unit, and whose participation has been verified by the VA, can help confirm your involvement in the same events. This will assist the VA in documenting your exposure to stressful events. They should include their rank in the service and their social security number.
If you have seen a professional for emotional or physical difficulties, the VA carefully considers statements made by your care provider on your behalf.
Family and/or friends may provide useful emotional support, information, and encouragement to follow through with a disability evaluation.
It is often helpful for someone to go with you when you report for the disability evaluation. If you have trouble talking, or have had a head injury or have memory loss, ask if a family member or friend can be present – at least in the initial part of the interview.
Your spouse or significant other may be a better historian about sleeping patterns, emotional reactions, and the impact of your difficulties on the family. They may be more aware of these matters and less likely to deny or minimize problems.
There may be some things to talk about that you are not comfortable discussing with others present. Some examiners will pick up on this and suggest they speak individually with you. Otherwise, you, your family member, or friend can suggest that it may be useful for you to talk privately with the examiner. This should be respected, without any subsequent pressure or inquiry by family or friends to talk about what was discussed.
7. Treatment
During the process of gathering evidence you should start or continue to be treated at a VA facility or a private physician for your PTSD. Remember, you need that diagnosis for your claim and possibly the medication to help you cope with your illness.
PTSD affects everyone in different ways and there are many symptoms that affect us. Your physician may choose to provide medication to you. Make sure you are incredibly honest with your physician about your problems.
Also, medications are strong. They may affect you in ways that you might not like. You and your doctor should work together so you are receiving the best treatment for you. In the beginning it will be trial and error with medication. You are really in control of your own treatment. The honesty with your physician is important because he needs to know that you want to try to feel as good as possible with what you are experiencing. No matter what horror stories you may have hear, most physicians are really willing to work for what's best for YOU.
8. More research and your claim.
Your health is the basis for your rating and by now you should be in the process of gathering all your evidence. You should be confident that you have proved your stressor and are now being treated for it.
Take the time to read The Code of Federal Regulations Title 38 Pension, Bonuses and Veterans Relief as it relates to PTSD. ( I would actually recommend reading this before seeing a Medical Professional to help describe your symptoms).
The Code of Federal Regulations Title 38
PART 4—SCHEDULE FOR RATING DISABILITIES
Subpart B—Disability Ratings
Mental Disorders
After reviewing the disability ratings you should have a pretty good idea what category your doctor will put you in or what category you think you fit in. Read the criteria for each rating and put yourself in it. You should expect, in your mind, nothing more and nothing less that where you fit in. This will help you, believe me, in the stress of waiting though the process of the claim.
A note on these ratings as it applies to your employment:
"If you are unable to work due to your service connected PTSD or mental disorder you will be granted 100% SC disability"
38 CFR 4.16
There are 3 ways the VA may choose to set your 100% rating.
IU...Individual unemployability. This means you are really a 70% rating but you cannot work so they grant you 100% based on that.
IU is a tough rating for PTSD. A letter sent to rating officials in the VA states:
"Don’t go through the I.U. process if there is clear evidence on the examination that the veteran is unable to work because of PTSD. A 100% evaluation would be more appropriate in such cases, and a future exam can be requested when indicated".
Compensation and Pension exam or C&P exam and what should I expect out of it.
Once you have submitted your evidence the VA will ask you to take a compensation and pension exam or C&P exam. This exam is not conducted by your treating physician but rather conducted by a different qualified examiner who specializes in mental disabilities.
This exam is crucial to your rating and is centralized on your health rather than all that evidence you gathered. I call the exam BAD (before, after, and during). The exam will focus on your life before the military where they ask you personal questions about your family life and childhood. The during part, which is the toughest focuses on your stressor. This will be the part where you explain what happened to you and why you believe you have PTSD. This part is very emotional at times. The after part focuses on your life outside the military. It looks into your behavior and mental well being. There are also parts of the exam where you will take common Psych tests like remembering three words after 5 minutes and drawing shapes and figures to test your memory and focus. You may have already taken these type of tests when you enrolled in the Psych clinic.
The examiner does work with a pre-determined set of written questions. You will tell them the story of your life, basically. This story is probably the same story you told your regular physician. The examiner already knows from reading your medical record what you have already said about this stuff. This is why you MUST be as honest as possible in this exam. This exam is also a test on your truthfulness. The exam may run up to two hours and it is most definitely the longest C&P exam you could take in the VA system. You may be asked to retell the same things two or three times during the same exam.
9. What is the GAF and what does it have to do with my rating?
GAF stands for Global Assessment of Function. It is a standard by which the VA puts a numerical value to your mental health. You receive a GAF score every time you visit your mental health professional. It is a value that represents what you are mentally like on that particular day. The higher the number the better you are on that day.
Here is a basic explanation on what the numbers actually mean:
GAF
100-91
Superior functioning in a wide range of activities. Life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.
90-81
Absent or minimum symptoms (e.g. mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns ("e.g.. an occasional argument with family members)
80-71
If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g temporarily falling behind in schoolwork).
70-61
Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
60-51
Moderate symptoms (e.g.. flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).
50-41
Serious symptoms(e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).
40-31
Some impairment in reality testing or communication (e.g... speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g depressed man avoids friends, neglects family, and is unable to work: child frequently beats up younger children. Is defiant at home, and is failing at school).
30-21
Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas. (e.g. stays in bed all day; no job, home, or friends).
20-11
Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death, frequency violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g smears feces) OR gross impairment in communication (e.g. largely incoherent or mute.)
10-0
Persistent danger of severely hurting self or others. (e.g. recurrent violence) OR recurrent inability to maintain minimal personal hygiene OR Serious suicidal act with clear expectation of death.
What does the GAF mean to your overall rating?
Well, its subjective. Some people get a GAF of 45 and receive a 100% rating and others with a GAF of 45 could end up with a 50% rating. Its really just a guide.
If you would like to see a general guide on how the GAF may correspond to ratings here it is:"The rule of thumb for the amounts the VA assigns for psychiatric disabilities is:
GAF Percentage
0-40=100%
41-50=70%
51-60=50%
61-70=30%
71-80=10%
81-100=0%
Raters may choose to ignore this, but it does give you a general idea of where you stand.
What does the Axis mean on my C&P report?
The AXIS I through AXIS V are your evaluation. The most important is AXIS I being the diagnosis, or what was found wrong, and AXIS V is the prognosis, or how it looks for future progress. Also you will find it says, "Competent for VA purposes," don't worry about that it's a good thing. It just means that you don't need to be locked up against your will, or "committed" as the doctors prefer saying.
AXIS 1: MAJOR PSYCHIATRIC ILLNESSES, INCLUDING SUBSTANCE ABUSE.
AXIS 2: PERSONALITY DISORDERS/FEATURES
AXIS 3: PHYSICAL PROBLEMS (MEDICAL DIAGNOSIS-AS OPPOSED TO A PSYCH DIAGNOSIS)
AXIS 4: PSYCHOSOCIAL STRESSORS (homeless, unemployment, marital conflict, etc.)
AXIS 5: GLOBAL ASSESSMENT of FUNCTIONING SCALE, expressed as: none, mild, moderate, severe and then it'll have numbers listed to represent, eye movement, or non-eye contact, tearful, fearful, and these kinds of assessments.
10. Meeting with your disability evaluator.
Be open with the evaluator when talking about traumas and difficulties you experienced in the service, and your subsequent adjustment.
Consider the evaluator as having a "need to know" with regard to traumatic experiences that you have had. As difficult as it is to acknowledge and talk about things you have experienced, there is no practical way to know what your experience was without hearing it from you.
If you can’t give the whole story, give part of the story. For example, "There is something that happened (e.g., that involved the death of individuals in my unit/enemy soldiers/civilians, etc.) that I can’t talk about. It’s so painful and upsetting. But I can’t get this out of my mind."
Also, it is best to acknowledge if you had a security clearance that prevents you from talking about certain classified matters. This way the examiner is made aware of and can consider this information in his/her formulation of your difficulties (i.e., that your security clearance may not allow you to speak about, and the VA to verify, certain traumatic experiences). When secret missions are declassified in twenty or more years, it can be established that you had indicated in a disability evaluation that classified events, about which you could not then speak, did have an adverse emotional impact on you.
It is important to remember that while missions may be classified, the deaths of individuals in your unit on such missions and the dates of their deaths are public information. At times, however, the location and circumstances surrounding their deaths may be reported inaccurately, officially, because of national security interests.
If you have concerns, tell the evaluator your impressions about the examination process.
Try to establish and to be part of a genuine dialogue between you and the evaluator. Even if you are not an American citizen (some foreign nationals serve in our armed forces), you are a veteran of the United States of America’s military, you have sworn to "support and defend the Constitution of the United States against all enemies, foreign and domestic," and you deserve to be listened to and heard.
During the evaluation, you may need to speak up and tell the evaluator your perceptions, not only of past events, but even current ones – i.e., including whether you feel that the evaluator is hearing or is interested in what you are trying to talk about.
If you are concerned about whether the evaluator is hearing and understanding your perspective and thoughts about your difficulties, you can say such things as:
"You don’t seem to have time to hear my story."
"I don’t think that you know how difficult it is to talk about this."
Speak up in a straightforward manner, without excessive irritability or hostility, if there is something that you want to tell the examiner. Although you may feel like swearing, storming out, or even physically assaulting the examiner, such behavior would not be productive to having your claim fully and fairly evaluated.
Avoid losing control of your emotions so that you receive a fair hearing of your concerns and difficulties. Perhaps, the examiner will remind you of your platoon leader or commanding officer, whom you hate and blame for some individuals’ deaths. If so, this will naturally stir up strong feelings. The examiner is not that person, however, even if the appearance or general demeanor of the examiner is quite similar. Transferring feelings that you have for leaders (who may have failed you while in the military) onto the examiner can interfere with your saying all that would be useful to say in your evaluation.
Choose not to "shoot yourself in the foot," and not to behave in a self-defeating, self-destructive way in the evaluation. You can undermine receiving a full evaluation of your disability claim by avoiding talking about real traumas, defensive denial of difficulties, withdrawal and avoidance, or by hostile, abrasive, sarcastic confrontation or belligerence with the examiner. Take the high road so you can receive a fair hearing. You, and everyone else who has served our country in the military, deserve to be heard and to be fairly and fully evaluated.
11. What to do if your disability is denied or underrated.
If a disability is denied or is rated lower than what seems to be appropriate, ask to see the evaluation on which the Rating Decision was made by the VA Regional Office. The Veterans Service Organization assisting you with your claim can help you obtain this report.
Review the examination report to determine if it is accurate, or if important information is left out. Notice whether you or the examiner denied or minimized problems that actually exist. Consider whether the degree of impairment acknowledged in the evaluation is realistic, and whether the evaluation adequately addresses the difficulties present and their impact in your life.
Also, closely read the Rating Decision to see if the reasoning behind the conclusions is reasonable, or if there are any flaws in the decision that was made. Look to see if accurate, truthful information is being discounted or denied.
If, after review of the evaluation on which the Rating Decision was made, you believe that your disability has been unfairly denied or underrated, appeal the Rating Decision.
Appeal the denial, sooner rather than later – i.e., if an erroneous decision was made and you are denied a disability when one exists, or if your disability is rated too low a percentage (and you are actually more disabled than you have been rated). Seek assistance from a Veterans Service Organization, and file your appeal with the VA Regional Office handling your claim.
You have only one year to appeal an incorrect Rating Decision, or else you have to start all over with new information that was not initially considered. If you have to start over, "new and material evidence" will need to be provided which shows a "nexus" or link between a service-related incident, illness or condition and a current or chronic condition.
Your appeal will result in a fresh look at the Rating Decision and all the information in your Claims File. Sometimes you may not have to be reevaluated, especially if you present clear, convincing information in your appeal letter which shows that you have been unfairly denied a disability rating, or that it has been underrated. More often, however, a reevaluation will be requested by the Regional Office, in order to reassess what the correct rating should be.
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.
1. How to file a claim.
File VA Form 21-526, Veteran’s Application for Compensation and/or Pension. You must file a claim to begin the process. If you do not file a claim, you cannot be granted a disability – even if you deserve one.
Seek help from a Veterans Service Organization so that the proper forms are submitted to the Department of Veterans Affairs (VA). A national service organization (American Ex-POW’s, American Legion, AM VETS, DAV, Military Order of the Purple Heart, PVA, VFW, VVA, etc), a State Veterans Affairs Office, or a County or Local Veterans Affairs Office can help you through the process. These organizations can provide you the correct forms, give you information and assistance in preparing these forms, and even submit your information to the appropriate Regional Office of the Department of Veterans Affairs. You need to be sure, however, that they will submit the documents you may leave with them, or you will need to do so yourself.
If you feel that a particular organization is not being responsive to your needs, talk with the person working with you, or, alternately, go to a different Veterans Service Organization for help.
2. Diagnosis
First step in starting the claim process is to be seen by a medical professional and be clinically diagnosed with Post Traumatic stress disorder. The diagnosis can come from a private physician or from a VA physician.
Your service officer can help you to make a decision to file the claim before receiving an official diagnosis or after receiving a diagnosis. I would suggest that if you truly believe you have PTSD and and are certain to receive a diagnosis of the illness, go ahead and file for PTSD.
A warning would be that it is more difficult to re-open your claim if denied. It does not matter how many people believe you have PTSD, a diagnosis from a medical professional is the only thing the VA accepts as proof of illness. Again, ask the opinion of your service representative.
When filing a claim the VA will ask for any or all medical evidence regarding you in-service health and health after leaving the military. This includes any medical treatment from private physicians, military physicians, or VA treatment centers. Your service officer will give you a form to fill out that will ask you for all the doctors you have seen. The VA will take care of requesting the information from these physicians. But, it may be important for you to have copies of these documents just in case any information is not received by the VA.
4. What evidence do I need to prove my claim?
Proof of that the stressor occurred. Get a copy of your military records if you don't already have them. If not get VA Form SF-180 to request your records. Your service officer may already have the form if not down the form here:
5. How to document your military experiences.
For a military-related disability to be recognized, the VA must verify that you were exposed to a severe or life-threatening stressor. Your military experience(s) can be documented using:
* VA Form 21-4138, Statement in Support of Claim (Stressor Letter)
* DD 214, and DD 215 if you have this
* original award documents of medals or awards
* newspaper articles about a traumatic event
* letters to or from loved ones, regarding traumatic events
* statements from fellow service personnel
* photographs relevant to traumatic experiences
Document military stressors in a Stressor letter. [VA Form 21-4138, Statement in Support of Claim - on which a Stressor letter may be written, or to which a Stressor letter can be attached.]
Submit a Stressor letter – (Save file and open in MS Word) from you, the veteran, if possible, or with others’ help, if needed. Writing a Stressor letter can take weeks, months or years to accomplish. It is important to get this done and submitted for consideration, as soon as you can, despite possibly stirring up painful memories and feelings. You do not have to go into extreme detail when writing down information about stressful events. Provide what information you can, however, about your stressors, including the unit in which you served, approximate date(s), location(s) where you were, who was with you, name and rank of individual(s) killed or wounded, what happened, etc.
Bring in a copy of your DD 214. Your DD 214 will show in which campaigns you served, the individual medals you were awarded, and if you were awarded the CAB, CAR, CIB or CMB. Sometimes, the DD 214 may not list all the individual medals and awards that you were given.
Bring in copies of the original award documents for any individual medals or awards that you received. Any medals or awards you received in the military are important. Those that show you were wounded or acted with bravery include the Purple Heart Medal, Air Medal with V Device, Soldier’s Medal, Bronze Star Medal with V Device, Silver Star Medal, Commendation with V Device, Distinguished Flying Cross, etc. Those that show you were in combat include the CAB, CAR, CIB or CMB.
Your DD 214, DD 215, medals, and awards verify whether you were wounded, performed with valor, and/or were exposed to a life-threatening stressor. The VA accepts the CAB, CAR, CIB or CMB as confirming exposure to a life-threatening stressor (i.e., combat), as well as any award for valor or a Purple Heart.
Also, bring in a copy of newspaper articles which document a traumatic event, and letters to and/or from loved ones about this having happened – if you have either of these. This documentation is especially important if your DD 214 and/or DD 215 does not confirm exposure to a life-threatening stressor.
6. How your family, friends, fellow service personnel, and care providers can help.
Provide current letters from loved ones, friends, fellow service personnel or people (including co-workers and employers) who have known you and observed problems. Remember that a former spouse, estranged relative or friend may be willing to provide useful information.
Individual letters can be attached to or written on VA Form 21-4138, Statement in Support of Claim, and need to include the veteran’s full name, social security number, and the date of the correspondence. In addition, the person writing the letter should also include their name, address, and how the veteran is known to them.
Ask family members, friends or people who have known you to write letters regarding changes they have observed in you. Ask them to describe changes in overall attitude and behavior, emotional state, including fluctuations; ability to get along with, and to work with, others; etc. How are you different now from how you were before military service? How do the changes observed impact your relationships with family, friends and people at work?
"Buddy letters" from military friends who have served with you in your unit, and whose participation has been verified by the VA, can help confirm your involvement in the same events. This will assist the VA in documenting your exposure to stressful events. They should include their rank in the service and their social security number.
If you have seen a professional for emotional or physical difficulties, the VA carefully considers statements made by your care provider on your behalf.
Family and/or friends may provide useful emotional support, information, and encouragement to follow through with a disability evaluation.
It is often helpful for someone to go with you when you report for the disability evaluation. If you have trouble talking, or have had a head injury or have memory loss, ask if a family member or friend can be present – at least in the initial part of the interview.
Your spouse or significant other may be a better historian about sleeping patterns, emotional reactions, and the impact of your difficulties on the family. They may be more aware of these matters and less likely to deny or minimize problems.
There may be some things to talk about that you are not comfortable discussing with others present. Some examiners will pick up on this and suggest they speak individually with you. Otherwise, you, your family member, or friend can suggest that it may be useful for you to talk privately with the examiner. This should be respected, without any subsequent pressure or inquiry by family or friends to talk about what was discussed.
7. Treatment
During the process of gathering evidence you should start or continue to be treated at a VA facility or a private physician for your PTSD. Remember, you need that diagnosis for your claim and possibly the medication to help you cope with your illness.
PTSD affects everyone in different ways and there are many symptoms that affect us. Your physician may choose to provide medication to you. Make sure you are incredibly honest with your physician about your problems.
Also, medications are strong. They may affect you in ways that you might not like. You and your doctor should work together so you are receiving the best treatment for you. In the beginning it will be trial and error with medication. You are really in control of your own treatment. The honesty with your physician is important because he needs to know that you want to try to feel as good as possible with what you are experiencing. No matter what horror stories you may have hear, most physicians are really willing to work for what's best for YOU.
8. More research and your claim.
Your health is the basis for your rating and by now you should be in the process of gathering all your evidence. You should be confident that you have proved your stressor and are now being treated for it.
Take the time to read The Code of Federal Regulations Title 38 Pension, Bonuses and Veterans Relief as it relates to PTSD. ( I would actually recommend reading this before seeing a Medical Professional to help describe your symptoms).
The Code of Federal Regulations Title 38
PART 4—SCHEDULE FOR RATING DISABILITIES
Subpart B—Disability Ratings
Mental Disorders
After reviewing the disability ratings you should have a pretty good idea what category your doctor will put you in or what category you think you fit in. Read the criteria for each rating and put yourself in it. You should expect, in your mind, nothing more and nothing less that where you fit in. This will help you, believe me, in the stress of waiting though the process of the claim.
A note on these ratings as it applies to your employment:
"If you are unable to work due to your service connected PTSD or mental disorder you will be granted 100% SC disability"
38 CFR 4.16
There are 3 ways the VA may choose to set your 100% rating.
IU...Individual unemployability. This means you are really a 70% rating but you cannot work so they grant you 100% based on that.
IU is a tough rating for PTSD. A letter sent to rating officials in the VA states:
"Don’t go through the I.U. process if there is clear evidence on the examination that the veteran is unable to work because of PTSD. A 100% evaluation would be more appropriate in such cases, and a future exam can be requested when indicated".
Compensation and Pension exam or C&P exam and what should I expect out of it.
Once you have submitted your evidence the VA will ask you to take a compensation and pension exam or C&P exam. This exam is not conducted by your treating physician but rather conducted by a different qualified examiner who specializes in mental disabilities.
This exam is crucial to your rating and is centralized on your health rather than all that evidence you gathered. I call the exam BAD (before, after, and during). The exam will focus on your life before the military where they ask you personal questions about your family life and childhood. The during part, which is the toughest focuses on your stressor. This will be the part where you explain what happened to you and why you believe you have PTSD. This part is very emotional at times. The after part focuses on your life outside the military. It looks into your behavior and mental well being. There are also parts of the exam where you will take common Psych tests like remembering three words after 5 minutes and drawing shapes and figures to test your memory and focus. You may have already taken these type of tests when you enrolled in the Psych clinic.
The examiner does work with a pre-determined set of written questions. You will tell them the story of your life, basically. This story is probably the same story you told your regular physician. The examiner already knows from reading your medical record what you have already said about this stuff. This is why you MUST be as honest as possible in this exam. This exam is also a test on your truthfulness. The exam may run up to two hours and it is most definitely the longest C&P exam you could take in the VA system. You may be asked to retell the same things two or three times during the same exam.
Click here to review exactly what will be asked by the C&P examiner
9. What is the GAF and what does it have to do with my rating?
GAF stands for Global Assessment of Function. It is a standard by which the VA puts a numerical value to your mental health. You receive a GAF score every time you visit your mental health professional. It is a value that represents what you are mentally like on that particular day. The higher the number the better you are on that day.
Here is a basic explanation on what the numbers actually mean:
GAF
100-91
Superior functioning in a wide range of activities. Life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.
90-81
Absent or minimum symptoms (e.g. mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns ("e.g.. an occasional argument with family members)
80-71
If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g temporarily falling behind in schoolwork).
70-61
Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
60-51
Moderate symptoms (e.g.. flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).
50-41
Serious symptoms(e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).
40-31
Some impairment in reality testing or communication (e.g... speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g depressed man avoids friends, neglects family, and is unable to work: child frequently beats up younger children. Is defiant at home, and is failing at school).
30-21
Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas. (e.g. stays in bed all day; no job, home, or friends).
20-11
Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death, frequency violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g smears feces) OR gross impairment in communication (e.g. largely incoherent or mute.)
10-0
Persistent danger of severely hurting self or others. (e.g. recurrent violence) OR recurrent inability to maintain minimal personal hygiene OR Serious suicidal act with clear expectation of death.
What does the GAF mean to your overall rating?
Well, its subjective. Some people get a GAF of 45 and receive a 100% rating and others with a GAF of 45 could end up with a 50% rating. Its really just a guide.
If you would like to see a general guide on how the GAF may correspond to ratings here it is:"The rule of thumb for the amounts the VA assigns for psychiatric disabilities is:
GAF Percentage
0-40=100%
41-50=70%
51-60=50%
61-70=30%
71-80=10%
81-100=0%
Raters may choose to ignore this, but it does give you a general idea of where you stand.
What does the Axis mean on my C&P report?
The AXIS I through AXIS V are your evaluation. The most important is AXIS I being the diagnosis, or what was found wrong, and AXIS V is the prognosis, or how it looks for future progress. Also you will find it says, "Competent for VA purposes," don't worry about that it's a good thing. It just means that you don't need to be locked up against your will, or "committed" as the doctors prefer saying.
AXIS 1: MAJOR PSYCHIATRIC ILLNESSES, INCLUDING SUBSTANCE ABUSE.
AXIS 2: PERSONALITY DISORDERS/FEATURES
AXIS 3: PHYSICAL PROBLEMS (MEDICAL DIAGNOSIS-AS OPPOSED TO A PSYCH DIAGNOSIS)
AXIS 4: PSYCHOSOCIAL STRESSORS (homeless, unemployment, marital conflict, etc.)
AXIS 5: GLOBAL ASSESSMENT of FUNCTIONING SCALE, expressed as: none, mild, moderate, severe and then it'll have numbers listed to represent, eye movement, or non-eye contact, tearful, fearful, and these kinds of assessments.
10. Meeting with your disability evaluator.
Be open with the evaluator when talking about traumas and difficulties you experienced in the service, and your subsequent adjustment.
Consider the evaluator as having a "need to know" with regard to traumatic experiences that you have had. As difficult as it is to acknowledge and talk about things you have experienced, there is no practical way to know what your experience was without hearing it from you.
If you can’t give the whole story, give part of the story. For example, "There is something that happened (e.g., that involved the death of individuals in my unit/enemy soldiers/civilians, etc.) that I can’t talk about. It’s so painful and upsetting. But I can’t get this out of my mind."
Also, it is best to acknowledge if you had a security clearance that prevents you from talking about certain classified matters. This way the examiner is made aware of and can consider this information in his/her formulation of your difficulties (i.e., that your security clearance may not allow you to speak about, and the VA to verify, certain traumatic experiences). When secret missions are declassified in twenty or more years, it can be established that you had indicated in a disability evaluation that classified events, about which you could not then speak, did have an adverse emotional impact on you.
It is important to remember that while missions may be classified, the deaths of individuals in your unit on such missions and the dates of their deaths are public information. At times, however, the location and circumstances surrounding their deaths may be reported inaccurately, officially, because of national security interests.
If you have concerns, tell the evaluator your impressions about the examination process.
Try to establish and to be part of a genuine dialogue between you and the evaluator. Even if you are not an American citizen (some foreign nationals serve in our armed forces), you are a veteran of the United States of America’s military, you have sworn to "support and defend the Constitution of the United States against all enemies, foreign and domestic," and you deserve to be listened to and heard.
During the evaluation, you may need to speak up and tell the evaluator your perceptions, not only of past events, but even current ones – i.e., including whether you feel that the evaluator is hearing or is interested in what you are trying to talk about.
If you are concerned about whether the evaluator is hearing and understanding your perspective and thoughts about your difficulties, you can say such things as:
"You don’t seem to have time to hear my story."
"I don’t think that you know how difficult it is to talk about this."
Speak up in a straightforward manner, without excessive irritability or hostility, if there is something that you want to tell the examiner. Although you may feel like swearing, storming out, or even physically assaulting the examiner, such behavior would not be productive to having your claim fully and fairly evaluated.
Avoid losing control of your emotions so that you receive a fair hearing of your concerns and difficulties. Perhaps, the examiner will remind you of your platoon leader or commanding officer, whom you hate and blame for some individuals’ deaths. If so, this will naturally stir up strong feelings. The examiner is not that person, however, even if the appearance or general demeanor of the examiner is quite similar. Transferring feelings that you have for leaders (who may have failed you while in the military) onto the examiner can interfere with your saying all that would be useful to say in your evaluation.
Choose not to "shoot yourself in the foot," and not to behave in a self-defeating, self-destructive way in the evaluation. You can undermine receiving a full evaluation of your disability claim by avoiding talking about real traumas, defensive denial of difficulties, withdrawal and avoidance, or by hostile, abrasive, sarcastic confrontation or belligerence with the examiner. Take the high road so you can receive a fair hearing. You, and everyone else who has served our country in the military, deserve to be heard and to be fairly and fully evaluated.
11. What to do if your disability is denied or underrated.
If a disability is denied or is rated lower than what seems to be appropriate, ask to see the evaluation on which the Rating Decision was made by the VA Regional Office. The Veterans Service Organization assisting you with your claim can help you obtain this report.
Review the examination report to determine if it is accurate, or if important information is left out. Notice whether you or the examiner denied or minimized problems that actually exist. Consider whether the degree of impairment acknowledged in the evaluation is realistic, and whether the evaluation adequately addresses the difficulties present and their impact in your life.
Also, closely read the Rating Decision to see if the reasoning behind the conclusions is reasonable, or if there are any flaws in the decision that was made. Look to see if accurate, truthful information is being discounted or denied.
If, after review of the evaluation on which the Rating Decision was made, you believe that your disability has been unfairly denied or underrated, appeal the Rating Decision.
Appeal the denial, sooner rather than later – i.e., if an erroneous decision was made and you are denied a disability when one exists, or if your disability is rated too low a percentage (and you are actually more disabled than you have been rated). Seek assistance from a Veterans Service Organization, and file your appeal with the VA Regional Office handling your claim.
You have only one year to appeal an incorrect Rating Decision, or else you have to start all over with new information that was not initially considered. If you have to start over, "new and material evidence" will need to be provided which shows a "nexus" or link between a service-related incident, illness or condition and a current or chronic condition.
Your appeal will result in a fresh look at the Rating Decision and all the information in your Claims File. Sometimes you may not have to be reevaluated, especially if you present clear, convincing information in your appeal letter which shows that you have been unfairly denied a disability rating, or that it has been underrated. More often, however, a reevaluation will be requested by the Regional Office, in order to reassess what the correct rating should be.
This is a lot of information to take in at once so take your time and review all the information and resources we have listed for you. We have done the hard part for you. The rest is up to you. We are adding information to this website daily so please check back often to check for updates