PTSD is a condition that is triggered by a stressful event that causes an individual to receive harm or be threatened with serious harm or death. Examples of stressful events, which are known as stressors, include combat, natural disasters or a personal or sexual assault. Some of the symptoms of PTSD include uncontrolled anger, flashbacks, and irritability. People who have PTSD may be unable to work or successfully engage in relationships with other individuals.

Under the new rule, veterans who are filing a claim for benefits as the result of PTSD will not need to provide corroborating evidence of a claimed stressor when it is claimed that the stressor is “related to the veteran’s fear of hostile military or terrorist activity.” Instead, a veteran’s statement is sufficient to establish the stressor. A VA psychiatrist or psychologist, including those who are providing services to the VA under contract, must determine that the stressor is “adequate to support a diagnosis of [PTSD] and that the veteran’s symptoms are related to the claimed stressor.” The stressor must also be “consistent with the places, types, and circumstances of the veteran’s service.”

The rule applies to veterans of all eras and involves claims for PTSD that are received on or after July 13, 2010. Veterans who have already filed claims for VA benefits due to PTSD but whose claims have not yet been decided by a VA regional office or, if in appellate status, have not yet been decided by the Board of Veterans’ Appeals will also have their claims adjudicated under the new rule. Claims that have been remanded for re-adjudication by the U.S. Court of Appeals for Veterans Claims will also be reviewed based on the new rule.

Click here to download more information on this rule (PDF)

VetsFirst supports the VA’s efforts to simplify the evidentiary burden for PTSD claims but believes that more needs to be done. Specifically, VetsFirst believes that private psychiatrists and psychologists should be able to make the determination required under the rule. VetsFirst will continue to monitor the implementation of this rule and work with Congress and the VA to further simplify and streamline the benefits process for our nation’s veterans.

In Porter v. McCollum (No. 08-10537. Nov. 30, 2009), the Supreme Court overturned the death sentence of a Korean War combat veteran who plead guilty to the 1986 murders of his ex-girlfriend and her boyfriend.

George Porter, Jr., was convicted of the murders following trials and appeals in the Florida and federal courts. A jury ultimately imposed a death sentence. However, during the trial and sentencing phases, Porter’s defense attorney failed to introduce evidence that Porter had experienced intense combat-related trauma and that he suffered from PTSD. A federal district court judge ruled that such ineffective legal counsel violated the defendant’s constitutional right to an attorney, but the U.S. Court of Appeals for the Eleventh Circuit disagreed and reinstated the death sentence.

Porter had been wounded in two violent enemy encounters during his Army service in Korea. Hand-to-hand combat and a rain of machine gun and mortar fire in freezing weather raged for days. On appeal of the jury’s death sentence, Porter’s commanding officer testified as to the horrific nature of the two battles. A psychiatrist also testified as to Porter’s PTSD.

“Our Nation has a long tradition of according leniency to veterans in recognition of their service, especially for those who fought on the front lines as Porter did,” said the Supreme Court in its opinion. “The relevance of Porter’s extensive combat experience is not only that he served honorably under extreme hardship and gruesome conditions, but also that the jury might find mitigating the intense stress and mental and emotional toll that combat took on Porter.”

In the end, the Court refused to overturn Porter’s conviction, but concluded that the jury and judge that imposed the death sentence, had it heard about Porter’s combat experiences and PTSD, might well have refused to invoke the death penalty. Therefore, the Eleventh Circuit’s decision that he was not prejudiced by his defense lawyer’s failure to raise these circumstances as mitigating factors was, in the Court’s opinion, unreasonable.

Ultimately, the Court sent the case back to the Eleventh Circuit and ordered it to start a new sentencing proceeding.

So, what does this case mean for veterans who suffer from PTSD and who commit violent crimes? Does combat service equal a get-out-of-jail-free card? Of course it doesn’t. What it does suggest is that at a time when our nation is fighting two wars, when we are going to escalate troop levels in Afghanistan, when more than a third of service members returning from the wars in Afghanistan and Iraq have reported symptoms of PTSD, our system of justice must affirmatively take into account the mental and emotional toll that combat can take on even the best of us. While military service cannot justify or excuse violent crime, knowledge about the circumstances surrounding a defendant’s military service can, as the Supreme Court recognized, “humanize” a criminal defendant so that a judge and jury can make an informed decision about the appropriate punishment.

Lawyers with clients in similar cases can point to the Supreme Court’s reference to the prevalence of PTSD in combat veterans and its favorable view of state laws, such as those in California and Minnesota that provide special legal protection for criminally accused veterans who suffer from PTSD, to argue that the Supreme Court intended the Porter decision to apply more broadly than just to the specific facts surrounding his case.

Currently, the law and VA regulations require veterans whose military records do not reflect combat service, and who assert that their diagnosed PTSD is related to a combat experience, provide documentary proof that the alleged experience actually occurred (e.g., official military records or a statement from someone who shared the experience with the veteran). This kind of proof is often very difficult or impossible to obtain.

The COMBAT PTSD Act would change the law to include service in a combat theater of operations to trigger the VA’s obligation to accept the veteran’s assertion of the incident(s) that resulted in the onset or aggravation of any disease or injury (including PTSD) as proof of service connection, provided that the asserted stressor is consistent with the “circumstances, conditions, or hardships of such service”. Veterans without documented combat service would no longer have to provide proof of their combat-related experience if they served in a combat zone.

VetsFirst strongly supports the COMBAT PTSD Act, but we believe that the bill, as written, will not eliminate the barriers to VA benefits and health care that still exist for these veterans. Even with the expansion of the definition of “engaged in combat with the enemy”, veterans without documented combat service who served in a combat zone will still have to provide medical evidence that their PTSD is related to their military service. Given the delay that may occur between the occurrence of a stressor event and the onset of PTSD, as well as the subjective nature of the individual’s response to a stressor event, it is often very difficult to obtain this kind of evidence as well, since it must be provided by a health care professional usually years after the event.

Consequently, VetsFirst urged Congress to establish a legal presumption of service connection for PTSD where a veteran has a current diagnosis of PTSD and served in a theater of combat operations. Since the VA would be required to accept the veteran’s assertion of a combat experience, and a diagnosis of PTSD includes a medical finding that the stressor event triggered PTSD, it is logical for the VA to conclude that the combat experience is related to the veteran’s PTSD. A presumption of service connection would allow the VA to do that by eliminating the need for medical evidence of a connection between the veteran’s military service and his or her PTSD. Such a presumption could only be rebutted by clear and convincing evidence to the contrary (e.g., the VA provides credible evidence that the claimed combat-related event did not occur or medical evidence that the veteran’s PTSD was caused by an independent post-service stressor event).

A presumption of service connection for PTSD in these situations would save the veteran and the VA the time, effort and expense of trying to uncover proof that the veteran experienced a combat-related event and medical evidence that such an event caused the veteran’s PTSD. With the large number of veterans returning from the wars in Iraq and Afghanistan with diagnoses or symptoms of PTSD, the COMBAT PTSD Act and a presumption of service connection will allow these veterans to receive VA disability benefits and health care much more quickly than they would otherwise.

VetsFirst Letter

April 27, 2009

The Honorable Bob Filner
Chairman, U.S. House Committee on Veterans Affairs
335 Cannon House Office Building
Washington, D.C. 20515

Re: Support for H.R. 952, The COMBAT PTSD Act of 2009

Dear Chairman Filner:

As a national veterans service organization, United Spinal Association and its veterans service program, VetsFirst, we wish to express our strong support for the Compensation Owed for Mental Health Based on Activities in Theater Post-traumatic Stress Disorder Act of 2009 (the COMBAT PTSD Act, H.R. 952). The passage and implementation of this legislation will dramatically improve the lives of in-country veterans of all eras who suffer from mental disabilities incurred as the result of their military service, as well as those of their loved ones.

Currently, VA regulations make it unduly burdensome for veterans without documentary evidence of combat service to prevail in claims for service connection for PTSD. Even with a confirmed diagnosis of PTSD and medical nexus evidence that such PTSD is the result of a stressor during military service, if there is no official documentation to corroborate a veteran’s assertion that he or she was involved in a combat situation, service connection will be denied. Without an award of service connection, veterans with PTSD remain ineligible for VA mental health care, as well as disability compensation and ancillary VA benefits.

The Act would amend 38 U.S.C. § 1154(b), which currently provides that in the case of a veteran “who engaged in combat with the enemy” the VA must accept as proof of service connection the veteran’s assertion of the incident(s) that resulted in the incurrence or aggravation of any disease or injury, provided that the asserted stressor is consistent with the “circumstances, conditions, or hardships of such service”. In such cases, the absence of official records to corroborate the incident(s) will not preclude an award of service connection. The problem has been the VA’s narrow construction of “engaged in combat with the enemy”. Under this construction, the VA requires that in order for a veteran to receive the benefit of the application of § 1154(b), there must be documentary evidence that the veteran was involved in a confrontation with hostile forces. Such evidence is generally in the form of a military occupational specialty or other designation that necessarily implies combat (e.g., infantryman), an award or decoration that signifies combat service (e.g., Combat Infantryman Badge, Combat Action Ribbon, Purple Heart or Bronze/Silver Star), or the statement of a buddy who served alongside the veteran in direct combat. Where a veteran who alleges a combat-related stressor cannot produce this kind of evidence, the VA invariably denies the application of § 1154(b) and, ultimately, the veteran’s claim for service connection for PTSD.

H.R. 952 would expand the definition of “combat with the enemy” to include active duty service in a theater of combat operations during a period of war. This legislation will help to break down often insurmountable barriers facing veterans who experienced combat circumstances, but who do not have a combat designation, decoration or corroboration from a buddy. Nevertheless, we believe that the expansion envisioned by H.R. 952 will not necessarily eliminate these barriers. The legislation needs to go further.

Section 1154(b) does not provide a presumption that a veteran is entitled to service connection for a disease or injury (including PTSD), even if the VA is required to concede that he or she had engaged in combat with the enemy. Rather, the U.S. Court of Appeals for Veterans Claims has interpreted § 1154(b) as providing a presumption of service incurrence. This means that the veteran must still provide medical evidence that his or her PTSD is etiologically related to his or her military service. See, e.g., Dalton v. Nicholson, 21 Vet.App. 23 (2006). Given the delay that may occur between the occurrence of a stressor and the onset of PTSD and the subjective nature of a person’s response to an event, it is often difficult to provide such medical nexus evidence. We therefore recommend the following in addition to the expansion of the term “combat with the enemy” contemplated by Section 2(a)(2) of the COMBAT PTSD Act:

(3) In the case of a veteran who has been diagnosed
with PTSD subsequent to active military service and who has
engaged in combat with the enemy as defined in sub-section (2)
above, a connection between PTSD and the veteran’s active
military service shall be presumed and may be rebutted only
by clear and convincing evidence to the contrary.

A presumption of service connection for PTSD in these situations will clearly benefit both veterans and the VA. According to a recent study by the RAND Corporation, the nation’s largest independent health policy research program, nearly 20 percent of military service members who have returned from Iraq and Afghanistan report symptoms of PTSD and related disorders. Claims for disability compensation and health care have already begun to flood the VA. Historically, the extensive delays associated with the adjudication of PTSD claims have been caused by the VA’s stringent evidence requirements. A presumption of service connection of PTSD for veterans who have a confirmed diagnosis and who served in combat zones would eliminate the need for tortuous searches on the part of both the VA and the veteran for stressor and medical nexus evidence. The VA would be freed from its statutory duty to assist veterans by scheduling Compensation and Pension Service examinations for nexus opinions as well. Consequently, PTSD claims would be adjudicated much more quickly and backlogs of these claims would dramatically decrease.

We thank you for your outstanding leadership on behalf of our nation’s veterans. United Spinal Association and VetsFirst stand ready to assist the Committee and Congress in any way in furtherance of our shared mission.

Sincerely,

Paul J. Tobin
President and CEO

(Washington, D.C., February 25) – United Spinal Association and its veterans services program, VetsFirst, in partnership with Vietnam Veterans of America introduced the Veterans Health Council at a press conference today at the National Press Club.

The Veterans Health Council hopes to improve veterans’ health by creating an ongoing educational forum for health care professionals, advocacy organizations, educational institutions, employee representatives, businesses, state and local governments and veterans themselves.

Approximately 80 percent of veterans do not use the Department of Veterans Affairs’ (VA) medical facilities for their health care. Many of these veterans are simply unaware that they may have health problems related to their military service that would entitle them to VA health care, as well as disability compensation and other VA benefits.

United Spinal Association President and CEO Paul J. Tobin said, “There has been a desperate need for the Veterans Health Council for a long time. Veterans must be informed about health risks related to their military service and the VA health care that is available to them.”

Tobin added, “We need to educate healthcare communities about the multiple health issues associated with military service, so that they can better identify, diagnose and treat at-risk veterans. We must also develop educational materials for medical schools, nursing schools, teaching hospitals and related entities along the same lines. Besides its educational functions, the Council will also advocate on behalf of healthcare initiatives for veterans.”

The Veterans Health Council is the first comprehensive collaboration between veteran’s service organizations, private sector businesses and nonprofits dedicated specifically to the welfare of veterans and their families.

The Veterans Health Council website provides information on health conditions associated with military service, links to healthcare websites related to specific diseases and general information about the VA claims process.

Veterans and other claimants for VA benefits can contact VetsFirst with questions about VA benefits, health care and to request representation from our accredited veterans service representatives by accessing the “Ask VetsFirst” service.

About United Spinal Association
United Spinal is a national 501(c)(3) non-profit membership organization formed in 1946 by paralyzed veterans and is dedicated to improving the quality of life for all Americans with spinal cord injuries, multiple sclerosis, spina bifida, ALS and post polio. We have played a significant role in writing the Americans with Disabilities Act, and other important legislation. For over 60 years we have provided vital and life enhancing services and assistance to disabled veterans and their families. Membership is free and is open to all individuals with spinal cord disorders.

VetsFirst, a program of United Spinal Association, is the embodiment of United Spinal’s veterans service program.

For more information contact:
Len Selfon
Senior Vice President
United Spinal Association VetsFirst
301-495-4460, Lselfon@unitedspinal.org

However, an article by Carl Glassman entitled “Healing the Wounds of War Downtown” reveals some interesting perspectives from veterans of Iraq, Afghanistan and Vietnam on the services that are available from the VA’s 232 commmunity-based Vet Centers nationwide.

While I have been known to be critical of the VA, Vet Centers deserve a lot of credit when they’re getting accolades like these from veterans who’ve been there. Well done.

Note: In the interest of full disclosure, I am doing a graduate social work internship at the Manhattan Vet Center, but I had nothing to do with Mr. Glassman’s article or any of the veterans who are quoted therein.

Paul J. Tobin
President, VetsFirst

PTSD is a debilitating anxiety disorder that is triggered by an extraordinarily stressful event (or “stressor”), such as combat, motor vehicle accidents and personal or sexual assaults. PTSD can become a life-long battle for not only the veteran, but his or her family and friends as well. Symptoms include uncontrolled anger, violent behavior, exaggerated startle response, flashbacks, hallucinations and blackouts. Service members and veterans with even moderate PTSD are often unable to work, go to school or have functional relationships with others. One of the scariest things about PTSD is that it can take months, years or even decades for symptoms to appear. While PTSD can be successfully treated, there is no known cure.

VA regulations require that in order to receive VA benefits for PTSD, a veteran must prove that the disorder is related to his or her military service. To prove service-connection for PTSD, there must be: (1) medical evidence of a current diagnosis of PTSD, (2) medical evidence that establishes a link between PTSD and a stressor during military service and (3) credible supporting evidence that the claimed stressor during service actually occurred.

If the veteran was in combat and the stressor is combat–related, the VA is required to accept his or her account of the in-service stressor as proof that the stressor occurred. If there is no evidence of combat, the veteran must produce military or other official documents that establish that the stressor occurred, even if the claimed stressor is combat-related.

Proving that a stressor occurred during service is often quite difficult, sometimes taking years for the VA and/or the veteran to find. Because of the backlog of pending VA PTSD claims, the VA decided to eliminate the requirement for veterans to produce credible supporting evidence of a stressor if they received a diagnosis of PTSD during service and the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service. In these cases, the veteran’s description of the stressor alone will now be sufficient to establish the occurrence of the claimed in-service stressor for benefits purposes.

Without having to produce documentary evidence of the stressor, veterans with diagnoses of PTSD during service will receive their VA claims decision much faster than under the old regulations.

The new VA regulation is currently in effect, however, the VA has invited the public to comment on the relaxed evidence requirements and can still change its policy. For now, the VA will apply the new burden of proof standard to all PTSD claims for service-connection that are pending as of October 28, 2008, or that are received afterwards. Veterans with diagnoses of PTSD during service whose claims were denied before that date will not receive automatic reconsideration. Rather, they must file a new claim and specifically request considerations under the new regulation,

The handbook is revised every year to reflect the most current VA benefits and health care programs and services, as well as the rates for certain benefits payments. The 2008 version of the handbook also contains a state-by-state listing of VA medical facilities, including locations and contact information, an overview of programs and services for veterans provided by other federal agencies and a list of related Internet websites.

Some of the programs discussed in the handbook include disability compensation for veterans with service-connected disabilities, VA health-care, burial benefits, home loan guaranties, special housing and automotive adaptations, educational assistance, training and vocational rehabilitation, income assistance pensions, life insurance and survivors’ benefits.

The handbook can be downloaded free from VA’s website at http://www.va.gov/OPA/vadocs/current_benefits.asp. Printed copies of the handbook may be ordered from the U.S. Government Printing Office (GPO). The GPO accepts credit card orders by calling 866-512-1800 (toll-free) for a cost of $5.00 per copy to U.S. addresses, or $67.00 for bulk orders of 25 copies. The handbook may also be ordered by mail from the GPO at Superintendent of Documents, P.O. Box 979050, St. Louis, MO 63197-9000 (stock number 051-000-00233-4), or on line at www.bookstore.gpo.gov.

“(IPS/GIN) – Two veterans groups sued the Department of Veterans Affairs Monday for alleged “shameful failures” to help veterans of the wars in Iraq and Afghanistan who suffer from post-traumatic stress disorder.

The lawsuit, which was filed by Veterans for Common Sense and Veterans United for Truth, seeks to be a nationwide class-action suit on behalf of an estimated 320,000 to 800,000 post-9/11 vets with post-traumatic stress disorder, which is commonly known as PTSD. The groups sued the department in federal court in San Francisco.

The VA’s motto, which was taken from Abraham Lincoln’s Gettysburg Address, is “to care for him who shall have borne the battle and for his widow and his orphan.”

Melissa Kasnitz, an attorney with Disability Rights Advocates, said that “instead of living up to this motto, the VA is abandoning disabled veterans and following a path that will lead to broken lives, homelessness and staggering social costs.” Kasnitz’s group is one of the organizations that prepared the lawsuit.”

Read the entire article at http://www.finalcall.com/artman/publish/article_3808.shtml 

June 11, 2007

Soldiers returning from the wars in Iraq and Afghanistan "are finding it more difficult" to receive mental health treatment because therapists say reimbursement rates for care are too low, the AP/Arizona Daily Star reports. According to the AP/Daily Star, about one-third of the 9.1 million people covered under the military health care system, called Tricare, seek mental health counseling in their first year after returning from war.

The following message is being sent in regards to a panel of medical experts urging the VA to gather data and provide reference materials to help disability raters better address the management of PTSD claims. The panel said the VA should base compensation decisions on how greatly PTSD affects all aspects of a veteran’s daily life, not just his or her ability to be gainfully employed.
Read the entire Military.com position