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EVERYTHING YOU EVER WANTED TO KNOW ABOUT FILING
A CLAIM FOR PTSD -- Advice from Veterans'
Advocate
Jim Strickland.
Veterans' Advocate Jim Strickland
provides regular columns for
VA Watchdog dot Org.
If you would like to contact Jim about
his columns, you can email him here...
The archive of Jim's articles
is here...
---------------
My mailbox reflects what concerned Veterans are
thinking. Many of you write to me about PTSD and the Veterans Benefits
Administration. You’ve said there is a distinct, measurable difference
between the psychological impact of this war compared to America’s
previous battles.
Your prediction is that it’s much worse this time around and getting
worse each day. Your Congress is in denial, beating political drums and
mouthing empty promises in their constant reelection bids. Congress
continues to deny adequate funding to the Veterans Health Administration
and that sets this country up for tragedy.
Our Australian friends are reaching similar conclusions. A recent Sky
News Online article points out that the suicide rate, early discharge
for mental illness and diagnosed PTSD among Australian soldiers is
abnormally high.(1)
Post Traumatic Stress Disorder wasn’t a household phrase when I was
growing up as the son of a decorated Marine Corps Gunny. He didn’t talk
much about his wartime experience during his service at Iwo Jima, Tinian
or Korea. He spent 20 years on active duty and he dismissed most talk of
those days as just, “doing what I was paid to do”. Whether it was an
infamous Med cruise, going ashore at Libya, freezing in a tent in Korea
or in February of 1945, being a part of that bloodiest battle in the
Corps’ history, he shrugged it off. Today, this many decades later, he
still shrugs it off.
Why so little publicity of anything PTSD-like from WWII, why the
increase of symptoms during the Vietnam war and why the rapid escalation
of PTSD afflicted Vets today?
The answer isn’t hard. We’ve always had PTSD but it’s worn different
labels through different periods in time. There was “soldier’s heart”
during the Civil War, “shell shock” in WWI, “combat fatigue” and other
titles were given to those warriors when it was apparent their nerves
were shot or they demonstrated other signs of any number of
psychological issues. The PBS “Frontline” show that examined PTSD notes
that after their return home from battle, some men drank, some worked
two jobs, some partied too hard with drugs or got in trouble with the
law. It seemed men would do anything to avoid confronting the terror
that was their life then. In years past that drunken Veteran who
couldn’t support his family wasn’t suffering from PTSD, he was an
alcoholic.(2)
We know that the horror of war inflicts wounds that may be invisible to
a casual observer but as real as any limb amputated by an IED or a 7.62
GSW to the gut. Psychiatry and psychology are hard sciences in our
modern world. Scars and disabilities left by PTSD are measurable and as
treatable as an open wound infection would be.
Your Veterans Benefits Administration recognizes PTSD as a condition
worthy of an award of disability compensation. Unlike losing a leg or
taking a round to the belly, proving the degree of your PTSD to VBA will
be more challenging. The attitude in years gone by was that you should
suck it up and take it like a man; “You were a soldier, war is hell,
leave us alone”.
Today’s more enlightened thinking has tilted toward; “Your mental
condition is one that existed prior to your military service and
therefore does not deserve a service connection. By voluntarily joining
the military during a time of war, you provided evidence of your poor
mental health”.
You’re a Veteran, you’ve seen battle and today your existence is maybe a
little less than it should be. Maybe you’re at the other end of that
scale and your life has tumbled into the gutter.
Now what?
The Department of Veterans Affairs is there to help you. The VA offers a
wealth of information on-line about PTSD, current research projects and
numerous fact sheets for affected Vets, their families and health care
providers.(3) A simple Google search for “PTSD Veterans” brings almost a
million references up in a split second. Web sites abound providing
everything from highly technical jargon for the psychiatrist to pages
full of rants by dysfunctional Vets venting anger at a system that isn’t
responsive to their needs.
What’s the reality if you’re the affected Veteran? How do you get help
if you can’t work and earn a reasonable income because your PTSD
condition is causing you to function at less than what you otherwise
might be capable of?
Let’s start by agreeing that the system of benefits administered by the
BVA isn’t there to give everyone money. Ultimately, the goal is to
return you to society functioning at the highest level you’re capable of
considering your own abilities, the extent of your service related
conditions and your age. This means that in many instances, when you’re
awarded a benefit of disability compensation VBA anticipates that you
will likely show some degree of improvement with appropriate treatment.
Your journey with VBA begins like any other application for disability
benefits. You fill out the appropriate forms yourself or you seek
assistance from a state or county Veterans Service Officer near you. As
this is occurring, you should be building your record of treatments by
seeking out counseling at a local Veterans Center. There are 207
community based Vets’ Centers across America. You can find one on-line
or ask any VHA or VSO staffer how to get in touch. These centers offer
counseling and other resources to get you started in the right
direction.(4)
It’s important for a Vet suffering with PTSD to seek treatment. If you
expect to be awarded a monetary benefit from VBA, it’s equally important
that you begin to build your paper trail of required evidence to present
in support of your claim. There is but one certainty when applying for
your PTSD disability benefit, VBA isn’t just going to take your word for
it. This condition isn’t as clear cut as that below the elbow amputation
and you have a lot of explaining to do before anyone writes you a check.
How is PTSD determined? The VBA and their examiner (at a Compensation &
Pension exam) will use strict criteria from the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, of the American
Psychiatric Association (DSM-IV). It’s listed in the Code of Federal
Regulations [Title 38, Volume 1] Sec. 4.130 Schedule of ratings--mental
disorders, Anxiety Disorders as “9411 Post-traumatic stress
disorder”.(5)
To determine that your symptoms are truly PTSD and service connected the
VA tells you; “A determination of service-connected disability for PTSD
is made by the Compensation and Pension Service, an arm of VA’s Veterans
Benefits Administration. The clinicians who provide care for veterans in
VA’s specialized PTSD clinics and Vet Centers do not make this decision.
A formal request (claim) must be filed by the veteran using forms
provided by the VA’s Veterans Benefits Administration. After all the
forms are submitted, the veteran must complete interviews concerning her
or his social history (a review of family, work, and educational
experiences before, during, and after military service) and psychiatric
status (a review of past and current psychological symptoms and of
traumatic experiences during military service).”(6)
From a recent VBA “Fast Letter” addressing some subtle direction in how
to rate a Veteran when awarding a monetery benefit for PTSD: (are mine)
--------------------------------------------
Effects of PTSD on Occupational and Social Functioning; Evaluation of
PTSD is based on its effects on occupational and social functioning.
Select the appropriate assessment of the veteran from the choices below:
Total occupational and social impairment due to PTSD signs and symptoms.
(100% rating)
Provide examples and pertinent symptoms, including those already
reported.
OR
PTSD signs and symptoms result in deficiencies in most of the following
areas: work, school, family relations, judgment, thinking, and mood.
(70% rating)
Provide examples and pertinent symptoms, including those already
reported for each affected area.
OR
There is reduced reliability and productivity due to PTSD signs and
symptoms. (50% rating)
Provide examples and pertinent symptoms, including those already
reported.
OR
There is occasional decrease in work efficiency or there are
intermittent periods of inability to perform occupational tasks due to
signs and symptoms, but generally satisfactory functioning (40% rating).
Provide examples and pertinent symptoms, including those already
reported.
OR
There are PTSD signs and symptoms that are transient or mild and
decrease work efficiency and ability to perform occupational tasks only
during periods of significant stress. (30% rating)
Provide examples and pertinent symptoms, including those already
reported.
OR
PTSD symptoms require continuous medication (?% rating)
OR
Select all that apply:
PTSD symptoms are not severe enough to require continuous medication.
(0% rating)
--------------------------------------------
Applying for a PTSD award sounds daunting enough that if you’re
afflicted by symptoms, unsure of yourself and unable to hold steady work
or interact with others normally, getting through this process will be
impossible.
To the contrary, winning a deserved benefits award is much like any
other benefits application where there may be reasonable doubt. If you
play by the rules, jump through all the hoops and keep at it, if you
suffer from service connected PTSD, you’ll get an award of benefits
based on the severity of your condition.
So, in practical terms what does all that mean?
You have to establish your record. Similar to all other benefits awards,
a PTSD rating isn’t going to be handed to you because you think you
deserve it or you need the money. To establish a record you have to seek
treatment. One of the best options are the Vet Centers mentioned
earlier. Many of these centers are run by combat experienced Vets and
you’ll meet many others there who share experiences with you. A lot of
the people you meet can also tell you how they won their award and how
they cope with their condition.
If you’re offered care by a mental health team at your VHA facility,
take it. Keep your appointments, get prescriptions filled or refilled on
a timely basis. Go to group sessions when they’re offered to you.
Turning down care and treatment may be seen as a sign that you don’t
think you need treatment. It’s not much of a reach from there to see
that VBA will apply that reasoning to your benefits application and
determine you aren’t eligible for a monetary award.
If your application for benefits is denied or if the award isn’t as much
as you know it should be, appeal. In that denial letter VBA will tell
you exactly why they chose to deny your plea for benefits. If you’re
able to quickly respond with your Notice of Disagreement (NOD) and
correct their error with new and material evidence, supporting
statements and other similar documentation of your condition, you may be
awarded your earned benefit with all retroactive benefits paid to you.
Once you have earned that award for PTSD and you’re satisfied that it’s
in the correct range of percentage, it becomes your job to keep it
there.
PTSD is a condition that has been determined to demonstrate improvement
with time and treatment. We agreed earlier the system of benefits
administered by the VBA isn’t there to give everyone who asks for it
some money. The system is designed to provide you with treatment to lead
a normal life. If you lose a limb, you receive a prosthesis and are
taught the skills to use it and get on with your life. PTSD should bring
treatment and improvement.
After your PTSD service connection is ceded and adjudicated, you’re
likely to see an award letter that says, “Future examinations are
scheduled in (x) months.” That means your benefits are temporary and
upon reexamination you must demonstrate to VBA that the severity of your
condition is the same or has worsened.
If you get your award, collect all that back pay and then settle back
thinking your task is complete, you’re very wrong. When you open your
mail a year or two later and your notice for reexamination is there, you
must be prepared with a medical and mental health record that accurately
reflects what you’ve done since you were last examined. If you took the
money and forgot about those weekly group sessions and skipped your
clinic appointments, you have a problem.
If you want to keep that benefit, you must play by the book. As before,
even after you’ve won that award you have to keep your appointments,
take the prescribed meds and so on. If you do the right thing and stay
on top of it, when the reexam letter comes, you’ll feel confident that
it’s just another hoop but no big deal. You won’t have to write me in a
panic asking what to do when it’s way too late.
As I wrote this article and researched PTSD and some of the recent buzz
about what’s happening in our world today, I made a contact who provided
me with some new ideas. We met almost by accident via the Internet, a
more common happening every day. I’d enjoy sharing some of her thoughts
with you.
Alivia Tagliaferri was a history major in college. Today she’s an
aspiring author and entrepreneur and recently published her first
fictional work, a novel called “Still The Monkey”. The book tells the
story of a Vietnam Vet and how he came to know a young Veteran of our
current conflicts who had lost both legs in Iraq. The issue of PTSD (The
Monkey) and the impact on their lives is front and center and makes for
a good read, even if often shockingly brutal and true to life.
I was curious how she had learned so much about us and even more to the
point, I was fascinated with the degree of historical accuracy she
provides. I’m not known to be particularly shy so I contacted her and we
talked. We talked longer and in more depth than I could have imagined.
She’s a civilian with scant connection to anything military but it was
quickly apparent that she gets it.
Her journey into our world began with a project at Walter Reed. Stunned
at what she saw there, real people, real wounds...not just words in a
newspaper...she began to work to understand.
In our talks Alivia has pointed out to me that PTSD may be worse today
than in the Vietnam era or before because this war has no respite, no
safe havens ever for a soldier to stand down. Bob Hope isn’t visiting
with a USO review. John Wayne isn’t filming the Green Berets. Soldiers
aren’t languishing in ports aboard ships for weeks or months waiting to
go somewhere.
There are no songs about a Boogie Woogie Bugle Boy, Praise The Lord and
Pass The Ammunition or even the G.I. Jive. Frank Capra isn’t making
films celebrating victories. Many soldiers are on their second, third or
even fourth tours and the stress of being home and preparing to go back
is now being looked upon as being as bad as the stress of being there.
Aliva has started to research and write of the reality of dealing with
PTSD and has set about interviewing VHA officials and Veterans and
families of Veterans. She’s written and is writing more about what a
family or friend can do to ease the battle fatigued Vet back into his or
her rightful place in our society.
From her recent non-fiction work;
What are the 5 most important things friends, families, and loved ones
of returning veterans can do to best provide support?
1) Respect the veteran’s right to control his or her own recovery.
2) Keep track of symptoms and of the veterans’ chosen treatment path.
3) Allow Room for CHANGE.
4) Drop ‘Proper Behavior’ Expectations.
5) Be Open and Respectful of Expressing your Perspective.
What are the 5 most important things NOT to do when a loved one returns
home from combat?
1) Don’t say “I understand.”
2) Don’t force socialization or push too hard.
3) Never say “It’s over now, time to move on.”
4) Don’t ask about the act of killing, or the witnessing of an event in
which there were KIA’s.
5) Don’t emphasize that the veteran is acting or talking strangely.
Alivia addresses each point above in detail enough to enable a family to
help guide a Veteran to recovery. She also addresses a number of issues
(Keep a daily diary of the Veteran’s activities for reexamination use)
that will help you understand how to win that award and keep it once you
have it.
And, with a little luck, a lot of treatment, more funding for research,
and people as dedicated to our cause as Alivia is, maybe we’ll meet that
goal of the VBA and see some Permanent and Total healing along the way.
You may contact Alivia at her email address
view her web site here
www.ironcuttermedia.com , and
alivia@ironcuttermedia.com
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1.
http://www.skynews.com.au/story.asp?id=166676
2.
http://www.pbs.org/wgbh/pages/frontline/
shows/heart/themes/shellshock.html
3.
http://www.ncptsd.va.gov/ncmain/index.jsp
4.
http://www.vetcenter.va.gov/
5.
http://a257.g.akamaitech.net/7/257/
2422/12feb20041500/edocket.access.
gpo.gov/cfr_2004/julqtr/38cfr4.130.htm
6.
http://www.ncptsd.va.gov/ncmain/
ncdocs/fact_shts/fs_help_for_vets.html
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Larry Scott --
