Sunday, April 23, 2006

PTSD Stressors due to Combat/non-Combat

Per 38 CFR 3.304(f), a finding of service connection for PTSD requires
· credible supporting evidence that the claimed in-service stressor
actually occurred
· medical evidence diagnosing the condition in accordance
with 38 CFR 4.125, and
· a link, established by medical evidence, between current symptomatology
and the claimed
in- service stressor.

Important: The lay testimony of a combat veteran alone may establish an in-service stressor for the purposes of establishing service connection for PTSD.
To establish service connection for PTSD the relationship between stressor and symptoms must be specifically addressed in the Department of Veterans Affairs (VA) examination report, and supported by documentation.

Stressor 1: Engaging in combat
Engaging in combat with the enemy means personal participation in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. It includes presence during such events either as a combatant, or service member performing duty in support of combatants, such as providing medical care to the wounded.

The VA can consider the receipt of any of the following individual decorations as evidence of exposure to combat-related stressors:
· Air Force Cross
· Air Medal with “V” Device
· Army Commendation Medal with “V” Device
· Bronze Star Medal with “V” Device
· Combat Action Badge
· Combat Action Ribbon (Note: Prior to February 1969, the Navy Achievement Medal with “V” Device was awarded.)
· Combat Aircrew Insignia
· Combat Infantry/Infantryman Badge
· Combat Medical Badge
· Distinguished Flying Cross
· Distinguished Service Cross
· Joint Service Commendation Medal with “V” Device
· Medal of Honor
· Navy Commendation Medal with “V” Device
· Navy Cross
· Purple Heart, and/or
· Silver Star.

Important: Receipt of a one of the decorations cited above is not the only acceptable evidence of engagement in combat.

Notes:
If a veteran received one of the decorations cited above, but does not expressly state the nature of the stressor
- assume that the stressor is combat-related
- order an examination, if necessary to decide the claim, and
- specify in the examination request which decoration(s) the veteran received.
Because the medals listed below may be awarded for either combat or non-combat service, their receipt does not necessarily confirm a veteran’s participation in combat. When in question, request documentation (using Personnel Information Exchange System (PIES) request code 019) showing justification for awarding the medal.
- Global War on Terrorism Expeditionary Medal
- Global War on Terrorism Service Medal
- Afghanistan Campaign Medal, andIraq Campaign Medal.

Credible supporting evidence that an in-service stressor actually occurred includes not only evidence that specifically documents the veteran’s personal participation in the event, but evidence that

· indicates the veteran served in the immediate area and at the particular time in which the stressful event is alleged to have occurred, and
· supports the description of the event.

Notes:
· Evaluate the evidence as a whole to determine whether a stressor is sufficiently corroborated. (See Moran v. Principi, 17 Vet. App. 149 (2003).)
· Corroborating evidence of a stressor is not restricted to service records, but may be obtained from other sources. (See Doran v. Brown, 6 Vet. App. 283 (1994).) The credible supporting evidence requirement does not necessarily demand the submission of official documentary evidence.

Corroboration of every detail, including the claimant’s personal participation in the claimed stressful event, is not required. The evidence may be sufficient if it implies a veteran’s personal exposure to the event.

Examples:
· When considered as a whole, evidence consisting of a morning report, radio log, and nomination for a Bronze Star may be sufficient to corroborate a veteran’s account of an event, even if it does not specifically include mention of the veteran’s name. (See Suozzi v. Brown, 10 Vet. App. 307 (1997).)Unit records documenting the veteran’s presence with a specific unit at the time mortar attacks occurred may be sufficient to corroborate a veteran’s statement that she/he experienced such attacks personally. (See Pentecost v. Principi, 16 Vet. App. 124 (2002).)

Stressor 2: Potential non-combat-related stressors

Potential non-combat-related stressors include, but are not limited to
· plane crash
· ship sinking
· explosion
· rape or assault
· duty
- on a burn ward
- in graves registration unit, or
- involving liberation of internment camps
· witnessing the death, injury, or threat to the physical being of another person not caused by the enemy actual or threatened death or serious injury, or other threat to one’s physical being, not caused by the enemy.

Primary evidence is generally considered the most reliable source for corroborating in-service stressors. It is typically obtained from the U.S. Army and Joint Services Records Research Center (JSRRC) (formerly the U.S. Armed Services Center for Unit Records Research (CURR)), the National Archives and Records Administration (NARA), or the Marine Corps University Archives (MCUA) and should be carefully reviewed for information confirming participation in combat or to otherwise corroborate a claimed in-service stressor. Primary evidence includes
· unit and organizational histories
· daily staff journals
· operational reports-lessons learned
· after action reports
· radio logs
· deck logs and ship histories
· muster rolls
· command chronology
· war diaries
· monthly summary, and morning reports.

Review the following alternative sources of evidence critically and carefully for information confirming participation in combat or to otherwise corroborate a claimed in-service stressor:

· military occupational specialty (MOS) evidence
(Note: A veteran’s MOS may be specified on his/her DD Form 214,
Certificate of Release or Discharge from Active Duty, or in the personnel folder.)
· hazard pay records
(Note: This information may be requested from the Department of Defense Finance and
Accounting Service (DFAS).)
· personnel folder (Note: This information may be requested via PIES.)
· service medical records
· performance reports (Note: This information may be requested via PIES.)
· buddy statements
· contemporaneous letters and diaries
· newspaper archives, and
· information from Veterans Benefits Administration (VBA)-sanctioned websites,
which may be accessed through the PTSD Rating Job Aid website.

Important: All sources of evidence obtained for purposes of stressor verification must be fully documented in the file.

A combat veteran’s lay testimony alone may establish an in-service stressor for purposes of establishing service connection for PTSD.

Evidence that does not qualify as credible supporting evidence of the occurrence of an in-service stressor as required by 38 CFR 3.304(f) includes

· a non-combat veteran’s testimony alone, and
· after-the-fact psychiatric analyses that infer the occurrence of a traumatic event.

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