crew v. army: re: ptsd diagnoses: 10/16/08 - vet affairs

8/7/2019 CREW v. Army: Re: PTSD Diagnoses: 10/16/08 - Vet Affairs

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DEPARTMENT OF VETERANS AFFAIRSVeterans Benefits Administration

Washington, D.C. 20420

Ms. Anne L. WeismannChief CounselCitizens for Responsibility and Ethics in Washington (CREW)1400 Eye Street, NW, Suite 450Washington, DC 20005

Dear Ms. Weismann:

This is in response to the appeal you filed requesting information under the Freedom o fInformation Act (FOIA), 5 U.S.c. 552.

WHAT YOU REQUESTED

In your clarified request you asked for records that are relevant to the extent to which theDepartment of Veterans' Affairs (VA) instructs or encourages doctors and other healthprofessionals involved in evaluating, assisting or reviewing claims of veterans seekingcompensation from VA to refrain from making or supporting a diagnosis of posttraumatic stress disorder (PTSD).

WHAT WE PROVIDED

We are providing the following concerning claims for PTSD:

Fast Letter 07-08, Revised Initial Post Traumatic Stress Disorder and ReviewPost Traumatic Disability Examination Worksheets; Fast Letter 08-08, Additional guidance on Post Traumatic Stress Disorder; Interim Development Text for Requesting Unit History Records Fast Letter 01-05, Relationship of PTSD or Stress to Cardiovascular

Disorders; Fast Letter 02-16, Revised Mental Disorders, Eating Disorders, Initial PTSD,

and Review PTSD Worksheets; and Fast Letter 05-08, Handling PTSD Claims Based on Stressors Experienced

During Service in the Marine Corps.


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Anne L. Weismann

IF YOU HAVE QUESTIONS

Please direct any questions you might have to General Counsel, Depar tmento f

VeteransAffairs, 810 Vermont Avenue, N.W., Washington DC 20420.

Sincerely,

Enclosures

cc: 20M35


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March 29, 2007 In Reply Refer To: 2110Fast Letter 07-08

Director (00/21)All VA Regional Offices and Centers

SUBJECT: Revised Initial Post Traumatic Stress Disorder and Review PostTraumatic Stress Disorder Disability Examination Worksheets

1. Revised disability examination worksheets for an Initial Evaluation of PostTraumatic Stress Disorder (PTSD) and a Review Examination fo r PTSDhave been released to VA medical centers for use by examiners.

2. These worksheets are changed in the following significant ways: They list the credentials of examiners that VB A and VH A recently

agreed can perform these types of examinations. The Initial PTSD examination no longer requires the examiner to

describe specific details of the stressor for confirmation purposes.Confirmation of the stressor must be done prior to scheduling theexamination, except in the case of claims for PTSD based onpersonal trauma.

The examiner performing the Initial PTSD examination must identifywhether the current symptoms are linked to the identified stressoror stressors.

On both types of examination, the examiner is expected to selectthe appropriate assessment of the veteran from the list providedand support the assessment with examples.

3. If you have any questions about this letter or enclosure, please contactVicki Milton, M.D., at (202) 273-9646 or bye-mail.

lSIBradley G. Mayes, DirectorCompensation & Pension Service


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April 7, 2008

Director (00/21)All VA Regional Offices and Centers Fast Letter 08-08

SUBJECT: Additional Guidance on Post Traumatic Stress Disorder (PTSD)

This letter provides guidance on:

Development for in-service mental health treatment records

In-service initial diagnosisof

PTSD Rating mental disorders that led to release from service Corroboration of in-service stressors based on combat Corroboration of in-service stressors not based on combat Stressor development follow-up Formal finding of insufficient stressor information Revised initial PTSD VA examination worksheet PTSD and individual unemployability (ill)

Development for In-Service Mental Health Treatment Records

The Department of Defense does not maintain in-service mental health treatment recordswith traditional service treatment records (STRs). The military or civilian treatingfacility maintains those mental health records. The records are typically destroyed afterfive years from the end of the year in which the case is closed (see M21-1MR,III.ii i.2.A.l.a). Unlike clinical records from military hospitals, civilian facility recordscannot be ordered from the National Personnel Records Center (NPRC) through thePersonnel Information Exchange System (PIES).

If a review of the claims folder indicates that the veteran underwent in-service mentalhealth treatment at a civilian mental health facility, request the veteran complete a VA

Form 21-4142, Authorization and Consent to Release Information. Upon receipt of acompleted VA Form 21-4142, develop for those records. Cease development if aresponse indicates that the records have been destroyed. If a response is receivedindicating that the records were transferred to another location, develop for these records


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from the location identified. Continue development until receiving the records or a

negative response. If the records are not available, prepare a formal finding of recordunavailability (see M21-1MR, III.iii.2.I.59).

In-Service Initial Diagnosis of PTSD

Military and civilian heal th care providers have a heightened awareness of the symptomsof PTSD and responsiveness to service personnel participating in the Global War onTerror (GWOT). As a result, health professionals are diagnosing and treating PTSD withgreater frequency. The initial diagnosis ofPTSD generally occurs after service, in whichcase service connection for this disability is considered under the provision of 38 CFR3.304(f). This provision requires "credible supporting evidence that the claimed in

service stressor occurred." Nevertheless, 38 CFR 3.303(a) contains provisions forestablishing service connection for a disability or disease incurred in service. Thisincurrence "may be accomplished by affirmatively showing inception or aggravationduring service." Therefore, when there is a prima facie diagnosis ofPTSD by a mentalhealth professional in service, verification of the stressor, whether in-service or preservice, is not required. (See Fast Letter 99-85, Service Connection fo r Post TraumaticStress Disorder (PTSD) Diagnosed In-Service, August 26, 1999, for a discussion of preservice stressors.) With an in-service initial diagnosis ofPTSD, accept any reasonablein-service stressor as long as it appears consistent with the circumstances of that veteran'sparticular service. If the VA examination and other evidence of record supports thedecision, grant service connection on a direct basis in accordance with 38 CFR 3.303(a).

Rating Mental Disorders That Led to Release From Service

Regional office decision makers must pay special attention to 38 CFR 4.129, MentalDisorders Due to Traumatic Stress, because of the exposure of many service persons tohighly stressful events, particularly while serving in Iraq and Afghanistan. 38 CFR 4.129states that an immediate evaluation of not less than 50 percent shall be assigned to aveteran who, because of a highly stressful event in service, develops a mental disorderthat results in release from service. Generally, these veterans have been determined asunfit for duty based on their mental disorder by the Medical Evaluation BoardfPhysicalEvaluation Board (MEB/PEB) process. In addition, 38 CFR 4.129 states that VA willschedule a medical examination within six months of discharge to determine if a changein this evaluation is warranted.

Maintain the initial evaluation until evidence from the examination provides the basis forreconsideration. [f evidence from the medical examination warrants an increasedevaluation, the effective date will be the date of the examination that supports the


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increase. An earlier effective date may be established based on additional evidence that

factually ascertains an increase in disability, per 38 CFR 30400(0)(2). If a reduction inevaluation is warranted based on the results of a medical examination, follow the dueprocess procedures outlined in 38 CFR 3.105(e). However, a reduction in evaluation maybe given without due process provided the veteran 's overall or combined evaluation isnot changed (see Stelzel v. Mansfield, November 15,2007).

Corroboration of In-Service Stressors Based on Combat

Once a veteran has identified a combat stressor in claims for PTSD diagnosed afterseparation from military service, it is the responsibility of the decision maker todetermine whether the veteran participated in combat or ifthere is sufficient credible

supporting evidence to establish that the stressor occurred. In the absence of one of thedecorations identified in M21-1MR, III.ivo4.H.29.c, the decision maker can stilldetermine that the veteran participated in combat i f the evidence supports thatdetermination (see VAOPGCPREC 12-99). Ifit is determined that the veteran wasengaged in combat, the veteran's testimony is usually sufficient to establish that the inservice stressor occurred (see 38 V.S.c. 1154(b) and 38 CFR 3.304(f)(1)). Corroborationof the claimed stressor is not necessary when credible supporting evidence shows combatparticipation and the stressor is based on combat.

Corroboration of In-Service Stressors Not Based on Combat

When combat participation cannot be confirmed, or when the claimed stressor is notrelated to combat, request credible supporting evidence. The claimed stressors may notbe limited to one episode. A group of experiences may also affect an individual and leadto the development ofPTSD (see M21-1MR, III.ivo4.H.32.a). I t is important toremember that the s.ufficiency ofthe stressor(s) to cause PTSD is a medical and not arating determination (see Cohen v. Brown 94-661).

For veterans discharged within the last five years, develop for the unit history from theveteran's former unit when we have received an adequate response to the PTSDdevelopment questionnaire (VA Form 21-0781, Statement in Support o f Claim fo r ServiceConnection fo r Post-Traumatic Stress Disorder) and there is insufficient credible

supporting evidence to concede that the claimed stressor(s) occurred. If necessary,contact the veteran for the unit's address.

If the veteran was discharged more than five years ago and a complete unit of assignmentduring the stressful event is available, corroborate the stressor using the C&P ServiceIntranet Stressor Verification site, official military websites, or other government


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websites. After exhausting all other resources, send a request to the Joint Services

Records Research Center (JSRRC). Until we update Modem Awards ProcessingDevelopment (MAP-D), please use the enclosed suggested text to solicit informationfrom the veteran' s unit. You may use the third party letter in MAP-D titled "Requestreport of accident investigation" in the interim, and paste the attached language to thebody of the letter in order to establish a tracked item.

Stressor Development Follow-Up

In the absence of individual decorations indicating personal participation in combat, theveteran must provide sufficient information about the stressful event to research it.Currently, i f the veteran fails to respond to the request within 60 days, VA must send a

second development letter requesting the information, allowing an additional 30 days fora response (see M2l-lMR, IV.ii.1.D.15.n). However, we have determined that the30-day follow-up request to the veteran is not necessary i f the veteran completely fails torespond to the initial request. A follow-up request must be made i f the veteran respondsbut the response lacks sufficient information to conduct a meaningful search. Themanual will be updated to reflect this change. Those stations still contacting the veteranand allowing an additional 10 days to respond to our request for stressor information (asoutlined in the former M2l- l , Part III, 5.14(c)(5)) may also cease this practice.

Formal Finding of Insufficient Stressor Information

If the veteran fails to respond to any initial or follow-up request for stressor informationor submits information that is still insufficient, refer the case to the JSRRC Coordinator.The JSRRC Coordinator will make a formal finding regarding the lack of sufficientinformation in the claims folder to document the occurrence of, and the veteran'sinvolvement in, the stressful event(s). The JSRRC Coordinator must review the claimsfolder to confirm the veteran was properly notified of the information required todocument the stressor(s), and that all relevant evidence, to include service records, havebeen considered in an attempt to confirm the occurrence of the stressful event(s) (seeM2l-1MR, Part IV, ii.1.D.16.a). The formal finding should be on a separate page, filedin the claims folder, and include all the requirements listed in M2l-lMR, Part IV,ii.1.D.16.b.

Revised Initial PTSD VA Examination Worksheet

The revised Initial PTSD Examination worksheet does not require the examiner todescribe specific details of the stressor for VA to confirm that it occurred. However, theexaminer must still opine whether the current symptoms are linked to the identifiedstressor or stressors (see FL 07-08, Revis ed Initial Post Traumatic Stress


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Disorder and Review Post Traumatic Stress Disorder Disability Examination

Worksheets, dated March 29,2007). Confirmation of the stressor must be completedprior to the examination request, except for PTSD claims based on personal trauma orin-service diagnosis. The verified stressor must be stated in the Remarks section of theexamination worksheet. If the veteran has not identified a specific stressor in his or herclaim, but combat participation is conceded because of the receipt of one or moredecorations listed in M2l-1MR, Part III, iv.4.H.29.c, include a statement in the Remarkssection of the examination worksheet indicating that the veteran has verified combataction.

PTSD and Individual Unemployability (IU)

The information contained in this Fast Letter rescinds Training Letter (TL) 01-01, J 0Important rating points about PTSD, dated January 8, 2001. A 100-percent schedularevaluation must be fully supported by current evidence showing the veteran has totaloccupational and social impairment solely due to the service-connected PTSD. If theveteran does not meet this criterion, but claims to be unable to work due to the effects ofservice-connected PTSD, assign the appropriate schedular evaluation for PTSD andconsider possible entitlement to ill .

Questions

Questions about this letter should be e-mailed to VAVBAW AS/C0/2l2A.

/ s /

Bradley G. Mayes,DirectorCompensation and Pension Service

Enclosure: Interim Development Text for Requesting Unit History Records


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Interim Development Text for Requesting Unit History Records

Dear SirlMadam:

This is a request for research of records in your possession with the purpose of verifyinga stressful event claimed by a veteran who previously served in your unit. This veteran isseeking benefits from the Department of Veterans Affairs (VA), and we need yourassistance to support his/her claim.

The veteran's name and information pertaining to the claimed stressful event(s) is shownbelow.

Name of Claimant:

Social Security Number:

Claimed Stressor(s):

Approximate date and location where the event took place:

Unit of assignment at the time the stressful event occurred:

Please provide any information (e.g.; photocopies of pages from relevant unit histories,documents showing veteran's location at the time an incident occurred, etc.) that pertainsto the claimed stressor(s). We would appreciate a response within 60 days. Ifnoinformation is found, please provide a negative response.

This letter is being sent in duplicate so that you may retain a copy. Attach one copy ofour letter to your reply so we may associate it with the proper claim. Please return yourinformation to the address shown at the top of this letter. A self-addressed envelope isenclosed [or your convenience.

Note: We can't pay any fees for this information.


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July 11,2002In Reply Refer To: 211 A

Director (00/210 Fast Letter 02-16All VA Regional Offices and Centers

SUBJ: Revised Mental Disorders, Eating Disorders, Initial PTSD, and Review PTSDworksheets

1. Enclosed are copies of the revised Mental Disorders, Eating Disorders, Initial PTSD, andReview PTSD disability examination worksheets. They are effective immediately. Therevised worksheets have been sent for programming into the VHA computer system, andwe will inform you when a new patch has been developed and released to VA medicalfacilities. Until then, you should send a copy of the worksheet by fax or e-mail to themedical facility when requesting one of these examinations.

2. This revision consists of a replacement of the former paragraph titled "Competency"ineach of these four worksheets. The substitute paragraph is titled "Capacity to ManageFinancial Affairs". The revision was made to conform to legal requirements.

3. If you have any questions about this fast letter, please contact the person named on theCalendar page for this date at http://vbaw.vba.va.govlbl/21/calendar/index.htm.

4. This letter rescinds on July 20, 2003.

lSI

Ronald J. Henke, DirectorCompensation and Pension Service

Enclosure


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Compensation and Pension Examination

INITIAL EVALUATION FO R POST-TRAUMATIC STRESS DISORDER (PTSD)# 091 0 Workshee t

Name: SSN:

Date of Exam: _ C-number:

Placeof

Exam: _

A. Identifying Information

- age- ethnic background- era of military service- reason for referral (original exam to establish PTSD diagnosis and

related psychosocial impairment; re-evaluation of status of existingservice-connected PTSD condition)

B. Sources ofInformation

* records reviewed (C-file, 00-214, medical records, other documentation)* review of social-industrial survey completed by social worker* statements from collaterals* administration of psychometric tests and questionnaires (identify here)

C. Review of Medical Records:I. Past Medical History:

a. Previous hospitalizations and outpatient care.b. Complete medical history is required, including history since discharge

from military service.c. Review of Claims Folder is required on initial exams to establish or

rule out the diagnosis.

2. Present Medical History - over the past one year.

a. Frequency, severity and duration of medical and psychiatric symptoms.b. Length of remissions, to include capacity for adjustment during periods

of remissions.

o. Examination (Objective Findings):Address each of the following and fully describe:

History (Subjective Complaints):Comment on:

Preliminary History (refer to social-industrial survey if completed)

* describe family structure and environment where raised (identifyconstellation of family members and quality of relationships)

* quality of peer relationships and social adjustment (e.g., activities.achievements, athletic and/or extracurricular involvements, sexualinvolvement, etc.)

* education obtained and performance in school


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* employment* legal infractions* delinquency or behavior conduct disturbances* substance use patterns* significant medical problems and treatments obtained* family psychiatric history* exposure to traumatic stressors (see CAPS trauma assessment checklist)* summary assessment of psychosocial adjustment and progression through

developmental milestones (performance in employment or schooling,

routine responsibilities of self-care, family role functioning,physical health, social/interpersonal relationship, recreation/leisurepursuits).

Military History

* branch of service (enlisted or drafted)* dates of service* dates and location of war zone duty and number of months stationed

In war zone* Military Occupational Specialty (describe nature and duration ofjob(s)

In war zone* highest rank obtained during service (rank at discharge if different)*

typeof

discharge from military* describe routine combat stressors veterans was exposed to(refer to Combat Scale)* combat wounds sustained (describe)* CLEARLY DESCRIBE SPECIFIC STRESSOR EVENT(S) VETERAN CONSIDERED

PARTICULARLY TRAUMATIC.Clearly describe the stressor. Particularly if the stressor is a typeof personal assault, including sexual assault, provide information,with examples, if possible.

* indicate overall level of traumatic stress exposure(high, moderate, low) based on frequency and severity of incidentexposure

* citations or medals received*

disciplinary infractions or other adjustment problems during military

NOTE: Service connection for post-traumatic stress disorder (PTSD) requiresmedical evidence establishing a diagnosis of the condition that conformsto the diagnostic criteria ofDSM-IV, credible supporting evidence thatthe claimed in-service stressor actually occurred, and a link, established bymedical evidence, between current symptomatology and the claimed in-servicestressor. It is the responsibility of the examiner to indicate the traumaticstressor leading to PTSD, ifhe or she makes the diagnosis ofPTSD.

Crucial in this description are specific details of the stressor, with names,dates, and places linked to the stressor, so that the rating specialist can

confirm that the cited stressor occurred during active duty.

A diagnosis of PTSD cannot be adequately documented or ruled out withoutobtaining a detailed military history and reviewing the claims folder.This means that initial review of the folder prior to examination, the historyand examination itself, and the dictation for an examination initiallyestablishing PTSD will often require more time than for examinations of otherdisorders. Ninet y minutes to two hours on an initial exam is normal.

Post-Military Trauma History (refer to social-industrial survey if completed)


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* describe post-military traumatic events (see CAPS trauma assessmentchecklist)

* describe psychosocial consequences o f post-military trauma exposure(s)(treatment received, disruption to work, adverse health consequences)

Post-Military Psychosocial Adjustment (refer to social-industrial surveyif completed)

* legal history (DWIs, arrests, time spent in jail)*

educational accomplishment* employment history (describe periods of employment and reasons)* marital and family relationships (including quality o f relationships with

children)* degree and quality of social relationships* activities and leisure pursuits* problematic substance abuse (lifetime and current)* significant medical disorders (resulting pain or disability; current

medications)* treatment history for significant medical conditions, including

hospitalizations* history o f inpatient and/or outpatient psychiatric care (dates and

conditions treated)* history o f assaultiveness* history o f suicide attempts* summary statement of current psychosocial functional status (performance

in employment or schooling, routine responsibilities of self care,family role functioning, physical health, social/interpersonalrelationships, recreation/leisure pursuits)

E. Mental Status Examination

Conduct a BRIEF mental status examination aimed at screening for DSM-IVmental disorders. Describe and fully explain the existence, frequency andextent o f the following signs and symptoms, or any others present, andrelate how they interfere with employment and social functioning:

* Impairment o f thought process or communication.* Delusions, hallucinations and their persistence.* Eye Contact, interaction in session, and inappropriate behavior cited

with examples.* Suicidal or homicidal thoughts, ideations or plans or intent.* Ability to maintain minimal personal hygiene and other basic activities

of daily living.* Orientation to person, place, and time.* Memory loss, or impaimlent (both short and long-term).* Obsessive or ritualistic behavior which interferes with routine activities

and describe any found.* Rate and flow o f speech and note any irrelevant, illogical, or obscure

speech patterns and whether constant or intermittent.* Panic attacks noting the severity, duration, frequency, and effect on

independent functioning and whether clinically observed or good evidenceo f prior clinical or equivalent observation is shown.

* Depression, depressed mood or anxiety.* Impaired impulse control and its effect on motivation or mood.* Sleep impairment and describe extent it interferes with daytime activities.* Other disorders or symptoms and the extent they interfere with activities,

particularly:


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- mood disorders (especially major depression and dysthymia)- substance use disorders (especially alcohol use disorders)- anxiety disorders (especially panic disorder, obsessive-compulsive

disorder, generalized anxiety disorder)- somatoform disorder- personality disorders (especially antisocial personality disorder

and borderline personality disorder)

Specify onset and durationof

symptoms as acute, chronic, or with delayed onset.F. Assessment of PTSD

* state whether or not the veteran meets the DSM-IV stressor criterion* identify behavioral, cognitive, social, affective, or somatic change

veteran attributes to stress exposure* describe specific PTSD symptoms present (symptoms of trauma

re-experiencing, avoidance/numbing, heightened physiological arousal,and associated features [e.g., disillusionment and demoralization])

* specify onset, duration, typical frequency, and severity of symptoms

G. Psychometric Testing Results

* provide psychological testing if deemed necessary.* provide specific evaluation information required by the rating board or

on a BVA Remand.* comment on validity of psychological test results* provide scores for PTSD psychometric assessments administered* state whether PTSD psychometric measures are consistent or inconsistent

with a diagnosis ofPTSD, based on normative data and established"cutting scores" (cutting scores that are consistent with or supportiveof a PTSD diagnosis are as follows: PC L - not less than 50;Mississippi Scale - not less than 107; MMPI PTSD subscale a scoregreater than 28; MMPI code type: 2-8 or 2-7-8)

* state degree of severity of PTSD symptoms based on psychometric data(mild, moderate, or severe)

* describe findings from psychological tests measuring other thanPTSD (MMPI, etc.)

H. Diagnosis:

I. The Diagnosis must conform to DSM-IV and be supported by the findingson the examination report.

2. If there are multiple mental disorders, delineate to the extent possiblethe symptoms associated with each and a discussion of relationship.

3. Evaluation is based on the effects of the signs and symptoms onoccupational and social functioning.

NOTE: VA is prohibi ted by statute, 38 U.S.c. 1110, from paying compensationfor a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.However, when a veteran's alcohol or drug abuse disability is secondary toor is caused or aggravated by a primary service-connected disorder, theveteran may be entitled to compensation. See Allen v. Principi, 237 F.3d1368,1381 (Fed. Cir. 2001). Therefore, it is important to determine therelationship, if any, between a service-connected disorder and a disabilityresulting from the veteran's alcohol or drug abuse. Unless alcohol or drugabuse is secondary to or is caused or aggravated by another mental disorder,


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you should separate, to the extent possible, the effects of the alcohol ordrug abuse from the effects of the other mental disorder(s). Ifit is notpossible to separate the effects in such cases, please explain why.

1. Diagnostic Status

Axis I disordersAxis II disordersAxis III disordersAxis IV (psychosocial and environmental problems)Axis V (GAF score - current)

J. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be requiredby BV A REMAND or specifically requested by the rating specialist. If so,include the GAF score and note whether it refers to current functioning.A BV A REMAND may also request, in addition to an overall GAF score,that a separate GAF score be provided for each mental disorder present whenthere are multiple Axis I or Axis II diagnoses and not all are serviceconnected. If separate GAF scores can be given, an explanation anddiscussion of the rationale is needed. If it is not possible, an explanationas to why not is needed. (See the above note pertaining to alcohol or drugabuse.)

K. Capacity to Manage Financial Affairs

Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VAbenefit payments in his or her own best interest, and not to any other subject. Mental incompetency, forVA benefits purposes, means that the veteran, because of injury or disease, is not capable of managingbenefit payments in his or her best interest. In order to assist raters in making a legal detennination as tocompetency, please address the following:

What is the impact of injury or disease on the veteran's ability to manage his or her financialaffairs, including consideration of such things as knowing the amount of his or her VA benefitpayment, knowing the amounts and types of bills owed monthly, and handling the paymentprudently? Does the veteran handle the money and pay the bills himself or herself?

Based on your examination, do you believe that the veteran is capable of managing his or herfinancial affairs? Please provide examples to support your conclusion.

If you believe a Social Work Service assessment is needed before you can give your opinion onthe veteran's ability to manage his or her financial affairs, please explain why.

L. Other Opinion:

Furnish any other specific opinion requested by the ratingboard or BVA remand (furnish the complete rationale and citation of medicaltexts or treatise supporting opinion, if medical literature review wasundertaken). If the requested opinion is medically not ascertainableon exam or testing please state WHY. If the requested opinion can not beexpressed without resorting to speculation or making improbable assumptionssay so, and explain why. If the opinion asks" ... is it at least as likelyas not..", fully explain the clinical findings and rationale for the opinion.

M. Integrated Summary and Conclusions

- Describe changes in PSYCHOSOCI AL FUNCTIONAL STATUS and QUALITY of LIFE


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following trauma exposure (performance in employment or schooling,routine responsibilities of self care, family role functioning, physicalhealth, social/interpersonal relationships, recreation/leisure pursuits)

- Describe linkage between PTSD symptoms and aforementioned changes inimpairment in functional status and quality of life.

Particularly in cases where a veteran is unemployed, specificdetails about the effects ofPTSD and its symptoms on employmentare especially important.

- I f possible, describe extent to which disorders other than PTSD

(e.g., substance use disorders) are independently responsible forimpairment in psychosocial adjustment and quality of life. I f this isnot possible, explain why (e.g., substance use had onset after PTSDand clearly is a means of coping with PTSD symptoms).

- I f possible, describe pre-trauma risk factors or characteristics thatmay have rendered the veteran vulnerable to developing PTSD subsequentto trauma exposure.

- I f possible, state prognosis for improvement of psychiatric conditionand impairments in functional status.Comment on whether veteran is capable of managing his or her financial affairs.

Signature: Date:


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- - - - - - - - -


REVIEW EXAMINATION FOR POST-TRAUMATIC STRESS DISORDER (PTSD)# 0920 Worksheet

Name: SSN:

Date of Exam: C-number:

Place of Exam:

A. Review of Medical Records

B. Medical History since last exam:Comments on:

1. Hospitalizations and outpatient care from the time between lastrating examination to the present, UNLESS the purpose of thisexamination is to ESTABLISH service connection, then the completemedical history since discharge from military service is required.

2. Frequency, severity and duration of psychiatric symptoms.3.

Length of remissions from psychiatric symptoms, to include capacityfor adjustment during periods of remissions.4. Treatments including statement on effectiveness and side effects

experienced.5. SUBJECTIVE COMPLAINTS: Describe fully.

C. Psychosocial Adjustment since the last exam

1. legal history (DWIs, arrests, time spent injail)2. educational accomplishment3. extent of time lost from work over the past 12 month period and social

impairment. If employed, identify current occupation and length of timeat this job.

Ifunemployed, note in COMPLAINTS whether veteran contends itis

due tothe effects of a mental disorder. Further indicate following DIAGNOSISwhat factors, and objective findings support or rebut that contention.

4. marital and family relationships ( including quality of relationships withspouse and children)

5. degree and quality of social relationships6. activities and leisure pursuits7. problematic substance abuse8. significant medical disorders (resulting pain or disability; current

medications)9. history of violence/assaultiveness

10. history of suicide attempts11. summary statement of current psychosocial functional status (performance

in employment or schooling, routine responsibilities of self care,family role functioning, physical health, social/interpersonalrelationship, recreation/leisure pursuits)

D. Mental Status Examination

Conduct a BRIEF mental status examination aimed at screening for DSM-IVmental disorders. Describe and fully explain the existence, frequency andextent of the following signs and symptoms, or any others present, and


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relate ho w they interfere with employment and social functioning:

1. Impairment of thought process or communication.2. Delusions, hallucinations and their persistence.3. Eye Contact, interaction in session, and inappropriate behavior cited

with examples.4. Suicidal or homicidal thoughts, ideations or plans or intent.5. Ability to maintain minimal personal hygiene and othe r basic activities

of daily living.6. Orientat ion to person, place, and time.7. Memory loss, or impairment (both short and long-term).8. Obsessive or ritualistic behav ior which interferes with routine activities

and describe any found.9. Rate and flow of speech and note any irrelevant, illogical, or obscure

speech patterns an d whether constant or intermittent.10. Panic attacks noting the severity, duration, frequency, and effect on

independent functioning and whether clinically observed or good evidenceof prior clinical or equivalent observation is shown.

11. Depression, depressed mood or anxiety.12. Impaired i mpulse control and its effect on motivation or mood.13. Sleep i mpairment and describe extent it interferes with daytime activities

14. Othe r disorders or symptoms and the extent they interfere with activities,particularly:

a. mood disorders (especially major depression an d dysthymia)b. substance use disorders (especia lly alcohol use disorders)c. anxiety disorders (especially panic disorder, obsessive-compulsive

disorder, generalized anxiety disorder)d. somatoform disorderse. personality disorders (especially antisocial personality disorder

and borderline personality disorder)

E. Assessment of PTSD

1. state whether or not the veteran meets the DSM-IV stressor criterion2. identify behavioral, cognitive, social, affective, or somatic symptoms

veteran attributes to PTSD3. describe specific PTSD symptoms present (symptoms of trauma

re-experiencing, avoidance/numbing, heightened physiological arousal,and associated features [e.g., disillusionment and demoralization])

4. specify typical frequency, and severity of symptoms

F. Psychometric Testing Results

1. provide psychological testing if deemed necessary.2. provide specific evaluation information required by the rating board or

on a BV A Remand.3. comment on validity of psychological test results4. provide scores for PTSD psychometric assessments administered5. state whether PTSD psychometric measures are consistent or inconsistent

with a diagnosis ofPTSD, based on normative data and established"cutting scores" (cutting scores that are consistent with or supportiveof a PTSD diagnosis are as follows: PCL - not less than 50;Mississippi Scale - not less than 107; MMPI PTSD subscale a scoregreater than 28; MMPI code type: 2-8 or 2-7-8)

6. state degree of severity of PTSD symptoms based on psychometric data


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(mild, moderate, or severe)7. describe findings from psychological tests measuring other than

PTSD (MMPI, etc.)

G. Diagnosis:

1. The Diagnosis must conform to DSM-IV and be supported by the findingson the examination report.

2. I f there are multiple mental disorders, delineate to the extent possible

the symptoms associated with each and a discussionof

relationship.3. Evaluation is based on the effects of the signs and symptoms onoccupational and social functioning.

NOTE: VA is prohibited by statute, 38 U.s.c. 1110, from paying compensationfor a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.However, when a veteran's alcohol or drug abuse disability is secondary toor is caused or aggravated by a primary service-connected disorder, theveteran may be entitled to compensation. See Allen v. Principi, 237 F.3d1368, 1381 (Fed. Cir. 2001). Therefore, it is important to determine therelationship, if any, between a service-connected disorder and a disabilityresulting from the veteran's alcohol or drug abuse. Unless alcohol or drugabuse is secondary to or is caused or aggravated by another mental disorder,you should separate, to the extent possible, the effects of the alcohol ordrug abuse from the effects of the other mental disorder(s). If it is notpossible to separate the effects in such cases, please explain why.

H. Diagnostic Status

Axis I disordersAxis II disordersAxis III disordersAxis IV (psychosocial and environmental problems)Axis V (GAF score - current)

I. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be requiredby BVA REMAND or specifically requested by the rating specialist. If so,include the GAF score and note whether it refers to current functioning.A BVA REMAND may also request, in addition to an overall GAF score,that a separate GAF score be provided for each mental disorder present whenthere are mult iple Axis I or Axis II diagnoses and not all are serviceconnected. If separate GAF scores can be given, an explanation anddiscussion of the rationale is needed. If it is not possible, an explanationas to why not is needed. (See the above note pertaining to alcohol or drugabuse.)

1. Capacity to Manage Financial Affairs

Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VAbenefit payments in his or her own best interest, and not to any other subject. Mental incompetency, forVA benefits purposes, means that the veteran, because of injury or disease, is not capable of managingbenefit payments in his or her best interest. In order to assist raters in making a legal determination as tocompetency, please address the following:

What is the impact of injury or disease on the veteran's ability to manage his or her financialaffairs, including consideration of such things as knowing the amount of his or her VA benefit


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payment, knowing the amounts and types of bills owed monthly, and handling the paymentprudently? Does the veteran handle the money and pay the bills himself or herself?


If you believe a Social Work Service assessment is needed before you can give your opinion onthe veteran's ability to manage his or her financial affairs, please explain why.

K. Other Opinion:

Furnish any other specific opinion requested by the ratingboard or BVA remand (i.e., furnish the complete rationale and citation ofmedical texts or treatise supporting opinion, if medical literature reviewwas undertaken). If the requested opinion is medically not ascertainableon exam or testing please state WHY. If the requested opinion can not beexpressed without resorting to speculation or making improbable assumptionssay so, and explain why. If the opinion asks" .,. is it at least as likelyas not..", fully explain the clinical findings and rationale for the opinion.

L. Integrated Summary and Conclusions

1. Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFEsince the last exam (performance in employment or schooling, routineresponsibilities of self care, family role functioning, physical health,social/interpersonal relationships, recreation/leisure pursuits)

2. Describe linkage between PTSD symptoms and aforementioned changes inimpairment in functional status and quality oflife.

Particularly in cases where a veteran is unemployed, specific detailsabout the effects of PTSD and its symptoms on employment are especiallyimportant.

3. If possible, describe extent to which disorders other than PTSD(e.g., substance use disorders) are independently responsible forimpairment in psychosocial adjustment and quality oflife. If this is notpossible, explain why (e.g., substance use had onset after PTSDand clearly is a means of coping with PTSD symptoms).

4. If possible, state prognosis for improvement of psychiatric conditionand impairments in functional status.

5. Comment on whether veteran is capable of managing his or her financial affairs.

Signature: Date:


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MENTAL DISORDERS (except PTSD and Eating Disorders)# 0905 Worksheet

Name: SSN:


Place of Exam:

A. Review of Medical Records:

B. Medical History (Subjective Complaints):Comment on:

1. Past Medical History:

a. Previous hospitalizations and outpatient care.b. Medical and occupational history from the time between last rating

examination and the present, UNLESS the purpose of this examinationis to ESTABLISH service connection, then the complete medical historysince discharge from military service is required.

2. Present Medical, Occupational, and Social History over the past one year.

a. Frequency, severity, and duration of psychiatric symptoms.b. Length of remissions, to include capacity for adjustment during

periods of remissions.c. Extent of time lost from work over the past 12 month period and

social impairment. If employed, identify current occupation andlength of time at this job. If unemployed, note in Complaints whetherveteran contends it is due to the effects of a mental disorder.Further indicate following DIAGNOSIS what factors, and objectivefindings support or rebut that contention.

d. Treatments including statement on effectiveness and side effectsexperienced.

3. Subjective Complaints:

a. Describe fully.

C. Examination (Objective Findings):Address each of the following and fully describe:

I. Mental status exam to confirm or establish diagnosis inaccordance with DSM-IV.

2. Additionally, to allow evaluation by the rating specialist, describeand fully explain the existence, frequency, and extent of the followingsigns and symptoms, or any others present, and relate how they interferewith employment and social functioning:

a. Impairment of thought process or communication.b. Delusions, hallucinations and their persistence.c. Inappropriate behavior cited with examples.

d. Suicidal or homicidal thoughts, ideations or plans or intent.e. Ability to maintain minimal personal hygiene and other basic


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activities of daily living.f. Orientation to person, place and time.g. Memory loss or impairment (both short and/or long term).h. Obsessive or ritualistic behavior which interferes with routine

activities (describe with examples).i. Rate and flow of speech and note irrelevant, illogical, or obscure

speech patterns and whether constant or intermittent.j. Panic attacks noting the severity, duration, frequency and effect

on independent functioning and whether clinically observed or goodevidence of prior clinical or equivalent observation.

k. Depression, depressed mood, or anxiety.I. Impaired impulse control and its effect on motivation or mood.m. Sleep impairment and describe extent it interferes with daytime

activities.n. Other symptoms and the extent to which they interfere with

activities.

D. Diagnostic Tests:

1. Provide psychological testing if deemed necessary.2. If testing is requested, the results must be reported and considered in

arriving at the diagnosis.3. Provide any specific evaluation infornlation required by the rating board

or on BVA Remand (in claims folder).

a. Capacity to Manage Financial Affairs

Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VAbenefi t payments in his or her own best interest, and not to any other subject. Mental incompetency, forVA benefits purposes, means that the veteran, because of injury or disease, is not capable of managingbenefit payments in his or her best interest. In order to assist raters in making a legal determination as tocompetency, please address the following:

What is the impact of injury or disease on the veteran's ability to manage his or her financialaffairs, including consideration of such things as knowing the amount of his or her VA benefitpayment, knowing the amounts and types of bills owed monthly, and handling the paymentprudently? Does the veteran handle the money and pay the bills himself or herself?


I f you believe a Social Work Service assessment is needed before you can give your opinion onthe veteran's ability to manage his or her financial affairs, please explain why.

b. Other Opinion: Furnish any other specific opinion requestedby the rating board or BVA Remand furnishing the completerationale and citation of medical texts or treatise supportingopinion, if medical literature review was undertaken.If the requested opinion is medically not ascertainable on examor testing, please indicate WHY. If the requested opinion can notbe expressed without resorting to speculation or making improbableassumptions say so, and explain why. If the opinion asks " .. .is itat least as likely as not..?", fully explain the clinical findingsand rationale for the opinion.

4. Include results of all diagnostic and clinical tests conductedin the examination report.

E. Diagnosis:


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Provide:

1. The Diagnosis must conform to DSM-IV and be supported by the findingson the examination report.

2. If the diagnosis is changed, explain fully whether the new diagnosisrepresents a progression of the prior diagnosis or development of a newand separate condition.

3. If there are multiple mental disorders, delineate to the extent possiblethe symptoms associated with each and a discussion o f relationship.

4. Evaluation is based on the effectsof

the signs and symptoms onoccupational and social functioning.

NOTE: VA is prohibited by statute, 38 U.S.c. 1110, from paying compensationfor a disability that is a result of the veteran's own ALCOHO L OR DRUG ABUSE.However, when a veteran's alcohol or drug abuse disability is secondary toor is caused or aggravated by a primary service-connected disorder, theveteran may be entitled to compensation. See Allen v. Principi, 237 F.3d1368, 1381 (Fed. Cir. 200 I). Therefore, it is important to determine therelationship, if any, between a service-connected disorder and a disabilityresulting from the veteran's alcohol or drug abuse. Unless alcohol or drugabuse is secondary to or is caused or aggravated by another mental disorder,you should separate, to the extent possible, the effects o f the alcohol ordrug abuse from the effects o f the other mental disorder(s). Ifit is notpossible to separate the effects in such cases, please explain why.

F. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be requiredby BVA REMAND or specifically requested by the rating specialist. If so,include the GAF score and note whether it refers to current functioning.A BVA REMAND may also request, in addition to an overall GAF score, that aseparate GAF score be provided for each mental disorder present when there aremultiple Axis I or Axis II diagnoses and not all are service-connected.If separate GAF scores can be given, an explanation and discussion ofthe rationale is needed. If it is not possible, an explanation as to why not isneeded. (See the above note pertaining to alcohol or drug abuse.)

Signature: Date:


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EATING DISORDERS (Mental Disorders)

Name: SSN:


Place of Exam

A. Review of Medical Records:

B. Medical History (Subjective Complaints):Comment on:1. Past Medical History:

a. Previous hospitalizations and outpatient care for parenteral nutrition or tubefeeding.

b. Medical and occupati onal history from the time between the last such ratingexamination and the present needs to be accounted for, UNLESS the purposeof this examination is to ESTABLISH service connection, then a completemedical history since discharge from military service is required.

c. Periods of incapacitation (during which bedrest and treatment by a physicianare required due to the eating disorder). Describe the frequency and duration.

d. Current treatment, response, side effects.

2. Present Medical, Occupational and Social History - over the past one year.a. History of onset of eating disorder.b. Its course, treatment, and current status to include symptoms.c. Extent of time lost from work over the past 12 month period and social

impairment. If employed, identify current occupation and length of time at thisjob.

3. Subjective Complaints:a. Describe fully.

C. Examination (Objective Findings):Address each of the following and fully describe:1. Mental status exam to confirm or establish diagnosis in accordance with DSM-IY.

1. Additionally, please provide this specific information:a. Current weight.b. Expected minimum weight based on age, height, and body build.c. Obtain weight history.

3. Additionally, to allow evaluation by the rating specialist, describe and fully explain theexistence, frequency, and extent of the following signs and symptoms and relate howthey interfere with employment:

a. Binge eating.

b. Self-induced vomiting or other measure to prevent weight gain when weightis

already below expected minimum normal weight.

D. Diagnostic Tests (including psychological testing if deemed necessary):

1. Provide specific evaluation information required by the rating board or on a BY ARemand. Diagnostic Tests (See the examination request remarks for specifics.):

a. Capacity to Manage Financial Affairs


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Mental competency, for VA benefits purposes, refers only to the ability of the veteran tomanage VA benefit payments in his or her own best interest, and not to any other subject.Mental incompetency, for VA benefits purposes, means that the veteran, because of injury ordisease, is not capable of managing benefit payments in his or her best interest. In order toassist raters in making a legal determination as to competency, please address the following:

What is the impact o f injury or disease on the veteran's ability to manage his or herfinancial affairs, including consideration o f such things as knowing the amount of hisor her VA benefit payment, knowing the amounts and types of bills owed monthly,

and handling the payment prudently? Does the veteran handle the money and pay thebills himsel f or herself?

Based on your examination, do you believe that the veteran is capable of managing hisor her financial affairs? Please provide examples to support your conclusion.

If you believe a Social Work Service assessment is needed before you can give youropinion on the veteran's ability to manage his or her financial affairs, please explainwhy.

b. Other Opinion: Furnish any other specific opinion requested by therating board or BV A Remand furnishing the complete rationale and citationof medical texts or treatise supporting opinion, if medical literature review was

undertaken.If

the requested opinion is medically not ascertainable on exam ortesting please state WHY. If the requested opinion can not be expressedwithout resorting to speculation or making improbable assumptions say so, andexplain why. If the opinion asks " .. .is it at least as likely as not...", fully explainthe clinical findings and rationale for the opinion.

2. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis:

Signature: Date:


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January 16, 2001

Director (00/21) 211AAll VB A Regional Offices and Centers FL01-05

SUBJ: Relationship of PTSD or Stress to Cardiovascular Disorders

1. A letter on this subject (96-95) was published on September 26, 1996. Thisletter explained that a causative relationship between PTSD or other longterm stress, such as the POW experience, and subsequently developingcardiovascular disease has not been established. More recent medicalliterature on this subject, for example, "Physician-Diagnosed MedicalDisorders in Relation to PTSD Symptoms in Older Military Veterans,"published in January 2000 (P. P. Schnurr, A. Spiro, III, and A. H. Paris,Health Psychology, 19 (1), 91-97), continues to state that it is premature to

draw firm conclusions about the relationship of combat and PTSD tocardiovascular and other disorders. Two VA studies now in progress mayshed further light on the subject of a possible relationship.

2. Some have used FL 96-95 as the basis of denial of a claim for acardiovascular condition secondary to PSTD. The lack of confirmation of arelationship in general, however, does not mean that a claim for acardiovascular condition secondary to PTSD, supported by a medical opinion,should routinely be denied. As with all medical opinions, the weight andcredibility of the opinion has to be considered in light of all other evidence ofrecord and in light of other medical information. The United States Court of

Appeals for Veterans Claims in Guerrieri v. Brown, 4 Vet. App. 467 (1993),stated that the probative value of medical opinion evidence is based on themedical expert's personal examination of the patient, the physician'sknowledge and skill in analyzing the data, and the medical conclusions thatthe physician reaches.

3. In the case of a claim for coronary artery disease (CAD) due to PTSD, forexample, the examiner would, at a minimum, have to discuss known riskfactors for CAD, what role they play in this particular veteran, and explain whyhe or she considers PTSD to be at least as likely as not the cause of the CADin this veteran. A similar discussion would be needed if the claimed condition

is hypertension or a stroke.

4. In some cases you may wish to request an additional medical opinion, eitherby a mental health professional or a cardiologist, or both, and in questionablecases, you may want to request an opinion from the Advisory Review staff(211 B). Whatever your decision, you must provide adequate reasons andRelationship of PTSD or stress to cardiovascular disorders bases to support


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it.

5. If you have questions about this letter, please contact the person shown onthe website at: http://vbaw.vba.va.gov/bI/21/calendar/index.htm.

6. This letter is rescinded January 1, 2003.

ls i

Robert J. Epley, DirectorCompensation and Pension Service


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Washington DC 20420

June 7, 2005

In Reply Refer To: 213BDirector (00/21) Fast Letter 05-08All VBA Regional Offices and Centers

SUBJ: Handling PTSD claims based on stressors experienced during service in theMarine Corps.

Purpose of This Letter

This letter provides instructions with regard to the handling of post-traumatic

stress disorder (PTSD) claims that are based on stressors experienced duringservice in the Marine Corps.

Background Information

Approximately three years ago, the Marine Corps Historical Center (MCHC)digitized all unit records in its custody covering the Korean and Vietnam wars andcopied them to compact discs (CD). The Compensation and Pension Service(C&P) collaborated to extract and upload the digitized unit records covering theVietnam Era to Virtual VA where they became available in December 2004.

Discussion of PTSD Claims

The Department of Veterans Affairs (VA) is not the custodian of Marine Corpsunit records, nor are regional office personnel recognized as experts in the field ofrecords research. For these reasons, denials of service connection for PTSD,based solely on VA's inabil ity to verify a claimed stressor through research ofthese records, may not be seen as sufficient in an appeal to the Board ofVeterans Appeals or Court of Appeals for Veterans Claims. It is current VA policythat claims for service connection for PTSD, filed by veterans alleging exposureto stressful situations while serving in the Army, Navy, and Air Force, cannot bedenied based solely on the absence of a verifiable stressor unless the Center for

Unit Records Research (CURR) first confirms that the stressor cannot be verified.CURR, however, does not have sufficient staffing to provide this service forMarine Corps cases.

C&P Service recognizes the MCHC as the ultimate authority with regard to thecontent and organization of Marine Corps unit records. C&P Service submitted aformal request to MCHC management asking for its assistance in resolving thismatter. They have agreed that if regional offices are unable to verify a claimed


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stressor following a meaningful search of the records available through VirtualVA, MCHC will either identify the appropriate record(s) for the regional office orprovide the required authoritative confirmation that the alleged stressor(s) cannotbe verified using records in its custody.

If information available through Virtual VA or official military web sites confirmsthe occurrence of an in-service stressor, and all other requirements have beenmet, the establishment of service connection for PTSD is in order. If, on the otherhand, the regional office is unable to verify the alleged stressor, the regionaloffice must request confirmation of its negative findings from MCHC beforedenying service connection. This same policy would apply to claims requiringresearch of unit records dated after the Vietnam Era, since VA does not currentlyhave access to these records.

How to Submit a Request to MCHC

Regional offices must follow the instructions below when submitting a request toMCHC for a determination as to whether or not it possesses records required toverify an alleged stressor:

1. Prepare a one page request, using VA letterhead, containing the following:a. veteran's name and VA file number;b. name of the veteran's squadron/battalion (or higher echelon);c. the date (month and year) the stressful event occurred (not to

exceed a 60-day period of time);d. a concise description of the stressful event;e. identification of the unit records reviewed through Virtual VA;f. the mailing address of the requesting regional office; andg. a point of contact at the regional office.

2. Do not attach to the request any medical information or statement(s) fromthe veteran.

3. Requests prepared prior to September 1,2005, may be faxed to (202)433-7265 or mailed to the following address:

Headquarters United States Marine CorpsMarine Corps Historical Center1254 Charles Morris St. SEWashington Navy YardWashington, DC 20374-5040

4. Due to organizational changes within the Marine Corps, requests preparedon or after September 1, 2005, must be faxed to (703) 784-4665 or mailed

to the following address:Marine Corps University ArchiveGray Research Center2040 Broadway StreetQuantico, VA 22134-5107

5. Per M21-1, Pt. 111,4.27, allow 60 days for a response before submitting afollow-up request.

2


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A sample memorandum to MCHC for a determination as to the availability ofrecords required to verify a claimed stressor is attached.

Important Points to Keep in Mind

Regional offices will reduce delays inherent in processing claims for serviceconnection for PTSD filed by Marine Corps veterans by following this guidance:

Send a request to MCHC only after exhausting all efforts to verify thealleged stressor(s) through other means, to include Virtual VA and officialmilitary web sites.

CURR requires a minimum amount of information before it will attempt toverify in-service stressors. Regional offices must take the same approachwhen handling claims that may require research of Marine Corps unitrecords. Before expending time and resources to conduct research, theveteran is expected to submit, at a minimum,

the name of the unit in which he/she served when the stressfulevent occurred;

the location where the stressful event occurred; and the date (month and year) the stressful event occurred (not to

exceed a 60-day period of time). Only assigned military records specialists should release requests to this

facility. M21-1, Pt. III, 5.14c(5) describes the action to take when a veteran fails to

provide the minimum information CURR requires to conduct research.Regional offices should follow the same procedure when a Marine Corpsveteran seeking service connection for PTSD fails to provide the minimuminformation described above.

Points of Contact

If you have any questions concerning information in this letter, please see eitherthe Calendar Page for this date, on our Intranet Site at:http://152.125.216.223/bI/21/calendar/cal week.aspOr the Fast Letter 2005 page at:http://vbaw.vba.va.gov/bl/21/publicat/Letters/FL05List.htm

lSI

Renee L. Szybala, DirectorCompensation and Pension Service

3


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Sample Letter to MCHC for a Determination as to the AvailabilityOf Records Required to Verify a Claimed Stressor

Headquarters, United States Marine CorpsMarine Corps Historical Center

1254 Charles Morris St. SEWashington Navy YardWashington, DC 20374-5040

00/21C 123-45-6789

JONES, John A.

Dear Sir/Madam:

This is a request for research of records in your possession for the purpose of verifying an inservice stressor claimed by a veteran seeking service connection for post-traumatic stressdisorder. Th e alleged stresso r occurred in . I have already reviewed thefollowing unit records that MCHC provided to VA on compact disc:

Th e following information is provided to assist you in your research:

Narne of claimant: John A. JonesVA File Number: 123-45-6789Mailing Address: Name of Unit: Description of Th e veteran alleges that he witnessed the collision of tw o helicoptersStressfu l Event: that killed 25 - 30 people at Camp Radcliffbetween January and

March of 1969. All the bodies were reportedly charred and fusedtogether.

Point of Contact: If additional information is required, please contact

crew v. army: re: ptsd diagnoses: 10/16/08 - vet affairs

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