Combat Post-Traumatic  Stress Disorder (PTSD)   Identification and Compensation Brief Mintcho E. Mintchev
Contents <ul><li>Combat PTSD Identification </li></ul><ul><ul><li>PTSD Detection </li></ul></ul><ul><ul><li>Signs and Symp...
Contents (Cont.) <ul><li>Combat PTSD Compensation </li></ul><ul><ul><li>Significance of Combat Service </li></ul></ul><ul>...
Combat PTSD Identification
PTSD Detection <ul><li>PTSD is hard to detect in the work place </li></ul><ul><li>Many who suffer from PTSD </li></ul><ul>...
Signs and Symptoms of PTSD <ul><li>Feeling of detachment or estrangement from others </li></ul><ul><li>Inability to recall...
PTSD Degrees of Severity <ul><li>Mild </li></ul><ul><ul><li>Occasional thoughts </li></ul></ul><ul><li>Severe </li></ul><u...
PTSD Specifiers <ul><li>The following specifiers may be used to describe the onset or the duration of PTSD symptoms </li><...
DSM-IV PTSD Diagnostic Criteria <ul><li>Diagnostic and Statistical Manual of Mental   Disorders,   Fourth Edition </li></u...
Six Diagnostic Criteria for PTSD <ul><li>1 - At Least 2 Basic Aspects of the Event </li></ul><ul><ul><li>Direct personal e...
Six Diagnostic Criteria for PTSD (Cont.) <ul><li>2 - Re-experiencing the Traumatic Event </li></ul><ul><ul><li>Despite eff...
Six Diagnostic Criteria for PTSD (Cont.) <ul><li>2 - Re-experiencing the Traumatic Event (Cont.) </li></ul><ul><ul><li>Int...
Six Diagnostic Criteria for PTSD (Cont.) <ul><li>3 - Stimuli Avoidance </li></ul><ul><ul><li>Persistent avoidance of stimu...
Six Diagnostic Criteria for PTSD (Cont.) <ul><li>4 - Increased Arousal </li></ul><ul><ul><li>Difficulty falling or staying...
Six Diagnostic Criteria for PTSD (Cont.) <ul><li>5 - Duration of Signs and Symptoms </li></ul><ul><ul><li>Symptoms must ha...
Combat PTSD Compensation
Significance of Combat Service <ul><li>Veteran's testimony may establish claimed in-service stressor if the evidence confi...
Significance of Combat Service (Cont.) <ul><li>No limitations to type of evidence that may be accepted to confirm engageme...
Decorations as Evidence of Combat <ul><li>Veteran in receipt of designated combat decorations  </li></ul><ul><ul><ul><li>P...
Decorations as Evidence of Combat (Cont.) <ul><li>Air Force Achievement Medal with &quot;V&quot; Device  </li></ul><ul><li...
Decorations as Evidence of Combat (Cont.) <ul><li>Combat Action Badge </li></ul><ul><li>Combat Action Ribbon </li></ul><ul...
Decorations as Evidence of Combat (Cont.) <ul><li>Distinguished Service Cross </li></ul><ul><li>Joint Service Commendation...
Granting Service Connection <ul><li>3 requirements must be met to grant service connection </li></ul><ul><ul><li>1 - Medic...
Granting Service Connection (Cont.) <ul><ul><li>3 - Link: nexus must be established by medical evidence between current sy...
Schedule of PTSD Disability Ratings <ul><li>100% Disability  </li></ul><ul><ul><li>Total occupational and social impairmen...
Schedule of PTSD Disability Ratings (Cont.) <ul><li>70% Disability  </li></ul><ul><ul><li>Occupational and social impairme...
Schedule of PTSD Disability Ratings (Cont.) <ul><li>50% Disability </li></ul><ul><ul><li>Occupational and social impairmen...
Schedule of PTSD Disability Ratings (Cont.) <ul><li>30% Disability </li></ul><ul><ul><li>Occupational and social impairmen...
Schedule of PTSD Disability Ratings (Cont.) <ul><li>10% Disability </li></ul><ul><ul><li>Occupational and social impairmen...
How to Seek Compensation <ul><li>To Seek Compensation One May </li></ul><ul><ul><li>Complete VA Form 21-526 </li></ul></ul...
QUESTIONS?
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Department of Veterans Affairs - VA - Combat Post-Traumatic Stress Disorder - PTSD - Identification and Compensation Brief

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Department of Veterans Affairs - VA - Combat Post-Traumatic Stress Disorder - PTSD - Identification and Compensation Brief

  1. 1. Combat Post-Traumatic Stress Disorder (PTSD) Identification and Compensation Brief Mintcho E. Mintchev
  2. 2. Contents <ul><li>Combat PTSD Identification </li></ul><ul><ul><li>PTSD Detection </li></ul></ul><ul><ul><li>Signs and Symptoms of PTSD </li></ul></ul><ul><ul><li>PTSD Degrees of Severity </li></ul></ul><ul><ul><li>PTSD Specifiers </li></ul></ul><ul><ul><li>DSM-IV Diagnostic Criteria </li></ul></ul><ul><ul><li>Six Diagnostic Criteria for PTSD </li></ul></ul>
  3. 3. Contents (Cont.) <ul><li>Combat PTSD Compensation </li></ul><ul><ul><li>Significance of Combat Service </li></ul></ul><ul><ul><li>Decorations as Evidence of Combat </li></ul></ul><ul><ul><li>Granting Service Connection </li></ul></ul><ul><ul><li>Schedule of PTSD Disability Ratings </li></ul></ul><ul><ul><li>How to Seek Compensation </li></ul></ul>
  4. 4. Combat PTSD Identification
  5. 5. PTSD Detection <ul><li>PTSD is hard to detect in the work place </li></ul><ul><li>Many who suffer from PTSD </li></ul><ul><ul><li>Hold full-time jobs </li></ul></ul><ul><ul><li>Seem to function &quot;normally“ </li></ul></ul><ul><ul><li>BUT </li></ul></ul><ul><ul><ul><li>May not be able to maintain relationships with family or friends </li></ul></ul></ul><ul><ul><ul><li>In the long run may not be able to function at work at all </li></ul></ul></ul>
  6. 6. Signs and Symptoms of PTSD <ul><li>Feeling of detachment or estrangement from others </li></ul><ul><li>Inability to recall an important aspect of the trauma </li></ul><ul><li>Markedly diminished interest or participation in significant activities </li></ul><ul><li>Restricted range of affect (e.g., unable to have loving feelings) </li></ul><ul><li>Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) </li></ul><ul><li>An individual who engaged in combat with the enemy avoids war movies or a particular nationality representative of the wartime enemy </li></ul>
  7. 7. PTSD Degrees of Severity <ul><li>Mild </li></ul><ul><ul><li>Occasional thoughts </li></ul></ul><ul><li>Severe </li></ul><ul><ul><li>Intense and constant thoughts </li></ul></ul>
  8. 8. PTSD Specifiers <ul><li>The following specifiers may be used to describe the onset or the duration of PTSD symptoms </li></ul><ul><ul><li>Acute: Duration of symptoms is less than 3 months </li></ul></ul><ul><ul><li>Chronic: Symptoms last 3 months or more </li></ul></ul><ul><ul><li>Delayed Onset: Onset of symptoms occurs at least 6 months following the traumatic stressor </li></ul></ul>
  9. 9. DSM-IV PTSD Diagnostic Criteria <ul><li>Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition </li></ul><ul><li>Diagnostic Criteria </li></ul><ul><ul><li>Response to the stressful event, or stressor, must involve feelings of intense fear, helplessness, or horror </li></ul></ul><ul><ul><li>Witnessing an event that involves death, injury, or a threat to the physical integrity of another person </li></ul></ul>
  10. 10. Six Diagnostic Criteria for PTSD <ul><li>1 - At Least 2 Basic Aspects of the Event </li></ul><ul><ul><li>Direct personal experience with a traumatic stressor </li></ul></ul><ul><ul><li>Response to the stressful event, or stressor, must involve feelings of intense fear, helplessness, or horror </li></ul></ul>
  11. 11. Six Diagnostic Criteria for PTSD (Cont.) <ul><li>2 - Re-experiencing the Traumatic Event </li></ul><ul><ul><li>Despite efforts to avoid traumatic stressors, re-experiencing of the traumatic event is persistent </li></ul></ul><ul><ul><li>Recurrent and intrusive distressing recollections of the event, including images, thoughts, and perceptions </li></ul></ul><ul><ul><li>Recurrent distressing dreams of the event </li></ul></ul><ul><ul><li>Acting or feeling as if the traumatic event were recurring (e.g., illusions, hallucinations, and flashback episodes) </li></ul></ul>
  12. 12. Six Diagnostic Criteria for PTSD (Cont.) <ul><li>2 - Re-experiencing the Traumatic Event (Cont.) </li></ul><ul><ul><li>Intense psychological distress when exposed to internal or external cues that symbolize or resemble an aspect of the traumatic event </li></ul></ul><ul><ul><li>Manifestations often occur when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event </li></ul></ul><ul><ul><ul><li>E.g. hearing a car backfire may be a trigger for Veterans who have been in combat </li></ul></ul></ul>
  13. 13. Six Diagnostic Criteria for PTSD (Cont.) <ul><li>3 - Stimuli Avoidance </li></ul><ul><ul><li>Persistent avoidance of stimuli associated with the traumatic event and a numbing of general responsiveness </li></ul></ul><ul><ul><li>Deliberate efforts to avoid thoughts, feelings, or conversations associated with the traumatic event </li></ul></ul><ul><ul><li>Avoid activities, situations, or people who arouse recollections of the traumatic event </li></ul></ul>
  14. 14. Six Diagnostic Criteria for PTSD (Cont.) <ul><li>4 - Increased Arousal </li></ul><ul><ul><li>Difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived </li></ul></ul><ul><ul><li>Hypervigilance </li></ul></ul><ul><ul><li>Exaggerated startle response </li></ul></ul><ul><ul><li>Some individuals report irritability or outbursts of anger and/or difficulty concentrating or completing tasks </li></ul></ul>
  15. 15. Six Diagnostic Criteria for PTSD (Cont.) <ul><li>5 - Duration of Signs and Symptoms </li></ul><ul><ul><li>Symptoms must have been present for at least 1 month </li></ul></ul><ul><li>6 - Social and Occupational Impairment </li></ul><ul><ul><li>Lack of interest in and withdrawal from relationships, work, and/or hobbies </li></ul></ul><ul><ul><li>Unable to communicate with family members or socialize with neighbors and co-workers </li></ul></ul><ul><ul><li>Repeatedly misses days of work due to severe symptoms of PTSD </li></ul></ul>
  16. 16. Combat PTSD Compensation
  17. 17. Significance of Combat Service <ul><li>Veteran's testimony may establish claimed in-service stressor if the evidence confirms that </li></ul><ul><ul><li>Veteran engaged in combat </li></ul></ul><ul><ul><li>Was a prisoner-of-war (POW) as defined by 38 CFR 3.1(y) </li></ul></ul><ul><ul><li>Claimed stressor related to combat experience </li></ul></ul><ul><ul><li>No clear and convincing evidence to the contrary </li></ul></ul><ul><ul><li>Claimed stressor consistent with circumstances, conditions, or hardships of respective service </li></ul></ul>
  18. 18. Significance of Combat Service (Cont.) <ul><li>No limitations to type of evidence that may be accepted to confirm engagement in combat </li></ul><ul><li>Any evidence probative of combat participation may be used to support engagement in combat </li></ul><ul><li>Engaging in combat </li></ul><ul><ul><li>Participation in events constituting actual fight or encounter with a military foe, hostile unit or instrumentality </li></ul></ul><ul><ul><li>Includes presence during such events either as a </li></ul></ul><ul><ul><ul><li>Combatant </li></ul></ul></ul><ul><ul><ul><li>Service member performing duty in support of combatants </li></ul></ul></ul>
  19. 19. Decorations as Evidence of Combat <ul><li>Veteran in receipt of designated combat decorations </li></ul><ul><ul><ul><li>Presumed to have engaged in combat unless there is clear and convincing evidence to the contrary </li></ul></ul></ul>
  20. 20. Decorations as Evidence of Combat (Cont.) <ul><li>Air Force Achievement Medal with &quot;V&quot; Device </li></ul><ul><li>Air Force Combat Action Medal </li></ul><ul><li>Air Force Commendation Medal with &quot;V&quot; Device </li></ul><ul><li>Air Force Cross </li></ul><ul><li>Air Medal with &quot;V&quot; Device </li></ul><ul><li>Army Commendation Medal with &quot;V&quot; Device </li></ul><ul><li>Bronze Star Medal with &quot;V&quot; Device </li></ul>
  21. 21. Decorations as Evidence of Combat (Cont.) <ul><li>Combat Action Badge </li></ul><ul><li>Combat Action Ribbon </li></ul><ul><ul><li>Prior to February 1969, the Navy Achievement Medal with &quot;V&quot; Device </li></ul></ul><ul><li>Combat Aircrew Insignia </li></ul><ul><li>Combat Infantry/Infantryman Badge </li></ul><ul><li>Combat Medical Badge </li></ul><ul><li>Distinguished Flying Cross </li></ul>
  22. 22. Decorations as Evidence of Combat (Cont.) <ul><li>Distinguished Service Cross </li></ul><ul><li>Joint Service Commendation Medal with &quot;V&quot; Device </li></ul><ul><li>Medal of Honor </li></ul><ul><li>Navy Commendation Medal with &quot;V&quot; Device </li></ul><ul><li>Navy Cross </li></ul><ul><li>Purple Heart </li></ul><ul><li>Silver Star </li></ul>
  23. 23. Granting Service Connection <ul><li>3 requirements must be met to grant service connection </li></ul><ul><ul><li>1 - Medical Evidence </li></ul></ul><ul><ul><ul><li>Evidence must show a diagnosis of PTSD in accordance with 38 CFR 4.125(a) </li></ul></ul></ul><ul><ul><li>2 - In-Service Traumatic Stressor </li></ul></ul><ul><ul><ul><li>Must have credible supporting evidence that the claimed in-service traumatic stressor occurred </li></ul></ul></ul><ul><ul><ul><li>A traumatic stressor may not be limited to just one single episode </li></ul></ul></ul>
  24. 24. Granting Service Connection (Cont.) <ul><ul><li>3 - Link: nexus must be established by medical evidence between current symptoms and in-service traumatic stressor </li></ul></ul><ul><ul><ul><li>Relationship between traumatic stressors during military service and current problems or symptoms will answer the question of whether service connection can be established </li></ul></ul></ul><ul><ul><ul><li>Symptoms must have a clear relationship to the military traumatic stressor as described in the medical reports </li></ul></ul></ul><ul><ul><ul><li>PTSD can occur hours, months, or years after a military traumatic stressor </li></ul></ul></ul>
  25. 25. Schedule of PTSD Disability Ratings <ul><li>100% Disability </li></ul><ul><ul><li>Total occupational and social impairment, due to such symptoms as </li></ul></ul><ul><ul><ul><li>Gross impairment in thought processes or communication; </li></ul></ul></ul><ul><ul><ul><li>Persistent delusions or hallucinations; </li></ul></ul></ul><ul><ul><ul><li>Grossly inappropriate behavior; </li></ul></ul></ul><ul><ul><ul><li>Persistent danger of hurting self or others; </li></ul></ul></ul><ul><ul><ul><li>Intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene) </li></ul></ul></ul><ul><ul><ul><li>Disorientation to time or place; memory loss for names of close relatives, own occupation, or own name </li></ul></ul></ul>
  26. 26. Schedule of PTSD Disability Ratings (Cont.) <ul><li>70% Disability </li></ul><ul><ul><li>Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as </li></ul></ul><ul><ul><ul><li>Suicidal ideation; obsessional rituals which interfere with routine activities; </li></ul></ul></ul><ul><ul><ul><li>Speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; </li></ul></ul></ul><ul><ul><ul><li>Impaired impulse control (such as unprovoked irritability with periods of violence); </li></ul></ul></ul><ul><ul><ul><li>Spatial disorientation; neglect of personal appearance and hygiene; </li></ul></ul></ul><ul><ul><ul><li>Difficulty in adapting to stressful circumstances (including work or a worklike setting); </li></ul></ul></ul><ul><ul><ul><li>Inability to establish and maintain effective relationships </li></ul></ul></ul>
  27. 27. Schedule of PTSD Disability Ratings (Cont.) <ul><li>50% Disability </li></ul><ul><ul><li>Occupational and social impairment with reduced reliability and productivity due to such symptoms as: </li></ul></ul><ul><ul><ul><li>Flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; </li></ul></ul></ul><ul><ul><ul><li>Difficulty in understanding complex commands; </li></ul></ul></ul><ul><ul><ul><li>Impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); </li></ul></ul></ul><ul><ul><ul><li>Impaired judgment; impaired abstract thinking; </li></ul></ul></ul><ul><ul><ul><li>Disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships </li></ul></ul></ul>
  28. 28. Schedule of PTSD Disability Ratings (Cont.) <ul><li>30% Disability </li></ul><ul><ul><li>Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as </li></ul></ul><ul><ul><ul><li>Depressed mood </li></ul></ul></ul><ul><ul><ul><li>Anxiety </li></ul></ul></ul><ul><ul><ul><li>Suspiciousness </li></ul></ul></ul><ul><ul><ul><li>Panic attacks (weekly or less often) </li></ul></ul></ul><ul><ul><ul><li>Chronic sleep impairment </li></ul></ul></ul><ul><ul><ul><li>Mild memory loss (such as forgetting names, directions, recent events) </li></ul></ul></ul>
  29. 29. Schedule of PTSD Disability Ratings (Cont.) <ul><li>10% Disability </li></ul><ul><ul><li>Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or </li></ul></ul><ul><ul><li>Symptoms controlled by continuous medication </li></ul></ul><ul><li>0 % Disability </li></ul><ul><ul><li>A mental condition has been formally diagnosed </li></ul></ul><ul><ul><li>Symptoms are not severe enough either to </li></ul></ul><ul><ul><ul><li>Interfere with occupational and social functioning </li></ul></ul></ul><ul><ul><ul><li>Require continuous medication </li></ul></ul></ul>
  30. 30. How to Seek Compensation <ul><li>To Seek Compensation One May </li></ul><ul><ul><li>Complete VA Form 21-526 </li></ul></ul><ul><ul><ul><li>Claim is not formal unless form is signed and dated </li></ul></ul></ul><ul><ul><ul><li>Mail or take application to the closest VA Regional Office </li></ul></ul></ul><ul><ul><ul><ul><li>Addresses available at http://www.va.gov/directory </li></ul></ul></ul></ul><ul><ul><li>Apply Electronically </li></ul></ul><ul><ul><ul><li>http://vabenefits.vba.va.gov/vonapp/main.asp </li></ul></ul></ul>
  31. 31. QUESTIONS?

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