PTSD UPDATES
and Mental Strategies
Celeste Krikorian
MOPH NSO Training Orlando, FL March 2013
PTSD UPDATES
and Mental Strategies
OBJECTIVES:
o Using the New PTSD rule.
o Stressors that are neglected. Cline
o How to make the most of your claim.
o 4.130. Significance of Symptoms.
o Acheiving 100% for Mental Claim.
MOPH NSO Training Orlando, FL March 2013o
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PTSD UPDATES
and Mental Strategies
New PTSD Rule: 38 C.F.R.3.304(f)(3):
• Fear of Hostile Military/Terrorist Activity
• Relaxation of the evidentiary burden
• Lay stmt. of stressor enough
• Key: No Stressor Verification Needed
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PTSD UPDATES
and Mental Strategies
Fear of hostile military or terrorist activity:
Vet experienced, witnessed, or was confronted with
event that involved actual or threatened death or
serious injury, or a threat to the physical integrity of
Vet or others, such as from improvised explosive
device; vehicle-imbedded explosive device; incoming
artillery, rocket or mortar fire; grenade; small arms
fire, including suspected sniper fire; or attack upon
friendly military aircraft, and Vets response involved a
psychological or psycho-physiological state of fear,
helplessness, or horror.
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PTSD UPDATES
and Mental Strategies
Mental Strategy 1: Possible Case Scenarios
• Combat Stressor cannot be verified
• In war zone but not personally in combat.
• Re-open PTSD claim denied prior to new
rule.
• Vet previously denied PTSD, SC for other
mental disorder.
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PTSD UPDATES
and Mental Strategies
TO PROVE:
 Lay stmt. of Stressor due to Fear of
Hostile Military or Terrorist Activity
 VA Doctor must decide claimed stressor
supports PTSD dx.
 VA Doctor must decide symptoms related
to that stressor
 Consistent with circumstances of service
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PTSD UPDATES
and Mental Strategies
Important Facts:
1. Rule not limited to Iraqi/Afghan Vets.
2. VA Doctor needed. If can easily show
Combat award, go with 3.304 (f)(2)
3. To Re-open under New Rule, use Lay
Stmts., MOS, Personnel Records.
4. If case pending before VA on 7/13/2010,
then Eff. date is date of claim.
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PTSD UPDATES
and Mental Strategies
NEW:Cline v. Shinseki: 38 CFR 3.156(c)(2)
Mental Strategy 2:Possible Case Scenario
Stressor Verification: Vet submitted Stressor
Statement that was not verified by JSRRC.
Vet loses due to lack of stressor verification.
Vet reopens. Stressor is verified.
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PTSD UPDATES
and Mental Strategies
Cases filed Prior to October 2006:
38 CFR 3.156(c) basically allowed that if Vet
submitted insuffic. stressor stmts. that were
later verified by Vet’s more clarified
submission or by later verification by VA or
JSRRC, Vet was entitled to Reconsideration
possibly allowing earlier eff. date (EED) to
date of original claim or date entitlement arose
whichever is later.
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PTSD UPDATES
and Mental Strategies
Example: Vet filed a claim in 1993 for PTSD.
He had dx of PTSD related to a stressor based
on seeing a comrade drown. He provided a
stressor statement stating, “I saw my comrade
Buddy drown.” He lost his case due to the lack
of a verifiable stressor. In 2005, Vet reopened
his claim and clarified that “Buddy” was John
Doe. JSRRC verified stressor. Vet asked for
Reconsideration. Vet granted earlier eff. date
of original claim in 1993.
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PTSD UPDATES
and Mental Strategies
After October 2006:
38 CFR 3.156(c)(2) limits reconsideration.
“…section does not apply to records that VA
could not have obtained when it decided the
claim because the records did not exist when
VA decided the claim, or because the claimant
failed to provide sufficient information for VA
to identify…or obtain from…respective
service department” (JSRRC).
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PTSD UPDATES
and Mental Strategies
After October 2006:
38 CFR 3.156(c)(2) limits reconsideration.
IF inability to initially verify stressor was
based upon lack of detailed information from
veteran, then no reconsideration.
IF VA or JSRRC failed to verify earlier
stressor statement that contained sufficient
info., Vet still entitled to reconsideration.
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PTSD UPDATES
and Mental Strategies
Mental Rating Schedule: 38 C.F.R. 4.130:
Mental Strategy 3:Possible Case Scenario
VA uses the same criteria for evaluating
most mental diseases. In practice, Vet may
have numerous diagnoses evaluated under
same schedule.
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PTSD UPDATES
and Mental Strategies
Example:
Vet has had several mental diagnoses since
separating from service 10 years ago. They
include depression, PTSD and anxiety.
1. How should you frame your claim?
2. What if claim was previously filed for
depression only?
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PTSD UPDATES
and Mental Strategies
How should you frame your claim?
“Entitlement to service connection for
mental disorder, to include PTSD.”
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PTSD UPDATES
and Mental Strategies
Tips:
 File your claim as broad as possible
 If PTSD is an option, go for it
 PTSD doesn’t require continuity of
symptomatology
 Other diagnoses can be symptoms of PTSD
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PTSD UPDATES
and Mental Strategies
What if claim was previously filed for
depression only?
• Ask VA to broaden claim to include all
mental diagnoses.
• Cite Clemons v. Shinseki
• Point out: Vet is lay person not expert
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PTSD UPDATES
and Mental Strategies
Mental Strategy 4:Possible Case Scenario
Vet wants a higher rating but does not
exhibit most symptoms in rating desired.
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PTSD UPDATES
and Mental Strategies
PTSD/MENTAL Ratings: 38 C.F.R. 4.130:
What Matters:
Total occupational and social impairment:
100%
Occup. & social impairment, deficiencies in most areas:
70%
Occup. & social impairment w reduced reliability/productivity: 50%
Occup. & social impairment w occasional decrease in work
effic. & intermittent periods of inability to perform occup. tasks: 30%
Occup. & social impairment due to mild or transient symptoms: 10%
Formal Dx Mental condition, but symptoms not severe enough: 0%
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PTSD UPDATES
and Mental Strategies
Tips:
• Focus on the tx recs and use to show
occup. and social impairment criteria.
• If symptoms in desired rating, Document!
• Point VA to work history or lack thereof
• Use GAF scores to Vet’s advantage
• Remember 38 CFR 4.3 and 4.7
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PTSD UPDATES
and Mental Strategies
Mental Strategy 5:Possible Case Scenario
Vet is currently rated 70% for mental
disorder. Vet is not working. Vet does not
have total social impairment or symptoms
for 100% rating.
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PTSD UPDATES
and Mental Strategies
Answer:
 Ask for TDIU (total disability based on
individual unemployability) 38 CFR 4.16
 Remember inability to obtain substantial
gainful employment must be due to
mental disorder or combo of SC
disabilities meeting 70%.
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PTSD UPDATES
and Mental Strategies
TDIU: 38 CFR 4.16
Criteria required:
• One disability rated at 60% or
• Two or more combined at 70% where at least
one disability is rated at 40%.
• Consider: Common etiology/single accident
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PTSD UPDATES
and Mental Strategies
QUESTIONS?
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