Post-traumatic stress disorder (PTSD) is a condition that many veterans have heard of, but do not quite really know what it is, or whether or not they have it. It has been my experience that PTSD is commonly misunderstood and underestimated by veterans and the VA alike. My hope is that this post will help to explain exactly what PTSD is and also give information regarding some of the factors the VA will consider when determining whether or not a veteran has PTSD in the first place.
PTSD is a mental health condition, classified as an anxiety disorder. The National Center for PTSD says that PTSD can develop after a traumatic event, after which a person experiences a stress-related reaction that does not go away after time. According to the Mayo Clinic, PTSD is triggered by a terrifying event, and the symptoms are generally grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal). In the medical literature, PTSD is sometimes classified as acute (symtpoms last less than 3 months), chronic (symptoms last 3 months or longer), or delayed onset (at least 6 months have passed between the traumatic event and the onset of the symptoms).
As stated in a previous post by my colleague, PTSD can be caused by many experiences, including combat, in-service personal assault or harassment, military sexual trauma, or any other traumatic event that satisfies the criteria. It is important to note that not everyone who is exposed to trauma will develop PTSD, in fact, most do not. However, for those who do, the PTSD is often life altering.
In order for the VA to recognize a veteran’s PTSD, the diagnosis must be provided by a qualified medical professional. Even though many veterans are treated by VA or private therapists who are not doctors or psychologists (i.e. licensed mental health social workers, licensed counselors, etc.), the VA will not accept their opinions initially diagnosing PTSD. For VA purposes, a qualified medical professional is either a medical doctor or a PhD in psychology.
With that being said, once a veteran files a VA claim for PTSD, even if the veteran has a valid diagnosis of PTSD from a qualified medical professional, the VA is still going to require that the veteran undergo a Compensation and Pension Examination in order to verify the diagnosis and assess the severity. This is normally the case, even if a VA doctor has diagnosed the veteran with PTSD.
The VA uses the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to evaluate whether there is a valid diagnosis of PTSD. The DSM-IV lists six criterion for a diagnosis of PTSD. In the VA context, the criterion is evaluated as follows:
1. CRITERION A: The Veteran has been exposed to a traumatic event where both of the following were present:
a. The Veteran experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
b. The Veteran’s response involved intense fear, helplessness or horror.
c. No exposure to a traumatic event.
2. CRITERION B: The traumatic event is persistently re-experienced in 1 or more of the following ways:
a. Recurrent and distressing recollections of the event, including images, thoughts or perceptions
b. Recurrent distressing dreams of the event
c. Acting or feeling as if the traumatic event were recurring; this includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated
d. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
e. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
f. The traumatic event is not persistently re-experienced
3. CRITERION C: Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by 3 or more of the following:
a. Efforts to avoid thoughts, feelings or conversations associated with the trauma
b. Efforts to avoid activities, places or people that arouse recollections of the trauma
c. Inability to recall an important aspect of the trauma
d. Markedly diminished interest or participation in significant activities
e. Feeling of detachment or estrangement from others
f. Restricted range of affection (e.g., unable to have loving feelings)
g. Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children or a normal life span)
h. No persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness
4. CRITERION D: Persistent symptoms of increased arousal, not present before the trauma, as indicated by 2 or more of the following:
a. Difficulty falling or staying asleep
b. Irritability or outbursts of anger
c. Difficulty concentrating
e. No persistent symptoms of increased arousal
5. CRITERION E: Duration of symptoms
a. The duration of the symptoms described in Criteria B, C and D is more than 1 month
b. The duration of the symptoms described in Criteria B, C and D is less than 1 month
c. Veteran does not meet full criteria for PTSD
6. CRITERION F: Clinically significant distress or impairment
a. The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
b. The PTSD symptoms described above do NOT cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
c. Veteran does not meet full criteria for PTSD
All six of the DSM-IV criterion must be satisfied in order for a diagnosis of PTSD to be valid. If this threshold is not met, the VA will decide that the veteran does not have a valid claim for PTSD. Therefore, it is important that all symptoms be thoroughly documented, that veterans are diagnosed by qualified medical professionals (as defined by the VA), and that veterans be open and honest with their treating providers so that the VA has a true picture of the way the PTSD has forever impacted their lives.