Monday, August 19, 2013

The PTSD Series - Part 2

Medical Records

The topic covered in this installment is the medical evidence a veteran (or that veteran’s advocate, attorney or representative) needs to secure disability benefits for PTSD. As you recall from the previous blog post, medical evidence of a current diagnosis is the first thing the Veteran needs to prove in his/her claim for PTSD disability benefits.

This post will address the two big issues in this element of a PTSD claim: how much medical evidence is enough, and what type of medical evidence is needed.

How much evidence you need to prove depends on when you filed your claim. If you have a Board of Veterans’ Appeals decision issued after March 7, 1997, the veteran need only show that it is “at least as likely as not” that you have the PTSD condition. Prior to March 7, 1997, the standard was that the veteran needed a “clear diagnosis” of PTSD – this is no longer the proper standard. (If you have a BVA decision after March 7, 1997, which denies your PTSD claim on the basis of the lack of a “clear diagnosis” of PTSD, you should consider contacting a Veteran Service Organization or contact a VA Benefits attorney – the VA may have committed error in denying your claim).

The type of evidence necessary is this: an examination by a doctor, preferably a psychiatrist, and a written report. That report should discuss the doctor’s medical opinion that the incident you allege triggered your PTSD was medically sufficient to support a diagnosis of PTSD and that your symptoms were adequate enough for the doctor to diagnose PTSD. This gets a little tricky – you still need to prove the link between the stressor event and the current condition, and your doctor’s testimony that they are linked may not be enough. This is because the question of “linkage” is a question of fact for the VA, not a medical matter.

If the VA doubts the medical evidence you provided, it must follow one of two courses of action. It can either a) set aside its doubts and accept your medical evidence, or b) seek clarification of the portions of the report that cause it to doubt the medical evidence. If the VA does not get the clarification it needs, it can either a) return the report for more clarification or b) obtain independent medical evidence concerning the portions of the report the VA doubts or needs clarified.

Now that you now what (and how much) information you need to provide to VA, what does the doctor need to put in the report to aid your claim. It is imperative that your doctor follow the PTSD criteria in the DSM-IV; using an older DSM (DSM III and DSM III-R) is going to delay your claim and require medical reevaluation under the DSM-IV. This is because the criteria in the DSM-III and III-R are significantly different than the DSM-IV criteria.

The change to the PTSD criteria in DSM-IV benefits veterans in many ways, and leads to an interesting point. The VA used to use the DSM III and DSM III-R. In 1996, the VA adopted DSM-IV as the standard for evaluating mental health impairments. If your claim for disability benefits due to PTSD was rejected prior to 1996, and you have a diagnosis of PTSD dated after 1994, you may be able to reopen your claim for benefits and have it evaluated under the new criteria. At the very least, you should be able to file a new claim for benefits. You should consider consulting an attorney if this issue sounds like it might apply to you.

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