As stated previously, for service connection of PTSD three elements are required.
- The veteran must have a current diagnosis of PTSD
- The in-service event/stressors must be supported by credible evidence
- A connection (called a nexus) between the current diagnosis of PTSD and the in-service event/stressor must be supported by medical evidence.
This article will focus on the second element: In-Service event/stressor and supporting evidence.
38 CFR 3.304(f)
Under 38 CFR 3.304(f) there are several categories a veteran can fall under when seeking service connection for PTSD. The category determines the burden of proof needed for the in-service stressor.
- Diagnosis during active military service.
- Fear related to hostile military or terrorist activity.
- Combat Veteran
- Personal assault or trauma in service
A veteran with a diagnosis of PTSD during active military service has a lower burden of proof for the in-service stressor. The veteran may use their own statements as evidence to support that the in-service stressor occurred if the statement is consistent with the circumstances and there is no clear and convincing evidence against the veteran’s statement.
An event that involved actual or threatened death or serious injury, the threat of physical harm of the veteran or others resulting in a psychological or psycho-physiological state of fear, helplessness, or horror qualifies as fear of hostile military or terrorist activity. A veteran may experience this themselves or witness the circumstances. Again, this is a lower burden of proof. If a VA psychologist or psychiatrist states that the PTSD stressor is related to the fear of hostile military or terrorist activity, then no corroborating evidence is needed provided that the circumstances are consistent and there is no clear and convincing evidence against the veteran’s statements.
Combat veterans also have a lower burden of proof. The VA concedes that if a veteran was engaged in combat the focus of the veteran was elsewhere and not on specific injuries. Therefore, the veteran’s statement may be sufficient evidence that the stressor was combat-related, provided that the statement is consistent with the circumstances and there is no clear and convincing evidence against the statement. The nexus may also be shown by a combat award, Military occupation specialty, or location of service shown in the veteran’s military service record.
VA Compensation and Pension Manuel Rewrite
According to the VA Compensation and Pension Manuel Rewrite, VA interprets 38 CFR 3.304(f) to presume that the veteran engaged in combat with the enemy if any of the following were awarded and listed on the veterans DD 214:
- Air Force Achievement Medal with “V” Device
- Air Force Combat Action Medal
- Air Force Commendation Medal with “V” Device
- Air Force Cross
- Air Medal with “V” Device
- Army Commendation Medal with “V” Device
- Bronze Star Medal with “V” Device
- “C” device, denoting combat conditions, when affixed to other awards for meritorious service or achievement
- Combat Action Badge (CAB)
- Combat Action Ribbon (CAR) (Prior to February 1969, the Navy Achievement Medal with “V” Device was awarded.)
- Combat Aircrew Insignia
- Combat Infantry/Infantryman Badge (CIB)
- Combat Medical Badge
- Distinguished Flying Cross
- Distinguished Service Cross
- Fleet Marine Force (FMF) Combat Operations Insignia
- Joint Service Commendation Medal with “V” Device
- Medal of Honor
- Navy Commendation Medal with “V” Device
- Navy Cross
- Parachutist Badge with Combat Jump Device
- Purple Heart, and/or
- Silver Star.
This list is not all-inclusive and additional evidence may be needed if the veteran’s military service record, MOS, or location of service do not show combat. Combat may also be shown through buddy statements, letters, other military decorations, pictures, or other sources of evidence.
If the stressor was an event such as personal trauma, assault, or sexual assault and the veteran’s military treatment records do not show the event, alternative sources of credible evidence may be used. Many times, veterans that suffered a traumatic event in service are reluctant to discuss such events after they occur. This means there is no evidence of the event in the military service record. Therefore, records from law enforcement, rape crisis centers, mental health centers, statements from friends and family, performance evaluations, medical reports, or other sources of evidence may be used to corroborate the event.
If the veteran does not fall into one of the first four categories, then they must have other evidence to corroborate the stressor. This means that the veteran’s statement is not enough. These can be events that occurred while the veteran was on active duty but did not occur during military training or deployment, such as an accident on a weekend. The veteran may bring police reports, news reports, statements from others who were at the event, medical records, or other evidence to corroborate the event as long as there is no evidence that speaks in opposition to the veteran’s account.
In all cases, the VA has a duty to assist the veteran in collecting documents and records that help corroborate the stressor.