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Post Traumatic Stress Disorder (PTSD)

Department of Veterans Affairs Definition, The Short Version.
The VA Home Page on the Internet says:

In order to establish service connection for PTSD, the evidence must establish that during active duty a veteran was subjected to a stressor or stressors that would cause characteristic symptoms in almost anyone. Evidence of combat or having been a prisoner of war may be accepted as conclusive evidence of a stressor incurred during active duty. Evidence of combat includes receipt of the Purple Heart, the CIB, or other similar citation. The medical evidence must establish a clear diagnosis of PTSD and must link the current symptoms to the claimed stressor. (

01-10. Department of Veterans Affairs (VA) Definition, The Technical Versions. The following, issued by the Department of Veterans Affairs (VA) in the Code of Federal Regulation (CFR), part 38, offers the "official" definition you will be most concerned with:

a. "Post-Traumatic Stress Disorder. 3.304 (f) Service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. Additionally, if the claimed stressor is related to the claimant having been a prisoner-of-war, prisoner-of-war experience which satisfies the requirements of 3.1(y) of this part will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor."

b. "Mental Disorders - 4.125 General considerations. The field of mental disorders represents the greatest possible variety of etiology, chronicity and disabling effects, and requires differential consideration in these respects. These sections under mental disorders are concerned with the rating of psychiatric conditions, specifically psychotic and psychoneurotic disorders and psychological factors affecting physical conditions as well as organic mental disorders. Advances in modern psychiatry during and since World War II have been rapid and profound and have extended to the entire medical profession a better understanding of and deeper insight into the etiological factors, psychodynamics, and psychopathological changes which occur in mental disease and emotional disturbances. The psychiatric nomenclature employed is based upon the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM - III), American Psychiatric Association. This nomenclature has been adopted by the Veterans Health Services and Research Administration of the Department of Veterans Affairs. It limits itself to the classification of disturbances of mental functioning. To comply with the fundamental requirements for rating psychiatric conditions, it is imperative that rating personnel familiarize themselves thoroughly with this manual (American Psychiatric Association Manual, 1980 Edition) which will be hereinafter referred to as the APA manual.

4.126 Substantiation of diagnosis. It must be established first that a true mental disorder exists. The disorder will be diagnosed in accordance with the APA manual. A diagnosis not in accord with this manual is not acceptable for rating purposes and will be returned through channels to the examiner. Normal reactions of discouragement, anxiety, depression, and self-concern in the presence of physical disability, dissatisfaction with work environment, difficulties in securing employment, etc., must not be accepted by the rating board as indicative of psychoneurosis. Moreover, mere failure of social or industrial adjustment or the presence of numerous complaints should not, in the absence of definite symptomatology typical of a psychoneurotic or psychological factor affecting physical condition, become the acceptable basis of a diagnosis in this field. It is the responsibility of rating boards to accept or reject diagnoses shown on reports of examination. If a diagnosis is not supported by the findings shown on the examination report, it is incumbent upon the board to return the report for clarification. (CFR 38)."

From the Military Veterans PTSD Reference Manual...

"01-07. The Diagnostic and Statistical Manual of Mental Disorders (DSM) definition.

PTSD is defined in Section 309.81. I have made every effort to provide an accurate definition based on both the DSM and the Internet Page cited at the end of this section without violating copyright laws. In doing so what follows is by no means complete. Ask your physician to show you an exact copy, if need be.

You would have been exposed to an traumatic stressor (event) in which BOTH of the following were present:

a. You experienced an event or events that involved actual or threatened death or injury; or witnessed an event or events that involved death, injury, or a threat to soundness of another person; or you learned about a death or injury experienced by a family member or other friend; and
b. The stressor or stressors scared you very badly.

Also included in the diagnosis of PTSD, the traumatic event is then persistently re-experienced in at least ONE of the following ways:

a. Repeated and hurtful recollections of the event;

b. Nightmares of the event;
c. Flashbacks (these can be anything from "thoughts" to what I call "memory movies") that include those events you remember the most that occur upon awakening or when drunk;
d. Heavy duty anxiety and/or fear when exposed to internal or external cues that that are similar to the traumatic event, including anniversaries; and/or
e. Anxiety and/or fear upon exposure to triggers that resemble part or all of the traumatic event (e.g., a soldier getting into a vehicle of the type he lost a buddy).

PTSD also involves avoiding things associated with the trauma as indicated by at least three of the following:

a. You make a conscious effort not to talk or think about the trauma;
b. Efforts to avoid activities, places or people that arouse recollections of the trauma;
c. You have a difficult time remembering the event;
d. You have no interest in participating in social events;
e. You have very few friends, and even have a hard time getting close to your immediate family;
f. You are unable to love or get close to others; and/or
g. You may feel there is no hope for the future (this may result in suicidal thoughts. Over 100,000 Vietnam vets have committed suicide).

PTSD also involves constant problems with at least two of the following (not present before the traumatic event):

a. You have a difficult time falling or staying asleep (I found that this will not happen every night but will occur in cycles);
b. You seem on edge and get angry for no apparent reason;
c. You can't seem to think straight or keep your thoughts in order (this is often caused by the depression that accompanies the problem);
d. You are almost always "on your toes" for dangerous situations (this includes sitting with your back to the wall when you go to a restaurant and making certain you know where the exits are. It may also include taking different routes to work so as not to form a pattern); and/or
e. You overreact to sudden noises more than you should.

The above symptoms must occur for at least one month and you will likely experience personal, social, and work related problems. You may also be experiencing "survival" guilt because you made it and so many others did not and you will tend to withdraw and detach yourself from those around you.

"PTSD is diagnosed acute (comes on quickly, severe symptoms normally for a short period, but not chronic) if the duration of the symptoms is less than three months and chronic (long or drawn out) if the duration of symptoms is three months or more. PTSD is diagnosed as being with delayed onset if the onset of symptoms is at least six months after the traumatic event. Symptoms of PTSD can take months or sometimes years to manifest themselves" according to the "National Victim Center" Home Page. (

Experiencing any or all of these symptoms does not mean you are "crazy," but that you are suffering the normal effects of trauma brought on by an abnormal event."

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