ptsd Looking For A Link To The New "relaxed" Ptsd Stressor Criteria

[Philip Rogers]

My feeling is that it related to new claims, by current war claimants, and I need to clarify. Thanks!!

pr

[carlie]

pr,

Is this the one your looking for.

Hope it helps.

XOOXO,

carlie

http://edocket.access.gpo.gov/2009/E9-20339.htm

[Federal Register: August 24, 2009 (Volume 74, Number 162)]

[Proposed Rules]

[Page 42617-42619]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr24au09-15]

-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 3

RIN 2900-AN32

Stressor Determinations for Posttraumatic Stress Disorder

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY:

The Department of Veterans Affairs (VA) proposes to amend its

adjudication regulations governing service connection for posttraumatic

stress disorder (PTSD) by liberalizing in some cases the evidentiary

standard for establishing the required in-service stressor.

This amendment would eliminate the requirement for corroborating that the

claimed in-service stressor occurred if a stressor claimed by a veteran

is related to the veteran's fear of hostile military or terrorist

activity and a VA psychiatrist or psychologist confirms that the

claimed stressor is adequate to support a diagnosis of PTSD, provided

that the claimed stressor is consistent with the places, types, and

circumstances of the veteran's service and that the veteran's symptoms

are related to the claimed stressor.

This amendment takes into consideration the current scientific

research studies relating PTSD to exposure to hostile military and

terrorist actions.

It is intended to acknowledge the inherently

stressful nature of the places, types, and circumstances of service in

which fear of hostile military or terrorist activities is ongoing. With

this amendment, the evidentiary standard of establishing an in-service

stressor would be reduced in these cases.

This amendment is

additionally intended to facilitate the timely VA processing of PTSD

claims by simplifying the development and research procedures that

apply to these claims.

DATES: Comments must be received by VA on or before October 23, 2009.

ADDRESSES:

Written comments may be submitted through http://

www.Regulations.gov; by mail or hand-delivery to Director, Regulations

Management (02REG), Department of Veterans Affairs, 810 Vermont Ave.,

NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026.

(This is not a toll free number). Comments should indicate that they

are submitted in response to ``RIN 2900-AN32--Stressor Determinations

for Posttraumatic Stress Disorder.'' Copies of comments received will

be available for public inspection in the Office of Regulation Policy

and Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m.,

Monday through Friday (except holidays). Please call (202) 461-4902 for

an appointment. (This is not a toll free number). In addition, during

the comment period, comments may be viewed online through the Federal

Docket Management System (FDMS) at http://www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Thomas J. Kniffen, Chief, Regulations

Staff (211D), Compensation and Pension Service, Veterans Benefits

Administration, Department of Veterans Affairs, 810 Vermont Avenue,

NW., Washington, DC 20420, (202) 461-9725. (This is not a toll-free

number.)

SUPPLEMENTARY INFORMATION:

The Secretary of Veterans Affairs has

authority under 38 U.S.C. 501(a)(1) to prescribe regulations governing

the nature and extent of proof and evidence required to establish

entitlement to benefits.

In addition, under 38 U.S.C. 1154(a), the

Secretary is required to ``include in the regulations pertaining to

service-connection of disabilities'' provisions requiring ``due

consideration'' of the places, types, and circumstances of a veteran's

service. These statutes provide authority for this proposed amendment

of PTSD regulations.

Current regulations governing service connection of PTSD are

provided at 38 CFR 3.304(f). Under this provision, service connection

for PTSD generally requires: (1) Medical evidence diagnosing PTSD; (2)

medical evidence establishing a link between a veteran's current

symptoms and an in-service stressor; and (3) credible supporting

evidence that the claimed in-service stressor occurred.

In some cases, the requirement to establish the occurrence of the

claimed in-service stressor can be met based on the veteran's lay

testimony alone, provided that there is an absence of clear and

convincing evidence to the contrary and that the claimed stressor is

consistent with the circumstances, conditions, or hardships of the

veteran's service.

Such cases are those described under Sec.

3.304(f)

(1), when the evidence establishes a diagnosis of PTSD during

service and the claimed stressor is related to that service; under

Sec. 3.304(f)(

2), when the evidence establishes that the veteran

engaged in combat with the enemy and the claimed stressor is related to

that combat; and under current Sec. 3.304(f)(3), when the evidence

establishes that the veteran was a prisoner-of-war and the claimed

[[Page 42618]]

stressor is related to that prisoner-of-war experience. Currently, in

all other cases where service connection for PTSD is claimed, VA

regulations require credible supporting evidence corroborating the

occurrence of the claimed in-service stressor before service connection

can be established.

VA is proposing to amend Sec. 3.304(f) by redesignating current

paragraphs (3) and (4) as paragraphs (4) and (5) and adding a new

paragraph (3), stating that, if a stressor claimed by a veteran is

related to the veteran's fear of hostile military or terrorist activity

and a VA psychiatrist or psychologist, or a psychiatrist or

psychologist with whom VA has contracted, confirms that the claimed

stressor is adequate to support a diagnosis of PTSD and that the

veteran's symptoms are related to the claimed stressor, in the absence

of clear and convincing evidence to the contrary, and provided the

claimed stressor is consistent with the places, types, and

circumstances of the veteran's service, the veteran's lay testimony

alone may establish the occurrence of the claimed in-service stressor.

VA proposes to limit the confirmation of a claimed stressor to an

examination by a VA psychiatrist or psychologist, or a psychiatrist or

psychologist with whom VA has contracted, to ensure standardization and

consistency of mental health evaluations and reporting of these

evaluations, which will be based upon uniform VA examination protocols.

Under 38 CFR 4.125(a), all mental disorder diagnoses must conform

to the American Psychiatric Association's Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition (1994) (DSM-IV). According

to DSM-IV at 427-428, the first diagnostic criterion for PTSD is:

The person has been exposed to a traumatic event in which both

of the following have been present:

(1) The person experienced, witnessed, or was confronted with an

event or events that involved actual or threatened death or serious

injury, or a threat to the physical integrity of self or others;

(

2) The person's response involved intense fear, helplessness,

or horror.

The evidentiary liberalization we propose in new Sec. 3.304(f)(3)

is consistent with DSM-IV criteria for a PTSD diagnosis, which include

experiencing or confronting ``a threat to the physical integrity of

self or others'' and ``intense fear, helplessness, or horror'' in

response.

Also consistent with DSM-IV, the proposed new Sec. 3.304(f)(3)

defines ``fear of hostile military or terrorist activity'' to mean that

``a veteran experienced, witnessed, or was confronted with an event or

circumstance that involved actual or threatened death or serious

injury, or a threat to the physical integrity of the veteran or others,

such as from an actual or potential 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 the veteran's response

to the event or circumstance involved a psychological or psycho-

physiological state of fear, helplessness, or horror.''

A claimed

stressor must be consistent with the places, types, and circumstances

of the veteran's service.

Additionally, the proposed regulation change is consistent with

scientific studies related to PTSD and military troop deployment. In

the recently published Gulf War and Health: Volume 6, Physiologic,

Psychologic, and Psychosocial Effects of Deployment-Related Stress

(2008), the National Academies' Institute of Medicine (IOM) reviewed

studies on PTSD in veterans who served in Vietnam, the Gulf War,

Operation Enduring Freedom (OEF), and Operation Iraqi Freedom (OIF).

The IOM review analyzed the long-term mental and physical health

effects of ``deployment to a war zone.''

The stressors associated with

``deployment to a war zone'' were not limited to combat because

[A]s military conflicts have evolved to include more guerilla

warfare and insurgent activities, restricting the definition of

deployment-related stressors to combat may fail to acknowledge other

potent stressors experienced by military personnel in a war zone or

in the aftermath of combat. Those stressors include constant

vigilance against unexpected attack, the absence of a defined front

line, the difficulty of distinguishing enemy combatants from

civilians, [and] the ubiquity of improvised explosive devices. * * *

(Summary, p. 2) The IOM ``considered that military personnel deployed

to a war zone, even if direct combat was not experienced, have the

potential for exposure to deployment-related stressors that might

elicit a stress response.'' (Introduction, p. 13)

Based on these IOM findings, VA is proposing to reduce the burden

of showing the occurrence of an in-service stressor if the claimed

stressor is related to fear of hostile military or terrorist activity,

and is consistent with the places, types, and circumstances of the

veteran's service. The proposed amendment is intended to reduce the

time devoted to VA claims development and research of the claimed

stressor that is required to adjudicate claims for service connection

for PTSD.

VA will instead rely on a veteran's lay testimony alone to

establish occurrence of a stressor related to fear of hostile military

or terrorist activity, provided the claimed stressor is consistent with

the places, types, and circumstances of the veteran's service, if a VA

mental health professional opines that the claimed stressor is adequate

to support a diagnosis of PTSD and that the veteran's symptoms are

related to the claimed stressor. The proposed amendment would benefit

all veterans and would not be limited to veterans serving during the

current OEF and OIF. Improved timeliness, consistent decision-making,

and equitable resolution of PTSD claims are the intended results of the

revised regulation.

Paperwork Reduction Act

This document contains no new collection of information under the

Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521). The Office of

Management and Budget has approved the collection of information

provisions that are related to this proposed rule under OMB control

number 2900-0001 (VA Form 21-526, Veterans Application for Compensation

and Pension) and under OMB control number 2900-0075 (VA Form 21-4138,

Statement in Support of Claim).

Regulatory Flexibility Act

The Secretary hereby certifies that this proposed rule will not

have a significant economic impact on a substantial number of small

entities as they are defined in the Regulatory Flexibility Act, 5

U.S.C. 601-612. This proposed rule would not affect any small entities.

Only VA beneficiaries could be directly affected. Therefore, pursuant

to 5 U.S.C. 605(b), this proposed rule is exempt from the initial and

final regulatory flexibility analysis requirements of sections 603 and

604.

Executive Order 12866

Executive Order 12866 directs agencies to assess all costs and

benefits of available regulatory alternatives and, when regulation is

necessary, to select regulatory approaches that maximize net benefits

(including potential economic, environmental, public health and safety,

and other advantages; distributive impacts; and equity). The Executive

Order classifies a ``significant regulatory action,'' requiring review

by the Office of Management and Budget (OMB), as any regulatory action

that is likely to result in a rule that may: (1) Have an annual effect

on the economy of $100 million or more or adversely affect in a

material way the economy, a

[[Page 42619]]

sector of the economy, productivity, competition, jobs, the

environment, public health or safety, or State, local, or Tribal

governments or communities; (2) create a serious inconsistency or

otherwise interfere with an action taken or planned by another agency;

(3) materially alter the budgetary impact of entitlements, grants, user

fees, or loan programs or the rights and obligations of recipients

thereof; or (4) raise novel legal or policy issues arising out of legal

mandates, the President's priorities, or the principles set forth in

the Executive Order.

The economic, interagency, budgetary, legal, and policy

implications of this proposed rule have been examined, and it has been

determined to be a significant regulatory action under the Executive

Order because it is likely to result in a rule that will raise novel

legal or policy issues arising out of legal mandates, the President's

priorities, or the principles set forth in the Executive Order.

Unfunded Mandates

The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.

1532, that agencies prepare an assessment of anticipated costs and

benefits before issuing any rule that may result in the expenditure by

State, local, and Tribal governments, in the aggregate, or by the

private sector, of $100 million or more (adjusted annually for

inflation) in any year. This proposed rule would have no such effect on

State, local, and Tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance Numbers and Titles

The Catalog of Federal Domestic Assistance program numbers and

titles for this rule are 64.109, Veterans Compensation for Service-

Connected Disability and 64.110, Veterans Dependency and Indemnity

Compensation for Service-Connected Death.

List of Subjects in 38 CFR Part 3

Administrative practice and procedure, Claims, Disability benefits,

Health care, Pensions, Radioactive materials, Veterans, Vietnam.

Approved: June 29, 2009.

John R. Gingrich,

Chief of Staff, Department of Veterans Affairs.

For the reasons set out in the preamble, VA proposes to amend 38

CFR part 3 as follows:

PART 3--ADJUDICATION

Subpart A--Pension, Compensation, and Dependency and Indemnity

Compensation

1. The authority citation for part 3, subpart A continues to read

as follows:

Authority: 38 U.S.C. 501(a), unless otherwise noted.

2. Amend Sec. 3.304 as follows.

a. Revise the introductory text of paragraph (f).

b. Redesignate paragraphs (f)(3) and (4) as paragraphs (f)(4) and

(5) respectively.

c. Add new paragraph (f)(3).

The revision and addition read as follows:

Sec. 3.304 Direct service connection; wartime and peacetime.

* * * * *

(f) Posttraumatic stress disorder. Service connection for

posttraumatic stress disorder requires medical evidence diagnosing the

condition in accordance with Sec. 4.125(a) of this chapter; a link,

established by medical evidence, between current symptoms and an in-

service stressor; and credible supporting evidence that the claimed in-

service stressor occurred. The following provisions apply to claims for

service connection of posttraumatic stress disorder diagnosed during

service or based on the specified type of claimed stressor:

* * * * *

(3) If a stressor claimed by a veteran is related to the veteran's

fear of hostile military or terrorist activity and a VA psychiatrist or

psychologist, or a psychiatrist or psychologist with whom VA has

contracted, confirms that the claimed stressor is adequate to support a

diagnosis of posttraumatic stress disorder and that the veteran's

symptoms are related to the claimed stressor, in the absence of clear

and convincing evidence to the contrary, and provided the claimed

stressor is consistent with the places, types, and circumstances of the

veteran's service, the veteran's lay testimony alone may establish the

occurrence of the claimed in-service stressor. For purposes of this

paragraph, ``fear of hostile military or terrorist activity'' means

that a veteran experienced, witnessed, or was confronted with an event

or circumstance that involved actual or threatened death or serious

injury, or a threat to the physical integrity of the veteran or others,

such as from an actual or potential 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 the veteran's response

to the event or circumstance involved a psychological or psycho-

physiological state of fear, helplessness, or horror.

* * * * *

[FR Doc. E9-20339 Filed 8-21-09; 8:45 am]

BILLING CODE 8320-01-P

[Testvet]

pr,

Is this the one your looking for.

Hope it helps.

XOOXO,

carlie

http://edocket.access.gpo.gov/2009/E9-20339.htm

[Federal Register: August 24, 2009 (Volume 74, Number 162)]

[Proposed Rules]

[Page 42617-42619]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr24au09-15]

-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 3

RIN 2900-AN32

Stressor Determinations for Posttraumatic Stress Disorder

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY:

The Department of Veterans Affairs (VA) proposes to amend its

adjudication regulations governing service connection for posttraumatic

stress disorder (PTSD) by liberalizing in some cases the evidentiary

standard for establishing the required in-service stressor.

This amendment would eliminate the requirement for corroborating that the

claimed in-service stressor occurred if a stressor claimed by a veteran

is related to the veteran's fear of hostile military or terrorist

activity and a VA psychiatrist or psychologist confirms that the

claimed stressor is adequate to support a diagnosis of PTSD, provided

that the claimed stressor is consistent with the places, types, and

circumstances of the veteran's service and that the veteran's symptoms

are related to the claimed stressor.

This amendment takes into consideration the current scientific

research studies relating PTSD to exposure to hostile military and

terrorist actions.

It is intended to acknowledge the inherently

stressful nature of the places, types, and circumstances of service in

which fear of hostile military or terrorist activities is ongoing. With

this amendment, the evidentiary standard of establishing an in-service

stressor would be reduced in these cases.

This amendment is

additionally intended to facilitate the timely VA processing of PTSD

claims by simplifying the development and research procedures that

apply to these claims.

DATES: Comments must be received by VA on or before October 23, 2009.

ADDRESSES:

Written comments may be submitted through http://

www.Regulations.gov; by mail or hand-delivery to Director, Regulations

Management (02REG), Department of Veterans Affairs, 810 Vermont Ave.,

NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026.

(This is not a toll free number). Comments should indicate that they

are submitted in response to ``RIN 2900-AN32--Stressor Determinations

for Posttraumatic Stress Disorder.'' Copies of comments received will

be available for public inspection in the Office of Regulation Policy

and Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m.,

Monday through Friday (except holidays). Please call (202) 461-4902 for

an appointment. (This is not a toll free number). In addition, during

the comment period, comments may be viewed online through the Federal

Docket Management System (FDMS) at http://www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Thomas J. Kniffen, Chief, Regulations

Staff (211D), Compensation and Pension Service, Veterans Benefits

Administration, Department of Veterans Affairs, 810 Vermont Avenue,

NW., Washington, DC 20420, (202) 461-9725. (This is not a toll-free

number.)

SUPPLEMENTARY INFORMATION:

The Secretary of Veterans Affairs has

authority under 38 U.S.C. 501(a)(1) to prescribe regulations governing

the nature and extent of proof and evidence required to establish

entitlement to benefits.

In addition, under 38 U.S.C. 1154(a), the

Secretary is required to ``include in the regulations pertaining to

service-connection of disabilities'' provisions requiring ``due

consideration'' of the places, types, and circumstances of a veteran's

service. These statutes provide authority for this proposed amendment

of PTSD regulations.

Current regulations governing service connection of PTSD are

provided at 38 CFR 3.304(f). Under this provision, service connection

for PTSD generally requires: (1) Medical evidence diagnosing PTSD; (2)

medical evidence establishing a link between a veteran's current

symptoms and an in-service stressor; and (3) credible supporting

evidence that the claimed in-service stressor occurred.

In some cases, the requirement to establish the occurrence of the

claimed in-service stressor can be met based on the veteran's lay

testimony alone, provided that there is an absence of clear and

convincing evidence to the contrary and that the claimed stressor is

consistent with the circumstances, conditions, or hardships of the

veteran's service.

Such cases are those described under Sec.

3.304(f)

(1), when the evidence establishes a diagnosis of PTSD during

service and the claimed stressor is related to that service; under

Sec. 3.304(f)(

2), when the evidence establishes that the veteran

engaged in combat with the enemy and the claimed stressor is related to

that combat; and under current Sec. 3.304(f)(3), when the evidence

establishes that the veteran was a prisoner-of-war and the claimed

[[Page 42618]]

stressor is related to that prisoner-of-war experience. Currently, in

all other cases where service connection for PTSD is claimed, VA

regulations require credible supporting evidence corroborating the

occurrence of the claimed in-service stressor before service connection

can be established.

VA is proposing to amend Sec. 3.304(f) by redesignating current

paragraphs (3) and (4) as paragraphs (4) and (5) and adding a new

paragraph (3), stating that, if a stressor claimed by a veteran is

related to the veteran's fear of hostile military or terrorist activity

and a VA psychiatrist or psychologist, or a psychiatrist or

psychologist with whom VA has contracted, confirms that the claimed

stressor is adequate to support a diagnosis of PTSD and that the

veteran's symptoms are related to the claimed stressor, in the absence

of clear and convincing evidence to the contrary, and provided the

claimed stressor is consistent with the places, types, and

circumstances of the veteran's service, the veteran's lay testimony

alone may establish the occurrence of the claimed in-service stressor.

VA proposes to limit the confirmation of a claimed stressor to an

examination by a VA psychiatrist or psychologist, or a psychiatrist or

psychologist with whom VA has contracted, to ensure standardization and

consistency of mental health evaluations and reporting of these

evaluations, which will be based upon uniform VA examination protocols.

Under 38 CFR 4.125(a), all mental disorder diagnoses must conform

to the American Psychiatric Association's Diagnostic and Statistical

Manual of Mental Disorders, Fourth Edition (1994) (DSM-IV). According

to DSM-IV at 427-428, the first diagnostic criterion for PTSD is:

The person has been exposed to a traumatic event in which both

of the following have been present:

(1) The person experienced, witnessed, or was confronted with an

event or events that involved actual or threatened death or serious

injury, or a threat to the physical integrity of self or others;

(

2) The person's response involved intense fear, helplessness,

or horror.

The evidentiary liberalization we propose in new Sec. 3.304(f)(3)

is consistent with DSM-IV criteria for a PTSD diagnosis, which include

experiencing or confronting ``a threat to the physical integrity of

self or others'' and ``intense fear, helplessness, or horror'' in

response.

Also consistent with DSM-IV, the proposed new Sec. 3.304(f)(3)

defines ``fear of hostile military or terrorist activity'' to mean that

``a veteran experienced, witnessed, or was confronted with an event or

circumstance that involved actual or threatened death or serious

injury, or a threat to the physical integrity of the veteran or others,

such as from an actual or potential 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 the veteran's response

to the event or circumstance involved a psychological or psycho-

physiological state of fear, helplessness, or horror.''

A claimed

stressor must be consistent with the places, types, and circumstances

of the veteran's service.

Additionally, the proposed regulation change is consistent with

scientific studies related to PTSD and military troop deployment. In

the recently published Gulf War and Health: Volume 6, Physiologic,

Psychologic, and Psychosocial Effects of Deployment-Related Stress

(2008), the National Academies' Institute of Medicine (IOM) reviewed

studies on PTSD in veterans who served in Vietnam, the Gulf War,

Operation Enduring Freedom (OEF), and Operation Iraqi Freedom (OIF).

The IOM review analyzed the long-term mental and physical health

effects of ``deployment to a war zone.''

The stressors associated with

``deployment to a war zone'' were not limited to combat because

[A]s military conflicts have evolved to include more guerilla

warfare and insurgent activities, restricting the definition of

deployment-related stressors to combat may fail to acknowledge other

potent stressors experienced by military personnel in a war zone or

in the aftermath of combat. Those stressors include constant

vigilance against unexpected attack, the absence of a defined front

line, the difficulty of distinguishing enemy combatants from

civilians, [and] the ubiquity of improvised explosive devices. * * *

(Summary, p. 2) The IOM ``considered that military personnel deployed

to a war zone, even if direct combat was not experienced, have the

potential for exposure to deployment-related stressors that might

elicit a stress response.'' (Introduction, p. 13)

Based on these IOM findings, VA is proposing to reduce the burden

of showing the occurrence of an in-service stressor if the claimed

stressor is related to fear of hostile military or terrorist activity,

and is consistent with the places, types, and circumstances of the

veteran's service. The proposed amendment is intended to reduce the

time devoted to VA claims development and research of the claimed

stressor that is required to adjudicate claims for service connection

for PTSD.

VA will instead rely on a veteran's lay testimony alone to

establish occurrence of a stressor related to fear of hostile military

or terrorist activity, provided the claimed stressor is consistent with

the places, types, and circumstances of the veteran's service, if a VA

mental health professional opines that the claimed stressor is adequate

to support a diagnosis of PTSD and that the veteran's symptoms are

related to the claimed stressor. The proposed amendment would benefit

all veterans and would not be limited to veterans serving during the

current OEF and OIF. Improved timeliness, consistent decision-making,

and equitable resolution of PTSD claims are the intended results of the

revised regulation.

Paperwork Reduction Act

This document contains no new collection of information under the

Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521). The Office of

Management and Budget has approved the collection of information

provisions that are related to this proposed rule under OMB control

number 2900-0001 (VA Form 21-526, Veterans Application for Compensation

and Pension) and under OMB control number 2900-0075 (VA Form 21-4138,

Statement in Support of Claim).

Regulatory Flexibility Act

The Secretary hereby certifies that this proposed rule will not

have a significant economic impact on a substantial number of small

entities as they are defined in the Regulatory Flexibility Act, 5

U.S.C. 601-612. This proposed rule would not affect any small entities.

Only VA beneficiaries could be directly affected. Therefore, pursuant

to 5 U.S.C. 605(:), this proposed rule is exempt from the initial and

final regulatory flexibility analysis requirements of sections 603 and

604.

Executive Order 12866

Executive Order 12866 directs agencies to assess all costs and

benefits of available regulatory alternatives and, when regulation is

necessary, to select regulatory approaches that maximize net benefits

(including potential economic, environmental, public health and safety,

and other advantages; distributive impacts; and equity). The Executive

Order classifies a ``significant regulatory action,'' requiring review

by the Office of Management and Budget (OMB), as any regulatory action

that is likely to result in a rule that may: (1) Have an annual effect

on the economy of $100 million or more or adversely affect in a

material way the economy, a

[[Page 42619]]

sector of the economy, productivity, competition, jobs, the

environment, public health or safety, or State, local, or Tribal

governments or communities; (2) create a serious inconsistency or

otherwise interfere with an action taken or planned by another agency;

(3) materially alter the budgetary impact of entitlements, grants, user

fees, or loan programs or the rights and obligations of recipients

thereof; or (4) raise novel legal or policy issues arising out of legal

mandates, the President's priorities, or the principles set forth in

the Executive Order.

The economic, interagency, budgetary, legal, and policy

implications of this proposed rule have been examined, and it has been

determined to be a significant regulatory action under the Executive

Order because it is likely to result in a rule that will raise novel

legal or policy issues arising out of legal mandates, the President's

priorities, or the principles set forth in the Executive Order.

Unfunded Mandates

The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.

1532, that agencies prepare an assessment of anticipated costs and

benefits before issuing any rule that may result in the expenditure by

State, local, and Tribal governments, in the aggregate, or by the

private sector, of $100 million or more (adjusted annually for

inflation) in any year. This proposed rule would have no such effect on

State, local, and Tribal governments, or on the private sector.

Catalog of Federal Domestic Assistance Numbers and Titles

The Catalog of Federal Domestic Assistance program numbers and

titles for this rule are 64.109, Veterans Compensation for Service-

Connected Disability and 64.110, Veterans Dependency and Indemnity

Compensation for Service-Connected Death.

List of Subjects in 38 CFR Part 3

Administrative practice and procedure, Claims, Disability benefits,

Health care, Pensions, Radioactive materials, Veterans, Vietnam.

Approved: June 29, 2009.

John R. Gingrich,

Chief of Staff, Department of Veterans Affairs.

For the reasons set out in the preamble, VA proposes to amend 38

CFR part 3 as follows:

PART 3--ADJUDICATION

Subpart A--Pension, Compensation, and Dependency and Indemnity

Compensation

1. The authority citation for part 3, subpart A continues to read

as follows:

Authority: 38 U.S.C. 501(a), unless otherwise noted.

2. Amend Sec. 3.304 as follows.

a. Revise the introductory text of paragraph (f).

b. Redesignate paragraphs (f)(3) and (4) as paragraphs (f)(4) and

(5) respectively.

c. Add new paragraph (f)(3).

The revision and addition read as follows:

Sec. 3.304 Direct service connection; wartime and peacetime.

* * * * *

(f) Posttraumatic stress disorder. Service connection for

posttraumatic stress disorder requires medical evidence diagnosing the

condition in accordance with Sec. 4.125(a) of this chapter; a link,

established by medical evidence, between current symptoms and an in-

service stressor; and credible supporting evidence that the claimed in-

service stressor occurred. The following provisions apply to claims for

service connection of posttraumatic stress disorder diagnosed during

service or based on the specified type of claimed stressor:

* * * * *

(3) If a stressor claimed by a veteran is related to the veteran's

fear of hostile military or terrorist activity and a VA psychiatrist or

psychologist, or a psychiatrist or psychologist with whom VA has

contracted, confirms that the claimed stressor is adequate to support a

diagnosis of posttraumatic stress disorder and that the veteran's

symptoms are related to the claimed stressor, in the absence of clear

and convincing evidence to the contrary, and provided the claimed

stressor is consistent with the places, types, and circumstances of the

veteran's service, the veteran's lay testimony alone may establish the

occurrence of the claimed in-service stressor. For purposes of this

paragraph, ``fear of hostile military or terrorist activity'' means

that a veteran experienced, witnessed, or was confronted with an event

or circumstance that involved actual or threatened death or serious

injury, or a threat to the physical integrity of the veteran or others,

such as from an actual or potential 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 the veteran's response

to the event or circumstance involved a psychological or psycho-

physiological state of fear, helplessness, or horror.

* * * * *

[FR Doc. E9-20339 Filed 8-21-09; 8:45 am]

BILLING CODE 8320-01-P

I don't see any restrictions to what war or time period I would imagine the same rules would apply to any veterans from WW2 to the present making the claim, the whole key relies on a VA pyschiatrist making the determination of PTSD not IMOs or any other doctors VA doctors only if the rules stand as proposed how soon before it becomes effective?

[Philip Rogers]

Thanks, Carla!!! That's it.

pr

[john999]

It almost sounds like PTSD is almost presumptive if a person serves in a combat zone.