A bad situtation can be made better with this information and advice from our VA claims expert.
By Raymond Gustavson
Having a claim for sexual trauma approved by the Department of Veterans Affairs (VA) should never be an agonizing or embarrassing process. First of all, Regional Office rating specialists are trained to handle your claim in a caring and compassionate manner. Second, all information concerning your claim is kept strictly confidential. Once the rating decision has been made, these documents are permanently sealed in your claims folder.
That said, the VA handles two types of claims for sexual trauma. The first concerns physical disabilities. These are rated on what is called “the merits of the case.” That is, the claim is reviewed by the rating specialist, and either granted or denied. A complete discussion of this process is, of course, beyond the scope of this article. Suffice it to say that service connection can be granted for these conditions provided that a physical examination was conducted shortly after the traumatic event.
The second type of claim encompasses post-traumatic stress disorder (PTSD), and by far comprises the majority of sexual trauma claims handled by the rating specialist.
There are three requirements necessary for a grant of PTSD secondary to sexual trauma. Simply put, you must have the following:
• Evidence that your in-service stressor occurred.
• A current diagnosis of PTSD.
• Medical evidence of a causal nexus (or link) between your current symptoms and the stressor.
What is it?
So, what exactly is sexual trauma? The VA, defines it as lingering emotional, physical, or psychological symptoms resulting from physical assault or battery of a sexual nature, and sexual harassment. By law, sexual harassment is defined as repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.
Now, we turn to the first of the three requirements for PTSD – the stressor. Technically speaking, it’s a conditiion, stimulus, or life event that causes or provokes a stressful response in someone. Simply put, it’s the rape, assault, or sexual harassment you went through. Other examples include unwanted touching, grabbing, etc. Always, the stressor occurs against your will. Sometimes this happens because you were forced or pressured by someone who had authority over you such as a sergeant, doctor, teacher, or boss. Other times this took place because you were given drugs or alcohol. Often it involves the use of force or violence.
Looking at the symptoms
Symptoms of PTSD do not always develop immediately after the event. They may be delayed for years, and include the following: sleep disturbances and nightmares, emotional problems, feelings of fear and anxiety, impaired concentration, and problems with intimacy and interpersonal relations.
The VA rating specialist who handles your claim will review your service medical records and military 201 File looking for verification, either in the form of sick call, hospital reports, or any other evidence that shows the stressor occurred. Other evidence will include the following:
• Records from law enforcement authorities.
• Records from rape crisis centers, hospitals, or physicians.
• Pregnancy tests or tests for sexually transmitted diseases.
• Statements from family members, roommates, fellow service members or clergy.
Be forewarned, however, that nothing may be found. If such is the case, do not lose hope, because the rating specialist will then look for alternative evidence, or “markers.” Such markers are isolated events that have no specific relationship to the traumatic event, but give clues that the stressor occurred. Examples include, but are not limited to, the following:
• Visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment.
• Sudden requests for a change in duty assignment without any justification.
• Increased use or abuse of leave without an apparent reason, such as family obligations or family illness.
• Changes in performance and performance evaluations.
• Episodes of depression, panic attacks, or anxiety, with no identifiable reasons for the episodes.
• Increased or decreased use of prescription medications.
• Increased use of over-the-counter medications.
• Substance abuse, such as alcohol or drugs.
• Increased disregard for military or civilian authority.
• Obsessive behavior, such as overeating or undereating.
• Unexplained economic or social behavior changes.
• Breakup of a primary relationship.
To ensure that the VA has all necessary evidence to rate your claim, the rating specialist will send you what is called a Post-Traumatic Stress Disorder-Sexual Trauma development letter. This letter will ask for a description of the incident(s). Painful as this may be, you should answer the questions to the best of your ability, as this information is vitally necessary to the processing of your claim. If you have any questions regarding this letter, contact the Women Veterans Coordinator. Her name and telephone number are listed in the body of the letter.
If you reported the sexual assault or harassment to military authorities, the rating specialist will attempt to secure investigative reports from your branch of service. Each branch has its own agency that handles this information.If the Military Police conducted an investigation, the report was filed at the military installation where the offense occurred. Please be sure to give the specific date(s) of the incident, witnesses present, and any other pertinent details. Likewise, if you reported the incident to civilian authorities the rating specialist will obtain police, doctor, and rape-crisis-center reports.
As you can see, there is not always a clear-cut pattern of evidence showing that a personal assault occurred. Most likely, the claimant was too humiliated to report the incident to military authorities. Even if this was done, there are cases where the unit commander or other responsible person did nothing to investigate and punish the perpetrator.
A resultant lack of record keeping is not uncommon. This makes the job of the rating specialist difficult, but not impossible. In such cases the rating specialist will resort to the markers listed above to determine if there was some type of behavioral change. For example, a serviceperson may have had an exemplary work record up to the time of the personal assault, but now it is considered marginal. That gives a pretty strong clue that the assault occurred.
After all this information has been obtained, and the stressor has been verified, the rating specialist will request a PTSD examination for you at a VA facility. Who can make a diagnosis of post traumatic stress disorder? Usually, it is a licensed psychiatrist, but VA regulations also stipulate a VA psychologist at the GS-13 level, or a private psychologist holding a Ph.D. in psychology or a related field of study, may make the diagnosis.
You must attend this examination when the VA requests it. If you fail to appear, your claim will be rated on the available evidence, and possibly denied. So take this opportunity and go to the examination, even if it will cause you mental anguish. Remember – this is a golden opportunity for you to state your case. It can also herald the start of the healing process.
At the examination, your doctor will determine whether your symptoms are a result of a threat to your physical integrity. Based on your answers, and a review of your claims file, he will make a diagnosis and establish a nexus (or link) to the stressor. To assist in his examination, your doctor will refer to the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual has been refined over the years with the latest one, DSM-IV-TR, issued in the year 2000.
After a nexus (or link) between the current symptomatology and the stressor has been established, the VA examiner will determine the severity of your PTSD. This is done with the use of a tool called the Global Assessment of Functioning (GAF). A GAF is an indicator of your psychological, social, and occupational functioning. It is assigned by the examiner, and ranges in severity from 100 to 0. That is, the lower the GAF score, the more severe the symptoms.
If additional mental disorders are present with a veteran who has post traumatic stress disorder, the rating specialist is obligated to ask the VA or other examiner to separate these disorders from the PTSD diagnosis. The examiner will then assign one GAF for the PTSD and another for the secondary condition. The resultant GAF for PTSD is then used to determine the exact degree of disability for your PTSD.
Once the VA examination has been forwarded to the VA Regional Office, the rating specialist will review your claim and prepare a rating decision granting the benefit. You will be sent a copy of this decision. If your claim for PTSD is denied, do not lose hope. A denial does not mean that the VA doubts your account of the events. It means that your claim does not meet the requirements of the law.
So what do you do with this VA denial letter? First of all, read the entire letter, and look specifically at the reasons why your claim was denied. Next, send a one-sentence letter to the VA stating that you disagree with the decision. This protects your appeal rights – however, your letter must be received within one year of the VA denial letter. In your letter, you can submit any additional evidence you feel is relevant to your claim, or any information the VA requested but you failed to send.
Since the VA appeals process is a precise yet often uneasy process to understand, I would strongly advise contacting a local service organization such as the DAV, American Legion, VFW, or others. One of their service representatives will explain exactly why your claim was denied, and help you process your appeal.
Sometimes, it’s as simple as not sending in that one piece of information you thought was too personal, or a waste of time. So, again, don’t lose hope.
The grant of a VA disability for PTSD as a result of in-service sexual assault or harassment is often a satisfying conclusion to a long, drawn-out struggle. The grant is satisfying to you, the veteran, but it is equally satisfying to the rating specialist. Nothing gave me greater pleasure than to prepare a rating granting this benefit. It seemed like I was helping someone to right a grievous wrong. Along with counseling offered by the VA, it can be the start of the healing process. That is significant.
Raymond Gustavson served with the U.S. Army in Vietnam, and is a retired VA Rating Specialist. He is currently working on a novel about the Civil War, and also is writing a self-help book for veterans who want to better understand the complexities of the VA claims process.
Question
usmcgirl
Your VA Claim for Sexual Trauma
A bad situtation can be made better with this information and advice from our VA claims expert.
By Raymond Gustavson
Having a claim for sexual trauma approved by the Department of Veterans Affairs (VA) should never be an agonizing or embarrassing process. First of all, Regional Office rating specialists are trained to handle your claim in a caring and compassionate manner. Second, all information concerning your claim is kept strictly confidential. Once the rating decision has been made, these documents are permanently sealed in your claims folder.
That said, the VA handles two types of claims for sexual trauma. The first concerns physical disabilities. These are rated on what is called “the merits of the case.” That is, the claim is reviewed by the rating specialist, and either granted or denied. A complete discussion of this process is, of course, beyond the scope of this article. Suffice it to say that service connection can be granted for these conditions provided that a physical examination was conducted shortly after the traumatic event.
The second type of claim encompasses post-traumatic stress disorder (PTSD), and by far comprises the majority of sexual trauma claims handled by the rating specialist.
There are three requirements necessary for a grant of PTSD secondary to sexual trauma. Simply put, you must have the following:
• Evidence that your in-service stressor occurred.
• A current diagnosis of PTSD.
• Medical evidence of a causal nexus (or link) between your current symptoms and the stressor.
What is it?
So, what exactly is sexual trauma? The VA, defines it as lingering emotional, physical, or psychological symptoms resulting from physical assault or battery of a sexual nature, and sexual harassment. By law, sexual harassment is defined as repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.
Now, we turn to the first of the three requirements for PTSD – the stressor. Technically speaking, it’s a conditiion, stimulus, or life event that causes or provokes a stressful response in someone. Simply put, it’s the rape, assault, or sexual harassment you went through. Other examples include unwanted touching, grabbing, etc. Always, the stressor occurs against your will. Sometimes this happens because you were forced or pressured by someone who had authority over you such as a sergeant, doctor, teacher, or boss. Other times this took place because you were given drugs or alcohol. Often it involves the use of force or violence.
Looking at the symptoms
Symptoms of PTSD do not always develop immediately after the event. They may be delayed for years, and include the following: sleep disturbances and nightmares, emotional problems, feelings of fear and anxiety, impaired concentration, and problems with intimacy and interpersonal relations.
The VA rating specialist who handles your claim will review your service medical records and military 201 File looking for verification, either in the form of sick call, hospital reports, or any other evidence that shows the stressor occurred. Other evidence will include the following:
• Records from law enforcement authorities.
• Records from rape crisis centers, hospitals, or physicians.
• Pregnancy tests or tests for sexually transmitted diseases.
• Statements from family members, roommates, fellow service members or clergy.
Be forewarned, however, that nothing may be found. If such is the case, do not lose hope, because the rating specialist will then look for alternative evidence, or “markers.” Such markers are isolated events that have no specific relationship to the traumatic event, but give clues that the stressor occurred. Examples include, but are not limited to, the following:
• Visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment.
• Sudden requests for a change in duty assignment without any justification.
• Increased use or abuse of leave without an apparent reason, such as family obligations or family illness.
• Changes in performance and performance evaluations.
• Episodes of depression, panic attacks, or anxiety, with no identifiable reasons for the episodes.
• Increased or decreased use of prescription medications.
• Increased use of over-the-counter medications.
• Substance abuse, such as alcohol or drugs.
• Increased disregard for military or civilian authority.
• Obsessive behavior, such as overeating or undereating.
• Unexplained economic or social behavior changes.
• Breakup of a primary relationship.
To ensure that the VA has all necessary evidence to rate your claim, the rating specialist will send you what is called a Post-Traumatic Stress Disorder-Sexual Trauma development letter. This letter will ask for a description of the incident(s). Painful as this may be, you should answer the questions to the best of your ability, as this information is vitally necessary to the processing of your claim. If you have any questions regarding this letter, contact the Women Veterans Coordinator. Her name and telephone number are listed in the body of the letter.
If you reported the sexual assault or harassment to military authorities, the rating specialist will attempt to secure investigative reports from your branch of service. Each branch has its own agency that handles this information.If the Military Police conducted an investigation, the report was filed at the military installation where the offense occurred. Please be sure to give the specific date(s) of the incident, witnesses present, and any other pertinent details. Likewise, if you reported the incident to civilian authorities the rating specialist will obtain police, doctor, and rape-crisis-center reports.
As you can see, there is not always a clear-cut pattern of evidence showing that a personal assault occurred. Most likely, the claimant was too humiliated to report the incident to military authorities. Even if this was done, there are cases where the unit commander or other responsible person did nothing to investigate and punish the perpetrator.
A resultant lack of record keeping is not uncommon. This makes the job of the rating specialist difficult, but not impossible. In such cases the rating specialist will resort to the markers listed above to determine if there was some type of behavioral change. For example, a serviceperson may have had an exemplary work record up to the time of the personal assault, but now it is considered marginal. That gives a pretty strong clue that the assault occurred.
After all this information has been obtained, and the stressor has been verified, the rating specialist will request a PTSD examination for you at a VA facility. Who can make a diagnosis of post traumatic stress disorder? Usually, it is a licensed psychiatrist, but VA regulations also stipulate a VA psychologist at the GS-13 level, or a private psychologist holding a Ph.D. in psychology or a related field of study, may make the diagnosis.
You must attend this examination when the VA requests it. If you fail to appear, your claim will be rated on the available evidence, and possibly denied. So take this opportunity and go to the examination, even if it will cause you mental anguish. Remember – this is a golden opportunity for you to state your case. It can also herald the start of the healing process.
At the examination, your doctor will determine whether your symptoms are a result of a threat to your physical integrity. Based on your answers, and a review of your claims file, he will make a diagnosis and establish a nexus (or link) to the stressor. To assist in his examination, your doctor will refer to the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual has been refined over the years with the latest one, DSM-IV-TR, issued in the year 2000.
After a nexus (or link) between the current symptomatology and the stressor has been established, the VA examiner will determine the severity of your PTSD. This is done with the use of a tool called the Global Assessment of Functioning (GAF). A GAF is an indicator of your psychological, social, and occupational functioning. It is assigned by the examiner, and ranges in severity from 100 to 0. That is, the lower the GAF score, the more severe the symptoms.
If additional mental disorders are present with a veteran who has post traumatic stress disorder, the rating specialist is obligated to ask the VA or other examiner to separate these disorders from the PTSD diagnosis. The examiner will then assign one GAF for the PTSD and another for the secondary condition. The resultant GAF for PTSD is then used to determine the exact degree of disability for your PTSD.
Once the VA examination has been forwarded to the VA Regional Office, the rating specialist will review your claim and prepare a rating decision granting the benefit. You will be sent a copy of this decision. If your claim for PTSD is denied, do not lose hope. A denial does not mean that the VA doubts your account of the events. It means that your claim does not meet the requirements of the law.
So what do you do with this VA denial letter? First of all, read the entire letter, and look specifically at the reasons why your claim was denied. Next, send a one-sentence letter to the VA stating that you disagree with the decision. This protects your appeal rights – however, your letter must be received within one year of the VA denial letter. In your letter, you can submit any additional evidence you feel is relevant to your claim, or any information the VA requested but you failed to send.
Since the VA appeals process is a precise yet often uneasy process to understand, I would strongly advise contacting a local service organization such as the DAV, American Legion, VFW, or others. One of their service representatives will explain exactly why your claim was denied, and help you process your appeal.
Sometimes, it’s as simple as not sending in that one piece of information you thought was too personal, or a waste of time. So, again, don’t lose hope.
The grant of a VA disability for PTSD as a result of in-service sexual assault or harassment is often a satisfying conclusion to a long, drawn-out struggle. The grant is satisfying to you, the veteran, but it is equally satisfying to the rating specialist. Nothing gave me greater pleasure than to prepare a rating granting this benefit. It seemed like I was helping someone to right a grievous wrong. Along with counseling offered by the VA, it can be the start of the healing process. That is significant.
Raymond Gustavson served with the U.S. Army in Vietnam, and is a retired VA Rating Specialist. He is currently working on a novel about the Civil War, and also is writing a self-help book for veterans who want to better understand the complexities of the VA claims process.
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