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A Combination Va Stressor Letter And Self Report



This a sample of a combination Stressor Letter and Self-Report of Medical and Mental Conditions. It is a sample and should not be used word-for-word. It is merely a template for veterans to use in developing their own reports. This is an actual history of a Marine who served in Vietnam and is now 100% P and T.


Name: John Doe Smith

FILE NUMBER (or SSN): 00-000-000

In support of a claim(s) and upgrade of a claim(s).

BACKGROUND: I am currently rated at (% of Disability here, or new claim description) service connected disability with Post-traumatic Stress Disorder, Diabetes type II, Peripheral Neuropathy, Chloracne, Shell Fragmentation Wounds, Tinnitis, and Hearing condition. I also receive SMC related to Diabetes type II for erectile dysfunction.

I served with the United States Marine Corps in the Republic of Vietnam from 1966 through 1967. I initially served in an infantry platoon with a combat MOS in the (Name of Unit). Most of our duty was in the I-Corps Area of Vietnam mainly around the Ashau Valley and Khe Sanh. Later, I was assigned to the (Name of Unit) as an infantryman with 95% of my duty in the DMZ and Ashua Valley. I was wounded on (Date if Wounded) by shell fragments during a heavy artillery and rocket attack at the base camp Gio Linh in the DMZ. My primary theater of operation was in the DMZ, Ashua Valley, Phu Bai, Khe Sanh, Dong Ha, and various base camps in these areas.

The (Name of Unit) was a primary combat unit spearheading major operations in the DMZ for the 3rd Marine Division. In total, I participated in countless patrols, ambushes, and 20 major operations of which Prairie I, II, October 18, 1966 thru December 1966; Operation Prairie III, April 9, 1967 thru April 26, 1967, and Operation Prairie IV, April 27, 1967 thru May 16, 1967; Operation Beacon Hill March 22, 1967 thru April 9, 1967, Operation Hickory dated May 17, 1967 thru May 28, 1967; and Operation Buffalo dated July 7, 1967 thru July 13, 1967 were the most costly operations in lives lost and wounded for the Marine Corps at that time. Since (Name of Unit) participated in all these operations, I witnessed significant deaths and wounds as a result. Fighting was often fierce, ferocious, and intense. During Operation Beacon Hill a member of our unit was later awarded the Congressional Medal of Honor posthumously. During my tour in Vietnam I witnessed many deaths and casualties on both sides. These casualties occurred because of fierce fire fights, mortars, mines, artillery and rocket rounds, booby-traps, ambushes, acts of terrorism (“snipers and sappers”), and hand-to-hand combat. I experienced all above mentioned actions. I recall one time we engaged in hand-to-hand combat that occurred at the base camp Con Thien in the DMZ in March of 1967. The base camp was overrun by North Vietnamese soldiers in a battle that lasted several hours. I experience 6 such overruns while serving at various base camps in Vietnam.

To address the intensity and violence I experienced because of combat actions and the impact it had on me when serving with the (Name of Unit), more than 100 Marines from my company were killed in combat actions during November and December 1966 alone. From July of 1966 to August of 1967, several hundred Marines died and were wounded during combat actions with each of the units I served with. On one occasion after fierce combat in the DMZ, only 35 Marines from our company survived. These casualties were came mainly by operations, search and destroy missions, ambushes, and patrols. Because of the high casualty rate, the (Name of Unit) was sent to Okinawa, Japan in December of 1966 to regroup as the unit had a diminished capacity to engage in combat actions. Once reorganized, the (Name of Unit) returned to Vietnam and again participated in many combat actions. From January of 1967 thru my rotation to the United States, I again witnessed the (Name of Unit) suffer significant losses.


I am currently compensated for PTSD chronic and delayed because of my combat experiences in Vietnam. In the past thirty years my symptoms have progressively worsened, and have become overwhelming and exacerbated. Certain circumstances have also influenced the worsening of my symptoms beginning with a loss of a family member to suicide because of his service in Vietnam with the US Army. Further, my son’s service as a Corpsman with a Marine Corps unit in the first Persian Gulf War, and family members currently serving in Iraq and Afghanistan War have caused severe reactions, responses, dreams, and intensified recollections of my own experiences of Vietnam.

As early as 1974, I recall seeing a Dr.(Name), a private psychiatrist, at the Vine Street Clinic in (Name of City) for outpatient treatment for combat related stress. Intermittently in the past 25 years, I have sought and received therapy from private practitioners and assistance from the Veterans Administration. In the past two years my symptoms have increased in severity and I routinely suffer from the following:

Continuous nightmares and night errors, startled responses, hypervigilance, flashbacks, reliving experiences, intrusive thought, sleep disturbance, mood disturbances (anger and irritability, chronic panic disorder, and depression), restriction of affect, poor social; interactions, immediate and short term memory problems, and reactivity to events that include images and recollections of my time in Vietnam.

I also experience avoidant behaviors and find isolation more preferable to interactions with others. I tend to avoid crowds, people, and situations that do not provide me an opportunity to escape. I have a sense of detachment from others and do not seek to interact with anyone. I am a (Name of Occupation)and have come to realize that I could no longer perform work, nor can I engage in extended exposure to other people because of my preoccupation with intrusive thoughts concerning my experiences in Vietnam. In spite of my efforts to cope with society, I find it increasingly difficult to do so..

The most predominate symptoms related to PTSD I experience are:

Panic disorder has been present for more than 25 years with bouts of agoraphobia; with panic attacks occurring on a daily basis 30 to 40 times a month, and severe panic attacks occurring monthly several of which are extremely severe. I take Alprazalom three times daily to aid in reducing the frequency, intensity, and severity of these panic attacks.

Intrusive thoughts have been present since I left Vietnam and have grown in

intensity. I constantly ruminate about events and my experiences in Vietnam. These intrusive thoughts are aggravating, upsetting, and annoying to the extent they cause anger and elevate frustration. More often that not, these intrusive thoughts trigger panic attacks and irritability.

Sleep disturbance has been present for more than 25 years, and requires the use of Alprazolam before bedtime to induce sleep. My sleep disturbances include problems getting to sleep, early morning awakenings, nightmares, and problems with fatigue. I sleep alone, as often happens, my spouse reporting I thrash about, scream out in my sleep, and wake suddenly. All of this startles and frightens her.

I also suffer symptoms of depression\dysthymia and have been depressed for more than 25 years. I have taken Tofranil in the past to aid in leveling my moods. I often become angry, with low frustration tolerance, sleep problems as described above, memory problems, weight loss (not dieting), and have periods of unhappiness and sadness more days than not. I currently take Elavil for problems related to peripheral neuropathy, and I derived some secondary gain from this medication to help with my depressive symptoms.

My current Global Adaptive Functioning (GAF) of 35 is considerably below normal, and much lower than indicated on my original C+P evaluation. I am receiving outpatient therapy on a weekly basis with (Name of Clinician), M.S.W. at the Vet Center (Name of City). My treatment is slow, difficult, and demanding with mixed feelings of helplessness and hopelessness.


I am currently receiving compensation from the Veterans Administration for Diabetes type II. Officially I was diagnosed in the early 1990's and was probably a diabetic for some time before this, but was unaware of it. I suffer from an erectile dysfunction because of diabetes and receive Special Monthly Compensation for this disorder. Additionally, I am suffering from peripheral neuropathy and high blood pressure because of diabetes. My current symptoms of peripheral neuropathy have worsened, and consist of: numbness in the arms and legs, erectile dysfunction, cramps, pains in the lower extremities, weakness (difficulty opening jars), fatigue, dizziness, tingling and burning sensations in the feet and hands. I receive treatment for diabetes and peripheral neuropathy at the VA Medical Center (Or Name of Doctor) in (Name of City). My treatment consists of the oral medication Glyuburide for diabetes, Elavil and Alprazalom for peripheral neuropathy, and Caverjet for erectile dysfunction. My first noticeable symptoms of peripheral neuropathy were diagnosed by Dr. (Name) of (Name of City) in 1997. This treatment included continued use of Glynase for diabetes type II, Caverjet for erectile dysfunction, and Alpha Lipoic Acid 600 mgs twice daily for peripheral neuropathy as an initial preventive measure. The VA has both Dr. (Name) and (Name) medical records on file.


High blood pressure was diagnosed in 1992 along with elevated glucose readings. Initially, I was placed on dietary control for diabetes type II with high blood pressure readings of 150/105 and average readings of 140/95. I was prescribed Calan SR 180 mgs by Dr. (Name) for hypertension, but blood pressure readings averaged 140/90+. Later, Dr. (Name) prescribed Calan SR 240 and Hytrin, then Calan SR 240 mgs and Lozol. Later I began to see Dr.(Name)of (Name of City) who placed me on Lotensin 20 mgs and Hydrochlorothiazide 12.5 mgs daily. Because of Managed Care changes I began to see a Dr. (Name) (Name of City) who continued care for my disorders,

Currently I am prescribed Lisinipril 20 mgs and Hychlrothiazide 12.5 mgs daily by physicians at the VA Medical Center (Or Clinic) in (Name of City). When on these medications my blood pressure is relatively normal. However, when I am without these medications, my blood pressures becomes chronically elevated. I Having done three trials in the past 4 years without medications, it has become apparent that I must continue taking medications. Data suggest the comorbid rate of hypertension to diabetes is approximately 80%.


I am compensated for Choracne, Acne Conglobata with residuals, or an acne form rash. I was treated while in the military at Lajes Field, Azores for 5 months receiving medications and ultra violet treatments to aid in preventing its spread. This treatment began 6 months after returning to the United States from Vietnam. Over the years I have sought and was given treatment for this skin condition, and to date, medications have not been effective in halting the progression or spread of this disorder. I was treated for a short duration at (Name of Medical Facity or VAMC)in (Named of City) for this condition. In the past few years, I engaged in treatment by Dr.(Name), a local Dermatologist who prescribed Accutane. However, this had no effect, and only elevated my cholesterol. This skin condition has not abated and the scars routinely become painful and infected.


I am also service connected for an ear problem. I also suffer from tinnitis and a slight loss of hearing on the right side with contributing factors of an ear infection and because of a rocket round explosion when I was wounded.

I feel that my condition has worsened and has created additional problems. As a Squad Leader in Vietnam, I was in charge of 6 men assigned to me. Of these six men, 3 were killed, the remaining three (including myself) were wounded, and the two remaining members of my squad are service 100% service connected for PTSD and other problems. I have long endured the anguish of the Vietnam experience through being wounded and by witnessing many deaths and injuries. I have attempted to deny I had serious problems and learned to become effective in hiding my condition. As I have progressed in age, I began to notice that I did not have the energy or will power to continue to resist my stressful experiences. Therefore, today, my experiences have taken its’ toll and my lifestyle has been significantly altered because of it I respectfully request an upgrade in my current disability compensation, and additional ratings for secondary problems.

John Doe Smith

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Interesting- I saw something missing-

All VA comp is rated based on its affect to ones ability to work- I didnt see the Marine mention that affect here-maybe I read it too fast-

and why two HBP meds?

HOWEVER- if a vet gave me a claim like this-(and this is a template- as Patrick said -based on a real claim) and if this vet didnt even have any SC rating- I would help him file for TDIU 'yesterday' as well as SSA disability-

My husband was USMC Ashau 1965=1966-Op Starlight etc-

100% SC PTSD-100% dead Sec 1151

I think this vets description is very probative based on war annuals of this period--I wonder if he was Amphibious Tracker Battalion

like Rod was-

this is the reality of what many many many Vietnam vets faced-

And yet you have so called PTSD experts like that Sally somebody in another forum here who try to demean the very essense of their service.

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VA compensation is not always based on the inability to work. Schedulars can work all they want with exception of 100% in mental disorders. This being as the rating for mental disorders at 100% contain total social and occupational impairment.

It is not uncommon for a person to take 2 blood pressure medications. If a person is taking an ACE Inhibitor they usually add a Hydrochlorothiazide or another form of Diuretic.

The Marine in question was a 0311 serving with two different regiments during his time in Vietnam. I was his psychologist when I worked for the VA.

Your referring to Sally Satel who is a hired gun by a private foundation to discredit veterans who have PTSD by suggesting that PTSD is curable. Since DSM-IV and DSM-IV-TR are owned by the American Psychiatric Association there is no plan to state that it is curable. There are no reptuable research involvements showing PTSD is curable. When DSM-V comes out in 2010, there will be additional criteria for PTSD including Complex PTSD and Combat Related PTSD.

If one looks at DSM, you will not see any mental disorder labeled as curable. All mental disorders are base on life-systems approach meaning that if a diagnosis is given for any mental disorder, then that diagnosis is for a lifetime. Is there any mental disorder that is curable? I know many that are manageable, but I have never seen anyone cured of a mental disorder. The same holds true with patients. If a person came to see me as a patient, then I have that person as a patient for my lifetime even if they do not return. I have had patients come to see me once or twice, vacate therapy, and come back in 10 years to reingage therapy.

I was a Marine Force recon late 65 to early 66; then returned to Vietnam in late 66 to 67. Was wounded twice and currently 100% Schedular with 9 differnent service connected disabilities.

Semper Fi, Berta


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Right-I STAND CORRECTED! Thank you- MARINE! sorry all-----

I always forget about schedular ratings----

This is something I dont get- a vet can get 70% for PTSD TDIU- yet not be considered 100% -somehow I see that as an oxymoron-

I seem to think of Lewis Puller (Chesty's son) as 100% PTSD-however Lewis worked for VACO as a lawyer and had other severe disabilities- Max Clelland too-

Lewis- I am not saying, got 100% SC from the VA- plus SMC etc-I dont think he ever applied or got any comp - dont know-

or even Audie Murphy-he never got comp

But my husband got 100% SC PTSD P & T posthumously-but not schedular-and not TDIU-

This is where I get confused-is this rating 100% direct SC P & T because he died-

making TDIU or schedular a moot issue?

Semper fi to you too Patrick-

The United States Marine Corps provides my instruction-and VA pays for it-I am a civilian-

there is some inner satisfaction for that, which I cannot even begin to describe.

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The original intent of Schedular 100% was because of wounds and issues such as Lewis Puller and Max Clelland. They are both double amputees and were wheel chair bound. Lewis Puller commited suicide which gave a lot of credance to PTSD. I am sure he had it. But somewhere along the line the schedule was formated that any veteran who had a number of disabilities that mathematically combined to make them 100% were considered schedulars. We as veterans only see the rounded off numbers, but internally if your 90% may be only 87%. And if one is exactly 90% it will take 50% additional disability to reach 95% which will be rounded to 100% and become schedular.

When I first started to work the for the VA there was no such thing as 70% PTSD IU. If your 70% and totally disabled and unable to work, then the rating team should just make it 100% P and T. Well the Liberalization Act was developed where that was all revamped and made the VA assist you with claims work which was not the case I believe before 1996.

Anyway, Semper Fi


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In terms of money per month L 1/2:

Single vet $3,130.00

Veteran and spouse $3,265.00

Veteran, Spouse and one Child $3,363.00


Edited by Patrick428
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