ptsd Nexus And Stressors

[Berta]

I have referred a few vets to the search feature so they can understand what we mean but maybe this doesn't help

A documented Stressor is a nexus-

also a nexus could be documented proof of any inservice event, accident, sexual trauma, combat trauma, etc etc- that is the Cause, etiology, or Reason for the present diagnosed disability.

A stressor is defined as :

Stressor: "Proof of a traumatic event in-service. Called a “stressor,” it is the basis on which all PTSD claims are based. In short, no stressor, no claim, end of story. A stressor is generally defined as personal exposure to a life-threatening event such as combat, a serious accident, or rape. For those who hold a combat-related decoration such as an individual valor award, the Purple Heart, or the Combat Infantryman’s Badge, the issue of a stressor is conceded by the VA."

From:http://www.ptsdhelp.net/id9.html

Also: This is an old BVA case that popped up when I googled the word stressor:

http://www.va.gov/vetapp/files1/9404441.txt

"Consequently, where the VA determines that the veteran did not engage

in combat with the enemy, or that the veteran did engage in combat

with the enemy but the claimed stressor is not related to such

combat, the veteran's lay testimony, by itself, will not be enough to

establish the occurrence of the alleged stressor. Zarycki, 6

Vet.App. at 97. In such a case, the record must contain credible

evidence which corroborates the veteran's testimony as to the

occurrence of the claimed stressor. Doran, No. 93-228, slip op. at

8. Additionally, the available service records must not contradict

the veteran's testimony concerning his non-combat-related stressors.

Id. Therefore, we find that the VA must make specific findings of

fact as to whether or not the veteran was engaged in combat with the

enemy and, if so, whether the claimed stressor is related to such

combat.

Finally, should the occurrence of a stressful episode be established,

it must then be determined whether the claimed stressful event was of

sufficient gravity to support a diagnosis of PTSD. Zarycki, 6

Vet.App. at 98; see American Psychiatric Association's Diagnostic and

Statistical Manual of Mental Disorders, (3d ed., revised, 1987) (DSM-

III-R). This means that the facts must establish that the veteran

was exposed to a sufficient stressor which is defined as an event

'that is outside the range of usual human experience and that would

be markedly distressing to almost anyone.' Zarycki, 6 Vet.App. at

98. In fact, the Court held that a veteran may not rely on mere

service in a combat zone, solely in and of itself, to support a

diagnosis of PTSD. Id.

Reviewing the evidence of record, it is unclear whether the veteran

actually served in combat. There is no evidence of any combat" etc etc

A stressor that raises to the level described here by the VA is anything that is "outside the range of usual human experience and that would be markedly distressing to almost anyone."

It is also anything that raises above the normal rigors of military life.

Maybe this will help- lots here on nexus and stressors but this might define it all-

Edited January 24, 2007 by Berta

[BoonDoc]

Berta,

I thought that I had read where the court of appeals had changed the part about the stressor being above what the average person could handle, I'm paraphrasing since I don't hav eit in front of me...I know that the VA is still holding to the old rule, but I think I read on watchdog about a new ruling...I have to go to physical therapy, or I would have done my research before porting, and when I get home I'll go and double check what I read.

Thanks for this info. as it will help many of us going through this process with the VA....and countless more in the future.

Boondoc

[Berta]

Thanks BoonDoc - that was an old BVA claim-You are RIGHT!

I wish I could find the recent post I made-

Stressor per the VBM (NVLSP) 2006 edition is defined for VA claims by the diagnostic criteria within the DSM IV-

"The criteria for Post Traumatic Stress Disorder have been changed. The new Criterion A requires that an individual "has experienced, witnessed or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others and that the person's response to the stressor must involve intense fear, helplessness, or horror." A new criterion requiring that the symptoms cause clinically significant distress or impairment has been added. The previous criterion A that described the stressor as "outside the range of normal human experience" has been deleted because experience with clinical application proved to be unreliable and inaccurate"

DSM IV

http://dpa.state.ky.us/library/manuals/mental/Ch20.html

Also as a former member here used to say- it is not the specific event as much as how the event affected the veteran---

Meaning- for example- I went to a viewing not long ago-

one woman -a close relative of the deceased-remained in the lobby and never went in to see the deceased.

I found out that she had a terrible fear of dead bodies and no one could get her to go in.

For this woman-dead bodies are a stressor -

For combat vets- although Rod was combat and had combat stressors-the most profound stressors he seemed to be troubled with were not those from direct combat-horrible events- they all msy have gotten PTSD.

Once my husband had a panic attack in a local park due to the high elevation and the way the roads climbed around the cliffs and asked me to take over the driving. This had nothing to do with his PTSD or Vietnam but the fear of height can be a major stressor for some-

yet others like me,like heights-it depends on the individual-

In that old decision this is an interesting remark:

"In fact, the Court held that a veteran may not rely on mere

service in a combat zone, solely in and of itself, to support a

diagnosis of PTSD."

When I worked at the Vet Center -some of our vets were asked to come to local TV studio and talk about their experiences in Vietnam.

It got pretty rough-this was the combat PTSD group I worked with-

some slipped and said curse words and one vet -the interviewer asked him (this should have been really set up with some foresight) if he ever killed anyone ( a no no question in the first place)

well the vet said yeah and then the interviewer asked him how it felt to kill people and the vet paused and said-

'not bad. actually I kind of liked it.'

In an effort to help support a positive image of Nam vets-and it was still negative in those days- the show reflected just the opposite---

as a vet center member of the combat group-I need to say that this vet was honest and perhaps did not present his feelings in an appropriate way- but for him, this part of his combat was the best part-I understood that-he did his job-

his stressors involved the combat deaths of many other men he knew-and

he accidently killed 2 Americans too- and sure didnt want to reveal that on TV.(whew)That was his major stressor and I spent a long time talking to him about that and how he had to forgive himself-he suffered from tremendous survival guilt.

It is our reactions to stressful events that often determine they are stressful enough to cause PTSD.

Edited January 24, 2007 by Berta

[Berta]

1968 Army-

This is the point I tried to make and you shared a poignant personal example-thank you----

the very first 100% PTSD Vietnam vet I ever met in 1985 never saw combat- he said his only war wounds were scratches on his knees from the mats in the houses of ill repute-if you catch my drift.

His MOS was handling the body bags and sending them home. His nightmares were hideous and his stress was over the fact that the overwhelming price of warfare was in his face day after day after day.He had horrible survival guilt too and yet he did his job and could not change at all what he saw.and like you- he too-felt it was a privilege to respectfully handle the dead before they left for the world but what a toll

it took on him.

PS all- the "world" to many Vietnam Incountry vets was the US of A.

I think that if they somehow didnt get PTSD there , they often got it as soon as they got back to the "world". long story----

It could begin in the first airport on US soil.

Edited January 25, 2007 by Berta

[huskerfanfl]

Others may have touched on it, but the event does not even have to be war related. I was one of the first people to arrive at the site of a bangolore torpedo accident while stationed in Germany. ALthough it was not my unit that was involved, I did have a lot of friends that were on site when the explosion occurred. I still have dreams of the body parts scattered over the area.

[BoonDoc]

And I'm just finding out all of the physical symptoms that PTSD can cause...

It's mind boggeling how the mind trys to protect us, and how traume can manifest in different physical bodily systems, and cause dis-ease.

Boondoc

[Objee]

Others may have touched on it, but the event does not even have to be war related. I was one of the first people to arrive at the site of a bangolore torpedo accident while stationed in Germany. ALthough it was not my unit that was involved, I did have a lot of friends that were on site when the explosion occurred. I still have dreams of the body parts scattered over the area.

Boy, this is enlightening! I was never in any heavy combat like a lot of you were, but my social worker said I might have mild PTSD. I said "bull----". Now, you make me wonder. I was a Coastie. Search and rescue is an intrinsic part of CG duties. Bloated bodies unrecognizable as human beings. My guys punched one on a boat cleat bringing it aboard to bag it. We all heaved before I could reach the throttles. Old social worker says this can be the type of experience that can result in PTSD. All I have is depression - or is it? Hell, I dunno.

I grieve for you guys and gals that have no doubt you have PTSD for any reason. Love you all. You ARE bloody heroes!

Ralph