Post-Traumatic Stress Disorder, or PTSD, develops when a person is exposed to a terrifying event. The person is either the victim of some horrific ordeal that evokes extreme fear or the person witnessed something that evoked that same level of terror. Instinctive behavior creates a fight or flight reaction to the stressor and once it is over and the harm is removed, most people return to normal functioning. Some people, however, never return to normal, and the flight or fight response is triggered in everyday situations to such an extent that it becomes debilitating.
Various studies are being conducted to determine why PTSD develops in some people and not in others, even when exposed to the same stressors. There are physiological and psychological conditions that cause or contribute to PTSD and the Veterans Health Administration and other organizations funded by the National Institutes of Mental Health are involved in research related to PTSD in Veterans.
Many Veterans who have PTSD do not acknowledge the problem and do not seek appropriate care. There are a myriad of reasons why these Veterans do not get the treatment they need; denial; fear; pride; ignorance; the list goes on. PTSD is not restricted to older Veterans. Many younger Veterans that served in the more recent conflicts from Desert Storm to the War on Terror have succumbed to PTSD. But Veterans from the Vietnam era conflicts are, perhaps, the most affected, most underdiagnosed, and undertreated demographic in the military.
PTSD is a complex syndrome made up of a number of inappropriate responses to stressors. It was not recognized as a disorder until several years after the Vietnam Conflict ended. PTSD did not appear in the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) until 1980 which is one of the reasons why Vietnam Veterans separating from the military in the 1960s and 1970s were not given adequate mental health screening. Now, Veterans are screened at the time they separate from the military but the quality and comprehensiveness of the screening may not identify all those suffering from PTSD.
Paralegals are often the point of contact between an attorney and the clients. Paralegals will likely have more communication and contact with the clients and thus are in a better position to identify Veteran clients with PTSD that are not receiving benefits and are not being treated. Of course, a diagnosis of PTSD can only be made by a qualified medical person however, understanding and recognizing the symptoms of this disorder may give the paralegal a unique opportunity to objectively identify an at-risk Veteran. The Veteran may not have been diagnosed and may not be getting the care and treatment he or she needs. The Veteran's family members may not even be aware the Veteran may have this condition. They will know something is wrong, but they probably have dealt with the Veteran's issues for so long, it has become a way of life.
PTSD has several diagnostic criteria which, if met, constitute a diagnosis. The DSM describes these criteria in detail. The occurrence of a stressor, i.e. violent event, which is either experienced or witnessed, is the first criterion. The second criterion is intrusion or re-experiencing. The Veteran will likely experience nightmares or flashbacks, intrusive thoughts or memories, and reminders such as the anniversary of the stressor. The third criterion is avoidant symptoms. The Veteran will try to avoid people and places connected to the stressor and will attempt to avoid thoughts of the stressor. The fourth criterion relates to negative alterations in mood or cognition. There are many symptoms encompassed by this condition including, depression, sadness, feelings of numbness, detachment or isolation, self-blame, etc. The fifth criterion is increased arousal symptoms such as hypervigilance; increased startle response; difficulty concentrating, extreme anger, explosive outbursts, irritability, and more. Other criteria deal with the severity of the criteria discussed above.
By interviewing the Veteran and family members, a paralegal can help establish a list of all the symptoms the Veteran experiences, and can help develop the evidence necessary to support a claim for service-connected PTSD, such as letters from family members, employers, co-workers, etc. This will support the Veteran's assertions that he has problems that fit the DSM criteria.
For a Veteran to get disability benefits for PTSD, it is important to prove that the condition is service-connected. 38 C.F.R. § 3.303 describes service-connection as the following, "(a) ... the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein."
In order to establish service connection for PTSD, the Veteran must show that he has a current diagnosis of post-traumatic stress disorder. If you identify a Veteran that you believe has PTSD and has not been diagnosed, the first step is to get the Veteran into treatment. The benefit of this is two-fold. First, the Veteran will get care that he needs. Second, the Veteran will have access to mental health professionals that can make the medical diagnosis necessary to file a PTSD claim.
The next requirement is perhaps the most difficult part of the process for the Veteran. The VA requires a statement from the Veteran about the "stressor" (traumatic event) that occurred during service. The difficulty arises because the Veteran is forced to recall and probably relive an event that was so traumatic that it changed his life forever. It is, however, essential, and an astute paralegal can be invaluable to both the Veteran and the attorney by helping the Veteran to articulate the in-service stressor.
The occurrence of the stressor must be consistent with the circumstances of the Veteran's service and there must be no strong evidence that the stressor did not occur. The claim must also be accompanied by a medical opinion from a VA psychologist or psychiatrist (or one under contract by the VA) that the stressor was sufficient to cause PTSD. Once all these requirements can be established the Veteran can file a claim that has a strong chance of success.
Helping clients recognize mental health conditions is difficult but the VA itself has, in the past 4 years, made significant efforts to identify at-risk Veterans and to provide services to them. The most recent effort is the establishment of a website www.maketheconnection.net which providers Veterans information on symptoms, treatment options, and more. More importantly, the website provides testimonial videos from other Veterans about their mental health problems and how getting help change their lives. Even if you cannot start the conversation with a Veteran you are assisting, encourage the Veteran to visit this website and get help. Once the Veteran takes that step, you may be able to help him get benefits.
Vanessa Brice, Esq. was born and raised in Zimbabwe Africa and came to the United States after marrying her husband, a U.S. Marine (now retired) who was stationed in her hometown of Harare. She practices VA and Personal Injury Law with the law firm of Colling, Gilbert, Wright & Carter in Orlando, Florida. vbrice@thefloridafirm.com
Reprinted with permission of the NALA and Author, Vanessa Brice, Esq. The article originally appeared in the March/April 2014 issue of Facts & Findings, the bi-monthly journal for paralegals. The article is reprinted here in its entirety. For further information, contact NALA at www.nala.org or phone (918) 587-6828.
