Veterans benefits for post-traumatic stress disorder in the United States

The United States provides a wide range of benefits for veterans with Posttraumatic stress disorder (PTSD), which was incurred in, or aggravated by, their military service. The United States Department of Veterans Affairs (VA) will provide benefits to almost all veterans that the VA has determined suffer from PTSD, which developed during, or as a result of, their military service, and which interferes at least to some extent in their ability to work. These benefits not only include tax-free cash payments but can also include free or low-cost mental health treatment and other healthcare;  vocational rehabilitation services; employment assistance;   independent living support; and more.

==U.S. Veterans Benefits==

Brief history of U.S. Veterans Disability Benefits
Since the founding of the country, the United States has sought to compensate the men and women who have served in its armed forces. Initially this compensation was given to all veterans as a gratuity payment, i.e., as a 'thank you' for their service. But in 1917, the U.S. Congress initiated a shift in the rationale for compensation away from a gratuity system and toward an indemnity scheme. Since that year, compensation has been provided to veterans suffering from physical or mental disabilities that were incurred during, or aggravated by, military service, and which have adversely impacted the veteran's ability to work. The amount of compensation provided—both cash payments and VA-sponsored services—are based on the veteran's average impairment in earnings capacity.

VA Disability Benefits Claim Process for PTSD
This section provides a brief overview of the 8-step claims process; describes how to file an initial claim for disability benefits for PTSD; how and why to ask for assistance with filing a claim; and how to locate and select sources for such assistance.

Overview of claims process
The VA provides a description of the 8-step benefits claims process on its website. This is a brief overview:

1. Claim Received - The veteran has submitted a disability compensation claim in person (e.g., while still on active duty with a VBA (Veterans Benefits Administration) representative visiting his or her base), online (via the Veterans On-Line Application [VONAPP]), or by postal mail to the VBA Regional Office (VARO) assigned to his or her geographical location (legal residence). The VARO sends a letter to the veteran via postal mail confirming receipt of the claim.

2. Under Review - A VSR (Veterans Service Representative ) reviews the information submitted by the veteran to determine if VBA needs any additional evidence (e.g., service medical records) to adjudicate the claim. 3. Gathering of Evidence - VA has a legal obligation to help veterans obtain any evidence that will support their claim. For example, the VSR might request a veteran's military personnel records (e.g., to confirm unit assignments), Social Security disability records (if the veteran applied for Social Security disability benefits), or private medical records. The veteran can also obtain such records and submit them to the VBA Regional Office handling his or her claim. If necessary, the VSR will request a Compensation and Pension examination (C&P exam) at this time.

4. Review of Evidence - A RVSR (Ratings Veterans Service Representative ) makes sure that all relevant evidence has been obtained, and, if so, renders a decision regarding the veteran's claim.

5. Preparation for Decision - It is not clear how this step differs from the previous step. The exact quote from the VA website is: "The Veterans Service Representative [presumably they mean the Ratings Veterans Service Representative] has recommended a decision, and is preparing required documents detailing that decision. If more evidence is required, the claim will be sent back in the process for more information or evidence."

6. Pending Decision Approval - Approval by a supervisor.

7. Preparation for Notification - Preparing the "claim decision packet" (Decision Letter and explanatory materials).

8. Complete - VBA mails the "claim decision packet" to the veteran.

Benefits application procedures
To begin the disability claim process, a veteran must submit an application to the Veterans Benefits Administration (VBA), an organizational element of the VA. The VBA, based on their review of medical and psychological evidence, must conclude that the veteran indeed suffers from service-connected PTSD. Reaching such a determination usually requires that the veteran receive a Compensation and Pension examination (C&P exam), which is a forensic mental health evaluation conducted by a psychologist or psychiatrist at a local VA medical facility or by a psychologist or psychiatrist in independent practice who conducts evaluations for a VA-contracted private vendor.

A veteran can apply for compensation benefits him or herself by filling out VA Form 21-526, Veterans Application for Compensation and/or Pension and mailing it to their local Veterans Benefits Administration Regional Office, often referred to as the "VARO" (VA Regional Office). Note that VA Form 21-526 and the accompanying instructions are quite detailed, which is probably why the VA recommends that veterans take advantage of expert assistance from specially trained Veterans Service Officers (see next section).

A veteran may also file a disability benefits claim online using the Veterans On-Line Application (VONAPP) System.

Obtaining Assistance with Filing a Disability Compensation Claim
Veterans may receive assistance with filing a VA disability compensation claim from Veterans Service Officers, also known as "VSO Representatives" when they are affiliated with a nonprofit Veterans Service Organization.

Note in this regard that the VA specifically recommends that veterans ask a Veterans Service Officer to help them file a disability compensation claim. Here is a quote from the VA website, which explains why the VA makes this recommendation: VA encourages individuals who are applying for disability compensation to work with an accredited representative ... to assist them.... Being accredited means organizations and individuals must have VA permission to represent Veterans before the Department in their claims for VA benefits. The purpose of this requirement is to ensure that Veterans have qualified and competent representation. These individuals receive specialized training in VA benefits law and procedure.

The next two sections briefly describe the two types of Veterans Service Officers.

County Veterans Service Officers
County Veterans Service Officers are public employees of their State's (or Territory's) veterans affairs agency. They are often called County Veterans Service Officers, because a majority of the states have set up local veterans affairs offices in each of the state's counties.

Veterans Service Officers Associated with Nonprofit Veterans Service Organizations
Many not-for-profit Veterans Service Organizations, such as AMVETS (American Veterans), recruit, train, and support their own Veterans Service Officers to help veterans file claims and navigate the claims process. In order to represent a veteran before the VA, the Veterans Service Organization must either have been Chartered by the U.S. Congress or have received official approval from the U.S. Department of Veterans Affairs to represent veterans in the disability compensation claims process.

As noted above, these Veterans Service Officers are sometimes called VSO Representatives.

Although to make matters somewhat confusing, note that the VA sometimes refers to both County Veterans Service Officers and VSO Representatives as "Veterans Service Organizations (VSO) Representatives" or "VSO Representatives." For example, if you conduct an "Accreditation Search" on the VA website and search for a "VSO Representative," the search results will list both County Veterans Service Officers and VSO Representatives.

Selecting a Veterans Service Officer
Veterans may select either type of Veterans Service Officer to help them file their disability compensation claim(s). After the veteran selects his or her Veterans Service Officer, he or she completes VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative and submits it to the Veterans Benefits Administration. (Note that for the purposes of Form 21-22, a State or Territory veterans affairs agency is considered to be a "Veterans Service Organization"). This appointment authorization gives the Veterans Service Officer legal authority to represent the veteran's interest in communications with VBA and any other related agencies or organizations involved in the disability benefits claims process.

After VA Form 21-22 has been received and accepted by the Veterans Benefits Administration, the Veterans Service Officer helps the veteran file the initial disability compensation claim. Subsequent to filing the claim, the Service Officer may also engage in a variety of other, related, activities on behalf of the veteran, for example, calling the Veterans Benefits Administration to inquire about the status of a veteran's claim, or appearing with a veteran when meeting with VBA officials, or helping the veteran understand the Compensation and Pension (C&P) examination process.

The veteran does not pay a Veterans Service Officer for their services. The Service Officers are either state employees, employees of a Veterans Service Organization, or are volunteers for a Veterans Service Organization.

Post-Adjudication Representation
If a veteran is not satisfied with the VBA's decision regarding their compensation claim, they may appeal the decision, and they may ask to be represented by an accredited attorney or claims agent in the appeals process. Veterans usually appeal a decision because their claim was either denied outright or because they believe that the disability rating assigned by the VBA is incorrect.

Note that the VA does not require a veteran to be represented by an attorney or claims agent. In addition, Veterans Service Officers may assist a veteran through the appeals process (although he or she is usually not an attorney so may not be as familiar with legal proceedings, relevant case law, legal strategies, etc.).

VA prohibits attorneys or claims agents from charging a veteran for professional services prior to the adjudication of the veteran's claim. A veteran may contract with an attorney or claims agent to represent them in an appeal only after the following three conditions have been met:


 * the veteran has filed his or her disability compensation claim;
 * the claim has been adjudicated (a decision on the claim has been made by the Veterans Benefits Administration); and
 * the veteran has filed a Notice of Disagreement (NOD) with the VBA Regional Office handling his or her claim.

Unless they agree to work on a pro bono basis, attorneys and claims agents who represent veterans before the Veterans Benefits Administration, Board of Veterans Appeals, and Court of Appeals for Veterans Claims require payment for their services. In most instances, the veteran and attorney (or claims agent) submit a signed payment agreement with the VA Office of General Counsel, which stipulates that the attorney will receive payment directly from the VA after the veteran's claim has been adjudicated, if the adjudicator awards service-connected disability compensation to the veteran. The amount of the attorney's fee is based on a percentage of the lump sum "back pay" compensation issued to the veteran by the VA.

Accredited Attorneys
Attorneys who wish to represent veterans in proceedings before the agency of original jurisdiction (the Veterans Benefits Administration), the Board of Veterans Appeals, or the Court of Appeals for Veterans Claims, must first receive accredition from the VA General Counsel. The attorney begins the process by submitting an Application for Accreditation as a Claims Agent or Attorney (VA Form 21a).

Claims Agents
Accredited claims agents must submit an application to the VA General Counsel, which includes submitting the names and contact information of three character references; pass a written examination; and complete three hours of qualifying continuing legal education (CLE) within 12 months of their initial accreditation.

Traumatic Stressor
A traumatic stressor is an event that meets Criterion A of the DSM-IV diagnostic criteria for PTSD. Criterion A reads as follows:

The person has been exposed to a traumatic event in which both of the following have been present:

A1. The person 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.

A2. The person's response involved intense fear,helplessness, or horror.

Note that Criterion A2 was removed for DSM-5. But note that the VA will continue using DSM-IV in both treatment and disability evaluation (C&P examination) settings until on or about 1 October 2013 at which time the VA will transition to using DSM-5.

Dr. Matthew J. Friedman of the National Center for PTSD notes that:

"PTSD is unique among psychiatric diagnoses because of the great importance placed upon the etiological agent, the traumatic stressor. In fact, one cannot make a PTSD diagnosis unless the patient has actually met the 'stressor criterion,' which means that he or she has been exposed to an historical event that is considered traumatic."

Service-Connection
The term, service-connected, means that a veteran has a disease or injury that is "connected" to his or her military service, i.e., the disease or injury was incurred in, or aggravated by, his or her military service.

The official definition in the Code of Federal Regulations begins:

"Service connection connotes many factors but basically it means that 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."

The relationship between service connection and access to VA healthcare is emphasized in this definition: "''Service connected' veterans are those with documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system.'"

Types of Service-Connection
There are four types of service connection: direct, secondary, aggravated, and presumptive. The present article is primarily concerned with direct service connection, since that is by far the most common type for soldiers, sailors, marines, airmen, or coast guardsmen suffering from PTSD.

Examples of Direct Service-Connection for PTSD
As noted, the vast majority of veterans with PTSD have a direct service-connection, i.e., they developed PTSD as a direct result of a traumatic stressor (or stressors) they endured during their military service. Traumatic stressors can be: These are the most common situations involving traumatic stressors that can lead to direct service connection for PTSD, but it is not an exhaustive list.
 * Combat-related (the most common kind), e.g., seeing a comrade's vehicle getting blown up by an IED blast, pulling him from the burning wreckage and carrying him to a helicopter, praying he will make it, only to learn a few hours later that he died en route to the field hospital.
 * A personal assault.
 * Such as a physical assault, e.g., as a result of domestic violence or being mugged.
 * Military sexual trauma (MST), which need not be perpetrated by another service member, e.g., if a service member is sexually assaulted by a neighbor, who is a civilian, the incident still constitutes MST.
 * An accident while performing military duties, e.g., during training exercises or maneuvers.
 * An accident that occurs while not performing military duties, e.g., a motor vehicle accident that occurs while a service member is travelling to visit family.

Also, note that a service member is still considered to be enrolled in military service even if he or she is not performing specific military duties at the time they are injured (e.g., if they are injured at their home on their day off, that injury, if it results in a permanent disability, would in most instances be considered service-connected).

Types of Military Service
The regulations describe three categories of military service, active duty, active duty for training, and inactive duty training. These categories and their very specific definitions would be particularly relevant to a veteran who, for example, experienced a traumatic stressor that led to PTSD during a period of training for the Reserves or National Guard.

And there are some types of military service which are defined as falling under one of the three categories that might not occur to many people, such as the fact that the definition of active duty military service includes "service at any time as a cadet at the United States Military, Air Force, or Coast Guard Academy, or as a midshipman at the United States Naval Academy." - 38 CFR § 3.6(b)(4). Thus, a midshipman who was sexually assaulted and developed PTSD would, when he or she left the Navy, qualify for VA benefits.

And there are other specifications in this set of regulations (38 CFR § 3.6) that one would never anticipate, such as the fact that the definition of active duty for training includes National Guard soldiers who participated in the reenactment of the Battle of First Manassas in July 1961 (38 CFR § 3.6(c)(3)).

In Line of Duty and Exceptions
"In line of duty means an injury or disease incurred or aggravated during a period of active military, naval, or air service unless such injury or disease was the result of the veteran’s own willful misconduct or ... was a result of his or her abuse of alcohol or drugs." The most important point here is that there are exceptions to the general rule that injuries or diseases incurred in, or aggravated by, military service are eligible for disability compensation benefits. Veterans who have questions about eligibility for VA benefits because of willful misconduct, alcohol or other drug abuse, or discharge status (see the next section), or other factors (see the regulation referenced above), can consult with a Veterans Service Officer in their area and/or contact the VBA Regional Office closest to their home for assistance.

Discharge Status
In order to be eligible for VA benefits, a veteran must have been discharged under other than dishonorable conditions. Stated differently, if a veteran received a Bad Conduct Discharge or a Dishonorable Discharge they will, under most circumstances, not be eligible for VA benefits.

U.S. Department of Veterans Affairs benefits information

 * Federal Benefits for Veterans, Dependents, & Survivors - The best and most comprehensive description of all veterans benefits. Available as a printable document (PDF) or download it to your tablet or smartphone.
 * Apply for Benefits Online - Not the most user-friendly online application process in the world, but it won't be a problem for younger vets and others with a fair amount of Internet savvy.
 * VA Benefits in Brief - Quick overview of all veterans benefits (PDF document).
 * Compensation and Pension Service - links to all the various C&P programs.
 * VA Healthcare Benefits Overview - A well-written and well-organized PDF booklet. You receive the most comprehensive information if you also download the Veterans Health Benefits Guide (the link immediately below).
 * Veterans Health Benefits Guide - Also an easy-to-read PDF booklet - download it with the VA Healthcare Benefits Overview (the link immediately above) for the most comprehensive info.
 * Online VA Healthcare Eligibility Check - Easy way to begin the process of finding out what healthcare benefits you are eligible to receive, although you will probably need to wait a day or two to receive a definitive answer from the VA.

Other veterans benefits resources

 * The American Veterans and Service Members Survival Guide - Published by the National Veterans Legal Services Program. Provides a wealth of information. A little challenging to navigate but a valuable reference because of its depth of coverage.
 * Overview of Benefit Claims Legal Process - A free download of the first chapter of the Basic Training Course on Veterans Benefits published by the National Veterans Legal Services Program. Although the Basic Training Course is intended for Veterans Service Officers and other advocates, this first chapter is concise, well-written, and easy to understand.

U.S. government resources for military personnel and veterans

 * MakeTheConnection.net - A Department of Veterans Affairs website designed to encourage military personnel, veterans, and family members to 'connect' with each other, relevant VA services, support & advocacy organizations, online support resources, telephone 'crisis line' assistance, mental health treatment, and more. Features videos of service members, veterans, and families sharing their personal stories and testimonials. Contains a "customize this site" application that will feature and prioritize information on the site depending on the visitor's status, e.g., their gender; whether they are active duty, Guard or Reserve, veteran, or family member; branch of service; era of service (e.g., WWII, Korea, Vietnam, Gulf War, OEF/OIF/OND); etc.
 * Make the Connection Resources Search Engine - Search for several types of information (e.g., educational programs, employment opportunities, healthcare, free transportation to a VA medical center) available on VA websites or the National Resource Directory.
 * National Resource Directory - A joint project by the Department of Defense, Department of Labor, and the Department of Veterans Affairs designed to help service members, veterans, families, and caregivers find several different kinds of programs and services, e.g., job banks, benefits information, mental health treatment, family and caregiver support, homeless assistance, housing programs, and much more.

PTSD treatment resources for veterans

 * Information & Resources About PTSD - From the VA's MakeTheConnection.net website.
 * Where to get help for PTSD
 * Understanding PTSD – From the US Department of Veterans Affairs
 * PTSD Treatment Programs in the US Deaprtment of Veterans Affairs
 * Access the Primary Care Clinician's Manual here
 * My HealtheVet – The Gateway to Veteran Health and Wellness
 * – Operation Warrior Wellness: Overcoming PTSD
 * – Healing the wounds of PTSD through Meditation:Effectively Overcoming PTSD Without Medication or Therapy
 * Military Sexual Trauma Resources Provided by the VA
 * Military Sexual Trauma Resources for Women Provided by Stateside Legal