Top 10 Stressors for PTSD Claim

Posted by Berry Law on February 14, 2023 in Appeals

Obtaining Service Connection for Post-Traumatic Stress Disorder: Stressors

Anyone can develop Post-Traumatic Stress Disorder or PTSD; all it requires is a stressor. A stressor is an event that is so traumatic it alters a person’s life and their brain. These stressors can permanently change a person’s view on life and the way they react to a variety of situations. Veterans are especially susceptible to developing PTSD because of the nature of their service. They are often removed from their friends and family for months at a time, put in stressful situations, and often left to think they must deal with their mental health on their own. The most publicly known stressor that causes a Veteran to develop PTSD is experiencing the traumas of war. While this is one of the most common ways, there are several other common stressors.

To obtain service connection, a Veteran must show they were exposed to a stressor in service, they currently suffer from PTSD, and their current PTSD resulted from that stressor. Since stressors are one factor to service connection, it is important for a Veteran to understand what constitutes a stressor and how they can prove they suffered from one while in service.

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a chronic, serious mental health condition characterized by persistent negative symptoms caused or aggravated by one or more traumatic incident(s). A Veteran may develop PTSD if they are exposed to, experience, witness, or hear about a traumatic event, such as a death, a severe injury, or intense violence.

Although any Veteran may develop PTSD, its symptoms can vary heavily. PTSD is a personal condition; it impacts the mind in complex ways, and no two people experience PTSD exactly the same.

However, PTSD can be very serious and lead to long-term consequences, including life-threatening ones. PTSD requires proper medical treatment — including but not limited to psychiatric assistance and medication — to be managed effectively.

Veterans like you do not need to cope with PTSD, its symptoms, or its medical costs alone. Knowledgeable Veterans law attorneys can help you acquire disability benefits for your PTSD and provide you with resources so you can feel more educated and knowledgeable regarding this topic.

Symptoms of PTSD

As noted above, PTSD symptoms can vary heavily from person to person. Some of the most common PTSD symptoms include but are not limited to:

• Depression and/or anxiety and associated symptoms 
• Intrusive thoughts or memories
• Avoidance of people, places, behaviors, etc.
• Mood swings, such as irritability or sudden anger
• Nightmares or night terrors
• Difficulty sleeping or insomnia
• Difficulty relaxing, even when there is no apparent stressor present
• Physical reactions or changes to stimuli, such as sweating, shaking, etc.
• Flashbacks, which can be very detailed and visceral or can be related to a single sense, like smell, hearing, etc.

Furthermore, PTSD symptoms may be persistent and affect your day-to-day life, while others may only occur if you are exposed to one or more triggers. 

Triggers are stimuli that remind you of the traumatic event that caused or aggravated your PTSD; for instance, if you developed PTSD because of a battle during your time in the service, the sound of an aircraft engine may trigger a reaction like anxiety.

Regardless, PTSD symptoms can have a negative outsized influence on your overall well-being. They can make it difficult for you to maintain relationships or hold a job. Some PTSD symptoms, such as difficulty concentrating, may make it almost impossible for you to obtain substantially gainful employment, thus qualifying you for disability benefits from the VA.

Some PTSD symptoms can be difficult to detect or diagnose. On top of that, many PTSD symptoms develop later than you may think, such as months or years after the inciting incident.

Therefore, if you believe that you have developed PTSD symptoms several years after leaving the military, you may still be entitled to disability benefits from the VA. Veterans law attorneys like Berry Law can help you get the support you need.

There are four main categories of stressors:

• Combat Related Stressors– Experiencing a stressful event like a direct firefight or an IED explosion, even if the person is not actually injured, can cause significant trauma. When a Veteran’s record proves they were involved in direct combat, the VA acknowledges that Veteran faced a variety of situations that could qualify as a stressor. Because of the chaotic nature of combat and the difficulty of documenting every incident, the VA understands not every event is included in a Veteran’s personnel file. So, the VA will often presume the Veteran’s PTSD is the result of the Veteran’s confirmed direct combat with nothing more than a lay statement and evidence of combat.
• Fear of hostile military or terrorist activity– Not every traumatic situation qualifies as direct combat. Also, not every unit documented direct combat situations in each Veteran’s file. However, if there is evidence the Veteran’s unit or base was exposed to hostile enemy activity such as news articles of a firefight or a report about the base in which the Veteran was stationed suffered a mortar attack and evidence shows Veteran was assigned to the unit or base at the time, the VA can acknowledge the incident as the stressor. The key for hostile military or terrorist activity is that the VA typically requires a nexus letter written by a psychiatrist or psychologist. The nexus letter should say that it is “at least as likely as not” that the Veteran’s reported stressor caused his/her PTSD.
• Non-Combat PTSD Stressors- If a Veteran was never in combat or never was exposed to hostile enemy activity, they can still develop service-related PTSD. Since non-combat stressors are not well documented in military personnel files, the VA requires more information and evidence. The VA will typically ask for more details about the stressor so the VA can investigate. Information like dates, locations, and descriptions of the event are very important to provide to the VA. It is also important that the Veteran and their representative do their own research. Obtaining public records like obituaries, news articles, photos, police reports, and personal letters to loved ones at the time or shortly after the incident are often critical to prove a Veteran’s stressor occurred. A nexus letter from a psychiatrist or psychologist is also required.
  • In-Service Personal Assault or Trauma- A special subcategory of Non-Combat PTSD Stressors is personal assaults or traumas. These are incidents that are not directly related to a Veteran’s MOS or activities while on the job. These types of stressors include military sexual trauma (MST), robbery at gun point, kidnapping, assault in the barracks, and repeated racial and physical discrimination, among many others. These can be very tricky to prove particularly when a claim has been pending for several years. The VA usually requires documented reports (beyond lay statements) of the stressor incident and a nexus letter.
    • MST– There are countless studies showing victims of sexual trauma are unable or unwilling to report these incidents. That number is significantly higher for members of the military. Often, the perpetrator is a superior, the victim feels the military’s culture does not support reports of sexual trauma, or the victim did report the incident but nothing happened, or worse, they were ridiculed and punished. Historically, the military has not been a victim friendly environment, so incidents went unreported and/or undocumented for decades. The VA acknowledges this and has reduced the burden of proof to prove a MST stressor. In most situations, a Veteran’s record should have documented evidence of a stressor, but in incidents involving sexual trauma, the VA will accept more circumstantial evidence such as a sudden change in work performance, emergency reports with pregnancy or sexually transmitted disease tests, request for a duty assignment transfer, unexplained economic or social behavior changes, among many others. There is an endless list of things that could be considered a stressor. Again, the key is to have a favorable nexus letter confirming the Veteran’s reported stressor is “at least as likely as not” to cause PTSD. Even if a Veteran provides all the evidence needed to prove a MST, VA employees do not understand how to properly process these claim. This resulted in the VA improperly processing 49 percent of all MST claims in fiscal year 2017 alone.

There are hundreds of situations that can be considered a stressor, and everyone reacts differently to a particular incident. However, in serving so many Veterans, Berry Law sees common stressors among clients. The ten most common stressors Berry Law sees include:

• Combat Related Stressors
  • Involvement in an improvised explosive device (IED) explosion
  • Watching a service member injured or killed
• Fear of hostile military or terrorist activity
  • Involvement in a mortar attack
  • Medical personnel working on several trauma patients every day
• Non-Combat PTSD Stressors
  • Involvement in a serious car or plane accident
  • Involvement in a training accident
  • Learning that a close friend or relative was exposed to trauma
  • In-Service Personal Assault or Trauma
    • Suffering an assault
    • Being exposed to a threat of violence
    • Military Sexual Trauma

Let’s dive a little deeper into each.

1. Combat Exposure

Combat exposure is one of the most common PTSD stressors, especially for Veterans who saw or participated in active duty or combat environments or events. Combat exposure can include:

• Being present during battle
• Firing a weapon at another person
• Killing another individual
• Friendly fire incidents
• Being shot out or attacked by another person

Combat is a harrowing experience regardless of the training one receives beforehand. Many Veterans may feel they should not experience PTSD because of their training, but they should recognize how normal it is to develop PTSD anyway.

Veterans should not be ashamed of developing PTSD because of combat exposure. Instead, they should seek out therapy and other remedial resources or benefits.

2. Sexual Violence or Abuse

Sexual violence or abuse, including sexual assault, rape, or inappropriate touching, can also lead to PTSD and similar symptoms. This can occur in the military or civilian life to both men and women. However, according to some studies, women are at a higher likelihood of suffering sexual violence or abuse than men.

Regardless, Veterans traumatized by sexual violence or abuse may develop PTSD as a result. VA benefits and therapy resources may help Veterans overcome their trauma and lead happy, healthy lives.

3. Physical Assault

Physical assaults, such as muggings, beatings, and other physical violence inflicted upon a person may lead to PTSD. These physical assaults occur outside of combat scenarios. They can include fights with other military personnel, fights in the civilian world, or other circumstances.

Physical assaults may be traumatizing because they represent damage or danger to one’s personal body and autonomy. This can threaten an individual’s sense of self or protection, leading them to develop paranoia or depression alongside other PTSD symptoms.

4. Childhood Assault or Abuse

Many PTSD conditions stem from childhood assault or abuse, including physical abuse, sexual abuse, and emotional abuse. Childhood is a particularly vulnerable time both physically and mentally, so any injuries suffered during childhood may have a greater than average likelihood of PTSD than if the Veteran sustained the injuries during adulthood.

PTSD can develop slowly, and some individuals may not even realize they have PTSD because of a childhood incident until they speak with a therapist.

5. Threatened With a Weapon

Like physical assaults, being threatened with a weapon like a gun, knife, or any other harmful implement may lead to PTSD symptoms. Being threatened with a weapon may damage or destroy one’s sense of self-protection, autonomy, or bodily wellness.

Even if the weapon is not used, a Veteran may develop PTSD symptoms. Those who develop PTSD after being threatened with a weapon during a robbery, mugging, or another incident should never feel ashamed of their symptoms and should instead seek out professional help.

6. Accidents

Accidents, including car accidents or similar scenarios, may lead to PTSD symptoms. Such accidents can make a person feel more mortal or vulnerable than before.

7. Natural Disasters

Natural disasters including fires, earthquakes, floods, and other major catastrophes may lead to PTSD symptoms, particularly related to the weather. 

For example, a Veteran who experiences a tornado at home may feel uneasy or experience other PTSD symptoms when clouds darken or when a tornado warning is announced.

8. Plane Crashes

Many people are already afraid of flying. Those who experience a plane crash may develop PTSD symptoms during flight or related to aircraft in general. For example, they may experience anxiety upon seeing an airport or boarding a plane.

It is also possible to develop secondhand PTSD from seeing a plane crash. Many people developed PTSD symptoms after the 9/11 attacks on the World Trade Center in New York, even though they were on the ground and were not directly injured by the event.

9. Medical Diagnoses

Certain medical diagnoses, such as news of cancer or being told that one has a limited time left to live, may cause PTSD symptoms to appear. Furthermore, certain medical procedures, such as surgeries, medication, treatments like chemotherapy, and other medical elements could cause PTSD, especially if the victim has a negative experience in conjunction with the treatment or procedure in question.

Furthermore, Veterans may develop medical-related PTSD when being treated for injuries sustained during their service.

10. Kidnapping

Kidnapping may lead to PTSD symptoms similar to physical assault or being threatened with a weapon. Kidnapping can be harmful, dangerous, and traumatizing regardless of whether one is a child or adult, man or woman.

PTSD Stressors vs. Triggers

As you can see, there are many common PTSD stressors that Veterans and other Americans may experience throughout their lives. However, when you apply for benefits for your PTSD symptoms, you need to understand the difference between PTSD stressors and triggers.

PTSD stressors are the events or circumstances that cause PTSD symptoms. On the other hand, PTSD triggers are experiences, events, or signals that may remind a victim of PTSD of the traumatic event in some way, either consciously or unconsciously.

For example, a Veteran with PTSD from combat experience may have a PTSD trigger upon hearing a gunshot at a shooting range. The gunshot causes physical symptoms like shakiness, sweating, dizziness, and more.

PTSD triggers are not controllable and can include sights, smells, sounds, thoughts, phrases, locations, objects, and more. Even people can trigger PTSD symptoms depending on the stressor that caused the condition in the first place.

Identifying Your PTSD Stressor

For many Veterans, it can be challenging to identify noncombat PTSD stressors. Some Veterans believe that PTSD stressors can only arise from combat conditions or similar circumstances.

However, any therapist will tell you that PTSD can arise from many different potential causes or events. Speaking to a therapist about your combat or non-combat traumatic experiences could help you determine the root causes or triggers for your PTSD symptoms.

Furthermore, a therapist will help you confirm your PTSD stressor so you can identify it and take steps to eliminate its influence in your life.

What Happens After a Veteran Proves a Stressor?

After proving a stressor, a Veteran must show they are currently suffering from a mental health condition. Attaching a PTSD diagnosis and current mental health treatment records to a new claim for service connection for PTSD is the best possible option when seeking a service connection. However, a diagnosis is not always necessary. If a Veteran can show symptoms of a mental health condition, the VA should provide that Veteran with an examination. Many Veterans have very negative experiences when they attend a VA examination, so the earlier a Veteran can obtain current mental health treatment the better. While a licensed psychiatrist or psychologist is best, these options are often expensive. There are other great options for Veterans, such as a VA medical center or a Vet Center. A local peer group would also be a great start. Even if a Veteran is not seeking service connection right away, having a history of mental health treatment can be tremendously helpful down the road.

The last thing a Veteran must prove for the VA to grant service connection for PTSD is a nexus. For combat Veterans, this is not always needed. But most other Veterans will need a psychiatrist or psychologist to confirm that Veteran has a PTSD diagnosis and the Veteran’s reported in-service stressor “at least as likely as not” caused their PTSD. This last step is why Veterans should start seeking mental health treatment as soon as possible. The more records showing a link between service and their PTSD, the more weight a positive nexus letter has. Likewise, the more records there are showing this link, the harder it is for any disinterested or disingenuous VA examiner to provide a negative nexus.

Once a Veteran obtains service connection for PTSD, or any other mental health condition, the claim may not be over. The VA often awards a lower rating than a Veteran is entitled to. Additionally, PTSD and other mental health conditions can cause a variety of other issues such as sleep apnea, headaches, hypertension, and sexual dysfunction, among many others. Since these conditions could be caused by a Veteran’s service-connected mental health, it is possible to obtain secondary service connection for those conditions.

Obtaining service connection for PTSD can be an uphill battle. Certain types of stressors require more attention and evidence development. Establishing a solid stressor is the first step to obtaining service connection. If you need help service-connecting your PTSD, Berry Law can help by discussing your case with you, reviewing your records, assisting with evidence development, and advocating for what you deserve. If you believe you have PTSD due to your service and the VA refuses to provide the benefits you earned, please contact Berry Law so we can assist you with your claim.

How Must These Stressors Impact a Veteran?

These main stressor categories must also be proven when applying for VA disability benefits. Veterans applying for disability benefits for their PTSD must specifically show that the stressor created a notable change in their life. Notable changes can include:

• Physical symptoms, such as sweating, nightmares, etc. It’s often helpful to have a doctor’s note or recommendation when applying for disability benefits for PTSD.
• Emotional symptoms, such as a lack of sociability or personality changes. Testimony from friends or family members may assist when proving emotional symptoms.
• Mental health symptoms, such as the development of personality disorders or other mental health conditions like depression. Again, the testimony or official note from a licensed therapist can go a long way toward proving your symptoms are severe and real. 

Berry Law

The attorneys at Berry Law are dedicated to helping injured Veterans. With extensive experience working with VA disability claims, Berry Law can help you with your disability appeals.

This material is for informational purposes only. It does not create an attorney-client relationship between the Firm and the reader, and does not constitute legal advice. Legal advice must be tailored to the specific circumstances of each case, and the contents of this blog are not a substitute for legal counsel.

Sources:

What is Posttraumatic Stress Disorder (PTSD)? | Psychiatry.org

NIMH » Post-Traumatic Stress Disorder | National Institutes of Health

What Are PTSD Triggers? | Web MD