DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420

Ms. Anne L. Weismann

Chief Counsel
Citizens for Responsibility and Ethics in Washington (CREW)
1400 Eye Street, NW, Suite 450
Washington, DC 20005

Dear Ms. Weismann:

This is in response to the appeal you filed requesting information under the Freedom of
Information Act (FOIA), 5 U.S.c. 552.

WHAT YOU REQUESTED

In your clarified request you asked for records that are relevant to the extent to which the
Department of Veterans' Affairs (VA) instructs or encourages doctors and other health
professionals involved in evaluating, assisting or reviewing claims of veterans seeking
compensation from VA to refrain from making or supporting a diagnosis of post­
traumatic stress disorder (PTSD).

WHAT WE PROVIDED

We are providing the following concerning claims for PTSD:

• Fast Letter 07-08, Revised Initial Post Traumatic Stress Disorder and Review
Post Traumatic Disability Examination Worksheets;
• Fast Letter 08-08, Additional guidance on Post Traumatic Stress Disorder;
• Interim Development Text for Requesting Unit History Records
• Fast Letter 01-05, Relationship ofPTSD or Stress to Cardiovascular
Disorders;
• Fast Letter 02-16, Revised Mental Disorders, Eating Disorders, Initial PTSD,
and Review PTSD Worksheets; and
• Fast Letter 05-08, Handling PTSD Claims Based on Stressors Experienced
During Service in the Marine Corps.
Page 2.

Anne L. Weismann

IF YOU HAVE QUESTIONS

Please direct any questions you might have to General Counsel, Department of Veterans
Affairs, 810 Vermont Avenue, N.W., Washington DC 20420.

Sincerely,

Enclosures

cc: 20M35
 DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420

March 29, 2007 2110

In Reply Refer To:
Fast Letter 07-08
Director (00/21)
All VA Regional Offices and Centers

SUBJECT: Revised Initial Post Traumatic Stress Disorder and Review Post
Traumatic Stress Disorder Disability Examination Worksheets

1. Revised disability examination worksheets for an Initial Evaluation of Post­

Traumatic Stress Disorder (PTSD) and a Review Examination for PTSD
have been released to VA medical centers for use by examiners.

2. These worksheets are changed in the following significant ways:

• They list the credentials of examiners that VBA and VHA recently
agreed can perform these types of examinations.
• The Initial PTSD examination no longer requires the examiner to
describe specific details of the stressor for confirmation purposes.
Confirmation of the stressor must be done prior to scheduling the
examination, except in the case of claims for PTSD based on
personal trauma.
• The examiner performing the Initial PTSD examination must identify
whether the current symptoms are linked to the identified stressor
or stressors.
• On both types of examination, the examiner is expected to select
the appropriate assessment of the veteran from the list provided
and support the assessment with examples.

3. If you have any questions about this letter or enclosure, please contact
Vicki Milton, M.D., at (202) 273-9646 or bye-mail.

lSI
Bradley G. Mayes, Director
Compensation & Pension Service
 DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420

April 7, 2008

Director (00/21)

All VA Regional Offices and Centers Fast Letter 08-08

SUBJECT: Additional Guidance on Post Traumatic Stress Disorder (PTSD)

This letter provides guidance on:

• Development for in-service mental health treatment records

• In-service initial diagnosis of PTSD
• Rating mental disorders that led to release from service
• Corroboration of in-service stressors based on combat
• Corroboration of in-service stressors not based on combat
• Stressor development follow-up
• Formal finding of insufficient stressor information
• Revised initial PTSD VA examination worksheet
• PTSD and individual unemployability (ill)

Development for In-Service Mental Health Treatment Records

The Department of Defense does not maintain in-service mental health treatment records
with traditional service treatment records (STRs). The military or civilian treating
facility maintains those mental health records. The records are typically destroyed after
five years from the end of the year in which the case is closed (see M21-1MR,
III.iii.2.A.l.a). Unlike clinical records from military hospitals, civilian facility records
cannot be ordered from the National Personnel Records Center (NPRC) through the
Personnel Information Exchange System (PIES).

If a review of the claims folder indicates that the veteran underwent in-service mental
health treatment at a civilian mental health facility, request the veteran complete a VA
Form 21-4142, Authorization and Consent to Release Information. Upon receipt of a
completed VA Form 21-4142, develop for those records. Cease development if a
response indicates that the records have been destroyed. If a response is received
indicating that the records were transferred to another location, develop for these records
Page 2.

Director (00/21)

from the location identified. Continue development until receiving the records or a
negative response. If the records are not available, prepare a formal finding of record
unavailability (see M21-1MR, III.iii.2.I.59).

In-Service Initial Diagnosis of PTSD

Military and civilian health care providers have a heightened awareness of the symptoms
of PTSD and responsiveness to service personnel participating in the Global War on
Terror (GWOT). As a result, health professionals are diagnosing and treating PTSD with
greater frequency. The initial diagnosis ofPTSD generally occurs after service, in which
case service connection for this disability is considered under the provision of 38 CFR
3.304(f). This provision requires "credible supporting evidence that the claimed in­
service stressor occurred." Nevertheless, 38 CFR 3.303(a) contains provisions for
establishing service connection for a disability or disease incurred in service. This
incurrence "may be accomplished by affirmatively showing inception or aggravation
during service." Therefore, when there is a prima facie diagnosis ofPTSD by a mental
health professional in service, verification of the stressor, whether in-service or pre­
service, is not required. (See Fast Letter 99-85, Service Connection for Post Traumatic
Stress Disorder (PTSD) Diagnosed In-Service, August 26, 1999, for a discussion of pre­
service stressors.) With an in-service initial diagnosis ofPTSD, accept any reasonable
in-service stressor as long as it appears consistent with the circumstances of that veteran's
particular service. If the VA examination and other evidence of record supports the
decision, grant service connection on a direct basis in accordance with 38 CFR 3.303(a).

Rating Mental Disorders That Led to Release From Service

Regional office decision makers must pay special attention to 38 CFR 4.129, Mental
Disorders Due to Traumatic Stress, because of the exposure of many service persons to
highly stressful events, particularly while serving in Iraq and Afghanistan. 38 CFR 4.129
states that an immediate evaluation of not less than 50 percent shall be assigned to a
veteran who, because of a highly stressful event in service, develops a mental disorder
that results in release from service. Generally, these veterans have been determined as
unfit for duty based on their mental disorder by the Medical Evaluation BoardfPhysical
Evaluation Board (MEB/PEB) process. In addition, 38 CFR 4.129 states that VA will
schedule a medical examination within six months of discharge to determine if a change
in this evaluation is warranted.

Maintain the initial evaluation until evidence from the examination provides the basis for
reconsideration. [f evidence from the medical examination warrants an increased
evaluation, the effective date will be the date of the examination that supports the
Page 3.

Director (00/21)

increase. An earlier effective date may be established based on additional evidence that
factually ascertains an increase in disability, per 38 CFR 30400(0)(2). If a reduction in
evaluation is warranted based on the results of a medical examination, follow the due
process procedures outlined in 38 CFR 3.105(e). However, a reduction in evaluation may
be given without due process provided the veteran's overall or combined evaluation is
not changed (see Stelzel v. Mansfield, November 15,2007).

Corroboration of In-Service Stressors Based on Combat

Once a veteran has identified a combat stressor in claims for PTSD diagnosed after
separation from military service, it is the responsibility of the decision maker to
determine whether the veteran participated in combat or ifthere is sufficient credible
supporting evidence to establish that the stressor occurred. In the absence of one of the
decorations identified in M21-1MR, III.ivo4.H.29.c, the decision maker can still
determine that the veteran participated in combat if the evidence supports that
determination (see VAOPGCPREC 12-99). Ifit is determined that the veteran was
engaged in combat, the veteran's testimony is usually sufficient to establish that the in­
service stressor occurred (see 38 V.S.c. 1154(b) and 38 CFR 3.304(f)(1)). Corroboration
of the claimed stressor is not necessary when credible supporting evidence shows combat
participation and the stressor is based on combat.

Corroboration of In-Service Stressors Not Based on Combat

When combat participation cannot be confirmed, or when the claimed stressor is not
related to combat, request credible supporting evidence. The claimed stressors may not
be limited to one episode. A group of experiences may also affect an individual and lead
to the development ofPTSD (see M21-1MR, III.ivo4.H.32.a). It is important to
remember that the s.ufficiency ofthe stressor(s) to cause PTSD is a medical and not a
rating determination (see Cohen v. Brown 94-661).

For veterans discharged within the last five years, develop for the unit history from the
veteran's former unit when we have received an adequate response to the PTSD
development questionnaire (VA Form 21-0781, Statement in Support ofClaim for Service
Connection for Post- Traumatic Stress Disorder) and there is insufficient credible
supporting evidence to concede that the claimed stressor(s) occurred. If necessary,
contact the veteran for the unit's address.

If the veteran was discharged more than five years ago and a complete unit of assignment
during the stressful event is available, corroborate the stressor using the C&P Service
Intranet Stressor Verification site, official military websites, or other government
Page 4.

Director (00/21)

websites. After exhausting all other resources, send a request to the Joint Services
Records Research Center (JSRRC). Until we update Modem Awards Processing­
Development (MAP-D), please use the enclosed suggested text to solicit information
from the veteran's unit. You may use the third party letter in MAP-D titled "Request
report of accident investigation" in the interim, and paste the attached language to the
body of the letter in order to establish a tracked item.

Stressor Development Follow-Up

In the absence of individual decorations indicating personal participation in combat, the
veteran must provide sufficient information about the stressful event to research it.
Currently, if the veteran fails to respond to the request within 60 days, VA must send a
second development letter requesting the information, allowing an additional 30 days for
a response (see M2l-lMR, IV.ii.1.D.15.n). However, we have determined that the
30-day follow-up request to the veteran is not necessary if the veteran completely fails to
respond to the initial request. A follow-up request must be made if the veteran responds
but the response lacks sufficient information to conduct a meaningful search. The
manual will be updated to reflect this change. Those stations still contacting the veteran
and allowing an additional 10 days to respond to our request for stressor information (as
outlined in the former M2l-l, Part III, 5.14(c)(5)) may also cease this practice.

Formal Finding of Insufficient Stressor Information

If the veteran fails to respond to any initial or follow-up request for stressor information
or submits information that is still insufficient, refer the case to the JSRRC Coordinator.
The JSRRC Coordinator will make a formal finding regarding the lack of sufficient
information in the claims folder to document the occurrence of, and the veteran's
involvement in, the stressful event(s). The JSRRC Coordinator must review the claims
folder to confirm the veteran was properly notified of the information required to
document the stressor(s), and that all relevant evidence, to include service records, have
been considered in an attempt to confirm the occurrence of the stressful event(s) (see
M2l-1MR, Part IV, ii.1.D.16.a). The formal finding should be on a separate page, filed
in the claims folder, and include all the requirements listed in M2l-lMR, Part IV,
ii.1.D.16.b.

Revised Initial PTSD VA Examination Worksheet

The revised Initial PTSD Examination worksheet does not require the examiner to
describe specific details of the stressor for VA to confirm that it occurred. However, the
examiner must still opine whether the current symptoms are linked to the identified
stressor or stressors (see FL 07-08, Revised Initial Post Traumatic Stress
Page 5.

Director (00/21)

Disorder and Review Post Traumatic Stress Disorder Disability Examination

Worksheets, dated March 29,2007). Confirmation of the stressor must be completed
prior to the examination request, except for PTSD claims based on personal trauma or
in-service diagnosis. The verified stressor must be stated in the Remarks section of the
examination worksheet. If the veteran has not identified a specific stressor in his or her
claim, but combat participation is conceded because of the receipt of one or more
decorations listed in M2l-1MR, Part III, iv.4.H.29.c, include a statement in the Remarks
section of the examination worksheet indicating that the veteran has verified combat
action.

PTSD and Individual Unemployability (IU)

The information contained in this Fast Letter rescinds Training Letter (TL) 01-01, J 0
Important rating points about PTSD, dated January 8, 2001. A 100-percent schedular
evaluation must be fully supported by current evidence showing the veteran has total
occupational and social impairment solely due to the service-connected PTSD. If the
veteran does not meet this criterion, but claims to be unable to work due to the effects of
service-connected PTSD, assign the appropriate schedular evaluation for PTSD and
consider possible entitlement to ill.

Questions

Questions about this letter should be e-mailed to VAVBAWAS/C0/2l2A.

/s/
Bradley G. Mayes,
Director
Compensation and Pension Service

Enclosure: Interim Development Text for Requesting Unit History Records

Interim Development Text for Requesting Unit History Records

Dear SirlMadam:

This is a request for research of records in your possession with the purpose of verifying
a stressful event claimed by a veteran who previously served in your unit. This veteran is
seeking benefits from the Department of Veterans Affairs (VA), and we need your
assistance to support his/her claim.

The veteran's name and information pertaining to the claimed stressful event(s) is shown
below.

Name of Claimant:

Social Security Number:

Claimed Stressor(s):

Approximate date and location where the event took place:

Unit of assignment at the time the stressful event occurred:

Please provide any information (e.g.; photocopies of pages from relevant unit histories,
documents showing veteran's location at the time an incident occurred, etc.) that pertains
to the claimed stressor(s). We would appreciate a response within 60 days. Ifno
information is found, please provide a negative response.

This letter is being sent in duplicate so that you may retain a copy. Attach one copy of
our letter to your reply so we may associate it with the proper claim. Please return your
information to the address shown at the top of this letter. A self-addressed envelope is
enclosed [or your convenience.

Note: We can't pay any fees for this information.

July 11,2002
211 A
In Reply Refer To:
Director (00/210 Fast Letter 02-16
All VA Regional Offices and Centers

SUBJ: Revised Mental Disorders, Eating Disorders, Initial PTSD, and Review PTSD
worksheets

1. Enclosed are copies of the revised Mental Disorders, Eating Disorders, Initial PTSD, and
Review PTSD disability examination worksheets. They are effective immediately. The
revised worksheets have been sent for programming into the VHA computer system, and
we will inform you when a new patch has been developed and released to VA medical
facilities. Until then, you should send a copy of the worksheet by fax or e-mail to the
medical facility when requesting one of these examinations.

2. This revision consists of a replacement of the former paragraph titled "Competency"in

each of these four worksheets. The substitute paragraph is titled "Capacity to Manage
Financial Affairs". The revision was made to conform to legal requirements.

3. If you have any questions about this fast letter, please contact the person named on the
Calendar page for this date at http://vbaw.vba.va.govlbl/21/calendar/index.htm.

4. This letter rescinds on July 20, 2003.

lSI
Ronald J. Henke, Director
Compensation and Pension Service

Enclosure
 Compensation and Pension Examination

INITIAL EVALUATION FOR POST-TRAUMATIC STRESS DISORDER (PTSD)

# 091 0 Worksheet

Name: SSN:

Date of Exam: _ C-number:

Place of Exam: _

A. Identifying Information

- age
- ethnic background
- era of military service
- reason for referral (original exam to establish PTSD diagnosis and
related psychosocial impairment; re-evaluation of status of existing
service-connected PTSD condition)

B. Sources ofInformation

* records reviewed (C-file, 00-214, medical records, other documentation)

* review of social-industrial survey completed by social worker
* statements from collaterals
* administration of psychometric tests and questionnaires (identify here)
C. Review of Medical Records:
I. Past Medical History:

a. Previous hospitalizations and outpatient care.

b. Complete medical history is required, including history since discharge
from military service.
c. Review of Claims Folder is required on initial exams to establish or
rule out the diagnosis.

2. Present Medical History - over the past one year.

a. Frequency, severity and duration of medical and psychiatric symptoms.

b. Length of remissions, to include capacity for adjustment during periods
of remissions.

o. Examination (Objective Findings):

Address each of the following and fully describe:

History (Subjective Complaints):

Comment on:

Preliminary History (refer to social-industrial survey if completed)

* describe family structure and environment where raised (identify

constellation of family members and quality of relationships)
* quality of peer relationships and social adjustment (e.g., activities.
achievements, athletic and/or extracurricular involvements, sexual
involvement, etc.)
* education obtained and performance in school
 * employment
* legal infractions
* delinquency or behavior conduct disturbances
* substance use patterns
* significant medical problems and treatments obtained
* family psychiatric history
* exposure to traumatic stressors (see CAPS trauma assessment checklist)
* summary assessment of psychosocial adjustment and progression through

developmental milestones (performance in employment or schooling,

routine responsibilities of self-care, family role functioning,

physical health, social/interpersonal relationship, recreation/leisure

pursuits).

Military History

* branch of service (enlisted or drafted)

* dates of service
* dates and location of war zone duty and number of months stationed

In war zone

* Military Occupational Specialty (describe nature and duration ofjob(s)

In war zone

* highest rank obtained during service (rank at discharge if different)

* type of discharge from military

* describe routine combat stressors veterans was exposed to

(refer to Combat Scale)

* combat wounds sustained (describe)

* CLEARLY DESCRIBE SPECIFIC STRESSOR EVENT(S) VETERAN CONSIDERED
PARTICULARLY TRAUMATIC.
Clearly describe the stressor. Particularly if the stressor is a type
of personal assault, including sexual assault, provide information,
with examples, if possible.
* indicate overall level of traumatic stress exposure

(high, moderate, low) based on frequency and severity of incident

exposure

* citations or medals received

* disciplinary infractions or other adjustment problems during military
NOTE: Service connection for post-traumatic stress disorder (PTSD) requires
medical evidence establishing a diagnosis of the condition that conforms
to the diagnostic criteria ofDSM-IV, credible supporting evidence that
the claimed in-service stressor actually occurred, and a link, established by
medical evidence, between current symptomatology and the claimed in-service
stressor. It is the responsibility of the examiner to indicate the traumatic
stressor leading to PTSD, ifhe or she makes the diagnosis ofPTSD.
Crucial in this description are specific details of the stressor, with names,
dates, and places linked to the stressor, so that the rating specialist can
confirm that the cited stressor occurred during active duty.

A diagnosis of PTSD cannot be adequately documented or ruled out without

obtaining a detailed military history and reviewing the claims folder.
This means that initial review of the folder prior to examination, the history
and examination itself, and the dictation for an examination initially
establishing PTSD will often require more time than for examinations of other
disorders. Ninety minutes to two hours on an initial exam is normal.

Post-Military Trauma History (refer to social-industrial survey if completed)

 * describe post-military traumatic events (see CAPS trauma assessment

checklist)

* describe psychosocial consequences of post-military trauma exposure(s)

(treatment received, disruption to work, adverse health consequences)

Post-Military Psychosocial Adjustment (refer to social-industrial survey

if completed)

* legal history (DWIs, arrests, time spent in jail)

* educational accomplishment
* employment history (describe periods of employment and reasons)
* marital and family relationships (including quality of relationships with

children)

* degree and quality of social relationships

* activities and leisure pursuits
* problematic substance abuse (lifetime and current)
* significant medical disorders (resulting pain or disability; current

medications)

* treatment history for significant medical conditions, including

hospitalizations

* history of inpatient and/or outpatient psychiatric care (dates and

conditions treated)

* history of assaultiveness
* history of suicide attempts
* summary statement of current psychosocial functional status (performance
in employment or schooling, routine responsibilities of self care,
family role functioning, physical health, social/interpersonal
relationships, recreation/leisure pursuits)

E. Mental Status Examination

Conduct a BRIEF mental status examination aimed at screening for DSM-IV

mental disorders. Describe and fully explain the existence, frequency and
extent of the following signs and symptoms, or any others present, and
relate how they interfere with employment and social functioning:

* Impairment of thought process or communication.

* Delusions, hallucinations and their persistence.
* Eye Contact, interaction in session, and inappropriate behavior cited

with examples.

* Suicidal or homicidal thoughts, ideations or plans or intent.

* Ability to maintain minimal personal hygiene and other basic activities

of daily living.

* Orientation to person, place, and time.

* Memory loss, or impaimlent (both short and long-term).
* Obsessive or ritualistic behavior which interferes with routine activities

and describe any found.

* Rate and flow of speech and note any irrelevant, illogical, or obscure

speech patterns and whether constant or intermittent.

* Panic attacks noting the severity, duration, frequency, and effect on

independent functioning and whether clinically observed or good evidence
of prior clinical or equivalent observation is shown.
* Depression, depressed mood or anxiety.
* Impaired impulse control and its effect on motivation or mood.
* Sleep impairment and describe extent it interferes with daytime activities.
* Other disorders or symptoms and the extent they interfere with activities,
particularly:
 - mood disorders (especially major depression and dysthymia)

- substance use disorders (especially alcohol use disorders)

- anxiety disorders (especially panic disorder, obsessive-compulsive

disorder, generalized anxiety disorder)

- somatoform disorder

- personality disorders (especially antisocial personality disorder

and borderline personality disorder)

Specify onset and duration of symptoms as acute, chronic, or with delayed onset.

F. Assessment of PTSD

* state whether or not the veteran meets the DSM-IV stressor criterion
* identify behavioral, cognitive, social, affective, or somatic change

veteran attributes to stress exposure

* describe specific PTSD symptoms present (symptoms of trauma

re-experiencing, avoidance/numbing, heightened physiological arousal,

and associated features [e.g., disillusionment and demoralization])

* specify onset, duration, typical frequency, and severity of symptoms

G. Psychometric Testing Results

* provide psychological testing if deemed necessary.

* provide specific evaluation information required by the rating board or

on a BVA Remand.

* comment on validity of psychological test results

* provide scores for PTSD psychometric assessments administered
* state whether PTSD psychometric measures are consistent or inconsistent

with a diagnosis ofPTSD, based on normative data and established

"cutting scores" (cutting scores that are consistent with or supportive

of a PTSD diagnosis are as follows: PCL - not less than 50;

Mississippi Scale - not less than 107; MMPI PTSD subscale a score

greater than 28; MMPI code type: 2-8 or 2-7-8)

* state degree of severity of PTSD symptoms based on psychometric data

(mild, moderate, or severe)

* describe findings from psychological tests measuring other than

PTSD (MMPI, etc.)

H. Diagnosis:

I. The Diagnosis must conform to DSM-IV and be supported by the findings

on the examination report.
2. If there are multiple mental disorders, delineate to the extent possible

the symptoms associated with each and a discussion of relationship.

3. Evaluation is based on the effects of the signs and symptoms on

occupational and social functioning.

NOTE: VA is prohibited by statute, 38 U.S.c. 1110, from paying compensation

for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.
However, when a veteran's alcohol or drug abuse disability is secondary to
or is caused or aggravated by a primary service-connected disorder, the
veteran may be entitled to compensation. See Allen v. Principi, 237 F.3d
1368,1381 (Fed. Cir. 2001). Therefore, it is important to determine the
relationship, if any, between a service-connected disorder and a disability
resulting from the veteran's alcohol or drug abuse. Unless alcohol or drug
abuse is secondary to or is caused or aggravated by another mental disorder,
you should separate, to the extent possible, the effects of the alcohol or
drug abuse from the effects of the other mental disorder(s). Ifit is not
possible to separate the effects in such cases, please explain why.

1. Diagnostic Status

Axis I disorders

Axis II disorders

Axis III disorders

Axis IV (psychosocial and environmental problems)

Axis V (GAF score - current)

J. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be required

by BVA REMAND or specifically requested by the rating specialist. If so,

include the GAF score and note whether it refers to current functioning.

A BVA REMAND may also request, in addition to an overall GAF score,

that a separate GAF score be provided for each mental disorder present when

there are multiple Axis I or Axis II diagnoses and not all are service­

connected. If separate GAF scores can be given, an explanation and

discussion of the rationale is needed. If it is not possible, an explanation

as to why not is needed. (See the above note pertaining to alcohol or drug

abuse.)

K. Capacity to Manage Financial Affairs

Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VA
benefit payments in his or her own best interest, and not to any other subject. Mental incompetency, for
VA benefits purposes, means that the veteran, because of injury or disease, is not capable of managing
benefit payments in his or her best interest. In order to assist raters in making a legal detennination as to
competency, please address the following:
What is the impact of injury or disease on the veteran's ability to manage his or her financial
affairs, including consideration of such things as knowing the amount of his or her VA benefit
payment, knowing the amounts and types of bills owed monthly, and handling the payment
prudently? Does the veteran handle the money and pay the bills himself or herself?

Based on your examination, do you believe that the veteran is capable of managing his or her
financial affairs? Please provide examples to support your conclusion.

If you believe a Social Work Service assessment is needed before you can give your opinion on
the veteran's ability to manage his or her financial affairs, please explain why.

L. Other Opinion:

Furnish any other specific opinion requested by the rating

board or BVA remand (furnish the complete rationale and citation of medical

texts or treatise supporting opinion, if medical literature review was

undertaken). If the requested opinion is medically not ascertainable

on exam or testing please state WHY. If the requested opinion can not be

expressed without resorting to speculation or making improbable assumptions

say so, and explain why. If the opinion asks" ... is it at least as likely

as not..", fully explain the clinical findings and rationale for the opinion.

M. Integrated Summary and Conclusions

- Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFE

 following trauma exposure (performance in employment or schooling,

routine responsibilities of self care, family role functioning, physical

health, social/interpersonal relationships, recreation/leisure pursuits)

- Describe linkage between PTSD symptoms and aforementioned changes in

impairment in functional status and quality of life.

Particularly in cases where a veteran is unemployed, specific

details about the effects ofPTSD and its symptoms on employment

are especially important.

- If possible, describe extent to which disorders other than PTSD

(e.g., substance use disorders) are independently responsible for

impairment in psychosocial adjustment and quality of life. If this is

not possible, explain why (e.g., substance use had onset after PTSD

and clearly is a means of coping with PTSD symptoms).

- If possible, describe pre-trauma risk factors or characteristics that

may have rendered the veteran vulnerable to developing PTSD subsequent

to trauma exposure.

- If possible, state prognosis for improvement of psychiatric condition

and impairments in functional status.
Comment on whether veteran is capable of managing his or her financial affairs.

Signature: Date:
 Compensation and Pension Examination

REVIEW EXAMINATION FOR POST-TRAUMATIC STRESS DISORDER (PTSD)

# 0920 Worksheet

Name: SSN:

Date of Exam: - - - - - - - C-number:

Place of Exam:
---------

A. Review of Medical Records

B. Medical History since last exam:

Comments on:

1. Hospitalizations and outpatient care from the time between last

rating examination to the present, UNLESS the purpose of this

examination is to ESTABLISH service connection, then the complete

medical history since discharge from military service is required.

2. Frequency, severity and duration of psychiatric symptoms.

3. Length of remissions from psychiatric symptoms, to include capacity

for adjustment during periods of remissions.

4. Treatments including statement on effectiveness and side effects

experienced.

5. SUBJECTIVE COMPLAINTS: Describe fully.

C. Psychosocial Adjustment since the last exam

1. legal history (DWIs, arrests, time spent injail)

2. educational accomplishment
3. extent of time lost from work over the past 12 month period and social

impairment. If employed, identify current occupation and length of time

at this job.

Ifunemployed, note in COMPLAINTS whether veteran contends it is due to

the effects of a mental disorder. Further indicate following DIAGNOSIS

what factors, and objective findings support or rebut that contention.

4. marital and family relationships ( including quality of relationships with

spouse and children)

5. degree and quality of social relationships

6. activities and leisure pursuits
7. problematic substance abuse
8. significant medical disorders (resulting pain or disability; current

medications)

9. history of violence/assaultiveness
10. history of suicide attempts
11. summary statement of current psychosocial functional status (performance

in employment or schooling, routine responsibilities of self care,

family role functioning, physical health, social/interpersonal

relationship, recreation/leisure pursuits)

D. Mental Status Examination

Conduct a BRIEF mental status examination aimed at screening for DSM-IV

mental disorders. Describe and fully explain the existence, frequency and

extent of the following signs and symptoms, or any others present, and

 relate how they interfere with employment and social functioning:

1. Impairment of thought process or communication.

2. Delusions, hallucinations and their persistence.
3. Eye Contact, interaction in session, and inappropriate behavior cited

with examples.

4. Suicidal or homicidal thoughts, ideations or plans or intent.

5. Ability to maintain minimal personal hygiene and other basic activities
of daily living.
6. Orientation to person, place, and time.
7. Memory loss, or impairment (both short and long-term).
8. Obsessive or ritualistic behavior which interferes with routine activities
and describe any found.
9. Rate and flow of speech and note any irrelevant, illogical, or obscure

speech patterns and whether constant or intermittent.

10. Panic attacks noting the severity, duration, frequency, and effect on
independent functioning and whether clinically observed or good evidence
of prior clinical or equivalent observation is shown.
11. Depression, depressed mood or anxiety.
12. Impaired impulse control and its effect on motivation or mood.
13. Sleep impairment and describe extent it interferes with daytime activities

14. Other disorders or symptoms and the extent they interfere with activities,
particularly:

a. mood disorders (especially major depression and dysthymia)

b. substance use disorders (especially alcohol use disorders)
c. anxiety disorders (especially panic disorder, obsessive-compulsive

disorder, generalized anxiety disorder)

d. somatoform disorders
e. personality disorders (especially antisocial personality disorder

and borderline personality disorder)

E. Assessment of PTSD

1. state whether or not the veteran meets the DSM-IV stressor criterion
2. identify behavioral, cognitive, social, affective, or somatic symptoms
veteran attributes to PTSD
3. describe specific PTSD symptoms present (symptoms of trauma
re-experiencing, avoidance/numbing, heightened physiological arousal,
and associated features [e.g., disillusionment and demoralization])
4. specify typical frequency, and severity of symptoms

F. Psychometric Testing Results

1. provide psychological testing if deemed necessary.

2. provide specific evaluation information required by the rating board or
on a BVA Remand.
3. comment on validity of psychological test results
4. provide scores for PTSD psychometric assessments administered
5. state whether PTSD psychometric measures are consistent or inconsistent
with a diagnosis ofPTSD, based on normative data and established
"cutting scores" (cutting scores that are consistent with or supportive
of a PTSD diagnosis are as follows: PCL - not less than 50;
Mississippi Scale - not less than 107; MMPI PTSD subscale a score
greater than 28; MMPI code type: 2-8 or 2-7-8)
6. state degree of severity of PTSD symptoms based on psychometric data
 (mild, moderate, or severe)
7. describe findings from psychological tests measuring other than

PTSD (MMPI, etc.)

G. Diagnosis:

1. The Diagnosis must conform to DSM-IV and be supported by the findings

on the examination report.

2. If there are multiple mental disorders, delineate to the extent possible

the symptoms associated with each and a discussion of relationship.

3. Evaluation is based on the effects of the signs and symptoms on

occupational and social functioning.

NOTE: VA is prohibited by statute, 38 U.s.c. 1110, from paying compensation

for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.
However, when a veteran's alcohol or drug abuse disability is secondary to
or is caused or aggravated by a primary service-connected disorder, the
veteran may be entitled to compensation. See Allen v. Principi, 237 F.3d
1368, 1381 (Fed. Cir. 2001). Therefore, it is important to determine the
relationship, if any, between a service-connected disorder and a disability
resulting from the veteran's alcohol or drug abuse. Unless alcohol or drug
abuse is secondary to or is caused or aggravated by another mental disorder,
you should separate, to the extent possible, the effects of the alcohol or
drug abuse from the effects of the other mental disorder(s). If it is not
possible to separate the effects in such cases, please explain why.

H. Diagnostic Status

Axis I disorders

Axis II disorders

Axis III disorders

Axis IV (psychosocial and environmental problems)

Axis V (GAF score - current)

I. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be required

by BVA REMAND or specifically requested by the rating specialist. If so,

include the GAF score and note whether it refers to current functioning.

A BVA REMAND may also request, in addition to an overall GAF score,

that a separate GAF score be provided for each mental disorder present when

there are multiple Axis I or Axis II diagnoses and not all are service­

connected. If separate GAF scores can be given, an explanation and

discussion of the rationale is needed. If it is not possible, an explanation

as to why not is needed. (See the above note pertaining to alcohol or drug

abuse.)

1. Capacity to Manage Financial Affairs

Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VA
benefit payments in his or her own best interest, and not to any other subject. Mental incompetency, for
VA benefits purposes, means that the veteran, because of injury or disease, is not capable of managing
benefit payments in his or her best interest. In order to assist raters in making a legal determination as to
competency, please address the following:
What is the impact of injury or disease on the veteran's ability to manage his or her financial
affairs, including consideration of such things as knowing the amount of his or her VA benefit
 payment, knowing the amounts and types of bills owed monthly, and handling the payment
prudently? Does the veteran handle the money and pay the bills himself or herself?

Based on your examination, do you believe that the veteran is capable of managing his or her
financial affairs? Please provide examples to support your conclusion.

If you believe a Social Work Service assessment is needed before you can give your opinion on
the veteran's ability to manage his or her financial affairs, please explain why.

K. Other Opinion:

Furnish any other specific opinion requested by the rating

board or BVA remand (i.e., furnish the complete rationale and citation of

medical texts or treatise supporting opinion, if medical literature review

was undertaken). If the requested opinion is medically not ascertainable

on exam or testing please state WHY. If the requested opinion can not be

expressed without resorting to speculation or making improbable assumptions

say so, and explain why. If the opinion asks" .,. is it at least as likely

as not..", fully explain the clinical findings and rationale for the opinion.

L. Integrated Summary and Conclusions

1. Describe changes in PSYCHOSOCIAL FUNCTIONAL STATUS and QUALITY of LIFE

since the last exam (performance in employment or schooling, routine

responsibilities of self care, family role functioning, physical health,

social/interpersonal relationships, recreation/leisure pursuits)

2. Describe linkage between PTSD symptoms and aforementioned changes in

impairment in functional status and quality oflife.

Particularly in cases where a veteran is unemployed, specific details

about the effects of PTSD and its symptoms on employment are especially

important.

3. If possible, describe extent to which disorders other than PTSD

(e.g., substance use disorders) are independently responsible for
impairment in psychosocial adjustment and quality oflife. If this is not
possible, explain why (e.g., substance use had onset after PTSD
and clearly is a means of coping with PTSD symptoms).
4. If possible, state prognosis for improvement of psychiatric condition

and impairments in functional status.

5. Comment on whether veteran is capable of managing his or her financial affairs.

Signature: Date:
 Compensation and Pension Examination

MENTAL DISORDERS (except PTSD and Eating Disorders)

# 0905 Worksheet

Name: SSN:

Date of Exam: C-number:

Place of Exam:

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

1. Past Medical History:

a. Previous hospitalizations and outpatient care.

b. Medical and occupational history from the time between last rating
examination and the present, UNLESS the purpose of this examination
is to ESTABLISH service connection, then the complete medical history
since discharge from military service is required.

2. Present Medical, Occupational, and Social History ­

over the past one year.

a. Frequency, severity, and duration of psychiatric symptoms.

b. Length of remissions, to include capacity for adjustment during
periods of remissions.
c. Extent of time lost from work over the past 12 month period and
social impairment. If employed, identify current occupation and
length of time at this job. If unemployed, note in Complaints whether
veteran contends it is due to the effects of a mental disorder.
Further indicate following DIAGNOSIS what factors, and objective
findings support or rebut that contention.
d. Treatments including statement on effectiveness and side effects
experienced.

3. Subjective Complaints:

a. Describe fully.

C. Examination (Objective Findings):

Address each of the following and fully describe:

I. Mental status exam to confirm or establish diagnosis in

accordance with DSM-IV.
2. Additionally, to allow evaluation by the rating specialist, describe
and fully explain the existence, frequency, and extent of the following
signs and symptoms, or any others present, and relate how they interfere
with employment and social functioning:
a. Impairment of thought process or communication.
b. Delusions, hallucinations and their persistence.
c. Inappropriate behavior cited with examples.
d. Suicidal or homicidal thoughts, ideations or plans or intent.
e. Ability to maintain minimal personal hygiene and other basic
 activities of daily living.
f. Orientation to person, place and time.
g. Memory loss or impairment (both short and/or long term).
h. Obsessive or ritualistic behavior which interferes with routine

activities (describe with examples).

i. Rate and flow of speech and note irrelevant, illogical, or obscure

speech patterns and whether constant or intermittent.

j. Panic attacks noting the severity, duration, frequency and effect

on independent functioning and whether clinically observed or good

evidence of prior clinical or equivalent observation.

k. Depression, depressed mood, or anxiety.

I. Impaired impulse control and its effect on motivation or mood.
m. Sleep impairment and describe extent it interferes with daytime

activities.

n. Other symptoms and the extent to which they interfere with

activities.

D. Diagnostic Tests:

1. Provide psychological testing if deemed necessary.

2. If testing is requested, the results must be reported and considered in

arriving at the diagnosis.

3. Provide any specific evaluation infornlation required by the rating board

or on BVA Remand (in claims folder).

a. Capacity to Manage Financial Affairs

Mental competency, for VA benefits purposes, refers only to the ability of the veteran to manage VA
benefit payments in his or her own best interest, and not to any other subject. Mental incompetency, for
VA benefits purposes, means that the veteran, because of injury or disease, is not capable of managing
benefit payments in his or her best interest. In order to assist raters in making a legal determination as to
competency, please address the following:
What is the impact of injury or disease on the veteran's ability to manage his or her financial
affairs, including consideration of such things as knowing the amount of his or her VA benefit
payment, knowing the amounts and types of bills owed monthly, and handling the payment
prudently? Does the veteran handle the money and pay the bills himself or herself?

Based on your examination, do you believe that the veteran is capable of managing his or her
financial affairs? Please provide examples to support your conclusion.

If you believe a Social Work Service assessment is needed before you can give your opinion on
the veteran's ability to manage his or her financial affairs, please explain why.

b. Other Opinion: Furnish any other specific opinion requested

by the rating board or BVA Remand furnishing the complete

rationale and citation of medical texts or treatise supporting

opinion, if medical literature review was undertaken.

If the requested opinion is medically not ascertainable on exam

or testing, please indicate WHY. If the requested opinion can not

be expressed without resorting to speculation or making improbable

assumptions say so, and explain why. If the opinion asks ".. .is it

at least as likely as not..?", fully explain the clinical findings

and rationale for the opinion.

4. Include results of all diagnostic and clinical tests conducted

in the examination report.

E. Diagnosis:
 Provide:

1. The Diagnosis must conform to DSM-IV and be supported by the findings

on the examination report.
2. If the diagnosis is changed, explain fully whether the new diagnosis

represents a progression of the prior diagnosis or development of a new

and separate condition.

3. If there are multiple mental disorders, delineate to the extent possible

the symptoms associated with each and a discussion of relationship.

4. Evaluation is based on the effects of the signs and symptoms on

occupational and social functioning.

NOTE: VA is prohibited by statute, 38 U.S.c. 1110, from paying compensation

for a disability that is a result of the veteran's own ALCOHOL OR DRUG ABUSE.
However, when a veteran's alcohol or drug abuse disability is secondary to
or is caused or aggravated by a primary service-connected disorder, the
veteran may be entitled to compensation. See Allen v. Principi, 237 F.3d
1368, 1381 (Fed. Cir. 200 I). Therefore, it is important to determine the
relationship, if any, between a service-connected disorder and a disability
resulting from the veteran's alcohol or drug abuse. Unless alcohol or drug
abuse is secondary to or is caused or aggravated by another mental disorder,
you should separate, to the extent possible, the effects of the alcohol or
drug abuse from the effects of the other mental disorder(s). Ifit is not
possible to separate the effects in such cases, please explain why.

F. Global Assessment of Functioning (GAF):

NOTE: The complete multi-axial format as specified by DSM-IV may be required

by BVA REMAND or specifically requested by the rating specialist. If so,
include the GAF score and note whether it refers to current functioning.
A BVA REMAND may also request, in addition to an overall GAF score, that a
separate GAF score be provided for each mental disorder present when there are
multiple Axis I or Axis II diagnoses and not all are service-connected.
If separate GAF scores can be given, an explanation and discussion of
the rationale is needed. If it is not possible, an explanation as to why not is
needed. (See the above note pertaining to alcohol or drug abuse.)

Signature: Date:
 Compensation and Pension Examination

EATING DISORDERS (Mental Disorders)

Name: SSN:

Date of Exam: C-number:

Place of Exam

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:
1. Past Medical History:
a. Previous hospitalizations and outpatient care for parenteral nutrition or tube
feeding.
b. Medical and occupational history from the time between the last such rating
examination and the present needs to be accounted for, UNLESS the purpose
of this examination is to ESTABLISH service connection, then a complete
medical history since discharge from military service is required.
c. Periods of incapacitation (during which bedrest and treatment by a physician
are required due to the eating disorder). Describe the frequency and duration.
d. Current treatment, response, side effects.

2. Present Medical, Occupational and Social History - over the past one year.
a. History of onset of eating disorder.
b. Its course, treatment, and current status to include symptoms.
c. Extent of time lost from work over the past 12 month period and social
impairment. If employed, identify current occupation and length of time at this
job.

3. Subjective Complaints:
a. Describe fully.

C. Examination (Objective Findings):

Address each of the following and fully describe:
1. Mental status exam to confirm or establish diagnosis in accordance with DSM-IY.
1. Additionally, please provide this specific information:
a. Current weight.
b. Expected minimum weight based on age, height, and body build.
c. Obtain weight history.

3. Additionally, to allow evaluation by the rating specialist, describe and fully explain the
existence, frequency, and extent of the following signs and symptoms and relate how
they interfere with employment:
a. Binge eating.
b. Self-induced vomiting or other measure to prevent weight gain when weight is
already below expected minimum normal weight.

D. Diagnostic Tests (including psychological testing if deemed necessary):

1. Provide specific evaluation information required by the rating board or on a BYA

Remand. Diagnostic Tests (See the examination request remarks for specifics.):

a. Capacity to Manage Financial Affairs

 Mental competency, for VA benefits purposes, refers only to the ability of the veteran to
manage VA benefit payments in his or her own best interest, and not to any other subject.
Mental incompetency, for VA benefits purposes, means that the veteran, because of injury or
disease, is not capable of managing benefit payments in his or her best interest. In order to
assist raters in making a legal determination as to competency, please address the following:
What is the impact of injury or disease on the veteran's ability to manage his or her
financial affairs, including consideration of such things as knowing the amount of his
or her VA benefit payment, knowing the amounts and types of bills owed monthly,
and handling the payment prudently? Does the veteran handle the money and pay the
bills himself or herself?

Based on your examination, do you believe that the veteran is capable of managing his
or her financial affairs? Please provide examples to support your conclusion.

If you believe a Social Work Service assessment is needed before you can give your
opinion on the veteran's ability to manage his or her financial affairs, please explain
why.

b. Other Opinion: Furnish any other specific opinion requested by the

rating board or BVA Remand furnishing the complete rationale and citation
of medical texts or treatise supporting opinion, if medical literature review was
undertaken. If the requested opinion is medically not ascertainable on exam or
testing please state WHY. If the requested opinion can not be expressed
without resorting to speculation or making improbable assumptions say so, and
explain why. If the opinion asks ".. .is it at least as likely as not...", fully explain
the clinical findings and rationale for the opinion.

2. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis:

Signature: Date:
January 16, 2001

Director (00/21) 211A

All VBA Regional Offices and Centers FL01-05

SUBJ: Relationship of PTSD or Stress to Cardiovascular Disorders

1. A letter on this subject (96-95) was published on September 26, 1996. This
letter explained that a causative relationship between PTSD or other long­
term stress, such as the POW experience, and subsequently developing
cardiovascular disease has not been established. More recent medical
literature on this subject, for example, "Physician-Diagnosed Medical
Disorders in Relation to PTSD Symptoms in Older Military Veterans,"
published in January 2000 (P. P. Schnurr, A. Spiro, III, and A. H. Paris,
Health Psychology, 19 (1), 91-97), continues to state that it is premature to
draw firm conclusions about the relationship of combat and PTSD to
cardiovascular and other disorders. Two VA studies now in progress may
shed further light on the subject of a possible relationship.

2. Some have used FL 96-95 as the basis of denial of a claim for a

cardiovascular condition secondary to PSTD. The lack of confirmation of a
relationship in general, however, does not mean that a claim for a
cardiovascular condition secondary to PTSD, supported by a medical opinion,
should routinely be denied. As with all medical opinions, the weight and
credibility of the opinion has to be considered in light of all other evidence of
record and in light of other medical information. The United States Court of
Appeals for Veterans Claims in Guerrieri v. Brown, 4 Vet. App. 467 (1993),
stated that the probative value of medical opinion evidence is based on the
medical expert's personal examination of the patient, the physician's
knowledge and skill in analyzing the data, and the medical conclusions that
the physician reaches.

3. In the case of a claim for coronary artery disease (CAD) due to PTSD, for
example, the examiner would, at a minimum, have to discuss known risk
factors for CAD, what role they play in this particular veteran, and explain why
he or she considers PTSD to be at least as likely as not the cause of the CAD
in this veteran. A similar discussion would be needed if the claimed condition
is hypertension or a stroke.

4. In some cases you may wish to request an additional medical opinion, either
by a mental health professional or a cardiologist, or both, and in questionable
cases, you may want to request an opinion from the Advisory Review staff
(211 B). Whatever your decision, you must provide adequate reasons and
Relationship of PTSD or stress to cardiovascular disorders bases to support
 it.

5. If you have questions about this letter, please contact the person shown on
the website at: http://vbaw.vba.va.gov/bI/21/calendar/index.htm.

6. This letter is rescinded January 1, 2003.

lsi
Robert J. Epley, Director
Compensation and Pension Service
 DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington DC 20420

June 7, 2005
In Reply Refer To: 213B
Director (00/21) Fast Letter 05-08
All VBA Regional Offices and Centers

SUBJ: Handling PTSD claims based on stressors experienced during service in the
Marine Corps.

Purpose of This Letter

This letter provides instructions with regard to the handling of post-traumatic

stress disorder (PTSD) claims that are based on stressors experienced during
service in the Marine Corps.

Background Information

Approximately three years ago, the Marine Corps Historical Center (MCHC)
digitized all unit records in its custody covering the Korean and Vietnam wars and
copied them to compact discs (CD). The Compensation and Pension Service
(C&P) collaborated to extract and upload the digitized unit records covering the
Vietnam Era to Virtual VA where they became available in December 2004.

Discussion of PTSD Claims

The Department of Veterans Affairs (VA) is not the custodian of Marine Corps
unit records, nor are regional office personnel recognized as experts in the field of
records research. For these reasons, denials of service connection for PTSD,
based solely on VA's inability to verify a claimed stressor through research of
these records, may not be seen as sufficient in an appeal to the Board of
Veterans Appeals or Court of Appeals for Veterans Claims. It is current VA policy
that claims for service connection for PTSD, filed by veterans alleging exposure
to stressful situations while serving in the Army, Navy, and Air Force, cannot be
denied based solely on the absence of a verifiable stressor unless the Center for
Unit Records Research (CURR) first confirms that the stressor cannot be verified.
CURR, however, does not have sufficient staffing to provide this service for
Marine Corps cases.

C&P Service recognizes the MCHC as the ultimate authority with regard to the
content and organization of Marine Corps unit records. C&P Service submitted a
formal request to MCHC management asking for its assistance in resolving this
matter. They have agreed that if regional offices are unable to verify a claimed
 stressor following a meaningful search of the records available through Virtual
VA, MCHC will either identify the appropriate record(s) for the regional office or
provide the required authoritative confirmation that the alleged stressor(s) cannot
be verified using records in its custody.

If information available through Virtual VA or official military web sites confirms

the occurrence of an in-service stressor, and all other requirements have been
met, the establishment of service connection for PTSD is in order. If, on the other
hand, the regional office is unable to verify the alleged stressor, the regional
office must request confirmation of its negative findings from MCHC before
denying service connection. This same policy would apply to claims requiring
research of unit records dated after the Vietnam Era, since VA does not currently
have access to these records.

How to Submit a Request to MCHC

Regional offices must follow the instructions below when submitting a request to
MCHC for a determination as to whether or not it possesses records required to
verify an alleged stressor:

1. Prepare a one page request, using VA letterhead, containing the following:

a. veteran's name and VA file number;
b. name of the veteran's squadron/battalion (or higher echelon);
c. the date (month and year) the stressful event occurred (not to
exceed a 60-day period of time);
d. a concise description of the stressful event;
e. identification of the unit records reviewed through Virtual VA;
f. the mailing address of the requesting regional office; and
g. a point of contact at the regional office.
2. Do not attach to the request any medical information or statement(s) from
the veteran.
3. Requests prepared prior to September 1,2005, may be faxed to (202)
433-7265 or mailed to the following address:

Headquarters United States Marine Corps

Marine Corps Historical Center

1254 Charles Morris St. SE

Washington Navy Yard

Washington, DC 20374-5040

4. Due to organizational changes within the Marine Corps, requests prepared

on or after September 1, 2005, must be faxed to (703) 784-4665 or mailed
to the following address:
Marine Corps University Archive

Gray Research Center

2040 Broadway Street

Quantico, VA 22134-5107

5. Per M21-1, Pt. 111,4.27, allow 60 days for a response before submitting a
follow-up request.

2
 A sample memorandum to MCHC for a determination as to the availability of
records required to verify a claimed stressor is attached.

Important Points to Keep in Mind

Regional offices will reduce delays inherent in processing claims for service
connection for PTSD filed by Marine Corps veterans by following this guidance:

• Send a request to MCHC only after exhausting all efforts to verify the
alleged stressor(s) through other means, to include Virtual VA and official
military web sites.
• CURR requires a minimum amount of information before it will attempt to
verify in-service stressors. Regional offices must take the same approach
when handling claims that may require research of Marine Corps unit
records. Before expending time and resources to conduct research, the
veteran is expected to submit, at a minimum,
• the name of the unit in which he/she served when the stressful
event occurred;
• the location where the stressful event occurred; and
• the date (month and year) the stressful event occurred (not to
exceed a 60-day period of time).
• Only assigned military records specialists should release requests to this
facility.
• M21-1, Pt. III, 5.14c(5) describes the action to take when a veteran fails to
provide the minimum information CURR requires to conduct research.
Regional offices should follow the same procedure when a Marine Corps
veteran seeking service connection for PTSD fails to provide the minimum
information described above.

Points of Contact
If you have any questions concerning information in this letter, please see either
the Calendar Page for this date, on our Intranet Site at:
http://152.125.216.223/bI/21/calendar/cal week.asp
Or the Fast Letter 2005 page at:
http://vbaw.vba.va.gov/bl/21/publicat/Letters/FL05List.htm

lSI

Renee L. Szybala, Director

Compensation and Pension Service

 Sample Letter to MCHC for a Determination as to the Availability

Of Records Required to Verify a Claimed Stressor

Headquarters, United States Marine Corps 00/21

Marine Corps Historical Center C 123-45-6789
1254 Charles Morris St. SE JONES, John A.
Washington Navy Yard
Washington, DC 20374-5040

Dear Sir/Madam:

This is a request for research of records in your possession for the purpose of verifying an in-
service stressor claimed by a veteran seeking service connection for post-traumatic stress
disorder. The alleged stressor occurred in <name ofcountry>. I have already reviewed the
following unit records that MCHC provided to VA on compact disc: <List the unit records
reviewed through Virtual VA. if applicable. >

The following information is provided to assist you in your research:

Narne of claimant: John A. Jones

VA File Number: 123-45-6789
Mailing Address: <Mailing address ofregional office. >
Name of Unit: <Name ofthe unit in which the veteran was serving when the stressful
incident occurred. >
Description of The veteran alleges that he witnessed the collision of two helicopters
Stressful Event: that killed 25 - 30 people at Camp Radcliffbetween January and
March of 1969. All the bodies were reportedly charred and fused
together.
Point of Contact: If additional information is required, please contact <regional office
employee's name> at ###-###-####.

Your assistance in this matter is appreciated.

Sincerely yours,

Veterans Service Center Manager