In this video and article, we’re going to discuss your upcoming PTSD examination.
We’re not going to cover the ins and outs of service connection, but instead, we’re going to ensure that you understand how the VA examines PTSD and other mental health conditions (see our mental health preparation video) and how they’re rated per the VA schedule of rating disabilities.
The VA applies the Diagnostic and Statistics Manual Number Five, a.k.a. the DSM-5, for all mental health conditions including PTSD. To be diagnosed with PTSD, you must meet specific criteria. It is important to note that the diagnostic criteria have some overlap but are generally separate from the symptoms the VA will use to rate the severity of your disability.
So we start with criterion A, which is a stressor. That means that you were exposed to death or threatened death, actual or threatened serious physical injury, or actual or threatened sexual violence in one of the following ways:
Let’s break that down. Direct exposure is pretty simple. You were directly exposed to death, serious physical injury, or at risk of death or serious physical injury. Common examples include firefights or car accidents, but other examples can include seeing dead bodies or severely injured people, such as after a suicide or an animal attack.
Witnessing the trauma is also fairly simple and straightforward. This is common in individuals who served in talks and other command centers, who watched firefights, IED strikes, or other traumatic incidents via drone or camera footage.
The learning that the trauma happened to a close friend or relative, likewise, is fairly self-explanatory. A common example we see in our practice is an individual whose best friend was killed in a firefight on patrol or a family member who was involved in a catastrophic car accident.
The last one, indirect exposure, primarily deals with first responders such as police, fire, or medics.
Next, we have criterion B, which is intrusion symptoms. It’s not enough to simply be exposed to a stressor, that stressor must result in you persistently re-experiencing the event in one or more of the following ways:
Upsetting memories, nightmares, and flashbacks are self-explanatory. Upsetting memories mean that you experience some emotional discomfort such as anger, sadness, or grief when you think about the traumatic event and that those memories intrude and affect your life.
Nightmares mean that you have nightmares about the event or something inspired by the event. For example, if you were on a base that got mortared and have nightmares about the Taliban overrunning the base, that is a nightmare.
Flashbacks mean that you flashback to the event and re-experience the event, either as if you were there again or sometimes as if you were watching the event like a movie.
Common examples of emotional and physical distress due to traumatic reminders include irritability, anger, or being upset after being reminded of an event.
Physical reactivity deals with the physical symptoms that accompany trauma, such as nausea, vomiting, sweating, tightness in the chest, or shortness of breath.
Next, we have criterion C, which is avoidance. That means that in one or more of the following ways, you:
This could mean avoiding things like unit reunions or talking to people you served with because those thoughts and feelings remind you of the traumatic event.
They also mean avoiding things like war movies, certain types of music, firearms, etc.
Next, we have criterion D, which is negative alterations in cognition and mood evidenced by at least two of the following:
Criterion E is alterations in arousal and reactivity in at least two of the following ways. Most of these symptoms are what most people consider to be PTSD:
And the last ones are relatively straightforward. For criterion F, the symptoms must last more than one month. Criterion G, they must create a distress or a functional impairment. Criterion H means that the symptoms aren’t attributable to another cause.
It’s important to note that a wide variety of stressors can cause PTSD.
While there is some level of stressor needed for criterion A, it does not require that you are Audie Murphy single-handedly assaulting German bunkers to qualify for PTSD.
Here at Stone Rose Law, we’ve successfully obtained service connections for clients exposed to a wide variety of stressors, including sexual assault, car accidents, and natural disasters such as Hurricane Katrina, tsunamis, or mudslides.
So while a general fear may not be enough (i.e., serving in the military and being concerned about deploying to a war zone) to satisfy criterion A, I urge veterans not to allow themselves or others to gatekeep post-traumatic stress and say their trauma isn’t enough. Leave the diagnosis to the professionals.
It’s important to remember that a C&P examination is not a therapy session. This is not the time to talk about your childhood trauma or how your parents treated you.
Oftentimes, C&P examiners will try and dig up unrelated nonsense from your childhood and try to pin everything you’re experiencing on that. While that is legally impermissible and easy to overturn on appeal, it’s always better to avoid the need for an appeal if at all possible.
It’s important to keep your examiner on track. There is no need to discuss childhood trauma, abuse, or mental health issues unless they have been formally diagnosed and are actually relevant to the issues at hand.
For example, if you entered service and a mental health condition was noted at the time of entrance or if you provided records of childhood mental health treatment, then the issue of childhood mental health issues is relevant in determining whether your mental health condition was aggravated by service.
But if you were never formally diagnosed, never received treatment, and never provided any treatment records from childhood, it’s best to gently remind the examiner that you’re not there to discuss your childhood and would like to focus on how your mental health condition is caused by service.
We also want to ensure you understand how to verbalize your symptoms accurately. When you go in and the doctor asks, “How do you get along with your coworkers?” you shouldn’t default to normal societal platitudes like, “Oh, fine.” Instead, you understand that that question is extremely pertinent to an accurate rating.
You should not be afraid to verbalize what is actually going on. Being honest is of paramount importance.
It is very easy for an examiner to determine when a veteran is exaggerating their symptoms. If you exaggerate, your credibility can be called into question and it’s harder to obtain an accurate rating.
However, in my years of practice, I’ve almost never had this problem with a client.
Instead, the problem I most often run into is my client not being truthful. By that, I mean they minimize their symptoms either out of embarrassment or fear of collateral consequences. I rarely, if ever, find that a client has exaggerated their symptoms, but all too often they underreport or minimize their symptoms.
Now, a VA C&P examination is not a treatment. You’re not going to end up committed, and they’re almost certainly not going to take away your gun rights or do anything other than assess your current level of functioning and disability.
The VA doesn’t want to discourage veterans from seeking treatment or pursuing their benefits. I’ve never seen a case where a veteran has left a mental health exam and had their firearms rights impacted, or ended up involuntarily committed.
Lastly, when preparing for this exam, don’t get dressed up in your Sunday best. Wear the clothes you would normally wear on a daily basis. Show up the way you show up every other day of the week.
You don’t need to shower and look good for your examiner if you don’t shower and look good every single day. Bring your spouse if you have one so they can accurately convey to the examiner what’s going on.
Now, that’s we’ve explained how each of these symptoms applies to you in lay terms, I hope that you’ll feel more comfortable being honest and forthright with your examiner. This is not the time for general niceties and societal pleasantries.
If they ask how you’re doing and you’re not doing fine, don’t say fine. Be honest. Verbalize your experience and ensure that you get the benefits you deserve as quickly as possible.
If you still have any questions about your upcoming exam, or how the VA evaluates or rates PTSD, please don’t hesitate to reach out to the team at Stone Rose Law at (480) 498-8998.
