Dual Diagnos for those folks who have a mental disorder and a substance abuse problem at the same time. In fact, up to 65.5% of people with a substance dependence disorder had at least one mental disorder and 51% of people with a mental disorder had at least one substance abuse disorder.
Veteran Resources-web-sites that provide information on Veterans benefits and how to file/ask for them. Accordingly, there are many sites that explain how to obtain books, military/medical records, information and how to appeal a denied claim with the VA.
Mesothelioma-Countless veterans are currently suffering from life-threatening illnesses that are a result of exposure to asbestos, a material that was commonly used in hundreds of military applications, products, and ships primarily because of its resistance to fire. Unfortunately, asbestos-related diseases are not always recognized by the VA, which is why I’m reaching out to veterans -- in hopes of helping them win the rights to their benefits.
I tried to embed the program so you could use it from here and it won't stay put. Email me and I will send it to you
As of this date, 17 June 2006 the following links are active and work. Some are direct links to pages and others are to Documents. Some documents are in MS Word format and some are PDF or Acrobat Reader format and are noted if they are several to many pages in lenghth.
Press Release - News Flash 11/4/2002 Supreme court sides with plaintiff. Lawsuit can proceed.
I transcribed the following excerpts about herbicide spraying in Vietnam from "The Vietnam Map Book" published by the Agent Orange Veteran's Committee to Winter Soldier Archive. Although the information was published over ten years ago. I believe that the information is still very relevant. Perhaps the situation with the VA has changed with the subsequent Agent Orange legislation.
I attempted to call and write the committee. I had mail returned from the address that was listed in the book:
Agent Orange Veteran's Advisory Committee, 2000 Center Street. Box 1251. Berkeley, CA 94704.
I do want to give credit to these people for their explanations and the information that was published. If I could locate a book, I would try to purchase it.
I believe that my brother-in-law, Thomas Karlovetz, who died died in April 1991 from Agent Orange exposure. The type of soft tissue cancer he had was rare, although often associated with dioxin poisons. He left three younger children and a wife behind. My sister will not receive any Agent Orange benefits from the government. Tom served as a captain in the graves registrars. Most of his tour he doing the dirty job of investigating and recovering our missing bodies from the jungled battlefields.
Agent Orange is the best known of the chemical "weedkillers" used as part of the massive defoliation program to destroy jungle cover, crops and other vegetation during the Vietnam War. Herbicides were authorized for use in Vietnam in 1961 to improve waterway visibility and clear base camp perimeters. Between 1962 and 1964 the military experimented with Agent Green, Agent Pink and Agent Purple. In 1965 Agent Orange and Agent White replaced the previous agents and began to be used in even larger amounts as the war escalated. Agent Blue, the only agent not derived from phenoxyacetic acid, was used through all phases of the war. All of these herbicides were named after the color-coded bands around the 55-gallon drums which contained them.
The defoliation program ran from January, 1962 to February, 1971 - almost the full length of the war. Exposure to these chemicals was as constant a factor in the war as artillery. Though estimates vary, Dr. Samuel Epstein, a toxicology expert, testified to the House Subcommittee on Veteran's Medical Facilities that between 17.4 and 19.1 million gallons of herbicide were aerially sprayed over South Vietnam; this amounted to approximately 107 million pounds of herbicide applied over about 6 million square miles. From 1965 Operation Ranch Hand sprayed between 10.6 and 11.7 million gallons of Herbicide Orange, between 5.2 and 5.6 million gallons of Herbicide White and between 1.1 and 2.1 million gallons of Herbicide Blue. The military region most heavily sprayed was III Corps, followed by I, II, and IV Corps. In addition, unknown amounts of herbicide were regularly sprayed by engineering units and riverine forces; additional unknown amounts were sprayed by the South Vietnamese military. Some areas were sprayed by more than one herbicide; other areas were sprayed by both herbicides and large amounts of pesticide. The ecological consequences and possible hazards to animal and human health of mixing these chemicals in large and often undiluted amounts within a single ecosystem is unknown, although the health consequences are now gradually emerging under the general description of the Agent Orange problem.
A single gallon of Agent Orange contains a mixture of 4 lbs. of 2,4-Dichlorophenoxyacetic acid and 4.6 lbs. of 2,4,5-Trichlorophenoxyacetic acid, Agent White is somewhat similar with 2 lbs of 22,4-D and .54 lbs. of picloram per gallon. These two agents were aimed at broadleaf plants, with Agent White having the longer lasting effect. Agent Blue is made up of Cacodylic acid
(organic arsenic) and 1.7 lbs of inorganic arsenic, used largely on crops. Agents Green, Pink, and Purple (used early in the war) were combinations of 2,4-D and 2,4,5-T. All of these agents were handled and sprayed with little or no regard for the minimum safety precautions against exposure to toxic substances.
The volume of undiluted herbicide sprayed is testimony to the wide degree of exposure among military personnel in all areas of Vietnam. All military personnel can be presumed to have been exposed, though some were exposed more directly with greater amounts of herbicide than others. The duration of exposure was generally over months and occurred from multiple routes. Exposure came through contaminated food and water; through direct contact to the skin from contaminated water and brush and from breathing the fumes of burning brush. Also, the multiple exposure to toxic agents like, 2,4,-D, 2,4,5-T, Cacodylic acid and Picloram were accompanied often by stress, fatigue, high humidity and temperatures and the use of other drugs.
The chemical likely to be the greatest health hazard is TCDD
(2,3,7,8-Tetracholorodibenzo-p-dioxin), better known simply as dioxin. There are 75 different dioxins, but the dioxin found in 2,4,5-T is recognized by scientists as the most toxic synthetic chemical in existence. Out of an estimated 44 million lbs. of 2,4,5-T sprayed, some 368 lbs. of TCDD were deposited in Vietnam.
The degree of toxicity of dioxin is measured in parts per trillion. This could roughly be compared to a teaspoon of salt mixed evenly through a dumptruck full of sand. The extreme toxicity of TCDD makes even this amount a potential lethal dose. TCDD is the most potent cancer-causing agent known. The tiniest amount causes malignant tumors in animals. It is also a powerful teratogen (causing birth defects and reproductive toxicity such as stillbirths and miscarriages)(. It was present in Agent Orange and the herbicides used before 1965 (especially Agent Purple). Because it was a contaminant arising out of the manufacturing process of 2,4,5-T, it was not essential to the purpose of the herbicide; TCDD does not kill plants. Its extreme toxicity was known to the manufacturers, but TCDD was not removed from 2,4,5-T because that would have increased production costs.
THE HUMAN COST
The human cost of herbicidal poisoning has yet to be totalled. Scientists recognize a wide range of health problems associated with exposure to dioxin and the other components of herbicides. The two most important features are the slow effect rate and the diverse symptomology. That is, the health effect of TCDD is "delayed." One important characteristic of TCDD is its resistance to metabolization. After being ingested by the body, TCDD is stored in the fat tissue only to be released at a later time. It is when TCDD is metabolized that symptoms of disease can begin to appear. The mechanism for this biochemical release of TCDD is unknown; the metabolites of TCDD (that is, the bio-chemical products of metabolization of TCDD) have barely been studied through a decade has passed since the hazard was recognized.
The range of symptoms includes as many as 15 dermatological, neurological, gastro-intestinal and psychological disorders. These disorders include chloracne (an incurable persistent acne-like skin rash on the face, neck, back, arms and legs that is unlike teenage acne), boils and blisters, skin irritation and sensitivity to sunlight, loss of sensation and tingling in the fingers and toes, intolerance to cold, damage to the peripheral nervous system, constant fatigue, depression, inability to concentrate, nervousness and irritability, insomnia, vertigo, loss of sex drive, recurring headaches, nausea and sudden unexplained weight loss. "Red blood" rectal bleeding has also been reported.
Additional symptoms include respiratory distress and shortness of breath ("asthma"), allergies, tender liver, recurring digestive upset and slowed digestion, vascular lesions, stomach, intestinal kidney and liver pain, and stiffness, swelling and pain in the joints of the arms and legs. Finally, numerous and varied birth defects in the children of Vietnam veterans have been noted.
The diversity of these symptoms and the slow effect rate have encouraged government agencies to downplay the problem and to deny disability to Vietnam veterans. Diseases known to be caused by herbicidal exposure-including a general decline and even collapse of the immune system, acute liver ailments and various cancers-have received no serious consideration. Though the Agent Orange problem was known to scientists as early as 1972 and became a public issue in 1978, no epidemiological study, either public or private, has been published. The National Academy of Sciences, in their 1974 report the Effect of Herbicides in South Vietnam, called for a variety of studies to begin immediately on whether herbicides caused illness. The report's conclusions were drawn from evidence collected even before herbicide spraying had stopped, yet neither the Federal government nor the scientists responsible for the report did anything. Currently the government seems to be shifting the burden of proof away from itself to the manufacturers of the herbicides who either minimize or deny the problem.
WILL I GET SICK?
There is no absolute way to know if exposure will lead to illness. Like radiation poisoning, the effect of contamination by chlorinated hydrocarbons may not appear until years after exposure. Some veterans exposed to toxic chemicals may never get sick; others may be exposed to tiny quantities and develop health problems. Dioxin (in Agent Orange) and Picloram (in Agent White) are highly carcinogenic. The arsenicals in Agent Blue degrade into the highly toxic Arsenic Trioxide. All chemicals have the capacity to potentiate in the environment. That is, the environment can serve the same purpose as a test tube; chemicals can interact. Potentiation is a chemical reaction in the environment that could increase the toxicity of herbicides and pesticides, creating greater toxic contamination. Potentiation of toxic substances rarely leads to the creation of less toxic substances. It seems not to have been studied in Vietnam.
A body of scientific evidence, however, has slowly emerged to show that the various herbicidal components cause a variety of health problems, chiefly damage to the nervous system and to the hormonal balance of the person contaminated. Damage to one organ can cause disturbances in other organs. For instance, porphyria cutanea tarda, a liver dysfunction linked to herbicide poisoning, generates hormonal imbalances, headaches, nervousness and a skin rash - all symptoms which have been regularly reported by Vietnam veterans.
The only safeguard against the delayed response to toxic herbicides is to regularly monitor your health and attempt to avoid toxic substances in the environment. Get a complete physical examination at least once a year. (if you have symptoms of herbicide poisoning, more frequent examinations are advisable.) When veterans begin to recognize possible symptoms, they often enter a denial phase and defer examinations or treatment. Recognize real symptoms for what they are-the body's signal that examination and possible treatment are necessary. Then check, on a regular basis, your liver, kidneys, heart, lungs, gastro-intestines, urinary tract, endocrine system, immune system, blood-forming system, nervous and reproductive systems. If you are in a situation in which birthing children is likely, seek genetic counseling. If you have seemingly minor medical problems now - for example, you have continual headaches, recurring nausea or colitis, stiffness in the joints, tingling in the fingers and toes - get a complete physical examination immediately. Show the examining physician this gook and explain that you were exposed to toxic herbicides in Vietnam. Remember, do not wait until you are seriously ill to see a doctor. Early diagnosis, and if necessary, treatment can prevent serious illness at a later time.
HOW DO I KNOW IF I WAS EXPOSED
Everyone who went to Vietnam during the period of defoliation
was exposed to toxic herbicides. The ecological system of South Vietnam was saturated with 96 million pounds of Agent Orange alone; millions of pounds of Agent White and Agent Blue add to the volume of toxic herbicides used. Along with the defoliation of jungle canopy, forests and crop lands, herbicides were sprayed around base camp perimeters, landing zones, mine fields, fire bases and along roadways and river banks. While some spraying was carried out by truck , boat or backpack, most spraying was done by specially-fitted C-123 cargo planes and UH-1 helicopters. In addition, empty herbicide drums were used indiscriminately in base camp areas for a variety of functions without removal of toxic residues. You know if you were exposed directly to herbicides if: you sprayed it or flew through the spray mist in support of spray missions; you loaded it or were otherwise involved in the transfer or maintenance of herbicide drums or herbicide aircraft; you were sprayed by herbicides (in the air or on the ground) during a military operation or went through defoliated areas soon after spraying. It is clear from scientific investigations that the chemical components of the herbicides-all of which were toxic in varying degrees - remained in the environment long after spraying.
Aircraft sprayed directly over waterways; large amounts of herbicide were washed into streams and bomb craters and were added to the ground water. Local food supplies were contaminated. Numerous examples of the drift of spray from the target area have been recorded. General Accounting Office reports indicate instances of aborted spray missions and dumping in so-called "free spray areas." You were exposed indirectly if you bathed in or drank the water in Vietnam.
THE VA APPROACH
The Veteran's Administration has been ordered to provide thorough physical examinations to any veteran who has been exposed to herbicides. This means that all Vietnam veterans without "bad paper" are eligible. Experience shows, however, that these examinations are merely routine. The VA is supposed to do follow up examinations yearly, but most veterans report the VA does not follow up. Long, tedious waits for medical evaluation or assistance at the local VA usually provides little or no information to the veteran who is often met with cold and ineffectual treatment. Most veterans consider VA health care inadequate at best; many refuse even to go to the VA. Nevertheless, VA medical examinations are free. Medical records are transferable to private doctors and clinics. Using the VA can save money. Also, filing an Agent Orange claim helps keep pressure on the VA and may provide benefits at a later time............
Below is an example of the information listed in detail. The UCM coordinates will tell you where the agents was sprayed. The Map book includes maps of all areas of South Vietnam. I have picked out a couple of grid coordinates that fall in the or near the Americal Division AO in Vietnam so that it would be more relevant.
There are approximately 15-20 pages of this type of information for the Americal Division AO. Based on the maps, most of the spraying should have been on or near Quang Ngai City, On or near Tam Ky, near LZ Ross, Hau Duc area, Tien Phuoc area,
Antennae Valley valley area.
Date Mission Agent Typ Gal AC Length Hectacre Acre PD UCM-Cord
670716 20166 O C 3000 3 13.345 320(1) 791 2A AS790540
690501 200469 W D 3000 3 17.61 423(1) 1044 1B AS854836
690501 200469 W D 3000 3 17.61 423(1) 1044 1C AS864859
690801 200469 O D 3000 3 11.15 268(1) 661 1A AS799903
690801 200469 O D 3000 3 11.15 268(1) 661 2C AS876903
690801 200469 O D 3000 3 11.15 268(1) 661 2B AS903938
A Map of all the sprayed area's in our AO is being shot down right now. It will be added here as soon as It is returned to me....Ron
Stars and Stripes Veterans Affairs Editor
Washington, D.C.--Each day, boxes of medical records arrive at VA headquarters from regional offices across the nation. Attorneys like Jimmy Pritchard of the National Veterans Legal Services Program (NVLSP) comb through each file for references to diseases linked to exposure to dioxin
from Agent Orange.
The VA says that about 8,700 veterans and 850 of their children currently receive benefits for dioxin-linked illnesses. But according to the NVLSP, the VA may not have been paying veterans or their widows the full amount owed them under a 1991 ruling by U.S. District Judge Thelton Henderson in San Francisco.
Henderson recently ruled that the VA must pay the estates of veterans who were owed compensation but who died before the VA got around to paying them. The Justice Department has not decided whether it will challenge that decision. The deadline for filing an appeal is May 31.
Congress, under the Agent Orange Act of 1991, directed the National Academy of Sciences (NAS) to determine which diseases suffered by veterans were linked to dioxin, a carcinogenic constituent of Agent Orange, a defoliant used by the U.S. military during the Vietnam War. Under "Operation Ranch Hand," the U.S. military sprayed 17.6 million gallons of herbicides over about 3.6 million acres.
In 1986 the National Veterans Legal Services Program (NVLSP) sued the VA in Henderson's court, saying the VA was denying disability payments to ailing Vietnam veterans exposed to dioxin. At the time, the VA insisted that the only dioxin-linked disease was chloracne, a skin condition.
The VA had sharply tipped the scales against veterans by requiring claimants to prove a cause-and-effect relationship between their illnesses and dioxin.
- Judge Henderson
In 1991, Henderson ruled that the VA had "sharply tipped the scales" against veterans by requiring claimants to prove a cause-and-effect relationship between their illnesses and dioxin. Admonishing the VA for failing to give veterans the benefit of the doubt when expert studies were split down the middle over dioxin's health effects, he also said the VA had consistently violated the Veterans' Dioxin and Radiation Exposure Compensation Standards Act of 1984.
Overturning its "chloracne-only" policy, Henderson reversed the VA's rejection of 31,000 claims and ordered it to draft new regulations. He eventually issued a landmark order specifying how much veterans would receive in retroactive benefits if their diseases were found to be linked to dioxin.
By the end of 2000, more than three-dozen illnesses had been officially linked to dioxin. Henderson repeatedly chastised the VA for ignoring veterans' claims and failing to follow his rulings on compensating them for their illnesses.
The list of Agent Orange-linked illnesses now includes cancers of the trachea, bronchus, larynx and lung; Hodgkin's disease, a cancer that starts in lymphatic tissue; multiple myeloma, a cancer of the bone marrow; and more than two dozen soft-tissue sarcomas--malignant tumors.
Also on the list are prostate cancer and spina bifida, a birth defect resulting from the failure of the spine to close properly during the first month of pregnancy. Its inclusion marked the first time veterans' offspring
had qualified for disability benefits.
Court Raps VA
In 1999, Henderson ruled that the VA's treatment of some claimants was "inconsistent with both the spirit and intent" of the court rulings and the "liberal nature of the VA's own claims process," under which the VA is required to help veterans and widows prepare claims.
The NVLSP so far has reviewed some 12,500 files and identified more than 1,500 disabled veterans and widows whom the organization says are owed money.
"I suppose I look at it the way a physician would look at someone who has just been in an accident," Pritchard said. "The best thing you can do to help that person is stay cool and calm. That way you won't make mistakes, or misread something or overreact. You solve the problem for somebody."
The NVLSP has turned over 300 files to the VA with requests for payment. Bill Russo, a VA spokesman, said the agency has reviewed about 200 of these files and paid benefits to about 130 individuals. Some claimants didn't qualify because they had received other military benefits, Russo said.
The average award has been about $35,000, according to the NVLSP. Last year, one disabled veteran received $109,659.
As they sifted through medical files, NVLSP researchers found that the VA apparently had withheld retroactive benefits due 1,268 veterans with prostate cancer. NVLSP lawyers returned to Henderson's courtroom last year, alleging the VA was again violating his 1991 order. The judge concurred.
NVLSP: Hundreds More
In the final analysis, the VA's position amounts to little more than an expression of its desire to be relieved from part of the obligations it agreed to in 1991.
- Judge Henderson
"In the final analysis, the VA's position amounts to little more than an expression of its desire to be relieved from part of the obligations it agreed to in 1991, a desire to which this Court will pay no heed," Henderson
wrote in a decision handed down last December.
NVLSP officials say there may be hundreds more veterans and widows who are owed benefits.
Veterans and surviving family members of Vietnam veterans can obtain information about VA benefits for Agent Orange exposure by writing to the National Veterans Legal Services Program, 2001 S Street NW, Suite 610, Washington, D.C. 20009-1125; calling the NVLSP at 202-265-8305, ext. 119, or
News Flash 2-18-02
All diabetes mellitus type II claims are being approved (as long as you had at least one day in country). The standard is about 20% for DM II and additional payments for DM 2 caused disabilities like hypertension, retinopathy, peripheral neuropathy, etc.
Presumptive service connection for respiratory cancers as a result of exposure to a herbicide (Agent orange, blue, white, etc) has always been limited to a thirty year period. In other words, it had to be diagnosed within thirty years of leaving VN. This is about to be changed and the time limit eliminated. This is BIG news for a lot of folks who have had previous claims (including widow’s claims for service connected death) will now be approved.
309.81 Posttraumatic Stress Disorder
This document is a direct copy of the DSM IV
Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition.
The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity, or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion Al) The persons response to the event must involve intense fear, helplessness. or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2) The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D) The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F)
Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack. robbery. mugging), being kidnapped, being taken hostage. Terrorist attack. Torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced by a family member or a close friend, learning about the sudden, unexpected death of a family member or a close friend, or learning that one's child has a life-threatening disease. The disorder may be especially severe or long lasting when the stressor is of human design (e g., torture, rape) The likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.
The traumatic event can be reexperienced in various ways Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event is replayed (Criterion B2) In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g, anniversaries of the traumatic event, cold, snowy weather or uniformed guards for survivors of death camps in cold climates hot, humid weather for combat veterans of the South Pacific, entering any elevator for a woman who was raped in an elevator)
Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event -Criterion Cl) and to avoid activities, situations, or people who arouse recollections of it -(Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3) Diminished responsiveness to the external world, referred to as psychic numbing' or “emotional anesthesia,” usually begins soon after the traumatic event The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with' intimacy, tenderness, and sexuality) (Criterion C6) The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7)
The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived (Criterion Dl), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5) Some individuals report irritability or outbursts of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)
The following specifiers may be used to specify onset and duration of the symptoms of Posttraumatic Stress Disorder
Acute. This specifier should be used when the duration of symptoms is less than 3 months
Chronic. This specifier should be used when the symptoms last 3 months or longer
With Delayed Onset. This specifier indicates that at least 6 months have passed between the traumatic event and the onset of the symptoms.
Associated Features and Disorders
Associated descriptive features and mental disorders. Individuals with Posttraumatic Stress Disorder may describe painful guilt feelings about surviving when others did not survive or about the things they had to do to survive. Phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or loss of job The following associated constellation of symptoms may occur and are more commonly seen in association with an interpersonal stressor (e g, childhood sexual or physical abuse, domestic battering, being taken hostage, incarceration as a prisoner of war or in a concentration camp, torture) impaired affect modulation, self-destructive and impulsive behavior, dissociative symptoms; somatic complaints, feelings of ineffectiveness, shame, despair. or hopelessness, feeling permanently damaged, a loss of previously sustained beliefs, hostility; social withdrawal; feeling constantly threatened, impaired relationships with others, or a change from the individual's previous personality characteristics
There may be increased risk of Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Social Phobia. Specific Phobia. Major Depressive Disorder. Somatization Disorder, and Substance-Related Disorders It is not known to what extent these disorders precede or follow the onset of Posttraumatic Stress Disorder
Associated laboratory findings. Increased arousal may be measured through studies of autonomic functioning (e g, heart rate, electromyography, sweat gland activity)
Associated physical examination findings and general medical conditions. General medical conditions may occur as a consequence of the trauma (e.g, head injury, bums)
Specific Culture and Age Features
Individuals who have recently emigrated from areas of considerable social unrest and civil conflict may have elevated rates of Posttraumatic Stress Disorder Such individuals may be especially reluctant to divulge experiences of torture and trauma due to their vulnerable political immigrant status Specific assessments of traumatic experiences and concomitant symptoms are needed for such individuals
In younger children, distressing dreams of the event may, within several weeks, change into generalized nightmares of monsters, of rescuing others, or of threats to self or others Young children usually do not have the sense that they are reliving the past, rather, the reliving of the trauma may occur through repetitive play (e g, a child who was involved in a serious automobile accident repeatedly reenacts car crashes with toy cars - Because it may he difficult for children to report diminished interest in significant activities and constriction of affect, these symptoms should be carefully evaluated with reports from parents, teachers, and other observers In children, the sense of a foreshortened future may he evidenced by the belief that life will be too short to include becoming an adult. There may also be “omen formation-that is, belief in an ability to foresee future untoward events Children may also exhibit various physical symptoms, such as stomachaches and headaches
Community-based studies reveal a lifetime prevalence for Posttraumatic Stress Disorder ranging from 1% to 14%, with the variability related to methods of ascertainment and the population sampled Studies of at-risk individuals (e.g, combat veterans, victims of volcanic eruptions or criminal violence) have yielded prevalence rates ranging from 3% to 58%.
Posttraumatic Stress Disorder can occur at any age, including childhood. Symptoms usually begin within the first 3 months after the trauma, although there may be a delay of months, or even years, before symptoms appear Frequently, the disturbance initially meets criteria for Acute Stress Disorder (see p. 429) in the immediate aftermath of the trauma. The symptoms of the disorder and the relative predominance of reexperiencing, avoidance, and hyperarousal symptoms may vary over time. Duration of the symptoms vanes, with complete recovery occurring within 3 months in approximately half of cases, with many others having persisting symptoms for longer than 12 months after the trauma.
The severity, duration, and proximity of an individual's exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder. There is some evidence that social supports, family history, childhood experiences, personality variables, and preexisting mental disorders may influence the development of Posttraumatic Stress Disorder This disorder can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme
In Posttraumatic Stress Disorder, the stressor must be of an extreme (i.e.. life-threatening) nature. In contrast, in Adjustment Disorder, the stressor can be of any severity The diagnosis of Adjustment Disorder is appropriate both for situations in which the response to an extreme stressor does not meet the criteria for Posttraumatic Stress Disorder (or another specific mental disorder) and for situations in which the symptom pattern of Posttraumatic Stress Disorder occurs in response to a stressor that is not extreme (e.g., spouse leaving, being fired).
Not all psychopathology that occurs in individuals exposed to an extreme stressor should necessarily be attributed to Posttraumatic Stress Disorder. Symptoms of avoidance, numbing, and increased arousal that are present before exposure to the strcssor do not meet criteria for the diagnosis of Posttraumatic Stress Disorder and require consideration of other diagnoses (e.g, a Mood Disorder or another Anxiety Disorder) Moreover, if the symptom response pattern to the extreme stressor meets criteria for another mental disorder (e.g, Brief Psychotic Disorder, Conversion Disorder, Major Depressive Disorder), these diagnoses should be given
instead of, or in addition to, Posttraumatic Stress Disorder.
Acute Stress Disorder is distinguished from Posttraumatic Stress Disorder because the symptom pattern in Acute Stress Disorder must occur within 4 weeks of the traumatic event and resolve within that 4-week period. If the symptoms persist for more than 1 month and meet criteria for Posttraumatic Stress Disorder, the diagnosis is changed from Acute Stress Disorder to Posttraumatic Stress Disorder
In Obsessive-Compulsive Disorder, there are recurrent intrusive thoughts, but these are experienced as inappropriate and are not related to an experienced traumatic event. Flashbacks in Posttraumatic Stress Disorder must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in Schizophrenia, other Psychotic Disorders, Mood Disorder With Psychotic Features, a delirium, Substance-Induced Disorders, and Psychotic Disorders Due to a General Medical Condition.
Malingering should be ruled out in those situations in which financial remuneration, benefit eligibility, and forensic determinations play a role
Diagnostic criteria for 309.81 Posttraumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following were present
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or
aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated) Note: In young children, trauma-specific reenactment may occur
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C Persistent avoidance of stimuli associated with the trauma and numbing of general
responsiveness (not present before the trauma), as indicated by three (or more) of the
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D Persistent symptoms of increased arousal (not present before the trauma), as indicated by two
(or more) of the following
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(5) exaggerated startle response
Duration of the disturbance (symptoms in Criteria B, C. and D) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more Specific
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor
A Simplistic Explanation of What Is PTSD?
They said I would be changed in my body. I would move through the physical world in a different manner. I would hold myself in a different posture. I would have pains where there was no blood. I would react to sights, sounds, scents, movement, and touch in a crazy way, as though I were back in the war.
They said I would be wounded in my thoughts. I would forget how to trust, and think that others were trying to harm me. I would see danger in the kindness and concern of my relatives and others. Most of all, I would not be able to think in a reasonable manner, and it would seem that everyone else was crazy. They told me that it would appear to me that I was alone and lost even in the midst of people, that there was no one else like me.
They warned me that it would be as though my emotions were locked up and that I would be cold in my heart and not remember the ways of caring for others. While I might give soft meat or blankets to the elders or food to the children, I would be unable to feel the goodness of these actions. I would do these things out of habit and not from caring. They predicted that I would be ruled by dark anger and that I might do harm to others without plan or intention.
They knew that my spirit would be wounded. They said I would be lonely and that I would find no comfort in family, friends, elders, or spirits. That I would feel deserted and abandoned by the same. I would be cut off from both beauty and pain. My dreams and visions would be dark, frightening, and unending. My days and nights would be filled with searching and finding. I would be unable to find connections between the rest of creation and myself. My isolation would be a way of dealing with my loneliness. That I would look forward to an early death.
And , I would need cleansing and healing in all these things.
Author "Unknown Native American" VietNam Veteran!
ADDITIONAL BENEFITS AVAILABLE FOR SERVICE CONNECTED DISABLED VETERANS
0% To 20%
* Certificate of Eligibility for home loan guaranty.
* Home loan guaranty fee exemption.
* VA Priority medical treatment card.
* Vocational Rehabilitation and Counseling under title 38 USC Chapter 31 (must be at least 10%).Service Disabled Veterans Insurance (Maximum of $10,000 coverage), must file within 2 years from date of new service connection.
* 10 point Civil Service preference (10 points added to Civil Service test score).
* Clothing allowance for veterans who use or wear a prosthetic or orthopedic appliance (artificial limb, braces, wheelchair) or use prescribed medications for skin condition which tend to wear, tear, or soil clothing.
* Temporary total evaluation (100%) based on hospitalization for a service connected disability in excess of 21 days; or surgical treatment service connected disability necessitating at least 1 month of convalescence or. immobilization by cast, without surgery of more major.
30% In addition to the above:
* Additional allowance for dependent (spouse, child(ren), step child(ren), helpless child(ren), full-time students between the ages of 18 as and parent(s).
* Additional allowance for a spouse who is a patient in a nursing home or helpless or blind or so nearly helpless or blind as to require the regular aid and attendance of another person.
40% In addition to the above:
* Automobile grant and/or special adaptive equipment for an automobile provided there is loss or permanent loss of use of one or both feet loss or permanent loss of one or both hands or permanent impaired vision of both eyes with central visual acuity of 20/200 or less in both eye.
* Special adaptive equipment may also be applied for if there is ankylosis of one or both knees or one or both hips.
50% In addition to the above:
* VA Medical outpatient treatment for any condition except dental.
* Preventive health care services. Hospital care and medical services in non-VA facilities under an authorized fee basis agreement.
60% In addition to the above:
* Increased compensation (100%) based on individual Unemployability (applies to veterans who are unable to obtain or maintain substantial or gainful employment due to service connected disability).
70% to 90% Same as above
100% In addition to the above:
* Dental treatment
* Department of Defense Commissary privileges.
* Waiver of National Service Life Insurance premiums.
* Veterans employment preference for spouse.
* National Service Life Insurance total disability income provisions.
* Specially Adapted Housing for veterans who have loss or permanent loss of use of both lower extremities or the loss or blindness in 1 eyes having light perception only plus loss or permanent loss of use of one lower extremity or the loss or permanent loss of use of ot lower extremity with loss or permanent loss of use of one upper extremity or the loss or permanent loss of use of one extremity together with an organic disease which affects the functions of balance and propulsion as to preclude locomotion without the aid of braces, ci canes or wheelchair.
* Special Home Adaptation Grant (for veterans who don't qualify for Specially Adapted Housing) may be applied for if the veteran is permanently and totally disabled due to blindness in both eyes with visual acuity of 5/200 or less or loss Qt permanent loss of use of both hands.
100% (Permanent and Total) In addition to the above:
* Civilian Health and medical Program for dependents and survivors (CHAMPVA).
* Survivors and dependents education assistance under Title 38 USC Chapter 35.
Smith Vs Nicholson
DAV Prevails in Fight Over Tinnitus Claims
On April 5, 2005, the United States Court of Appeals for Veterans Claims handed down its decision in Smith v. Nicholson. The DAV had argued on behalf of Mr. Smith that he was entitled to two separate ten-percent disability ratings for service-connected tinnitus, i.e., ringing, in his right and left ears. The Department of Veterans Affairs (VA) argued in Smith’s case, as well as in a large number of other cases, that the VA Schedule for Rating Disabilities provided for only one ten-percent rating, regardless of whether the tinnitus was present in only one ear or both ears.
The Court held that: “Based on the plain language of the regulations, the Court holds that the pre-1999 and pre-June 13, 2003 versions of [diagnostic code] 6260 required the assignment of dual ratings for bilateral tinnitus.” Veterans who filed a claim for service connection for tinnitus in both ears, or who claimed an increased rating for that condition, prior to June 13, 2003, may be entitled to receive combined disability compensation based on two ten-percent ratings for tinnitus. Additionally, the law does not permit any such ratings to be reduced in the future, unless the severity of the tinnitus is shown to have actually improved.
The decision of the Court of Appeals for Veterans Claims in the Smith case has not yet become final. The VA appealed that decision to the United States Court of Appeals for the Federal Circuit on June 22, 2005. The VA and Mr. Smith have both filed opening briefs, and the VA’s reply brief is due in January 2006. DAV anticipates that the Federal Circuit will hold oral argument on the VA’s appeal in the spring. The Federal Circuit is likely to hand down a decision in the second half of 2006.
Veterans who believe that they may be entitled to benefits based on the Smith precedent should promptly contact their DAV National Service Officer.
It's official; DD-214s are NOW Online.
The National Personnel Records Center (NPRC) has provided the following website for veterans to gain access to their DD-214s
This may be particularly helpful when a veteran needs a copy of his DD-214 for employment purposes. NPRC is working to make it easier for veterans with computers and Internet access to obtain copies of documents from their military files.
Military veterans and the next of kin of deceased former military members may now use a new online military personnel records system to request documents.
Other individuals with a need for documents must still complete the Standard Form 180 , which can be downloaded from the online web site. Because the requester will be asked to supply all information essential for NPRC to process the request , delays that normally occur when NPRC has to ask veterans for additional information will be minimized. The new web-based application was designed to provide better service on these requests by eliminating the records centers mailroom and processing time.
Please pass this information on to former military personnel you may know and their dependents.