ATTACHMENT TO PTSD CLAIM
From: "Bruce K. Melson" <doc32751@cookeville.com>
There
is a section in M21 that states that a stressor letter should not be requested
with award of certian medals i.e. Purple Heart, CIB, CAR and Valor Medals. But
experience has shown that it is best to submit one (letter). If the incident
that is the stressor is connected to a medal like the Purple Heart or Valor
Medals, that would be the vertification.
We
have used the following when submitting PTSD claims that was published several
years back by NVLSP.
ATTACHMENT
TO PTSD CLAIM
SECTION
I
I
served in Southeast Asia from the month of
19 , to the month
19 .
I served with the following
organizations:__________________________________________________________
I
had the following duties during this time:
_______________________________________________________________
The
military experiences I found most terrifying, life-threatening, or stressful
include the following:
___armed
combat or enemy action
___bombed
or shelled or tripped booby-trap
___shipwrecked
or in airplane or vehicle accident
___captured
___grave
registration duty
___other
action that threatened my life
___other
___
treating or dealing with casualties
I
have attached a detailed description of the stressful event(s) and have
attached portions of military records or other evidence that are objective
proof of or support the existence of the
stressful
event.
SECTION
II
A.
Since the event described above, I have re-experienced the event in
nightmares, flashbacks and just over and over again in my mind.
___Nightmares
have occurred___times each month over the past ___
year(s).
___I
have thought about the event___times each month over the
past
___ year(s).
___Flashbacks
have occurred___times each month over the past
__year(s).
B.
I felt numb after the event, or had difficulty "feeling".
C.
I have much less interest in my family, friends and activities such as
______________________________________________________________
that
used to be important to me. I
feel close to almost no one anymore.
D.
The following problems were not present before the event described above but
are now:
___I'm
jumpy or hyper-alert or startle easily
___My
sleep is disturbed; I can't get to sleep or stay asleep; I
wake
up too early; or I have nightmares.
___I
feel guilty that I survived when others did not; and guilty about what I had
to do or didn't do to survive.
___I
have trouble concentrating on things or remembering things.
___I
avoid activities that remind me of the event or of Vietnam.
___Certain
activities that resemble the event and remind me of it
make
me more nervous or anxious.
___I
have trouble concentrating on things or remembering things.
___I
avoid activities that remind me of the event or of Vietnam.
___Certain
activities that resemble the event and remind me of it
make
me more nervous or anxious.
___I
avoid getting close to anyone in my family, or on my job, or
among
friends.
___I
have no interest or little interest in getting close to
anyone
in my family, or on my job, or among my friends.
It just
doesn't
seem worth it to get close.
___I have self-medicated on alcohol or other substances to try
to
block out Vietnam-related feelings, thoughts, nightmares, or
to
get to sleep.
___I
am very concerned with the possibility of losing control of
my
temper or having other strong feelings.
___OTHER(specify):_________________
SECTION
III
A.
I request service-connected benefits and believe I have been and continue to
be unable to function in social settings like I used to or to work to my
fullest capacity because of Stress
Disorder
and that it had its origin in my active duty service. I also request increased
compensation based on unemployability if the service-connected rating is less
than 100%. The following
information explains my social and employment history since I was
discharged(see attached letters and documents):
B.
I have received psychiatric or psychological treatment for my nervous
condition or treatment for alcohol or drug abuse or counseling for my problems
identified above:
___in
the military in _____ while stationed at _______________
___within
one year following discharge from the service at_____
___more
than one year following discharge from the service at___
SECTION
IV
A.
I knew the following people in Vietnam and they might be able to verify
some of my experiences:______________________________
B.
I knew the following people before and after going to Vietnam. They could
verify how I was different after returning:
_________________________________
Willie G. Dougherty
Operations Director
The National Veterans Organization of America, Inc.
Visit NVO Website at http://www.nvo.org
Veterans Voice of Austin http://vvoa.com