ATTACHMENT TO PTSD CLAIM

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.

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