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Updated Jun 28, 2024

In This Section

  
This section contains the following topics:
  
Topic
Topic Name
1
2
3
4
 

 

1.  General Information on Developing Claims for SC for PTSD

 

Introduction

  
This topic contains general information on developing claims for SC for PTSD, including

Change Date

  
July 27, 2023

VIII.iv.1.A.1.a.  Definition:  PTSD

  
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, also known as a stressor. 

VIII.iv.1.A.1.b.  Definition:  Stressor

  
A PTSD stressor is a traumatic event (or series of events) in which an individual has been personally or indirectly exposed to actual or threatened
  • death
  • serious injury, or
  • sexual violence.
Claims processors need to identify which stressor type a Veteran’s claim falls under, so that proper development will occur.  Claims can be based on a stressor related to
  • an in-service PTSD diagnosis
  • personal assault
  • combat or former prisoner of war (FPOW) service
  • fear, or
  • a stressful event unrelated to hostile military or terrorist activity.
Notes: 
  • PTSD has the same claim elements regardless of the type of stressor.  The distinction between the different types of PTSD claims is based on how the stressor is verified or conceded.
  • Veterans will not generally know what category their stressor falls in or what evidence is needed to support it, so it is incumbent on the claims processor to make that determination, considering that some stressor types have a lower evidentiary threshold than others. 

VIII.iv.1.A.1.c.  Developing Claims of SC for PTSD Due to In-Service Stressors

  
When a Veteran claims service connection (SC) for PTSD associated with an in-service stressor, undertake required development of the claim for
  • credible supporting evidence that the claimed in-service stressor actually occurred
  • medical evidence diagnosing the condition in accordance with 38 CFR 4.125, and
  • a link, established by medical evidence, between current symptomatology and the claimed in-service stressor.
References:  For more information on

VIII.iv.1.A.1.d.  Responsibility for Stressor Verification 

  
Claims processors must review all evidence of record to determine if credible supporting evidence that a claimed in-service stressor occurred is of record prior to undertaking any additional development.
 
When evidence of record is not sufficient to concede the claimed stressor, additional steps to corroborate the claim must be undertaken, including
Important:  It is the responsibility of Veterans Benefits Administration (VBA) claims processors to establish the occurrence of the event the Veteran claims to have resulted in PTSD.  A medical professional makes the determination of whether an event is sufficient to meet the stressor criteria for a diagnosis of PTSD.
 
Reference:  For more information on developing for personal trauma stressors, see M21-1, Part VIII, Subpart iv, 1.B.

VIII.iv.1.A.1.e.  Verification of In-Service Stressors Using Available Resources 

  
The stressor verification process must include a review of information from VBA-sanctioned stressor research websites and the Official Military Activities Report (OMAR) tool.  OMAR is a VBA-sanctioned research tool that aggregates several approved data sources for stressor verification. 
 
Notes: 
  • When using evidence obtained from either a VBA-sanctioned stressor research website or the OMAR tool, carefully note the stressor source and weigh the evidence appropriately.
  • Stressor research using the OMAR tool is generally the responsibility of the RO Research Coordinator.
References:  For more information on

VIII.iv.1.A.1.f.  Examples of Sources for Stressor Verification

  
Stressor verification information can often be found in the Veteran’s service records or other official documents.  The list below, although not all-inclusive, provides examples of the types of official service records that may be useful in stressor verification:
  • service personnel records and pay records
  • military occupation evidence
  • hazard pay records
  • service treatment records (STRs)
  • military performance reports
  • verification that the Veteran received Combat/Imminent Danger/Hostile Fire Pay
  • unit and organizational histories
  • daily staff journals
  • operational reports-lessons learned (ORLLs)
  • after action reports (AARs)
  • radio logs, deck logs, and ship histories
  • muster rolls
  • command chronologies and war diaries, and
  • monthly summaries and morning reports.

VIII.iv.1.A.1.g.  Accepting Buddy Statements of a Fellow Veteran as Corroboration of a Claimed In-Service Stressor

  
Accept a buddy statement from a fellow Veteran as corroboration of a claimed in-service stressor if the statement is consistent with the time, place, and circumstances of the service of both the Veteran and the fellow Veteran making the buddy statement. 
  
If the evidence available calls into question the qualifications of the fellow Veteran to make the statement, ask the person to submit their DD Form 214, Certificate of Uniformed Service, or other evidence of service with the claimant.
 
Notes: 
  • Upon receipt of a DD Form 214 (or other document containing personally identifiable information (PII)) from a fellow Veteran in support of a paper-based claim
    • place the document in a separate envelope in the claims folder, and
    • annotate on the envelope that the contents must not be
      • reproduced, or
      • reviewed by the Veteran to whom the claims folder pertains or their representative.
  • In paperless claims processing, individual documents bearing the PII of a Veteran other than the claimant should be designated with a  Veterans Benefit Management System (VBMS) bookmark or SUBJECT value that clearly identifies the restricted nature of the content.

 Example 1:

Image of working notes regarding PII

Example 2:

Image of subject value.

 
References:  For more information on
  • bookmarking an electronic claims folder (eFolder) document, see the VBMS Core User Guide, and
  • using a document’s SUBJECT field as a note, see M21-1, Part II, Subpart ii, 2.A.1.e.

VIII.iv.1.A.1.h.  Annotating Documents Used to Concede a Stressor

  
When sufficient evidence is received to concede a claimed stressor, 
  • ensure the evidence is properly uploaded to the eFolder, and
  • edit the subject line of the relevant document(s) used to concede the PTSD stressor using the following format:  [nature of stressor], pg. [number].
References:  For more information on
  • uploading documents to the eFolder and editing document properties, see
  • adding links to eFolder documents containing evidence of PTSD stressors on the MILITARY SERVICE page in VBMS, see the VBMS Core User Guide.
 

2.  Development for Medical Evidence, Service Records, and Stressor Information 

 

 

Introduction

  
This topic contains information on development for in-service and post-service medical evidence, other service records, and stressor information, including

Change Date

  
June 28, 2024

VIII.iv.1.A.2.a.  Location of In-Service Mental Health Treatment Records

  
In-service mental health treatment records are not stored with the STRs.
  
They are maintained with the records of a
  • military treatment facility (MTF), or
  • civilian treating facility.
Note:  Follow the procedures at M21-1, Part III, Subpart ii, 2.A to determine when and how to request STRs, including in-service mental health records.

VIII.iv.1.A.2.b. Developing for Service Department Records of In-Service Mental Health Treatment

  
In order to develop for service department records of in-service mental health treatment administered at an MTF, refer to guidance on clinical record requests as described in
Reference:  For more information on requesting records in the custody of a Federal department or agency, see

VIII.iv.1.A.2.c.  Developing for Civilian Records of In-Service Mental Health Treatment

  
If a service member obtains treatment “off-base” at a civilian facility, any mental health records created during the course of treatment are not automatically associated with the service member’s STRs.  It is the responsibility of the patient and civilian provider to transfer records of care to the service department.
  
Records retained by a civilian provider are not records in the custody of a Federal department or agency.  They are not forwarded for long-term storage to the National Personnel Records Center (NPRC) and cannot be obtained through Personnel Information Exchange System (PIES)/Defense Personnel Records Image Retrieval System (DPRIS). 
  
To obtain identified civilian treatment records, follow procedures for requesting non-Federal or private records.
  
References:  For more information on

VIII.iv.1.A.2.d.  When to Request Hospital Reports and Clinical Records

  
Request hospital reports and clinical records if the Veteran indicates pertinent treatment in a Department of Veterans Affairs (VA) facility, Vet Center, or elsewhere.
 
Reference:  For more information on requesting VA medical or Vet Center records, see M21-1, Part III, Subpart ii, 1.A.2.

VIII.iv.1.A.2.e.  PIES Request Code to Use When Submitting a Records Request Involving PTSD

  
If a stressor is not confirmed based on evidence of record, service personnel records may be obtained using either PIES or DPRIS based on the date of the Veteran’s discharge, as described in M21-1, Part III, Subpart ii, 2.C.
 
Exception:  Do not submit a request for personnel records if they have been previously requested, such as through a prior PIES O50 request. 
  
Notes:
  • When a request for records is appropriate in PIES, use PIES request code O50.
  • A copy of all documents within the personnel folder is provided in response to a PIES O50 request.
References:  For more information on

VIII.iv.1.A.2.f.  Relevant Forms Related to Personnel Records in PTSD Cases by Branch of Service

  
The table below identifies the forms that contain information about the Veteran’s unit(s) of assignment, military occupation, and service locations. 
  
Note:  These forms are among the documents that will be provided in response to requests for service personnel records submitted through PIES or DPRIS.
  
Branch of Service
Name(s) of Forms
Army
DA Form 2-1, Personnel Qualification Record
  
Notes:
  • DA Form 2-1
    • is used for both officers and enlisted personnel, and
    • first came into use in January 1973.
  • Prior to January 1973, DA Form 20, Enlisted Qualification Record, and DA Form 66, Officer Qualification Record, were used.
Navy
  • enlisted record of Transfer and Receipts, pages
    • 12
    • 32, and
    • 33
  • enlisted record Administrative Remarks, pages
    • 4 through 9
    • 13, and
    • 34, and
  • officer record, NAVPERS 1301/51, Officer Data Card, page 35.
Note:  DD Form 214 and enlistment contracts are usually included.
Air Force
  • enlisted record, AF Form 7, Airman Military Record, pages 36 through 39
  • officer record, AF Form 11, Officer Military Record, pages 39 and 40, and
  • performance reports for both enlisted personnel and officers.
Marine Corps
  • enlistment contracts
  • discharge papers
  • MABMC-11 (Discharge Order), and
  • service records, pages
    • 3
    • 5 through 6
    • 8 through 9
    • 12 through 13, and
    • 17.
Coast Guard
  • enlisted record
  • Endorsement on Order Sheet, (DoT Form CG 3312B)
  • officer record
  • Service Records Card
  • DoT Form CG 3301, Enlistment Contract
  • DoT Form CG 3303, Achievement Sheet
  • DoT Form CG 3305, Leave Record, pages 3, 5, 6-7, and
  • DD Form 214.
 

VIII.iv.1.A.2.g.  When to Request Additional Evidence From the Veteran to Establish an In-Service Stressor

  
It is unnecessary to issue Section 5103 notice when a Veteran files a claim for SC for PTSD on a form that provides, or otherwise indicates the claimant received, the notice, such as VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.
 
Do not send the Veteran a subsequent development letter requesting credible supporting evidence to establish that an in-service stressor occurred if the evidence of record shows that
  • PTSD was initially diagnosed in service
  • a confirmed stressor is already of record, or
  • the evidence already of record establishes
    • verified combat or FPOW service, or
    • service in an area of potential hostile military or terrorist activity or as a drone aircraft crew member.
Note:  If evidence to establish an in-service stressor is already of record, links to eFolder documents containing evidence of the stressor(s) may be accessed and/or added, as applicable, on the MILITARY SERVICE page in VBMS.
 
Important:  Send a subsequent development letter prior to deciding the claim, if the Veteran
References:  For more information on

VIII.iv.1.A.2.h.  Information to Request From the Veteran to Support an In-Service Stressor

  
When stressor development is necessary,
  • use the appropriate PTSD development paragraphs referenced in M21-1, Part VIII, Subpart iv, 1.A.2.i to request information from the Veteran
  • enclose VA Form 21-0781 to solicit specific details of the in-service stressor, such as
    • the type of in-service traumatic event(s)
    • a brief description of the traumatic event(s)
    • location of the traumatic event(s), to include unit of assignment at the time
    • date(s) of the traumatic event(s), and
    • name(s) of any other individuals involved in or present during the traumatic event(s), if appropriate, and
  • allow the claimant 30 days to submit the requested evidence.
Important: 
  • Do not enclose VA Form 21-0781 if the Veteran submitted one with the claim.
  • Do not unnecessarily delay an examination or claim by asking the Veteran for specific details or send the Veteran VA Form 21-0781 in any case in which
    • there is credible supporting evidence that demonstrates that the claimed in-service stressor occurred, or
    • the Veteran already provided sufficient details to allow for additional stressor research.
References:  For more information on

VIII.iv.1.A.2.i.  VBMS Paragraphs for Stressor Development

  
When it is necessary to request additional stressor details from the Veteran, generate and send a subsequent development letter.
 
Refer to the table below to determine which PTSD development paragraph or language and attachment is appropriate based on the stressor evidence submitted by the Veteran.
 
 Stressor Evidence
VBMS development paragraph or language
Attachment
  • Combat, fear, or hostile military or terrorist activities that cannot otherwise be corroborated based on evidence currently of record, and
  • no VA Form 21-0781 submitted.
PTSD—Need stressor details/med evid combat-related incdnt
  • Non-combat event such as a car accident, or hurricane, or
  • does not mention a source for the stressor and does not provide details, and
  • no VA Form 21-0781 submitted.
PTSD—Need stressor details/med evid of stressful incdnt
  • MST or similar personal trauma event such as harassment, and
  • no VA Form 21-0781 submitted.
PTSD—Need stressor details/med evid personal trauma incdnt
 
Important:  Include the language in M21-1, Part VIII, Subpart iv, 1.B.2.e when sending an MST subsequent development letter to the Veteran.
  • Any of the above stressor types, and
  • VA Form 21-0781 was submitted, but
  • the Veteran failed to provide sufficient details for the stressor to be corroborated.
PTSD—Follow Up for Stressor Details
 
Important: 
  • Inform the Veteran of the specific information that is still needed to allow for corroboration.
  • Include the language in M21-1, Part VIII, Subpart iv, 1.B.2.e when sending an MST subsequent development letter to the Veteran.
 
Important:  Do not send a second development letter requesting stressor information if the Veteran
  • fails to respond to the request for stressor information within 30 days, or
  • submits insufficient information in response to the 30-day request.
Reference:  For more information on obtaining information from the Veteran in claims based on MST or personal trauma, see M21-1, Part VIII, Subpart iv, 1.B.
 
 
 

3.  Concession of an In-Service Stressor

 

 
Introduction
  
This topic contains information on concession of an in-service stressor, including 
Change Date
  
June 28, 2024

VIII.iv.1.A.3.a.  How Stressors Are Claimed

  
While claims for SC of PTSD require a standard claim form, stressors do not require a specific claim form.  Stressors can be researched based on information found in
  • lay statements
  • military records in which a stressor can be inferred based on
    • combat participation, or
    • service in an area consistent with hostile military or terrorist activity, or
  • medical records or statements made to an examiner.
Note:  In some cases, such as combat or fear-based stressors, examinations can be ordered without specific stressor details.  However, if the examination is returned with a PTSD diagnosis, verify the stressor associated with the diagnosis is consistent with the places and circumstances of service. 
 
Reference:  For more information on examinations in claims for SC for PTSD, see M21-1, Part VIII, Subpart iv, 1.C.

VIII.iv.1.A.3.b.  When a Veteran’s Lay Testimony Alone May Establish an In-Service Stressor

  
A Veteran’s lay testimony alone may, under specified circumstances, establish an in-service stressor for purposes of establishing SC for PTSD if
  • PTSD is diagnosed in service, and the stressor is related to that service, or
  • the stressor is related to the Veteran’s
    • engagement in combat with the enemy
    • experience as an FPOW as defined by 38 CFR 3.1(y), or
    • fear of hostile military or terrorist activity or duties as a drone aircraft crew member, if a VA psychiatrist or psychologist, or contract equivalent, confirms the
      • claimed stressor is adequate to support a diagnosis of PTSD, and
      • Veteran’s symptoms are related to the claimed stressor.
Notes:
  • For the Veteran’s lay testimony alone to establish the occurrence of a claimed stressor,
    • the stressor must be consistent with the
      • circumstances, conditions, or hardships of service for claims based on an in-service PTSD diagnosis or FPOW or combat service, or
      • places, types, and circumstances of service for claims based on a fear of hostile military or terrorist activity or duties as a drone aircraft crew member, and
    • there must be no clear and convincing evidence to the contrary.
  • For claims decided prior to July 13, 2010, a Veteran’s testimony alone could not establish the occurrence of a stressor that was related to the Veteran’s fear of hostile military or terrorist activity.
References:  For more information on

VIII.iv.1.A.3.c.  Reviewing for Credible Supporting Evidence of a Stressor

  
Review the claim for credible supporting evidence that a claimed in-service stressor occurred when the stressor cannot be conceded based on the Veteran’s lay statement as described in M21-1, Part VIII, Subpart iv, 1.A.3.b.
 
Credible supporting evidence is evidence that 
  • documents the Veteran’s participation in the event
  • indicates the Veteran served in the immediate area and at the particular time in which the stressful event is reported to have occurred, and
  • supports the description of the event.
Credible supporting evidence of a stressor may be obtained from sources other than service records.  When reviewing evidence to corroborate a claimed in-service stressor, claims processors must consider the credibility and probative value of the evidence to determine if the stressor is consistent with the circumstances of the Veteran’s service.
 
Notes:
  • Corroboration of every detail is not required.
  • Evidence may be sufficient if it implies a Veteran’s personal exposure to the event.
  • Evaluate the evidence as a whole to determine whether a stressor is sufficiently corroborated.
Important:  While it is incumbent upon each claims processor to review evidence to determine if a claimed in-service stressor can be conceded, stressor concession is ultimately the rating activity’s responsibility.
 
References:  For more information on

VIII.iv.1.A.3.d.  Stressor Verification Review Procedure

  
Follow the steps in the table below to determine if there is credible supporting evidence that a claimed in-service stressor occurred.
 
Important:  Ensure all necessary service records have been requested as noted in M21-1, Part VIII, Subpart iv, 1.A.2.e.
 
Exception:  For claims based on personal trauma, follow the procedures in M21-1, Part VIII, Subpart iv, 1.B.
  
Step
Action
1
Review the available evidence of record, evidence submitted by the Veteran, including VA Form 21-0781, if any, as well as all other service records, medical evidence, and lay or other evidence, and determine the nature of the stressor. 
 
Use the table below to find information on corroborating the stressor type that applies to the claim.   
 
If the nature of the stressor is related to …
Then refer to guidance regarding establishing a stressor in …
combat or FPOW service
fear of hostile military or terrorist activity, to include duties as a drone aircraft crew member
a non-combat event
 
2

Can the claimed stressor be conceded based on the Veteran’s lay testimony alone, as described in M21-1, Part VIII, Subpart iv, 1.A.3.b?
3
Obtain all relevant sources of evidence identified by the Veteran.  Review all evidence of record, to include evidence found in VBA-sanctioned stressor research websites.
 
Can the stressor be corroborated based on the evidence of record and/or research of available resources?
Notes: 
  • Refer to Step 1 for references for the types of evidence necessary to concede the stressor based on the nature of the stressor.
  • The criteria for concession of a stressor are provided in M21-1, Part VIII, Subpart iv, 1.A.3.c.
  • Ensure all stressor research is documented in a VBMS note.
4
Has the Veteran provided the minimum information needed to allow for additional research as described in M21-1, Part VIII, Subpart iv, 1.A.3.o? 
5
Did the Veteran provide the details requested in Step 4? 
6
Determine if an examination is warranted as detailed in M21-1, Part VIII, Subpart iv, 1.C.
 
Important: 
  • Do not route a claim to the RO Research Coordinator for review until development is complete in every respect per the above procedures. 
  • A diagnosis of PTSD is not a prerequisite for initiating the stressor verification process. 

VIII.iv.1.A.3.e.  Definition:  Engaging in Combat With the Enemy

  
Engaging in combat with the enemy means personal participation in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality.  It includes presence during such events either as a
  • combatant, or
  • service member performing duty in support of combatants, such as providing medical care to the wounded.
Reference:  For more information on determining combat service, see

VIII.iv.1.A.3.f.  Definition:  Fear of Hostile Military or Terrorist Activity

  
Fear of hostile military or terrorist activity means
  • the Veteran experienced, witnessed, or was confronted with an event or circumstance that involved
    • actual or threatened death or serious injury, or
    • a threat to the physical integrity of the Veteran or others, and
  • the Veteran’s response to the event or circumstances involved a psychological or psycho-physiological state of fear, helplessness, or horror.
Examples of exposure to hostile military or terrorist activity include presence at events involving
  • actual or potential improvised explosive devices (IEDs)
  • vehicle-embedded explosive devices
  • incoming artillery, rocket, or mortar fire
  • small arms fire, including suspected sniper fire, or
  • attacks upon friendly aircraft.
Note:  Fear-based stressor criteria were added at 38 CFR 3.304(f)(3) effective July 13, 2010.
 
References:  For more information on

VIII.iv.1.A.3.g.  Definition: Non-Combat Events

  
Non-combat events involve specific events other than engaging in combat with the enemy or fear of hostile military or terrorist activity.
 
Examples of non-combat stressors may include
  • natural disasters
  • life-threatening disease of self or significant other
  • duty on burn ward
  • graves registration
  • witnessing the death, injury, or threat to the physical integrity of another person not caused by the enemy
  • actual or threatened death or serious injury, or other threat to one’s physical integrity not caused by the enemy
  • ship sinking, explosion, and/or plane crash during routine drills, or
  • friendly fire that occurs on a gunnery range during a training mission.
Notes:
  • The main distinction between a combat and non-combat stressor is that the non-combat stressor must always be corroborated with credible supporting evidence.  The Veteran’s lay statement, in the absence of any other credible evidence, cannot serve as evidence for verification of the stressor.
  • Although a personal trauma stressor is generally related to a non-combat event, there are special criteria and considerations for claims based on personal traumatic event(s), which are provided in M21-1, Part VIII, Subpart iv, 1.B.
Reference:  For more information on non-combat PTSD, see

VIII.iv.1.A.3.h.  Individual Decorations as Evidence of Combat Participation

  
When a Veteran has received any of the combat decorations listed below, VA will presume that the Veteran engaged in combat with the enemy, unless there is clear and convincing evidence to the contrary:
  • Air Force Achievement Medal with “V” Device
  • Air Force Combat Action Medal
  • Air Force Commendation Medal with “V” Device
  • Air Force Cross
  • Air Medal with “V” Device
  • Army Commendation Medal with “V” Device
  • Bronze Star Medal with “V” Device
  • “C” device, denoting combat conditions, when affixed to other awards for meritorious service or achievement
  • Combat Action Badge (CAB)
  • Combat Action Ribbon (CAR) (Prior to February 1969, the Navy Achievement Medal with “V” Device was awarded.)
  • Combat Aircrew Insignia
  • Combat Infantry/Infantryman Badge (CIB)
  • Combat Medical Badge
  • Distinguished Flying Cross
  • Distinguished Service Cross
  • Fleet Marine Force (FMF) Combat Operations Insignia
  • Joint Service Commendation Medal with “V” Device
  • Medal of Honor
  • Navy Commendation Medal with “V” Device
  • Navy Cross
  • Parachutist Badge with Combat Jump Device
  • Purple Heart, and/or
  • Silver Star.
Important:  Receipt of one of the decorations cited above is not the only acceptable evidence of engagement in combat.
 
Reference:  For more information on determining combat service, see

VIII.iv.1.A.3.i.  Examples of Service in Areas of Hostile Military or Terrorist Activity

  
Evaluation of evidence for service in a location associated with hostile military or terrorist activity must be done on a case-by-case basis.  The fear-based regulation is intended to encompass military service not involving direct combat but where there was always a potential for hostile military or terrorist activity.  The list below includes examples of service in areas of hostile military or terrorist activity.  The list is not all-inclusive. 
  • Service along the Korean demilitarized zone, which separates North Korea from South Korea, has been a location of hostile military activity since the Korean War armistice of 1953, whereas service on U.S. bases in the rest of South Korea generally has not been.
  • Service aboard a ship in the offshore “blue waters” of Vietnam or service in Thailand for which the Veteran received the Vietnam Service Medal or Vietnam Campaign Medal is sufficient to establish service in a potentially hostile military environment. 
Reference:  For more information on fear of hostile military or terrorist activity, see

VIII.iv.1.A.3.j.  Establishing a Stressor Related to Combat

  
Concede a stressor when   
Note:  If the Veteran does not expressly state the nature of the stressor,
References:  For more information on

VIII.iv.1.A.3.k.  Establishing a Stressor Related to Fear of Hostile Military or Terrorist Activity

  
Concede a stressor when the Veteran’s DD Form 214 or other service records show service in an area of potential hostile military or terrorist activity. 
 
Notes:
  • Service personnel records must be requested prior to or concurrently with any necessary examination being ordered so as to avoid unnecessary delays in claims processing.
  • The receipt of military awards such as, but not limited to, the Vietnam Service or Campaign Medal, Kuwait Liberation Medal, Iraq Campaign Medal, and Afghanistan Campaign Medal is generally considered evidence of service in an area of potential hostile military or terrorist activity.    
  • The receipt of military awards such as the National Defense Service Medal, Armed Forces Service Medal, and Global War on Terrorism (GWOT) Service Medal generally does not indicate service in locations that involve exposure to hostile military or terrorist activity because these are general medals that do not denote service in a particular area or campaign.  If the Veteran served in an area of potential hostile military or terrorist activity, they likely would have received a more specific medal for such service.
  • The GWOT Expeditionary Medal also does not necessarily indicate service in an area that would involve exposure to hostile military or terrorist activity.  Consider that award and the other evidence of record to determine if there was service in an area of potential hostile military or terrorist activity before scheduling an examination.
  • The fear-based stressor criteria are not met based on
    • anticipation of future deployment to a location of hostile military or terrorist activity, or
    • learning of the death of another person, when such death occurred remote from the Veteran in a location of hostile military or terrorist activity.      
References:  For more information on

VIII.iv.1.A.3.l.  Establishing a Stressor Related to Drone Aircraft Crew Member Duties

  
Recent military operations and warfare have involved the expansive use of armed drone aircraft, including, but not limited to, the Predator and Reaper.  Concede a stressor if the Veteran’s DD Form 214 or other service record shows service as an armed drone aircraft crew member.
 
Note:  Service personnel records must be requested prior to or concurrently with any necessary examination being ordered so as to avoid unnecessary delays in claims processing.
 
References:  For more information on

VIII.iv.1.A.3.m.  Establishing a Stressor Related to Non-Combat Events

  
Concede a non-combat stressor event when credible supporting evidence
  • documents the Veteran’s participation in the event
  • indicates the Veteran served in the immediate area and at the particular time in which the stressful event is reported to have occurred, and
  • supports the description of the event.
Note:  Corroborating evidence of a non-combat-related stressor is not restricted solely to service records, but may be obtained from other sources.
 
Reference:  For more information on non-combat PTSD, see

VIII.iv.1.A.3.n.  Use of APO Mailbox Information to Verify Republic of Vietnam Service

  
The listing of Army post office (APO) address numbers for the Asian Pacific Theater during the Vietnam Era contains APO numbers for all major Army and Air Force bases in Asia, including Vietnam, Korea, Thailand, Japan, Taiwan, Okinawa, Guam, and the Philippines.  Review the record, to include personnel and medical records, for an APO number written or stamped in the records.  As this is official evidence of the Veteran’s presence at that location, the listing can assist with establishing service in a location of potential hostile military or terrorist activity.
  
Note:  The APO listing is available on the Compensation Service Intranet website under the Stressor Verification Site.  To access the  listing, open the General Information folder and click on General 1942-2002 APO-FPO Files.  Each APO number is shown along with the location it identifies and the previous number that it replaced.  When successive locations are identified with the same APO number, the dates of use at each location are specified as well as the close-out date.

VIII.iv.1.A.3.o.  Minimum Information Required to Research an In-Service Stressor

  

When initial review of the available sources of evidence does not establish an in-service stressor, the next step is to determine if additional research and development is possible.  At a minimum, in order to undertake the additional research, the Veteran or available records must provide the following:

  • a stressor that can be documented
  • the location where the event took place
  • the approximate date (within a two-month period) of the event, and
  • the unit of assignment at the time the stressful event occurred. 
Notes:
  • For casualty-related stressors, the full name and unit designation of the casualty is preferred.  However, this information is not required for research as long as a description of the casualty event is given.  When the name and/or unit of a casualty is of record, this information must be included in any research request submitted to the Military Records Research Center (MRRC).
  • Only RO Research Coordinators are authorized to submit stressor research requests to the MRRC.
  • Specific details of claimed stressful events may also be gathered from such sources as VA or private medical treatment reports and examination reports.
  • Claims processors may obtain the date and location of well-documented events, such as the Tet Offensive, from VBA-sanctioned websites (available through the PTSD Rating Job Aid website) and supply this information on the Veteran’s behalf.

References:  For more information on the

VIII.iv.1.A.3.p.  Stressors That Cannot Be Verified

  
Some stressors are clearly impossible to verify and should not be referred to MRRC.  The following are examples of types of stressors that should not be referred to MRRC:
  • events that almost happened, and
  • mistreatment of enemy prisoners.

VIII.iv.1.A.3.q.  When to Refer a Claim to an RO Research Coordinator

  
Prior to referring a claim to the RO Research Coordinator for additional stressor research, the development activity must first determine if a stressor can be conceded with available evidence.  Refer the claim to the RO Research Coordinator for stressor corroboration only when the
Reference:  For more information on procedures for routing a PTSD claim for RO Research Coordinator review, see M21-1, Part VIII, Subpart iv, 1.A.3.r.

VIII.iv.1.A.3.r.  Procedures for Routing a PTSD Claim for RO Research Coordinator Review

  
To route a claim to the RO Research Coordinator, the claims processor conducting routine development of the claim for SC for PTSD unrelated to personal trauma or MST will
  • ensure all development is complete as directed in M21-1, Part VIII, Subpart iv, 1.A.3.c
  • establish a VBMS tracked item using the RO RESEARCH COORDINATOR REVIEW option from the COMPMGT drop-down menu, and
  • add the MRRC Request special issue for routing the request to the RO Research Coordinator.
References:  For more information on
 
 

4.  Requesting Corroboration of an In-Service Stressor

 

Introduction

  
This topic contains information on requesting corroboration of an in-service stressor, including

Change Date

  
February 5, 2024

VIII.iv.1.A.4.a.  Duties of the RO Research Coordinator

  
The RO Research Coordinator is the primary point of contact within each RO for all procedures related to requests for corroboration of stressors unrelated to MST or personal trauma.    
 
The RO Research Coordinator or individual acting in the capacity of an RO Research Coordinator
  • submits all of the RO’s requests for stressor corroboration
  • notifies MRRC when further action on a pending research request is no longer necessary, such as when evidence is received that verifies the claimed stressor or the claim is withdrawn altogether, and
  • forwards inquiries from the RO to the Office of Field Operations VBA MRRC mailbox at VAVBAWAS/CO/OFO/RAR/MRRC.
Note:  The Veterans Service Center Manager, Decision Review Operations Center Manager, or designee must notify the MRRC of any changes to the employee(s) in the RO Research Coordinator role by sending an e-mail to VAVBAWAS/CO/OFO/RAR/MRRC.  This includes instances in which an employee is no longer serving as an RO Research Coordinator, as well as when an employee is newly assigned the role.

VIII.iv.1.A.4.b.  Criteria for Submission to MRRC

  
The following general criteria must be met before the RO Research Coordinator may submit a request for corroboration of a claimed stressor to MRRC:
Important: 
  • Do not schedule a VA examination before receiving corroboration of the claimed in-service stressor. 
  • A diagnosis of PTSD is not a prerequisite for initiating the stressor verification process.
  • While historically, the U.S. Army and Joint Services Records Research Center did not conduct research of all branches, MRRC conducts research of stressors for all military branches.  
  • Only RO Research Coordinators are authorized to submit stressor research requests to MRRC.

VIII.iv.1.A.4.c.  Procedures for Conducting RO Research Coordinator Review

  
The table below describes the procedure for conducting RO Research Coordinator review.
  
Step
Action
1
Review all sources of evidence, to include records in VBA-sanctioned stressor research websites and the OMAR tool, to determine if there is credible supporting evidence that the claimed stressor occurred.
  
Can the stressor be conceded without submitting a research request to MRRC?
Note:  Ensure all stressor research is documented in a VBMS note, to include required research conducted in VBA-sanctioned stressor research websites and the OMAR tool.
 
Reference:  For more information on credible supporting evidence, see M21-1, Part VIII, Subpart iv, 1.D.2.f-h.
2
  • Submit a request for corroboration of the stressor utilizing the RECORDS RESEARCH REQUEST chevron in VBMS, and
  • go to Step 3. 
Reference:  For more information on using VBMS to submit requests to MRRC, see
3
Mark the RO RESEARCH COORDINATOR REVIEW tracked item as RECEIVED and remove the MRRC Request special issue indicator, which will allow the claim to be recalled to the NWQ.
 
Note:  At this point, the RO Research Coordinator’s duties are complete for the request phase.  When a response to the request is received, go to Step 4.
4
Did the MRRC response result in additional credible supporting evidence the claimed stressor occurred?
Important: 
  • The determination that a claimed in-service stressor cannot be corroborated is to be made based on the objective evidence of record and not the claims processor’s own personal feelings about the believability of the stressor.
  • If the MRRC response indicates that the required records are unavailable, follow the instructions in M21-1, Part III, Subpart ii, 1.A.1.e.
5
Review the evidence of record to determine whether a compensation examination is warranted as detailed in M21-1, Part VIII, Subpart iv, 1.C.   
 
Important:  Guidance prescribed in this block is not routinely applicable in cases involving stressors related to personal trauma and/or MST, as is emphasized in M21-1, Part VIII, Subpart iv, 1.B.2.g.
  
References:  For more information on

VIII.iv.1.A.4.d.  Format of Requests for Stressor Corroboration to MRRC

  
When submitting a request for stressor corroboration to MRRC, submit all requests using VBMS. 
 
Reference:  For more information on using VBMS to submit requests to MRRC, see

VIII.iv.1.A.4.e.  Information to Include in Requests to MRRC for Stressor Corroboration

  
Military records are organized by units.  Unit records are further organized by date.  When submitting a request for stressor corroboration to MRRC, include the following:
  • Veteran’s full name and Social Security number (SSN) or VA claim number
  • a description of the claimed stressor(s)
  • the most specific date(s), at minimum the month and year, during which the stressful event occurred (MRRC will research a period up to 120 days) 
  • the Veteran’s complete tour dates related to the unit of assignment when the event occurred
  • the designation of the Veteran’s unit of assignment at the time of the stressful event down to the lowest possible level, and
  • the geographic location where the stressful event took place.  In the UNIT LOCATION block, provide more concise locations such as Fallujah, Iraq, instead of Iraq, or Seoul, Korea, instead of just Korea.
Additional information identified by MRRC as helpful in conducting research includes
  • the medals or citations received by the Veteran, and
  • the names of other soldiers or sailors involved in the stressful event.
Important:
  • For Army requests, provide the full unit designation to the company level, such as HHC, 1st Brigade, 2d Armored Division (instead of 2d Armored Division only), and Company C, 1st Battalion, 14th Infantry, 1st Brigade Combat Team, 4th Infantry Division.
  • For Navy requests, provide the full unit designation and hull numbers for ships, such as USS Franklin D. Roosevelt (CVA-42) instead of USS Roosevelt only.
  • For Air Force requests, at a minimum, provide squadron and group designations, such as 366th Field Maintenance Squadron, 366th Combat Support Group instead of 366th Tactical Fighter Wing only.  Providing just the wing is insufficient because there are numerous units under a wing and various unit locations.
References:  For more information on

VIII.iv.1.A.4.f.  Circumstances in Which MRRC Requests May Be Expedited

  
MRRC is able to expedite requests only under the following extraordinary circumstances:
  • terminal illness
  • homeless
  • over 85 years old
  • extreme financial hardship, or
  • FPOW.
Reference:  For more information on following up on MRRC requests, see M21-1, Part III, Subpart ii, 2.D.4.e.

VIII.iv.1.A.4.g.  Invalid or Incomplete Research Requests to MRRC

  
MRRC will return to the appropriate RO any research request identified as invalid or incomplete, with an explanation of the deficiency(ies) identified.  MRRC then closes out the request, and it must be resubmitted as a new request to receive further consideration.