In This Section

This section contains the topic “Evaluating Evidence and Deciding a Claim for PTSD Related to Personal Trauma.”

Introduction

This topic contains information about evaluating evidence in claims related to personal trauma, including

• general information on personal trauma
• importance of obtaining and analyzing available evidence of personal trauma
• alternative sources of evidence of in-service personal trauma
• evidence that may constitute a marker of personal trauma
• interpretation of behavioral changes as markers of personal trauma
• military sexual trauma (MST) during inactive duty training (IADT)
• training and signature requirements for MST decisions, and
• rating decision requirements for claims based on MST.

Change Date

December 18, 2024

VIII.iv.1.E.1.a.  General Information on Personal Trauma

Personal trauma, for the purpose of Department of Veterans Affairs (VA) disability compensation claims, refers broadly to stressor events (also referred to as “personal traumatic events”) involving harm perpetrated by a person who is not considered part of an enemy force.

Examples:  Assault, battery, robbery, mugging, stalking, harassment.

Military sexual trauma (MST) is a subset of personal trauma and refers to sexual harassment, sexual assault, or rape that occurs during military service.

Notes: 

• MST and other types of personal trauma are events that may result in disability, but they are not disabilities in and of themselves.
• Experiences of MST are not limited to a specific sex or background.
• The perpetrator of an MST or other personal traumatic event may or may not be affiliated with the military.
• Posttraumatic stress disorder (PTSD) is commonly associated with MST and other types of personal trauma, and service connection (SC) for PTSD on this basis may be established under the provisions of 38 CFR 3.304(f)(5).  However, PTSD is not the only diagnosis that can result from personal traumatic events.

 References:  For more information on

• the definition of MST, see 38 U.S.C. 1166(d)(2)
• handling claims based on MST without an associated claimed disability, see
  • M21-1, Part VIII, Subpart iv, 1.B.1.e, and
  • M21-1, Part II, Subpart iii, 1.C.2.d
• processing claims for PTSD based on personal trauma, see
  • the PTSD Personal Assault Information site on the Compensation Service Intranet, and
  • M21-1, Part VIII, Subpart iv, 1.B, and
• handling claims for SC for non-PTSD conditions based on an in-service personal traumatic event, see
  • M21-1, Part VIII, Subpart iv, 1.B.1.b and c
  • M21-1, Part VIII, Subpart iv, 1.B.2.a, and
  • M21-1, Part VIII, Subpart iv, 1.D.2.k.

VIII.iv.1.E.1.b.  Importance of Obtaining and Analyzing Available  Evidence of Personal Trauma

Prior to deciding a claim based on personal trauma, claims processors must 

• obtain all relevant records, to include any alternative sources of evidence identified by the claimant, when the evidence of record is insufficient to substantiate the claim, and
• review the claim for credible supporting evidence, including evidence of markers when the personal traumatic event cannot otherwise be established, as detailed in M21-1, Part VIII, Subpart iv, 1.B.2.c.

Important:  The guidance provided in this section is intended to supplement the general procedures for evaluating evidence and decision making in PTSD claims located in M21-1, Part VIII, Subpart iv, 1.D.

References:  For more information on  

• developing claims based on personal trauma, see M21-1, Part VIII, Subpart iv, 1.B
• alternative sources of evidence, see M21-1, Part VIII, Subpart iv, 1.E.1.c, and
• markers of personal trauma, see M21-1, Part VIII, Subpart iv, 1.E.1.d and e.

VIII.iv.1.E.1.c.  Alternative Sources of Evidence of In-Service Personal Trauma

If service records contain no sufficient documentary evidence that personal trauma, including in-service sexual assault, occurred, evidence from alternative sources other than the Veteran’s service records may corroborate the Veteran’s account of the personal traumatic event(s). 

Examples of such alternative sources of evidence include, but are not limited to

• a rape crisis center or center for domestic abuse
• a counseling facility or health clinic
• family members or roommates
• a faculty member
• civilian police reports
• medical reports from civilian physicians or caregivers who treated the Veteran immediately following the event or sometime later
• a chaplain or clergy
• fellow service members, and
• personal diaries or journals.

Note:  38 CFR 3.304(f)(5) provides that in PTSD claims based on in-service personal assault, evidence from sources other than the Veteran’s service records may be used to corroborate the Veteran’s account of the stressor incident.  However, VA Office of General Counsel concluded in VAOPGCPREC 3-2012 that PTSD personal assault regulation changes and guidance are not a sufficient basis for invocation of liberalizing law effective date rules.

Important:  

• VA may not treat the absence of a service record documenting an unreported sexual assault as evidence that the sexual assault did not occur as indicated in AZ and AY v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013).  In addition, VA may not rely on a Veteran’s failure to report an in-service sexual assault to military authorities as pertinent evidence that the sexual assault did not occur.  Therefore, do not use the absence of service record documentation or lack of report of in-service sexual assault to military authorities as evidence to conclude that a sexual assault did not occur.
• Alternative sources of evidence, such as those described above, may or may not be sufficient on their own to establish the occurrence of the claimed personal traumatic event(s).
  • If the alternative evidence is sufficient on its own to establish the in-service personal traumatic event(s), then a medical opinion for the purpose of clinical interpretation of behavioral changes, or markers, to corroborate the event is not necessary. 
  • In a claim for SC for PTSD based on personal trauma, when neither service records nor alternative evidence are sufficient to establish the in-service personal traumatic event(s), it will be necessary to review for evidence of behavioral changes and request a medical opinion for clinical interpretation of any such evidence, as described in M21-1, Part VIII, Subpart iv, 1.E.1.d and e.

References:  For more information

• on negative evidence, see
  • M21-1, Part V, Subpart ii, 1.A.2.f-h
  • Forshey v. Principi, 284 F.3d 1335 (Fed. Cir. 2002) (en banc), and
  • Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000), and
• sufficient evidence to document occurrence of a personal traumatic event, see M21-1, Part VIII, Subpart iv, 1.B.2.a.  

VIII.iv.1.E.1.d.  Evidence That May Constitute a Marker of Personal Trauma

If service records contain no sufficient documentary evidence that personal trauma occurred, and alternative sources of evidence do not provide credible supporting evidence of the trauma, evidence of behavioral changes around the time of, and after, the event(s), may constitute a marker of a personal traumatic event to support a claim for PTSD.

The term marker means an indicator of the effect or consequences of the personal trauma on the Veteran.  A marker could be one or more behavioral events, or a pattern of changed behavior.  Even if there is no reference to the personal trauma, evidence of the behavior changes below may circumstantially support the possibility that the claimed personal traumatic event(s) occurred.

Evidence that may be a marker of trauma includes, but is not limited to

• increased use or abuse of leave without an apparent reason, such as family obligations or family illness
• episodes of depression, panic attacks, or anxiety without identifiable reasons
• visits to a medical or counseling clinic or dispensary without a specific diagnosis or specific ailment
• use of, or increased interest in, pregnancy tests or tests for sexually-transmitted diseases (including the human immunodeficiency virus (HIV)) around the time of the event
• sudden requests that the Veteran’s military occupational series or duty assignment be changed without other justification
• changes in performance and performance evaluations (worsening or improvement)
• increased or decreased use of prescription medications
• increased use of over-the-counter medications
• alcohol or drug abuse
• increased disregard for military or civilian authority
• obsessive behavior such as overeating or undereating
• unexplained economic or social behavior changes
• treatment for physical injuries around the time of the claimed trauma, but not reported as a result of the trauma, and/or
• changes in or breakup of a significant relationship.

Example:  The Veteran indicated an in-service personal traumatic event of being sexually harassed by their superior.  Service personnel records show that during this time frame, the Veteran had minimally sufficient or average performance reviews.  After a routine transfer to a new duty station, the Veteran began to receive commendations and exemplary performance reviews from the new supervising officer.  This evidence would be considered a marker that may circumstantially support the possibility that the claimed personal traumatic event occurred.

Important:

• The provisions of 38 CFR 3.304(f)(5) regarding clinical interpretation of behavioral changes, or markers,
  • are applicable to both sexual (MST) and non-sexual (non-MST) personal traumatic events, and
  • should only be applied when the
    • in-service personal traumatic event(s) cannot otherwise be established through sufficient documentary evidence of the event(s), and
    • claimed or diagnosed condition is PTSD.
• Claims for non-PTSD diagnoses must be adjudicated under the general SC provisions of 38 CFR 3.303, which require sufficient documentary evidence to establish the in-service event.

Notes: 

• Behavioral change evidence may include lay statements or documentary evidence.
• Behavioral changes after a personal traumatic event(s) can occur during, or any time after, the Veteran’s military service.  Post-service behavioral changes may be considered potential markers if they can reasonably be associated with the claimed in-service personal traumatic event(s).
• Although the examiner’s opinion is not determinative of the outcome of the claim, it will be accepted as significant probative evidence when evaluating SC for the diagnosed mental disorder. 

References:  For more information on

• interpretation of behavior changes by a clinician, see Patton v. West, 12 Vet. App. 272 (1999), and
• probative value of evidence, see M21-1, Part V, Subpart ii, 1.A.

VIII.iv.1.E.1.e.  Interpretation of Behavioral Changes as Markers of Personal Trauma

Evidence of behavioral changes typically needs interpretation by a clinician, when necessary to support a claim based on personal trauma.  Marker evidence is insufficient, on its own, to serve as credible supporting evidence that the claimed personal traumatic event(s) occurred.

When the available evidence is otherwise insufficient to establish the occurrence of the claimed personal traumatic event(s), request a medical opinion as to whether the identified evidence of behavior changes is consistent with the expected reaction or adjustment of a person who has been subjected to an assault or other specified personal trauma.  Ensure that all marker evidence is identified and annotated or bookmarked for the examiner’s review.

If the examiner offers a credible, unequivocal, and nonspeculative assessment that the evidence of record is consistent with the occurrence of the claimed personal traumatic event(s), that opinion can constitute credible supporting evidence that the claimed in-service stressor occurred.  If the opinion is merely speculative, equivocal, contradictory, or otherwise insufficient for rating purposes, it should be returned for clarification.

References:  For more information on

• examinations for PTSD claims, see M21-1, Part VIII, Subpart iv, 1.C
• VA’s responsibility to obtain evidence needed to corroborate a claim based on personal trauma, see Patton v. West, 12 Vet.App. 272 (1999)
• use of medical opinion evidence to determine whether a stressor is corroborated, see Menegassi v. Shinseki, 638 F.3d 1379 (Fed. Cir. 2011)
• qualification requirements of examiners for psychological examinations, see M21-1, Part IV, Subpart i, 3.A.1.i, and
• requesting medical opinions, see M21-1, Part IV, Subpart i, 2.A.7.

VIII.iv.1.E.1.f.  MST During IADT

Veterans whose stressor occurred during inactive duty for training (IADT) are eligible for SC in the same manner as those whose stressor occurred during active duty or active duty for training (ADT).  The VA Office of General Counsel concluded in VAOPGCPREC 8-2001 that “PTSD resulting from sexual assault may be considered a disability resulting from an injury.”

References:  For more information on

• determining duty periods, see 38 CFR 3.6
• the definition of
  • qualifying service, see M21-1, Part III, Subpart i, 1.A.1.c, and
  • injury for ADT and IADT purposes, see M21-1, Part III, Subpart i, 1.A.2.g
• requirements for IADT to be considered active service, see M21-1, Part V, Subpart ii, 2.A.2.f
• service department records for verifying periods of ADT and IADT, see M21-1, Part III, Subpart i, 1.A.2.e, and
• adjudicating claims based on ADT and IADT, see M21-1, Part III, Subpart i, 1.A.2.k.

VIII.iv.1.E.1.g.  Training and Signature Requirements for MST Decisions

All rating decisions that address an MST-related disability as an issue must only be worked/reviewed by a Rating Veterans Service Representative or Decision Review Officer who

• has completed the required MST training module(s)
• has been designated as an MST claims processor, and
• is assigned to a
  • specialized MST claims processing site, or
  • special mission station responsible for the claim due to other special circumstances.

Decisions for MST-related disabilities require two signatures until a decision maker has demonstrated an accuracy rate of 90 percent or greater based on a review of at least 10 MST cases, to include, as proportionately as feasible, grants, denials, and evaluations.

Important:  To ensure accurate claims processing, the following checklist and worksheet are required for completion and uploading to the claims folder:

• Personal Trauma Development Checklist, and
• Personal Trauma Incident/Marker Worksheet. 

Exception:  When processing an active duty Integrated Disability Evaluation System, Benefits Delivery at Discharge (BDD), or BDD-excluded claim based on personal trauma, to include MST, the above checklist and worksheet are not required.

References:  For more information on

• the requirement that MST-related claims be worked by specialized claims processors, see 38 U.S.C. 1166, and
• two-signature requirements in MST rating decisions, see M21-1, Part V, Subpart iv, 1.B.7.d.

VIII.iv.1.E.1.h.  Rating Decision Requirements for Claims Based on MST

In order to properly identify and track disabilities for which SC is awarded or denied based on MST, decision makers must appropriately document these decisions in the Veterans Benefits Management System – Rating (VBMS-R).

When awarding or denying a claim based on MST, decision makers must

• affix the applicable special issue in VBMS-R, either
  • PTSD – Personal Trauma, or
  • Non-PTSD Personal Trauma, and
• select the special issue basis relevant to the claim.

Important:  The Non-PTSD Personal Trauma special issue in VBMS-R should be used for any non-PTSD condition (mental or physical) for which SC is awarded or denied based on MST. 

Note:  The instructions in this block apply to the special issues used in VBMS-R when completing a rating decision.  For claim-level special issue indicators used in VBMS, follow the instructions in M21-1, Part VIII, Subpart iv, 1.B.1.c

Reference:  For more information on assigning a special issue in VBMS-R, see the VBMS Rating User Guide.