As a veteran's disability attorney, a substantial part of our practice is devoted towards representing veterans with PTSD. Although the rules of ethics would prohibit me from saying that we specialize in PTSD cases, I will say that we have a significant concentration in representing veterans with PTSD. As such, we are always careful to examine all possibilities to establish an in-service stressor.
As some of you know, in order to establish service connection for PTSD, you must have corroborating evidence of an in-service stressor, unless you are a combat veteran and unless your stressor is based upon a fear of hostile attack in a combat theater. So in a non-combat type situation all possible avenues must be considered when seeking to corroborate a stressor.
Take for example a recent client of ours who was a Navy hospital corpsman during the Korean War. He was stationed at a naval hospital in Guam. So he was far from the combat theater and obviously could not prove a stressor based upon fear of hostile attack in a combat theater because he was located in Guam.
He was also not in combat so we could not utilize the combat provisions to force the VA to accept his statements as to a stressor. So we had to examine what stressors he had that we could actually verify.
He alleged a number of stressors, including having to respond to a fire on the base where a number of children lost their lives, but there was no evidence to corroborate this event. He also gave descriptions of the generalized horrors of working as a hospital corpsman and having to treat the combat wounded, including severe burn victims.
He was traumatized by the horrors that he experienced as a hospital corpsman in the naval hospital in Guam. This was offered as a stressor.
The Board of Veterans' Appeals, however, denied the claim on the grounds that there was no corroborating evidence as to the actual patients that he treated.
We took this issue up on appeal to the U.S. Court of Appeals where we were able to obtain a remand based on the errors of the Board. Specifically, we argued that every single detail of a veteran's claimed stressor did not necessarily have to be proven.
We argued that the basic facts are consistent with the time, place, and circumstances of his service and should be enough to verify a stressor.
Specifically, we argued that his rating as a hospital corpsman would have exposed him to horrific battlefield casualties in the time of his service during the Korean War, coupled with evidence that the naval hospital did receive combat wounded was enough to corroborate his claimed stressor of treating horrific battlefield injuries.
The argument was enough to get the Court of Appeals to overturn the matter and remand the matter back to the Board for readjudication. On remand, we were able to obtain an expert opinion from a Ph.D. in nursing who was able to give an opinion as to the training of a hospital corpsman and discussing that their duties would entail treating people with horrific battlefield injuries.
She was also able to obtain literature to confirm that the Guam hospital at that time would have been treating casualties from Korea. She was also able to determine the exact scope of duties and training that a hospital corpsman would have had at that period of time in the early 1950's, and she was able to give an expert opinion as to the interworkings of a hospital setting, in a trauma unit, to conclude that there would be no way that the veteran could have performed as a hospital corpsman at that time and that place without being exposed to such casualties.
However, the Board still remanded the matter for a VA medical opinion. On remand we were able to convince the VA that his stressor was verified and service connection was eventually granted. In the course of litigating this case we uncovered significant research that pertains to the ability of medic or hospital corpsman duties to produce PTSD.
Our research indicated that based on historical compilations of the Korean War, U.S. Naval hospitals would have employed many aspects of the current trauma centers available today. This would include caring for combat casualties of a gruesome and distressing nature.
In addition, we noted research by Jim Goodwin for the Korean War Educator, and Alan Pringle's article in "Korean War Flashbacks: Treating PTSD" published in Mental Health Nursing (July 2003) that focused on symptoms directly related to the stressors of caring for combat-related casualties. They also noted in the article that "the spouses of many veterans complain that the men are cold, uncaring individuals".
In another article in Korean War topics health issues - post-traumatic stress syndrome, researchers observed that "those veterans who suffer the most painful effects from PTSD due to their military service are primarily those who served as corpsmen or medics."
Accordingly, we see that medics and corpsmen who served in naval hospitals, and perhaps other military hospitals, during periods of war would have been exposed to horrific casualties and gruesome injuries. The research also confirms that exposure to such medical trauma does in fact produce a psychiatric state sufficient to produce PTSD.
In other words, working as a medic or hospital corpsman exposes you to medical casualties of such a horrific nature that it is capable of serving as a stressor to produce PTSD.
In this particular case of our client, we methodically built our case based upon a logical sequence. First, we established that the hospital would have been treating casualties from Korea. Next, we established that the duties of a corpsman would have required interaction with patients suffering from horrific injuries from combat.
We also established that the hospital would have treated these victims and then we finally established that the medical literature supports the idea that an exposure to combat casualties in a hospital setting is clearly sufficient to produce post-traumatic stress disorder, and is a sufficient stressor to produce PTSD.
Accordingly, the veteran had a rating or MOS during service that involved treatment or care for individuals in a medical setting that involved horrific and gruesome injuries, this must be considered as a sufficient stressor to produce the PTSD.
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