1. Veterans, VA, and PTSD Claims NAMI, June 2013 1

2. Veterans, VA, and PTSD Claims Introduction of Bergmann & Moore Iraq / Afghanistan War Statistics What is VA Disability Compensation? VA Claim Process, focusing on PTSD Q & A 2

3. Introduction Bergmann & Moore is Maryland Law Firm Founded in 2004. Represent Veterans Nationwide at VA Regional Offices, Board, and Court. Successfully represented thousands of clients on VA claim appeals. Partners and several staff are former VA employees. 3

4. Introduction Paul Sullivan, Managing Director of Public Affairs and Veterans Outreach. Gulf War Veteran, Army Scout. Advocate for fellow Veterans for more than two decades at VBA and VCS. Congressional Testimony plus New York Times, “60 Minutes,” and CNN. 4

5. Introduction Main topic is VA’s disability compensation claims, especially PTSD. Main audience is Veterans and advocates assisting with claims. Questions and Answers at the end. 5

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7. Iraq / Afghanistan War This section deals with the impact of the Iraq and Afghanistan wars on our veterans, families, and VA. The official VA statistics were obtained from VA using the Freedom of Information Act (FOIA), and they are current through December 2012. 7

8. Iraq / Afghanistan War 2.5 million deployed to war since 9/11 - 900,000 remain in military - 1.6 million Veterans eligible for VA 900,000 new Veteran patients at VHA - 520,000 musculoskeletal injuries - 486,000 mental health patients - 286,000 diagnosed with PTSD - 11,000 new patients per month 8

9. Iraq / Afghanistan War 800,000 new claims filed against VBA - 186,000 claims still pending - 138,000 approved PTSD claims - No VBA count for TBI claims - 9,500 new claims per month - Reserve/Guard less likely to file claims and more likely to be denied 9

10. Iraq / Afghanistan War Estimated 40-Year VA impact: - Patients and claims: 1,000,000 + - Medical and disability: $1 Trillion + Source: Columbia University Professor Joseph Stiglitz and Harvard University Professor Linda Bilmes, Congressional testimony on September 30, 2010. 10

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12. Before We Begin Veterans should obtain free help from an accredited veteran service officer (VSO) before filing a claim against VA. There are many important filing and appeal deadlines, so time is critical. Presentation is general information, not legal advice, as laws change. 12

13. VA Claims What is VA Disability Compensation ? Why? Veterans with “service-connected” conditions receive free VA care. Paid by VA to Veterans who are disabled by an injury or illness incurred or aggravated during active military service. Paid monthly, and amount depends on severity of condition and dependents 13

14. VA Claims What is VA Disability Compensation ? Monthly payment ranges from $129 for a single Veteran rated at 10% to as high as $3,088 for a married Veteran with one child rated at 100%. Veteran receives payment for life. Most Veterans are rated at 30% or lower. Survivor benefits available for families. 14

15. VA Claims What is VA Disability Compensation ? For FY 2013, VBA plans to receive 1.25 million paper-based disability claims and begin a new paperless system. 841,000 Veterans’ claims pending. 554,000 Veterans waiting more than 125 days, or two-out-of-three. Average nationwide wait is 365.5 days (one year) to decide new disability claims. 15

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17. VA Claim Process The nine steps of a VA claim described in this presentation raise significant challenges for Veterans, especially those with mental health conditions such as: Posttraumatic stress disorder (PTSD) Depression Anxiety Traumatic Brain Injury 17

18. VA Claim Process Step One: Veteran Veteran should seek VSO assistance. Veteran files a claim against VA. Effective date is date of claim, or day after discharge if filed within one year. 18

19. VA Claim Process Step Two: VA VA issues “Rating Decision,” describes reasons for decision to grant or deny. VA has no time limit to decide, and VA averages one year to decide. VA’s Inspector General reports VA’s error rate was 30 percent in 2012. 19

20. VA Claim Process Step Three: Veteran If a Veteran disagrees with any part of VA’s Rating Decision, then the Veteran files a Notice of Disagreement (NOD). Veteran has one year from mailing date of VA Rating Decision to file an NOD. 20

21. VA Claim Process Step Three, Continued: Veteran A Veteran may also ask a for a VA Decision Review Officer (DRO) to review claim. Ask VSO for guidance. A DRO is a more experienced VA employee and often finds VA errors. 21

22. VA Claim Process Step Four: VA When VA receives an NOD, then VA prepares and mails the Veteran a Statement of the Case (SOC) further explaining VA’s actions. VA has no time limit to mail SOC. VA averages 257 to mail an SOC. 22

23. VA Claim Process Step Five: Veteran If Veteran disagrees with VA, then the Veteran files a “Substantive Appeal,” also called a Form 9 Appeal. Veteran has 60 days from date of SOC (or remainder of one year from Rating Decision) and appeal to the Board of Veterans’ Appeals. 23

24. VA Claim Process Step Five, Continued: Veteran VA has no time limit to review and respond to a Form 9 appeal. VA averages 4 more years from receiving Form 9 to a decision by the Board of Veterans’ Appeals. 24

25. VA Claim Process Step Six: VA If a Veteran submits new evidence, VA issues a “Supplemental Statement of the Case” (SSOC) before sending to claim Board. VA has no time requirement to issue and SSOC. VA averages 571 days to issue an SSOC. 25

26. VA Claim Process Step Seven: Board of Veterans’ Appeals Board issues a decision. Board grants or remands (sends to VA) 75 percent of Veterans’ appeals. The Board has no time requirement to issue a decision, averaging 240 days. 26

27. VA Claim Process Step Eight: Veteran If a Veteran disagrees with the Board, then the Veteran may appeal to the Court of Appeals for Veterans Claims. A Veteran has 120 days from the date of the Board decision to appeal to the Court. 27

28. VA Claim Process Step Nine: Court of Appeals for Veterans Claims Court issues a decision. Court grants or remands 61 percent of Veterans’ appeals. The Court averages 328 days to decide. 28

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30. Key Points Increasing the chances for success: Find a VSO to provide free assistance before filing a claim against VA, especially for PTSD, TBI, or MST. When not satisfied with VA Rating Decision or Board decision, consider contacting a law firm for guidance. 30

31. Key Points To win Service Connection (SC) for most disability claims, generally, a Veteran must meet three criteria: A) A current medical condition B) An event in the military C) A medical opinion “linking” the current condition and the event 31

32. Key Points A) A current medical condition: The veteran must have a diagnosis of an existing medical condition. An exposure alone, such as Agent Orange in Vietnam or burn pit in Iraq, without a condition is not a claim. 32

33. Key Points B) An event in the military: Veteran’s military records must show corroborating evidence of an event in the military such being wounded in combat, accident, injury, assault, or illness. 33

34. Key Points C) A medical opinion “linking” the current condition and the event: A medical professional’s opinion the Veteran’s current condition is related to service is called a “nexus statement.” VA rules say veterans win a tie. For example, “as likely as not” is a tie. 34

35. Key Points Three Types of PTSD Claims: War Zone (formerly combat), where deployment is the event. Non-Deployment, with event in records (such as training accident). Military Sexual Trauma (MST), and “markers” such as transfers, non- judicial punishment, etc. 35

36. Key Points PTSD Deployment Rule Change in 2010: VA’s new rule liberalized the evidentiary standard when PTSD was diagnosed after military service. Old rule: VA required “combat” and extensive war record reviews. New rule: Deployed Veteran had “fear of hostile military or terrorist activity.” 36

37. Key Points PTSD Deployment Rule Change in 2010: All deployments to war zones are covered; must appear in records. VA’s MDs and PhDs confirm PTSD diagnosis is related to deployment. New rule is “consistent with the current medical science” about PTSD. 37

38. Summary PTSD Deployment Rule Change in 2010: If a Veteran was deployed to a war, and If a Veteran is diagnosed after service with PTSD, and If a VA exam confirms the diagnosis is associated with deployment, Then VA is supposed to grant claim. 38

39. Key Points Other Ways to Service Connection: Presumptive illness: Agent Orange, Prisoner of War, Gulf War and Burn Pit Secondary: Related to an SC condition Aggravated: A pre-existing condition worsened by military service VA malpractice: VA treatment caused condition (called an “1151” claim) 39

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41. Referral Sources Bergmann & Moore: 877-838-2889 VBA’s Claim Status: 800-827-1000 VA’s Veterans Crisis Line (Suicide Prevention): 800-273-8255, then Press 1 http://veteranscrisisline.net/ VA’s Homeless Hotline: 800-424-3838 http://www.va.gov/homeless/ http://www.va.gov/homeless/ 41

42. Contact Information Paul Sullivan Managing Director of Public Affairs & Veterans Outreach Bergmann & Moore, LLC (301) 290-3131 – office (202) 491-6953 – cell psullivan@vetlawyers.com 42

43. Thank You ! Q & A 43