Post-traumatic Stress Disorder
Combat and deployment stressor exposure and the epidemiology of PTSD in service members and veterans, supporting direct service connection.
38 CFR diagnostic code 9411
Peer-reviewed evidence · 16 studies
Every one links to its record
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351(1):13-22. PMID:15229303. doi:10.1056/NEJMoa040603.
PMID 15229303Check the record (opens in a new tab)Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science. 2006;313(5789):979-82. PMID:16917066. doi:10.1126/science.1128944.
PMID 16917066Check the record (opens in a new tab)Smith TC, Ryan MAK, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D. New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. BMJ. 2008;336(7640):366-71. PMID:18198395. doi:10.1136/bmj.39430.638241.AE.
PMID 18198395Check the record (opens in a new tab)
Key facts
- Diagnostic code
- 9411
- Verified studies
- 16
- Legal theories
- Direct (§ 3.303)
Peer-reviewed evidence (16)
The verified studies behind a Post-traumatic Stress Disorder claim — each links to its real PubMed or DOI record. These are sources our nexus drafts can draw from; none are invented.
- Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351(1):13-22. PMID:15229303. doi:10.1056/NEJMoa040603.
- Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science. 2006;313(5789):979-82. PMID:16917066. doi:10.1126/science.1128944.
- Smith TC, Ryan MAK, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D. New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. BMJ. 2008;336(7640):366-71. PMID:18198395. doi:10.1136/bmj.39430.638241.AE.
- Xue C, Ge Y, Tang B, Liu Y, Kang P, Wang M, Zhang L. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS One. 2015;10(3):e0120270. PMID:25793582. doi:10.1371/journal.pone.0120270.
- Phillips CJ, LeardMann CA, Gumbs GR, Smith B. Risk factors for posttraumatic stress disorder among deployed US male marines. BMC Psychiatry. 2010;10:52. PMID:20579379. doi:10.1186/1471-244X-10-52.
- Kang HK, Natelson BH, Mahan CM, Lee KY, Murphy FM. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. Am J Epidemiol. 2003;157(2):141-8. PMID:12522021. doi:10.1093/aje/kwf187.
- Wisco BE, Marx BP, Miller MW, Wolf EJ, Mota NP, Krystal JH, Southwick SM, Pietrzak RH. Probable Posttraumatic Stress Disorder in the US Veteran Population According to DSM-5: Results From the National Health and Resilience in Veterans Study. J Clin Psychiatry. 2016;77(11):1503-1510. PMID:27631148. doi:10.4088/JCP.15m10188.
- Shalev A, Liberzon I, Marmar C. Post-Traumatic Stress Disorder. N Engl J Med. 2017;376(25):2459-2469. PMID:28636846. doi:10.1056/NEJMra1612499.
- Kimerling R, Gima K, Smith MW, Street A, Frayne S. The Veterans Health Administration and military sexual trauma. Am J Public Health. 2007;97(12):2160-6. PMID:17971558. doi:10.2105/AJPH.2006.092999.
- Kimerling R, Street AE, Pavao J, Smith MW, Cronkite RC, Holmes TH, Frayne SM. Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. Am J Public Health. 2010;100(8):1409-12. PMID:20558808. doi:10.2105/AJPH.2009.171793.
- Wilson LC. The Prevalence of Military Sexual Trauma: A Meta-Analysis. Trauma Violence Abuse. 2018;19(5):584-597. PMID:30415636. doi:10.1177/1524838016683459.
- Millegan J, Milburn EK, LeardMann CA, Street AE, Williams D, Trone DW, Crum-Cianflone NF. Recent Sexual Trauma and Adverse Health and Occupational Outcomes Among U.S. Service Women. J Trauma Stress. 2015;28(4):298-306. PMID:26201507. doi:10.1002/jts.22028.
- Millegan J, Wang L, LeardMann CA, Miletich D, Street AE. Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military. J Trauma Stress. 2016;29(2):132-40. PMID:27077493. doi:10.1002/jts.22081.
- Suris A, Lind L. Military sexual trauma: a review of prevalence and associated health consequences in veterans. Trauma Violence Abuse. 2008;9(4):250-69. PMID:18936282. doi:10.1177/1524838008324419.
- Gates MA, Holowka DW, Vasterling JJ, Keane TM, Marx BP, Rosen RC. Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychol Serv. 2012;9(4):361-382. PMID:23148803. doi:10.1037/a0027649.
- Richardson LK, Frueh BC, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Aust N Z J Psychiatry. 2010;44(1):4-19. PMID:20073563. doi:10.3109/00048670903393597.
Controlling law
The CFR sections and cases the theories relevant to this condition rest on — the legal standard raters evaluate against, never a prediction about any claim.
Direct (§ 3.303)
Regulation
38 C.F.R. § 3.303
Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)
Case law
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)
The three-element test: current disability, in-service event, and a nexus between them.
Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)
Federal Circuit restatement of the same three direct-service-connection elements.
Caluza v. Brown, 7 Vet. App. 498 (1995)
The evidentiary framework a rater weighs each element against.
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)
Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)
A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)
A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).
McLendon v. Nicholson, 20 Vet. App. 79 (2006)
A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.
38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)
When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.
Related guides & tools
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Educational information about the evidentiary standard — not legal or medical advice, and never a prediction about any claim.