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)
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.
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