M21-1 Manual  /  Part VIII, Subpart iv, Chapter 1, Section A

General Information and Development for Posttraumatic Stress Disorder (PTSD) Claims

M21-1, Part VIII, Subpart iv, Chapter 1, Section A

Overview

In This Section

This section contains the following topics:
TopicTopic Name
1 General Information on Developing Claims for Service Connection (SC) for PTSD
2 Development for Medical Evidence, Service Records, and Stressor Information
3Concession of an In-Service Stressor
4Requesting Corroboration of an In-Service Stressor

1. General Information on Developing Claims for SC for PTSD

Introduction

This topic contains general information on developing claims for SC for PTSD, including
  • definition of
    • PTSD, and
    • stressor
  • developing claims of SC for PTSD due to in-service stressors
  • responsibility for stressor verification
  • verification of in-service stressors using available resources
  • examples of sources for stressor verification
  • accepting buddy statements of a fellow Veteran as corroboration of a claimed in-service stressor, and
  • annotating documents used to concede a stressor.

Change Date

June 30, 2025

VIII.iv.1.A.1.a. Definition: PTSD

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, also known as a stressor.

VIII.iv.1.A.1.b. Definition: Stressor

A PTSD stressor is a traumatic event (or series of events) in which an individual has been personally or indirectly exposed to actual or threatened
  • death
  • serious injury, or
  • sexual violence.
Claims processors need to identify which stressor type a Veteran’s claim falls under, so that proper development will occur. Claims can be based on a stressor related to
  • an in-service PTSD diagnosis
  • personal assault
  • combat or former prisoner of war (FPOW) service
  • fear, or
  • a stressful event unrelated to hostile military or terrorist activity.
Notes:
  • PTSD has the same claim elements regardless of the type of stressor. The distinction between the different types of PTSD claims is based on how the stressor is verified or conceded.
  • Veterans will not generally know what category their stressor falls in or what evidence is needed to support it, so it is incumbent on the claims processor to make that determination, considering that some stressor types have a lower evidentiary threshold than others.

VIII.iv.1.A.1.c. Developing Claims of SC for PTSD Due to In-Service Stressors

When a Veteran claims service connection (SC) for PTSD associated with an in-service stressor, undertake development as necessary for
  • credible supporting evidence that the claimed in-service stressor occurred
  • medical evidence diagnosing the condition in accordance with 38 CFR 4.125, and
  • a link, established by medical evidence, between current symptomatology and the claimed in-service stressor.
References: For more information on

VIII.iv.1.A.1.d. Responsibility for Stressor Verification

Claims processors must review all evidence of record to determine if credible supporting evidence that a claimed in-service stressor occurred is of record prior to undertaking any additional development.When evidence of record is not sufficient to concede the claimed stressor, additional steps to corroborate the claim must be undertaken, including
  • obtaining all military or other medical records and additional stressor information, when needed, as noted in M21-1, Part VIII, Subpart iv, 1.A.2
  • attempting concession of the stressor based on the criteria noted in M21-1, VIII, Subpart iv, 1.A.3, and
  • performing additional stressor corroboration procedures by the regional office (RO) Research Coordinator as outlined in M21-1 Part VIII, Subpart iv, 1.A.4.
Important: It is the responsibility of Veterans Benefits Administration (VBA) claims processors to establish the occurrence of the event the Veteran claims to have resulted in PTSD. A medical professional makes the determination of whether an event is sufficient to meet the stressor criteria for a diagnosis of PTSD. Reference: For more information on developing for personal trauma stressors, see M21-1, Part VIII, Subpart iv, 1.B.

VIII.iv.1.A.1.e. Verification of In-Service Stressors Using Available Resources

The stressor verification process must include a review of information from VBA-sanctioned stressor research websites and the Official Military Activities Report (OMAR) tool. OMAR is a VBA-sanctioned research tool that aggregates several approved data sources for stressor verification. Notes:
  • When using evidence obtained from either a VBA-sanctioned stressor research website or the OMAR tool, carefully note the stressor source and weigh the evidence appropriately.
  • Stressor research using the OMAR tool is generally the responsibility of the RO Research Coordinator.
Reference: For more information on conducting stressor research in the OMAR tool, see the OMAR training videos.

VIII.iv.1.A.1.f. Examples of Sources for Stressor Verification

Stressor verification information can often be found in the Veteran’s service records or other official documents. The list below, although not all-inclusive, provides examples of the types of official service records that may be useful in stressor verification:
  • service personnel records and pay records
  • military occupation evidence
  • hazard pay records
  • service treatment records (STRs)
  • military performance reports
  • verification that the Veteran received Combat/Imminent Danger/Hostile Fire Pay
  • unit and organizational histories
  • daily staff journals
  • operational reports-lessons learned (ORLLs)
  • after action reports (AARs)
  • radio logs, deck logs, and ship histories
  • muster rolls
  • command chronologies and war diaries, and
  • monthly summaries and morning reports.

VIII.iv.1.A.1.g. Accepting Buddy Statements of a Fellow Veteran as Corroboration of a Claimed In-Service Stressor

Accept a buddy statement from a fellow Veteran as corroboration of a claimed in-service stressor if the statement is consistent with the time, place, and circumstances of the service of both the Veteran and the fellow Veteran making the buddy statement. If the evidence available calls into question the qualifications of the fellow Veteran to make the statement, ask the person to submit DD Form 214, Certificate of Uniformed Service, or other evidence of service with the claimant.Note: In the electronic claims folder (eFolder), individual documents bearing the personally identifiable information (PII) of a Veteran other than the claimant should be designated with a Veterans Benefits Management System (VBMS) bookmark or SUBJECT field note that clearly identifies the restricted nature of the content. Example 1:Example 2:References: For more information on

VIII.iv.1.A.1.h. Annotating Documents Used to Concede a Stressor

When sufficient evidence is received to concede a claimed stressor,
  • ensure the evidence is properly uploaded to the eFolder, and
  • edit the SUBJECT field of the relevant document(s) used to concede the PTSD stressor using the following format: [nature of stressor], pg. [number].
References: For more information on
  • uploading documents to the eFolder and editing document properties, see
  • adding links to eFolder documents containing evidence of PTSD stressors on the MILITARY SERVICE page in VBMS, see the VBMS Core User Guide.

2. Development for Medical Evidence, Service Records, and Stressor Information

Introduction

This topic contains information on development for in-service and post-service medical evidence, other service records, and stressor information, including
  • location of in-service mental health treatment records
  • developing for
    • service department records of in-service mental health treatment, and
    • civilian records of in-service mental health treatment
  • when to request hospital reports and clinical records
  • submitting a personnel records request involving PTSD
  • relevant forms related to personnel records in PTSD cases by branch of service
  • when to request additional evidence from the Veteran to establish an in-service stressor
  • information to request from the Veteran to support an in-service stressor, and
  • VBMS paragraphs for stressor development.

Change Date

March 17, 2026

VIII.iv.1.A.2.a. Location of In-Service Mental Health Treatment Records

In-service mental health treatment records are not stored with the STRs. They are maintained with the records of a
  • military treatment facility (MTF), or
  • civilian treating facility.
Note: Follow the procedures in M21-1, Part III, Subpart ii, 2.A to determine when and how to request STRs, including in-service mental health records.Reference: For more information on the relevancy of in-service mental health records, see M21-1, Part III, Subpart i, 2.E.1.e.

VIII.iv.1.A.2.b. Developing for Service Department Records of In-Service Mental Health Treatment

In order to develop for service department records of in-service mental health treatment administered at an MTF, refer to guidance on clinical record requests as described inReference: For more information on requesting records in the custody of a Federal department or agency, see

VIII.iv.1.A.2.c. Developing for Civilian Records of In-Service Mental Health Treatment

If a service member obtains treatment "off-base" at a civilian facility, any mental health records created during the course of treatment are not automatically associated with the service member's STRs. It is the responsibility of the patient and civilian provider to transfer records of care to the service department. Records retained by a civilian provider are not records in the custody of a Federal department or agency. They are not forwarded for long-term storage to the National Personnel Records Center (NPRC) and cannot be obtained using procedures for requesting service records. To obtain identified civilian treatment records, follow procedures for requesting non-Federal or private records. References: For more information on

VIII.iv.1.A.2.d. When to Request Hospital Reports and Clinical Records

Request hospital reports and clinical records if the Veteran indicates pertinent treatment in a Department of Veterans Affairs (VA) facility, Vet Center, or elsewhere. Reference: For more information on requesting VA medical or Vet Center records, see M21-1, Part III, Subpart ii, 1.A.

VIII.iv.1.A.2.e. Submitting a Personnel Records Request Involving PTSD

If a stressor is not confirmed based on evidence of record, service personnel records may be obtained using the applicable method based on the Veteran’s branch of service and date of discharge, as described in M21-1, Part III, Subpart ii, 2.C.Exception: Do not submit a request for personnel records if they have been previously requested, such as through a prior code O50 request. Note:​​​​​​​ A copy of all documents within the personnel folder is provided in response to a code O50 request.

VIII.iv.1.A.2.f. Relevant Forms Related to Personnel Records in PTSD Cases by Branch of Service

The table below identifies forms that contain information about the Veteran’s unit(s) of assignment, military occupation, and service locations. Note: These forms are among the documents that will be provided in response to requests for service personnel records.
Branch of ServiceName(s) of Forms
ArmyDA Form 2-1, Personnel Qualification RecordNotes:
  • DA Form 2-1
    • is used for both officers and enlisted personnel, and
    • first came into use in January 1973.
  • Prior to January 1973, DA Form 20, EnlistedQualificationRecord, and DA Form 66, Officer Qualification Record, were used.
Navy
  • enlisted record of Transfer and Receipts, pages
    • 12
    • 32, and
    • 33
  • enlisted record Administrative Remarks, pages
    • 4 through 9
    • 13, and
    • 34, and
  • officer record, NAVPERS 1301/51, Officer Data Card, page 35.
Note: DD Form 214 and enlistment contracts are usually included.
Air Force
  • enlisted record, AF Form 7, Airman Military Record, pages 36 through 39
  • officer record, AF Form 11, Officer Military Record, pages 39 and 40, and
  • performance reports for both enlisted personnel and officers.
Marine Corps
  • enlistment contracts
  • discharge papers
  • MABMC-11 (Discharge Order), and
  • service records, pages
    • 3
    • 5 through 6
    • 8 through 9
    • 12 through 13, and
    • 17.
Coast Guard
  • enlisted record
  • Endorsement on Order Sheet, (DoT Form CG 3312B)
  • officer record
  • Service Records Card
  • DoT Form CG 3301, Enlistment Contract
  • DoT Form CG 3303, Achievement Sheet
  • DoT Form CG 3305, Leave Record, pages 3, 5, 6-7, and
  • DD Form 214.

VIII.iv.1.A.2.g. When to Request Additional Evidence From the Veteran to Establish an In-Service Stressor

It is unnecessary to issue Section 5103 notice when a Veteran files a claim for SC for PTSD on a form that provides, or otherwise indicates the claimant received, the notice, such as VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. Do not send the Veteran a subsequent development letter requesting credible supporting evidence to establish that an in-service stressor occurred if the evidence of record shows that
  • PTSD was initially diagnosed in service
  • a confirmed stressor is already of record, or
  • the evidence already of record establishes
    • verified combat or FPOW service, or
    • service in an area of potential hostile military or terrorist activity or as a drone aircraft crew member.
Note: If evidence to establish an in-service stressor is already of record, links to eFolder documents containing evidence of the stressor(s) may be accessed and/or added, as applicable, on the MILITARY SERVICE page in VBMS.Important: Send a subsequent development letter prior to deciding the claim, if the VeteranReferences: For more information on
  • circumstances under which it is necessary to issue Section 5103 notice, see
  • adding links to eFolder documents containing evidence of PTSD stressors on the MILITARY SERVICE page in VBMS, see the VBMS Core User Guide
  • sending a subsequent development letter for stressor information, see M21-1, Part VIII, Subpart iv, 1.A.2.h and i, and
  • required information in military sexual trauma (MST) development letters, see M21-1, Part VIII, Subpart iv, 1.B.2.e.

VIII.iv.1.A.2.h. Information to Request From the Veteran to Support an In-Service Stressor

When stressor development is necessary,Important:
  • Do not enclose VA Form 21-0781 if the Veteran submitted one with the claim.
  • Do not unnecessarily delay an examination or claim by asking the Veteran for specific details or send the Veteran VA Form 21-0781 in any case in which
    • there is credible supporting evidence that demonstrates the claimed in-service stressor occurred, or
    • the Veteran already provided sufficient details to allow for additional stressor research.
References: For more information on
  • when to proceed with an examination in a PTSD claim, see M21-1, Part VIII, Subpart iv, 1.C.1.a
  • stressor verification, see M21-1, Part VIII, Subpart iv, 1.A.3.d
  • minimum information required to research an in-service stressor, see M21-1, Part VIII, Subpart iv, 1.A.3.o
  • VBMS paragraphs for stressor development, see M21-1, Part VIII, Subpart iv, 1.A.2.i, and
  • developing claims based on personal trauma, see M21-1, Part VIII, Subpart iv, 1.B.

VIII.iv.1.A.2.i. VBMS Paragraphs for Stressor Development

When it is necessary to request additional stressor details from the Veteran, generate and send a subsequent development letter. Refer to the table below to determine which PTSD/trauma development paragraph or language and attachment is appropriate based on the stressor evidence submitted by the Veteran.
Stressor EvidenceVBMS development paragraph or language Attachment
  • Combat or fear of hostile military or terrorist activities that cannot otherwise be corroborated based on evidence currently of record, and
  • no VA Form 21-0781 submitted.
PTSD (Trauma) – Need stressor details or med evidence of combat-related incidentVA Form 21-0781
  • Non-combat event such as a car accident or hurricane that cannot otherwise be corroborated based on evidence currently of record, or
  • the Veteran (or available evidence) does not mention a source for the stressor and does not provide details, and
  • no VA Form 21-0781 submitted.
PTSD (Trauma) – Need stressor details or med evidence of stressful incidentVA Form 21-0781
  • MST or other personal traumatic event that cannot otherwise be corroborated based on evidence currently of record, and
  • no VA Form 21-0781submitted.
PTSD (Trauma) – Need stressor details or med evidence of personal trauma incdntImportant: Include the MST –Important Information VBMS development paragraph when sending an MST subsequent development letter to the Veteran.VA Form 21-0781
  • Any of the above stressor types, and
  • VA Form 21-0781 was submitted, but
  • the Veteran (or available evidence) failed to provide sufficient details for the stressor to be corroborated.
PTSD (Trauma) – Follow-up for Stressor DetailsImportant:
  • Inform the Veteran of the specific information that is still needed to allow for corroboration.
  • Include the MST – Important Information VBMS development paragraph when sending an MST subsequent development letter to the Veteran.
VA Form 21-10210, Lay/Witness Statement
Important:
  • Do not send a second development letter requesting completion of VA Form 21-0781 if the Veteran
    • fails to respond to the initial request for stressor information within 30 days, or
    • submits insufficient information in response to the initial request.
  • If an incomplete VA Form 21-0781 is submitted in response to the initial request, then a development letter to request necessary missing details, as described in the table above, may be warranted if the available evidence is still insufficient to establish the occurrence of the stressor or to allow for further research.
Reference: For more information on obtaining information from the Veteran in claims based on MST or other personal trauma, see M21-1, Part VIII, Subpart iv, 1.B.

3. Concession of an In-Service Stressor

IntroductionThis topic contains information on concession of an in-service stressor, including
  • how stressors are claimed
  • when a Veteran’s lay testimony alone may establish an in-service stressor
  • reviewing for credible supporting evidence of a stressor
  • stressor verification review procedure
  • definition of
    • engaging in combat with the enemy
    • fear of hostile military or terrorist activity, and
    • non-combat events
  • individual decorations as evidence of combat participation
  • examples of service in areas of hostile military or terrorist activity
  • establishing a stressor related to
    • combat
    • fear of hostile military or terrorist activity
    • drone aircraft crew member duties, and
    • non-combat events
  • use of Army post office (APO) mailbox information to verify Republic of Vietnam service
  • minimum information required to research an in-service stressor
  • stressors that cannot be verified
  • when to refer a claim to an RO Research Coordinator, and
  • procedures for routing a PTSD claim for RO Research Coordinator review.

Change Date

June 30, 2025

VIII.iv.1.A.3.a. How Stressors Are Claimed

While claims for SC of PTSD require a standard claim form, stressors do not require a specific claim form. Stressors can be researched based on information found inNote: In some cases, such as combat or fear-based stressors, examinations can be ordered without specific stressor details. However, if the examination is returned with a PTSD diagnosis, verify the stressor associated with the diagnosis is consistent with the places and circumstances of service. Reference: For more information on examinations in claims for SC for PTSD, see M21-1, Part VIII, Subpart iv, 1.C.

VIII.iv.1.A.3.b. When a Veteran’s Lay Testimony Alone May Establish an In-Service Stressor

A Veteran’s lay testimony alone may, under specified circumstances, establish an in-service stressor for the purpose of establishing SC for PTSD if
  • PTSD is diagnosed in service, and the stressor is related to that service, or
  • the stressor is related to the Veteran’s
    • engagement in combat with the enemy
    • experience as an FPOW as defined by 38 CFR 3.1(y), or
    • fear of hostile military or terrorist activity or duties as a drone aircraft crew member, if a VA psychiatrist or psychologist, or contract equivalent, confirms the
      • claimed stressor is adequate to support a diagnosis of PTSD, and
      • Veteran’s symptoms are related to the claimed stressor.
Notes:
  • For the Veteran’s lay testimony alone to establish the occurrence of a claimed stressor,
    • the stressor must be consistent with the
      • circumstances, conditions, or hardships of service for claims based on an in-service PTSD diagnosis or FPOW or combat service, or
      • places, types, and circumstances of service for claims based on a fear of hostile military or terrorist activity or duties as a drone aircraft crew member, and
    • there must be no clear and convincing evidence to the contrary.
  • For claims decided prior to July 13, 2010, a Veteran’s testimony alone could not establish the occurrence of a stressor that was related to the Veteran’s fear of hostile military or terrorist activity.
References: For more information on
  • evidence requirements for claims based on
  • definitions of
    • engaging in combat with the enemy, see M21-1, Part VIII, Subpart iv, 1.A.3.e
    • fear of hostile military or terrorist activity, see M21-1, Part VIII, Subpart iv, 1.A.3.f, and
    • non-combat events, see M21-1, Part VIII, Subpart iv, 1.A.3.g, and
  • establishing a stressor related to
    • combat, see M21-1, Part VIII, Subpart iv, 1.A.3.j
    • fear of hostile military or terrorist activity, see M21-1, Part VIII, Subpart iv, 1.A.3.k
    • drone aircraft crew member duties, see M21-1, Part VIII, Subpart iv, 1.A.3.l, and
    • non-combat events, see M21-1, Part VIII, Subpart iv, 1.A.3.m.

VIII.iv.1.A.3.c. Reviewing for Credible Supporting Evidence of a Stressor

Review the claim for credible supporting evidence that a claimed in-service stressor occurred when the stressor cannot be conceded based on the Veteran’s lay statement as described in M21-1, Part VIII, Subpart iv, 1.A.3.b. Credible supporting evidenceis evidence that
  • documents the Veteran's participation in the event
  • indicates the Veteran served in the immediate area and at the particular time in which the stressful event is reported to have occurred, and
  • supports the description of the event.
Credible supporting evidence of a stressor may be obtained from sources other than service records. When reviewing evidence to corroborate a claimed in-service stressor, claims processors must consider the credibility and probative value of the evidence to determine if the stressor is consistent with the circumstances of the Veteran’s service. Notes:
  • Corroboration of every detail is not required.
  • Evidence may be sufficient if it implies a Veteran's personal exposure to the event.
  • Evaluate the evidence as a whole to determine whether a stressor is sufficiently corroborated.
Important: While it is incumbent upon each claims processor to review evidence to determine if a claimed in-service stressor can be conceded, stressor concession is ultimately the rating activity's responsibility. References: For more information on

VIII.iv.1.A.3.d. Stressor Verification Review Procedure

Follow the steps in the table below to determine if there is credible supporting evidence that a claimed in-service stressor occurred. Important: Ensure all necessary service records have been requested as noted in M21-1, Part VIII, Subpart iv, 1.A.2. Exception: For claims based on personal trauma, follow the procedures in M21-1, Part VIII, Subpart iv, 1.B.
StepAction
1Review the available evidence of record, evidence submitted by the Veteran, including VA Form 21-0781, if any, as well as all other service records, medical evidence, and lay or other evidence, and determine the nature of the stressor. Use the table below to find information on corroborating the stressor type that applies to the claim.
If the nature of the stressor is related to …Then refer to guidance regarding establishing a stressor in …
combat or FPOW serviceM21-1, Part VIII, Subpart iv, 1.A.3.b and j.
fear of hostile military or terrorist activity, to include duties as a drone aircraft crew memberM21-1, Part VIII, Subpart iv, 1.A.3.k and l.
a non-combat eventM21-1, Part VIII, Subpart iv, 1.A.3.m.
2

Can the claimed stressor be conceded based on the Veteran’s lay testimony alone, as described in M21-1, Part VIII, Subpart iv, 1.A.3.b?

  • If yes,
    • annotate the claims folder as directed in M21-1, Part VIII, Subpart iv, 1.A.1.h, and
    • go to Step 6.
  • If no, go to the next step.
3Obtain all relevant sources of evidence identified by the Veteran. Review all evidence of record, to include evidence found in VBA-sanctioned stressor research websites. Can the stressor be corroborated based on the evidence of record and/or research of available resources?
  • If yes,
    • annotate the claims folder as directed in M21-1, Part VIII, Subpart iv, 1.A.1.h, and
    • go to Step 6.
  • If no, go to the next step.
Notes:
  • Refer to Step 1 for references on the types of evidence necessary to concede the stressor based on the nature of the stressor.
  • The criteria for concession of a stressor are provided in M21-1, Part VIII, Subpart iv, 1.A.3.c.
  • Ensure all stressor research is documented in a VBMS note.
4Has the Veteran provided the minimum information needed to allow for additional research as described in M21-1, Part VIII, Subpart iv, 1.A.3.o?
  • If yes, refer the claim to the RO Research Coordinator, as directed in M21-1, Part VIII, Subpart iv, 1.A.3.r.
  • If no,
    • send a subsequent development letter as directed in M21-1, Part VIII, Subpart iv, 1.A.2.g-i
    • allow 30 days for a response, and then
    • go to the next step.
5Did the Veteran provide the details requested in Step 4?
  • If yes, refer the claim to the RO Research Coordinator, as directed in M21-1, Part VIII, Subpart iv, 1.A.3.r.
  • If no, refer the claim to the rating activity.
6Determine if an examination is warranted as discussed in M21-1, Part VIII, Subpart iv, 1.C.
Important:
  • Do not route a claim to the RO Research Coordinator for review until development is complete in every respect per the above procedures.
  • A diagnosis of PTSD is not a prerequisite for initiating the stressor verification process.

VIII.iv.1.A.3.e. Definition: Engaging in Combat With the Enemy

Engaging in combatwith the enemy means personal participation in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. It includes presence during such events either as a
  • combatant, or
  • service member performing duty in support of combatants, such as providing medical care to the wounded.
Reference: For more information on determining combat service, see

VIII.iv.1.A.3.f. Definition: Fear of Hostile Military or Terrorist Activity

Fear of hostile military or terrorist activity means
  • the Veteran experienced, witnessed, or was confronted with an event or circumstance that involved
    • actual or threatened death or serious injury, or
    • a threat to the physical integrity of the Veteran or others, and
  • the Veteran’s response to the event or circumstances involved a psychological or psycho-physiological state of fear, helplessness, or horror.
Examples of exposure to hostile military or terrorist activity include presence at events involving
  • actual or potential improvised explosive devices (IEDs)
  • vehicle-embedded explosive devices
  • incoming artillery, rocket, or mortar fire
  • small arms fire, including suspected sniper fire, or
  • attacks upon friendly aircraft.
Note: Fear-based stressor criteria were added at 38 CFR 3.304(f)(3) effective July 13, 2010.References: For more information on

VIII.iv.1.A.3.g. Definition: Non-Combat Events

Non-combatevents involve specific events other than engaging in combat with the enemy or fear of hostile military or terrorist activity. Examples of non-combat stressors may include
  • natural disasters
  • life-threatening disease of self or significant other
  • duty on burn ward
  • graves registration
  • witnessing the death, injury, or threat to the physical integrity of another person not caused by the enemy
  • actual or threatened death or serious injury, or other threat to one’s physical integrity not caused by the enemy
  • ship sinking, explosion, and/or plane crash during routine drills, or
  • friendly fire that occurs on a gunnery range during a training mission.
Notes:
  • The main distinction between a combat and non-combat stressor is that the non-combat stressor must always be corroborated with credible supporting evidence. The Veteran’s lay statement, in the absence of any other credible evidence, cannot serve as evidence for verification of the stressor.
  • Although a personal trauma stressor is generally related to a non-combat event, there are special criteria and considerations for claims based on personal traumatic event(s), which are provided in M21-1, Part VIII, Subpart iv, 1.B.
Reference: For more information on non-combat PTSD, see

VIII.iv.1.A.3.h. Individual Decorations as Evidence of Combat Participation

When a Veteran has received any of the combat decorations listed below, VA will presume that the Veteran engaged in combat with the enemy, unless there is clear and convincing evidence to the contrary:
  • Air Force Achievement Medal with “V” Device
  • Air Force Combat Action Medal
  • Air Force Commendation Medal with “V” Device
  • Air Force Cross
  • Air Medal with “V” Device
  • Army Commendation Medal with “V” Device
  • Bronze Star Medal with “V” Device
  • “C” device, denoting combat conditions, when affixed to other awards for meritorious service or achievement
  • Combat Action Badge (CAB)
  • Combat Action Ribbon (CAR) (Prior to February 1969, the Navy Achievement Medal with “V” Device was awarded.)
  • Combat Aircrew Insignia
  • Combat Infantry/Infantryman Badge (CIB)
  • Combat Medical Badge
  • Distinguished Flying Cross
  • Distinguished Service Cross
  • Fleet Marine Force (FMF) Combat Operations Insignia
  • Joint Service Commendation Medal with “V” Device
  • Medal of Honor
  • Navy Commendation Medal with “V” Device
  • Navy Cross
  • Parachutist Badge with Combat Jump Device
  • Purple Heart, and/or
  • Silver Star.
Important: Receipt of one of the decorations cited above is not the only acceptable evidence of engagement in combat. Reference: For more information on determining combat service, see

VIII.iv.1.A.3.i. Examples of Service in Areas of Hostile Military or Terrorist Activity

Evaluation of evidence for service in a location associated with hostile military or terrorist activity must be done on a case-by-case basis. The fear-based regulation is intended to encompass military service not involving direct combat but where there was always a potential for hostile military or terrorist activity. The list below includes examples of service in areas of hostile military or terrorist activity. The list is not all-inclusive.
  • Service along the Korean demilitarized zone, which separates North Korea from South Korea, has been a location of hostile military activity since the Korean War armistice of 1953, whereas service on U.S. bases in the rest of South Korea generally has not been.
  • Service aboard a ship in the offshore “blue waters” of Vietnam or service in Thailand for which the Veteran received the Vietnam Service Medal or Vietnam Campaign Medal is sufficient to establish service in a potentially hostile military environment.
Reference: For more information on fear of hostile military or terrorist activity, see

VIII.iv.1.A.3.j. Establishing a Stressor Related to Combat

Concede a stressor when
  • a Veteran received one of the combat decorations cited in M21-1, Part VIII, Subpart iv, 1.A.3.h, or
  • there is other credible supporting evidence that the Veteran engaged in combat as defined in M21-1, Part VIII, Subpart iv, 1.A.3.e.
Note: If the Veteran does not expressly state the nature of the stressor,
  • assume the stressor is combat-related if the Veteran received one of the combat decorations cited in M21-1, Part VIII, Subpart iv, 1.A.3.h, and
  • request service personnel records as discussed in M21-1, Part VIII, Subpart iv, 1.A.2.e.
References: For more information on

VIII.iv.1.A.3.k. Establishing a Stressor Related to Fear of Hostile Military or Terrorist Activity

Concede a stressor when the Veteran’s DD Form 214 or other service records show service in an area of potential hostile military or terrorist activity. Notes:
  • Service personnel records must be requested prior to or concurrently with any necessary examination being ordered so as to avoid unnecessary delays in claims processing.
  • The receipt of military awards such as, but not limited to, the Vietnam Service or Campaign Medal, Kuwait Liberation Medal, Iraq Campaign Medal, and Afghanistan Campaign Medal is generally considered evidence of service in an area of potential hostile military or terrorist activity.
  • The receipt of military awards such as the National Defense Service Medal, Armed Forces Service Medal, and Global War on Terrorism (GWOT) Service Medal generally does not indicate service in locations that involve exposure to hostile military or terrorist activity because these are general medals that do not denote service in a particular area or campaign. If the Veteran served in an area of potential hostile military or terrorist activity, a more specific medal for such service would likely have been awarded.
  • The GWOT Expeditionary Medal also does not necessarily indicate service in an area that would involve exposure to hostile military or terrorist activity. Consider that award and the other evidence of record to determine if there was service in an area of potential hostile military or terrorist activity before scheduling an examination.
  • The fear-based stressor criteria are not met based on
    • anticipation of future deployment to a location of hostile military or terrorist activity, or
    • learning of the death of another person, when such death occurred remote from the Veteran in a location of hostile military or terrorist activity.
References: For more information on

VIII.iv.1.A.3.l. Establishing a Stressor Related to Drone Aircraft Crew Member Duties

Recent military operations and warfare have involved the expansive use of armed drone aircraft, including, but not limited to, the Predator and Reaper. Concede a stressor if the Veteran’s DD Form 214 or other service record shows service as an armed drone aircraft crew member. Note: Service personnel records must be requested prior to or concurrently with any necessary examination being ordered so as to avoid unnecessary delays in claims processing. References: For more information on

VIII.iv.1.A.3.m. Establishing a Stressor Related to Non-Combat Events

Concede a non-combat stressor event when credible supporting evidence
  • documents the Veteran's participation in the event
  • indicates the Veteran served in the immediate area and at the particular time in which the stressful event is reported to have occurred, and
  • supports the description of the event.
Note: Corroborating evidence of a non-combat-related stressor is not restricted solely to service records but may be obtained from other sources. Reference: For more information on non-combat PTSD, see

VIII.iv.1.A.3.n. Use of APO Mailbox Information to Verify Republic of Vietnam Service

The listing of Army post office (APO) address numbers for the Asian Pacific Theater during the Vietnam Era contains APO numbers for all major Army and Air Force bases in Asia, including Vietnam, Korea, Thailand, Japan, Taiwan, Okinawa, Guam, and the Philippines. Review the record, to include personnel and medical records, for an APO number written or stamped in the records. As this is official evidence of the Veteran’s presence at that location, the listing can assist with establishing service in a location of potential hostile military or terrorist activity. Note: The APO listing is available on the Compensation Service Intranet Stressor Verification Site. To access the listing, open the General Information folder and click on General 1942-2002 APO-FPO Files. Each APO number is shown along with the location it identifies and the previous number that it replaced. When successive locations are identified with the same APO number, the dates of use at each location are specified as well as the close-out date.

VIII.iv.1.A.3.o. Minimum Information Required to Research an In-Service Stressor

When initial review of the available sources of evidence does not establish an in-service stressor, the next step is to determine if additional research and development is possible. At a minimum, in order to undertake additional research, the Veteran or available records must provide the following:

  • a stressor that can be documented
  • the location where the event took place
  • the approximate date (within a two-month period) of the event, and
  • the unit of assignment at the time the stressful event occurred.
Notes:
  • For casualty-related stressors, the full name and unit designation of the casualty is preferred. However, this information is not required for research as long as a description of the casualty event is given. When the name and/or unit of a casualty is of record, this information must be included in any research request submitted to Records Acquisition and Research (RAR).
  • Only RO Research Coordinators are authorized to submit stressor research requests to RAR.
  • Specific details of claimed stressful events may also be gathered from such sources as VA or private medical treatment reports and examination reports.
  • Claims processors may obtain the date and location of well-documented events, such as the Tet Offensive, from VBA-sanctioned stressor research websites and supply this information on the Veteran’s behalf.

References: For more information on

VIII.iv.1.A.3.p. Stressors That Cannot Be Verified

Some stressors are clearly impossible to verify and should not be referred to RAR. The following are examples of types of stressors that should not be referred to RAR:
  • events that almost happened, and
  • mistreatment of enemy prisoners.

VIII.iv.1.A.3.q. When to Refer a Claim to an RO Research Coordinator

Prior to referring a claim to the RO Research Coordinator for additional stressor research, the development activity must first determine if a stressor can be conceded with available evidence. Refer the claim to the RO Research Coordinator for stressor corroboration only when the
  • required development is completed, but the claimed stressor cannot be conceded based on the stressor verification review procedures in M21-1, Part VIII, Subpart iv, 1.A.3.d, and
  • claims folder contains the minimum information needed to allow for additional research as described in M21-1, Part VIII, Subpart iv, 1.A.3.o.
    • Reference: For more information on procedures for routing a PTSD claim for RO Research Coordinator review, see M21-1, Part VIII, Subpart iv, 1.A.3.r.

VIII.iv.1.A.3.r. Procedures for Routing a PTSD Claim for RO Research Coordinator Review

To route a claim to the RO Research Coordinator, the claims processor conducting routine development of the claim for SC for PTSD (unrelated to personal trauma or MST) will
  • ensure all development is complete as directed in M21-1, Part VIII, Subpart iv, 1.A.3.d
  • establish a VBMS tracked item using the RO RESEARCH COORDINATOR REVIEW option from the COMPMGT drop-down menu, and
  • add the Records Research Request special issue to route the request to the RO Research Coordinator.
Reference: For more information on establishing tracked items and special issues in VBMS, see the
  • VBMS Core User Guide
  • M21-4, Appendix D, 1, and
  • M21-4, Appendix E, 2.

4. Requesting Corroboration of an In-Service Stressor

Introduction

This topic contains information on requesting corroboration of an in-service stressor, including
  • duties of the RO Research Coordinator
  • criteria for submission to RAR
  • procedures for conducting RO Research Coordinator review
  • format of requests for stressor corroboration to RAR
  • information to include in requests to RAR for stressor corroboration
  • circumstances in which RAR requests may be expedited, and
  • invalid or incomplete research requests to RAR.

Change Date

June 30, 2025

VIII.iv.1.A.4.a. Duties of the RO Research Coordinator

The RO Research Coordinator is the primary point of contact within each RO for all procedures related to requests for corroboration of stressors unrelated to MST or personal trauma. The RO Research Coordinator or individual acting in the capacity of an RO Research Coordinator
  • submits all of the RO’s requests for stressor corroboration
  • notifies RAR when further action on a pending research request is no longer necessary, such as when evidence is received that verifies the claimed stressor or the claim is withdrawn altogether, and
  • forwards inquiries from the RO to the Office of Field Operations VBA RAR mailbox at VAVBAWAS/CO/OFO/RAR.
Note: The Veterans Service Center Manager, Decision Review Operations Center Manager, or designee must notify the RAR of any changes to the employee(s) in the RO Research Coordinator role by sending an e-mail to VAVBAWAS/CO/OFO/RAR. This includes instances in which an employee is
  • no longer serving as an RO Research Coordinator, or
  • newly assigned the role.

VIII.iv.1.A.4.b. Criteria for Submission to RAR

The following general criteria must be met before the RO Research Coordinator may submit a request for corroboration of a claimed stressor to RAR:
  • the required development is completed, but the claimed stressor cannot be conceded based on the stressor verification review procedures in M21-1, Part VIII, Subpart iv, 1.A.3.d, and
  • the claims folder contains the minimum information needed to allow additional research as described in M21-1, Part VIII, Subpart iv, 1.A.3.o.
Important:
  • Do not schedule a VA examination before receiving corroboration of the claimed in-service stressor.
  • A diagnosis of PTSD is not a prerequisite for initiating the stressor verification process.
  • While historically, the U.S. Army and Joint Services Records Research Center did not conduct research of all branches, RAR conducts research of stressors for all military branches.
  • Only RO Research Coordinators are authorized to submit stressor research requests to RAR.

VIII.iv.1.A.4.c. Procedures for Conducting RO Research Coordinator Review

The table below describes the procedure for conducting RO Research Coordinator review.
StepAction
1Review all sources of evidence, to include records in VBA-sanctioned stressor research websites and the OMAR tool, to determine if there is credible supporting evidence that the claimed stressor occurred. Can the stressor be conceded without submitting a research request to RAR?
  • If yes,
    • annotate the claims folder as directed in M21-1, Part VIII, Subpart iv, 1.A.1.h, and
    • go to Step 5.
  • If no, go to Step 2.
    • Note: Ensure all stressor research is documented in a VBMS note, to include required research conducted in VBA-sanctioned stressor research websites and the OMAR tool.References: For more information on
2
  • Submit a request for corroboration of the stressor utilizing the RECORDS RESEARCH REQUEST chevron in VBMS, and
  • go to Step 3.
Reference: For more information on using VBMS to submit requests to RAR, see
3Mark the RO RESEARCH COORDINATOR REVIEW tracked item as received and remove the Records Research Request special issue indicator, which will allow the claim to be recalled to the NWQ. Note: At this point, the RO Research Coordinator’s duties are complete for the request phase. When a response to the request is received, go to Step 4.
4Did the RAR response result in credible supporting evidence that the claimed stressor occurred?
  • If yes,
    • annotate the claims folder as directed in M21-1, Part VIII, Subpart iv, 1.A.1.h, and
    • go to Step 5.
  • If no, refer the claim to the rating activity.
Important:
  • The determination that a claimed in-service stressor cannot be corroborated is to be made based on the objective evidence of record and not the claims processor’s own personal feelings about the believability of the stressor.
  • If the RAR response indicates that the required records are unavailable, follow the instructions in M21-1, Part III, Subpart ii, 1.A.1.g.
5Review the evidence of record to determine whether a compensation examination is warranted as discussed in M21-1, Part VIII, Subpart iv, 1.C.
Important: Guidance prescribed in this block is not routinely applicable in cases involving stressors related to personal trauma, including MST, as is emphasized in M21-1, Part VIII, Subpart iv, 1.B.2.g. References: For more information on
  • RO Research Coordinator’s duties, see M21-1, Part VIII, Subpart iv, 1.A.4.a, and
  • general information required to submit requests for stressor research to RAR, see M21-1, Part VIII, Subpart iv, 1.A.4.b.

VIII.iv.1.A.4.d. Format of Requests for Stressor Corroboration to RAR

Submit all requests for stressor corroboration to RAR through VBMS. Reference: For more information on using VBMS to submit requests to RAR, see

VIII.iv.1.A.4.e. Information to Include in Requests to RAR for Stressor Corroboration

Military records are organized by units. Unit records are further organized by date. When submitting a request for stressor corroboration to RAR, include the following:
  • Veteran’s full name and Social Security number (SSN) or VA claim number
  • a description of the claimed stressor(s)
  • the most specific date(s), at minimum the month and year, during which the stressful event occurred (RAR will research a period up to 120 days)
  • the Veteran’s complete tour dates related to the unit of assignment when the event occurred
  • the designation of the Veteran’s unit of assignment at the time of the stressful event down to the lowest possible level, and
  • the geographic location where the stressful event took place. In the UNIT LOCATION block, provide more concise locations such as Fallujah, Iraq, instead of Iraq, or Seoul, Korea, instead of just Korea.
Additional information identified by RAR as helpful in conducting research includes the
  • medals or citations received by the Veteran, and
  • names of other soldiers or sailors involved in the stressful event.
Important:
  • For Army requests, provide the full unit designation to the company level, such as HHC, 1st Brigade, 2d Armored Division (instead of 2d Armored Division only), and Company C, 1st Battalion, 14th Infantry, 1st Brigade Combat Team, 4th Infantry Division.
  • For Navy requests, provide the full unit designation and hull numbers for ships, such as USS Franklin D. Roosevelt (CVA-42) instead of USS Roosevelt only.
  • For Air Force requests, at a minimum, provide squadron and group designations, such as 366th Field Maintenance Squadron, 366th Combat Support Group instead of 366th Tactical Fighter Wing only. Providing just the wing is insufficient because there are numerous units under a wing and various unit locations.
References: For more information on
  • personnel documents containing the Veteran’s unit(s) of assignment and service locations, see M21-1, Part VIII, Subpart iv, 1.A.2.f, and
  • submitting a request to RAR, see

VIII.iv.1.A.4.f. Circumstances in Which RAR Requests May Be Expedited

RAR is able to expedite requests only under the following extraordinary circumstances:
  • terminal illness
  • homeless
  • over 85 years old
  • extreme financial hardship, or
  • FPOW.
Reference: For more information on following up on RAR requests, see M21-1, Part III, Subpart ii, 2.D.4.e.

VIII.iv.1.A.4.g. Invalid or Incomplete Research Requests to RAR

RAR will return to the appropriate RO any research request identified as invalid or incomplete, with an explanation of the deficiency(ies) identified. RAR then closes out the request, and it must be resubmitted as a new request to receive further consideration.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart iv, Chapter 1, Section A (U.S. government work, reproduced for reference). Browse all sections →