DEPARTMENT OF VETERANS AFFAIRS

Board of Veterans' Appeals

Washington DC 20420

In Reply Refer To: 0ICI

FOIA Number 08-7908
December 19, 2008

Anne L. Weismann
Chief Counsel
Citizens for Responsibility and Ethics in Washington (CREW)
1400 Eye Street, NW, Suite 450
Washington, DC 20005

Dear Ms. Weismann:

This is in response to your June 10,2008, letter to the Department of Veterans' Affairs
(VA) Office of General Counsel, which was referred to my office for response on
November 18,2008. In your letter you request:

all records from January 1, 2001, to the present relating to any

and all guidance given to any VA Staff, consultants and/or
other recipient(s) of federal funds regarding the diagnosis of
post traumatic stress disorder ("PTSD") in veterans. This
request includes, but is not limited to, any and all records that
reflect or contain guidance on (1) whether or not to make a
diagnosis of PTSD; (2) alternative diagnoses that should or
could be made in lieu of diagnosing PTSD; (3) time or
expense factors bearing on a diagnosis of PTSD; and
(4) guidance on PTSD diagnoses as they relate to veteran
appeals.

As I understand your request, you are seeking copies of any VA guidance given to
clinicians on how, when, or why to diagnose PTSD, as opposed to information, such as
regulations, concerning the legal requirements for establishing a grant of service
connection for PTSD, or for evaluating already service-connected PTSD.

Although the Board of Veterans' Appeals (Board) does make requests for medical
opinions in certain individual cases as to the presence of PTSD for purposes of deciding a
claim for service connection, these requests do not include any guidance or suggestions to
the VA or non-VA clinician responding to the request on whether or not to make a
FOIA Number 08-7908 December 18, 2008

diagnosis ofPTSD. Instead, the Board simply asks for a forensic diagnosis to be made.
There is no standard language that is used in making these requests, and each request
relies heavily on the particular facts of the case. For purposes of ensuring that the opinion
provided is adequate for deciding a claim for service connection under the "benefit of the
doubt" doctrine that governs VA claims adjudication, the opinion is requested to be
provided in a format that is consistent with this legal standard. For instance, a request
may ask a clinician to state whether it is "at least as likely as not," i.e., a 50 percent
probability for or against the claim, that a disorder arose in service. Similar language is
used in remand orders directing the VA Agency of Original Jurisdiction (AOJ) to
schedule a medical examination that may include a request for a medical opinion.

I conclude that neither requests for medical opinions nor remand instructions in individual
cases meet the criteria you describe; and that the Board has no documents responsive to
your request.

The Board does periodically conduct training for Board attorney staff on the adjudication
of mental disorder claims. Though most likely not pertinent to your request, I have
included, for the sake of completeness, copies of handouts made available to Board
attorneys at such training sessions held in 2006 and 2008. Recordings of these training
sessions were made and if you wish to receive copies of them, please contact me at the
above address. The focus of these training events was the legal adjudication ofPTSD and
psychiatric disorder claims by the Board's legal staff, and not the diagnosis ofPTSD by
health-care providers.

This response is limited to records maintained or produced by the Board. Separate

responses to your request for records should be received, or may have already been
received, from other VA organizations.

If you disagree with this response you may appeal by writing to the Assistant General
Counsel (024), Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington,
DC 20420. Please refer to the FOIA number at the top of this letter, and state your
reasons for disagreeing with the determination of this office.

Sincerely,
L ... 7 "'! /(/1 ~

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Margaret 1.. Peak .
FOIA/Privacy Act Officer