PTSD Stressors and VA Disability Benefits

Video Transcription:

Maura Clancy: Hello everyone. Thank you so much for joining our CCK live discussion today. My name is Maura Clancy. I am an attorney here at Chisholm Chisholm and Kilpatrick. I am joined today by Alyse Galoski also an attorney at CCK and Nicholas Briggs an accredited VA claims agent who practices before the VA. Today, we are going to be talking about PTSD stressors or Post-traumatic Stress Disorder stressors. We have a bunch of topics to cover but before I go into them, I just wanted to note a couple of quick things to get everyone on the same page.

First of all, as always there is going to be some form of a comments feed associated with this video on numerous platforms. So, please feel free to leave questions or comments in the comments feed. We have a number of folks who are really good about getting back to people if they have any resources that would be helpful for them to share with you. So, please feel free to check out any materials that are posted there. As well as any materials that you might find helpful on our website at cck-law.com. Another thing I want to know at the outset is that today we are going to be discussing mental health issues and examples of their military-related causes during this broadcast and these topics can be difficult to navigate especially for those with a personal family or other history of military-related trauma. So we want to first start by saying that if you are a veteran in crisis or you are concerned about one, you can connect with someone through the Veterans Crisis Line. The Veterans Crisis Line provides free confidential twenty-four-seven support and serves all service members, veterans, national guard members, reservists, and their friends and family.

So for more information, please access the Veterans Crisis Line website. It is veteranscrisisline.net or you can reach them by phone at 1-800-273-8255. And finally my last introductory point is that today we are going to be talking, as I said before, about PTSD stressors. There are a number of different mental health conditions that veterans routinely suffer from including anxiety, depression, and other psychiatric issues. The topic we have today is specifically geared toward PTSD because VA has in place different rules that apply to claims for service connection for PTSD. Based on studies and science, there are a lot of different ways that VA will account for the evidence to prove your claim for service connection for PTSD. And so legally the requirements differ a little bit than they do from the requirements for service connection for other mental health conditions other than PTSD.

So just be mindful we have information about other service connection claims generally on our website. So keep in mind that the elements of service connection are a little bit different for PTSD, but hopefully the discussion today is going to kind of demystify and break down what we mean by PTSD stressors and why those are important in proving your PTSD claim. So let us start with you, Alyse. The first thing we want to do is define what a stressor is, so when we talk about PTSD stressors, what does that mean? And can you give us some examples?

Alyse Galoski: What a stressor is, it is basically a word for the traumatic event that is associated with PTSD. So some examples of what VA recognizes as stressors could be exposure to death whether that is somebody being threatened by death or just or witnessing somebody else be threatened by death. It can also be an actual serious injury or threatened serious injury so it does not necessarily have to actually be death. It could also just be a serious injury. It can also be actual sexual violence or threatened sexual violence. Those are probably some of the most common examples but we are going to discuss some more specific examples as we continue talking about to stop it.

Maura: I think it is important to know the variety like you did, Alyse, because a lot of times when people think about PTSD stressors, they think about combat or hostile military activity, but that is not the only type of stressor that applies with PTSD claims. And another thing that you touched on Alyse that I am actually going to ask you a little bit more about, Nick, is that the experience of the stressor can happen or can affect a person in different ways in other ways a person can be exposed to a stressor in different ways. So Nick, can you talk a little bit about the different ways in which a veteran might be exposed to a stressor?

Nicholas Briggs: So like Alyse mentioned, oftentimes is when we think about PTSD. We think about a veteran being directly exposed to the actual or threatened harm, but PTSD can also be granted based off of stressors that involve more indirect exposure to trauma. So for example, a veteran might actually have been injured in an event, but they may also have witnessed an event in which other people were injured that could qualify for purposes of a PTSD stressor. We can also have situations where the veteran indirectly learns about a traumatic event that happened to somebody else. For example, a family member or friend or fellow service member that they are close with was themselves subjected to traumatic injury or traumatic events. And that could have a secondary effect on a particular veteran. And then finally there is the idea of repeated or severe indirect exposure to trauma. These are often people who even though they were not specifically exposed to these incidents in person are repeatedly exposed to them after the fact in some way or another usually related to their military occupational specialty. Some of the examples we have seen over the years have been medics, morticians, combat reporters, things like that, where they are not necessarily involved in the stressor event themselves, but because they are so constantly involved in documenting the details of it and seeing different traumatic things that happen to other people, it becomes sort of a stressor for themselves as well.

Maura: Great, and I think again, you know to the same point. It is kind– it is important to understand that the exposure to a stressor can be through a number of different events like the ones that Alyse had described and also in a lot of different ways. So even if you were not in the traumatic car accident or something like that, but witnessed it or you were not directly involved in another type of event, but were repeatedly exposed to details of that event, as you said, Nick. All of those things could constitute PTSD stressors. It is not just that you have to have served in combat, or you have to have been you know, seriously bodily injured or anything like that. There is a lot of different types of events that can qualify as a stressor. So after we have talked about the different types of stressors, now we want to switch to how your stressor can serve to get you service-connected for PTSD. So before we get into a lot of these specific different categories because there are different rules that apply based on the certain different types of stressors that there are. Alyse, I wanted to ask you if you could break down, the kind of easiest way or the most clean way to get service connection for PTSD which is on a direct basis? I only say it is the easiest because it is usually the evidence is usually wind up in a pretty direct way and there is not the need to kind of think about the different types of rules that apply with all different types of stressors. So can you explain how those elements can be met for a direct service connection claim?

Alyse: So direct service connection for PTSD even though we are going to talk about it as the easiest way in this PTSD realm. It is still– you are going to see their stricter requirements with PTSD than there are in really getting any other condition service-connected as more touched upon. The first requirement is that you need a current diagnosis of PTSD, whereas in a lot of other realms of VA law, you do not necessarily need an actual diagnosis. This is something that is currently being challenged at the court. But for now, it is just easiest if you have a current diagnosis of PTSD to meet that first element, which is a current disability element. The second element is you need to have a statement from the veteran that is going to detail the stressor that occurred in service and detail is an important thing to know whereas in a lot of other areas, say you are going from maybe service connection for a knee, you would just have to have some in-service injury that shows up in your records. Here you need to have an actual affirmative detailed stressor noted. And then the third element is going to be that medical nexus from a VA psychiatrist or psychologist or a VA contracted psychologist or psychiatrist. Again, that is a little bit stricter of standard than you see with other realms of direct service connection.

Maura: Okay, great. And now I think we are going to be turning to one of the harder parts of PTSD claims which is, how does a veteran go about proving or establishing that a stressor occurred? I think Nick and Alyse can speak to the same experience that I have had over the years, which is that these claims for PTSD that we assist veterans with are routinely denied because there is a lack of corroboration or a lack of evidence to sort of prove that the stressor happened. In recognition of this, VA has a regulation at 38 CFR 3.304, and that regulation breaks down the different types of evidentiary standards that are applicable in PTSD claims. The reason for this I am sure that there are multiple reasons but the ones that I usually think about to kind of understand the purpose of this regulation and the different evidentiary standards are that, first of all, documented notes and records and you know paperwork about certain stressors is not to be expected. In all cases, if you think about the types of documentation that there are in claims files and in military personnel records, not every single occurrence of a stressor is going to be noted.

These are just things that are happening that are not easily documented or easily reduced to writing. And so based on that, VA recognizes that there needs to be some relaxed evidentiary standard for these types of claims. And another thing is that the regulation and the amendments that were made years ago for 3.304 talk about how studies conclusively show that veterans who serve in hostile conditions or other conditions can develop PTSD due to their military service. And so the stressor corroboration rules can be tough. There is a lot of them. VA does not always get them right. They do not always apply the right ones depending on what the veteran’s experience has been. So hopefully the next few minutes of our discussion breaks down what different rules apply based on what type of stressor is being asserted. And then also on the more practical side how you can go about submitting proof and enough evidence to sort of prove to VA that the stressor actually occurred.

So I want to go back to you, Alyse, for the first part of this. The first thing on the list is an in-service PTSD diagnosis. I think this kind of goes along with the direct service connection elements that you outlined a minute ago. So, can you talk about what kind of evidence or proof is needed if a veteran does have a PTSD diagnosis in service?

Alyse: Sure. So when you do have that in-service PTSD diagnosis like you mentioned Maura. You do not have to necessarily corroborate the stressor instead you are going to have to have your stressor be consistent with the circumstances of your service. And there also has to be no clear and convincing evidence showing otherwise. So typically in these cases, the lay statements can be used. So long again as those lay statements of what you are describing is the stressor is something that would be consistent with the particular circumstances of the veterans service.

Maura: And when you say circumstances of a veteran service, do you– what exactly does that mean? Like what other kinds of details about the veteran service might be consistent with a claim stressor? In other words, there are certain types or aspects of a veteran service that they should think about putting VA on notice of when they are submitting evidence about a stressor.

Alyse: Yeah, it can really range. It can go down to basically your military specialty if that is something that would be consistent with something that you would deal with, with what your actual placement is within the military or it can actually have to do with where you were– where you served. So if you are this is just a very general example, but if you are claiming that you experienced something in Iraq, but whatever the claim is really only happened in Afghanistan, that might not be something that is consistent with the circumstances of your service. Something they will– should mention about with your particular MOS. If you ever did jobs outside of your MOS, that is another thing that you should mention. We see that as a very common reason to find that something is not corroborated or not consistent with circumstances of services if someone has a particular MOS and for whatever reason you are doing jobs outside of that, you should really be noting the fact that you are doing jobs outside of that and if there is any evidence that you have, that you did such jobs may be medals or anything else like that that you could have should be submitted.

Maura: Those are great examples and I completely agree with your point about how veterans are often called on to do duties and service that do not always get documented or reduced to writing. This is kind of the problem we were talking about before. Not everything is in the record and VA kind of expects it to be. If it is in the record, it is usually an easier fight. If it is not in the record it takes a lot to kind of persuade VA that whatever you are describing actually happened. So to that point it is very important to provide details and also maybe any explanation as to why those things were not documented. So to Alyse’s point, if you were engaging in duties or responsibilities outside the scope of your military occupational specialty that appears on your DD-214. It might be helpful to explain. “I only did this for a temporary time.” or “I was just picking up a shift for someone else who was out on leave unexpectedly.” All of those details can kind of help VA get some context and understand why the records that they are looking at do not tell the whole story because they often do not and it is really not fair that VA can be denying things just because they are not documented in a certain place. So unfortunately it kind of falls on veterans to supplement all that information in their file to the best of their ability, but it does make it easier to pursue these things in the long run. So I am going to turn to you now Nick. Can you talk to us about PTSD claims that involve a stressor that is based on a fear of hostile military or terrorist activity?

Nick: Sure. I want to take a step back first and talk about combat because I think the two are almost inherently related. So first if a veteran claims a stressor that is directly related to their combat service and they can prove that combat service. Their statements are presumed to be credible by statue. So for psychologist or psychiatrist later diagnosis the veteran with PTSD based off of that combat stressor. They are going to can see the PTSD diagnosis and likely grant service connection. When we are talking about combat. We are talking specifically about being personally involved in the fight or encounter with the military foe or hostile unit, and that usually will involve small arms fire being targeted with weaponry, so on and so forth. In those specific situations, if the veterans participated in those specific actions, there is often going to be some kind of corroboration in the file in their service personnel records. Most often we see the DD Form 214 including awards and medals like Alyse mentioned. We see the Combat Action ribbon. We see the Medal of Honor. Bronze Star with Valor device. The Valor device is usually what separates a typical award from an award that specifically related to combat participation and in those situations so long as the veteran specifically attest to the stress or being related to combat.

There is some corroborative evidence of that combat and there is no clear and convincing evidence to the contrary. They are going to accept the stressor most of the time. But oftentimes like you mentioned, sometimes those specific medals or recommendations or anything like that. They are not going to be in the file. So around twenty-ten, VA amended their regulations to sort of ease the standard by introducing the concept of fear of hostile military activity, where there is a recognition on VA’s part that there is not necessarily going to be corroboration in every circumstance that the veteran was subjected to an attack or feared an attack from an enemy force. Either because their MOS was not specifically for combat or because there is no documentation in their own personal records that their base came under attack. So in those situations, VA is going to concede fear of hostile military activity on the recommendation of the VA psychologist or psychiatrist. But again, you are going to need some additional corroborative evidence to show that that fear of hostile military activity is consistent with time place and circumstances of the service.

So the things that we tend to look for when developing these cases are going to be records related not specifically to the veteran but to the veterans unit itself, so we look to unit commendations where an award might have been presented to the entire unit but not specifically designated for individual people. For Vietnam specifically, we often see what is called an operation– operative report, lessons learned report, where it documents the individual campaigns and actions that an entire unit took that would not necessarily be reflected on the veteran’s own personnel records. So in those situations, we might be able to show that the veteran’s unit was in a certain place in Vietnam during the Tet Offensive, making it very likely that they did come under attack. But those records are not necessarily going to be in the veteran’s file unless you are able to find them.

The VA’s adjudication manual does some work toward providing specific examples of what should be considered as being related to fear of hostile military activity. It provides examples of being subjected to mortar fire, being subjected to small arms fire or sniper fire because those are those specific small incidents than are not necessarily going to be documented in the records, but are very likely to have occurred if a veteran was stationed in Iraq during operation during either of the Persian Gulf Wars. One specific example that the M21 includes is the Demilitarized Zone in Korea. Even to this day, they recognize service along the DMZ to be a possible site of hostile military activity because there are ongoing skirmishes between North Korean and South Korean forces. Ultimately it is going to come down to being able to provide newspaper articles, depart– unit-wide service records or things like that. But ultimately if the veteran is able to provide a credible statement and it is consistent with where they served and what was going on in the country at that time. They are likely to conceive the stressor. If you can provide that additional evidence.

Maura: That is all really good detail. And as you were talking about all the different things that veterans need to obtain and think about and kind of put to– put the pieces together. It almost seems like these rules even though they are not requiring direct affirmative, its very specific corroboration of stressors. It just seemed like veterans have to go through a lot to be able to put things together for a VA, especially if the records in your file are somehow lacking and they do not detail every aspect of your service. And so therefore VA does not understand what the circumstances of your service really include. I think to Nick’s point, it is important to remember that you should be able to prove the occurrence of a stressor or get VA to concede the stressor with a detailed statement that is consistent with the circumstances of your service but to Nick’s point as well, it really is better in the long run, the more that you can put together for them the more you can point out these were my duties, this is where I was at this time, if you have access to that information because I think all of that helps VA kind of understand that they do not need to directly corroborate stressors when they are based on the types of things that you were talking about, Nick. Combat and fear of hostile military activity.

Nick: And one of the problems we often run into and see is the fact that VA does their stressor verification work through the Joint Services Record Research Center and they specifically holds records that are unit-wide or you know based of– they do not have individualized personal service records. So often times VA will specifically be on the lookout for records that mention the veteran by name but oftentimes those records that might prove that the veteran’s unit was attacked are not going to include a specific reference to the veteran. A lot of the time those records might be publicly available on the National Archives and Records Administration’s website, especially those operation report and lessons learned that I mentioned earlier. So it is always helpful to look at those other resources that the U.S. Government and the VA maintain online to see if you can pull any of the things that VA themselves might not necessarily have been looking for.

Maura: Thank you Nick. I want to move on to you Alyse. Another type of stressor is an in-service personal assault or trauma. These types of stressors are specifically contemplated along with the types of stressors that Nick talked about in VA’s PTSD regulation. We keep mentioning it but it bears repeating 3.304 that is where you are going to find a breakdown about a lot of the different evidentiary standards for the types of situations we have been talking about today and one of those sections is devoted to in-service personal assault or trauma. So Alyse, if that is the circumstance of a veteran who is seeking service connection for PTSD. What do they need to know about pursuing benefits based on that claim?

Alyse: Sure. So there is you know, there are several different types of assault or traumas that fall under this category. It can be a physical assault or it could be a sexual assault or rape. It can also be a domestic battery or stalking or harassment. So it does not have to be an actual assault but it can– it goes off all under this category and you know, one of the reasons why I think this has its own category under the regulation is because these types of assault and traumas are so severely underreported and underdocumented in the military. Unfortunately, you know, there is a stigma unfortunately still around this and it is a very complicated area to navigate really. So we are left with a lot of underreporting and underdocumenting, people are very unlikely to report assaults while they are actually in the military. And even after the military, but for that reason, they came up with, in the regulations some alternatives to basically establish that the stressor occurred that do not involve looking at the record and looking for a report of sexual assault or a physical assault in the record.

Some of these different avenues are lay statements and buddy statements may be there are statements– well basically statements that the assault occurred, statements that make buddy statements, statements may be that the person who assault occurred to, you know, expressed the assault to maybe a friend or a family member. Those also count. Also, you can look at mental health counseling records, but even less specific than this you can– there is evidence of behavioral changes that we can look to maybe someone was really high performing when they first entered the service and then after around the date of the incident, they stopped being high performing or they started basically being disciplined or reprimanded for different things that occurred in service. You are also seeing maybe substance abuse that started to occur after the date. Depression, anxiety, or maybe even requests to transfer. Those can all be looked at and all should be looked at by VA examiners.

And I will mention that it is a common error that we see with VA exams and with VA, in general, is that they forget to look at those instances and they only look for some type of corroborating statement in service, which we are very very rarely going to find. So that is probably the most common error that we see with this sexual assault or physical assault cases, is the failure to recognize the regulations and alternative avenues to establish that an assault occurred. We also see unfortunately a lot of issues with credibility, but there is a lot of literature out there that a veteran can use to their benefit to show that oftentimes with trauma, you know, statements are always consistent. There are memory issues that are involved with such traumas and things like that. So that is all things that we should keep in mind when we are dealing with this sensitive topic. Biggest thing, think of those alternative avenues to establish that also occurred. You do not have to report your assault in-service to get service-connected for it or for the PTSD resulting from it.

Maura: We all– I think we were talking about this earlier this week, we have all had instances where VA really grossly messes up these claims. It is really unfortunate. It is really not justified at all. VA does have a history of being inconsistent with the way that they adjudicate claims for PTSD that are based on assault and as Alyse mentioned one of the things that we see with the VA all the time that I think we have mentioned a few times now, today, is that VA gets really hung up on the lack of documentation. This happens in the context of other claims for service connection, for increased ratings. They love to say there is nothing in the treatment records that would allow us to grant this claim or there is nothing in your service records that would allow us to grant this claim. But it is particularly problematic with personal assault and MSC cases because we are talking about events that science and literature and all types of reputable sources say are underreported.

It is an overarching problem and it is just the reality of the situation. So when VA is denying these claims based on a lack of corroborating information as Alyse said, it is really important to think about other ways other than direct corroboration because number one, direct corroboration is not required. That is the whole purpose of the relaxed standard in the regulation at 3.304 but also, it unfortunately, again kind of falls on veterans to have to remind VA that they do not need direct corroboration of these types of instances and there are still other ways to show sort of circumstantially that an event occurred by using things like maybe a pattern of substance abuse that occurred after an assault, certain mental health records, performance deficiencies, changes in behavior, statements made to family members, etcetera. Nick, I wanted to pivot to you. Are there any other common issues that we did not get to cover about these claims that you see because I know that there are many out there that we run into.

Nick: One important thing to keep in mind is that because of the gap between what VA expects to find in terms of corroboration and what the regulations say should be accepted. There is a lot of relevant case law on the subject that is meant to help bridge the gap and sort of spell things out for VA. There are situations where a VA examiner can accept the veteran’s report regarding a military sexual assault as credible. Even if there are not that sort of typical markers that they– that we would look for. At the end of the day the regulations written in such a way that if the examiner accepts the report as credible that is it. They will go diagnosed PTSD based off of the reported stressor. At the end of the day, there is also case law that says that the veteran does not need to report every single specific detail every time they report the stressor, in order for it to be accepted as credible. Like Alyse mentioned there are situations where because of memory problems related to their underlying psychological condition or because it is an event that made it happen thirty or forty years ago. At the end of the day, the fact that they might get one small date wrong or one small detail wrong should not undercut the overall consistent credible report of the incident that happened and how it affected them thereafter.

Maura: We could probably spend a whole separate hour on just these types of issues. But I know we do have some resources that our website if you are interested in reading any further on this topic. Again, the website is cck-law.com and so feel free to utilize anything we have up there on our blogs and the website in general. So Nick I want to stick with you because so far we have been talking about types of stressors that do not require specific and direct and explicit corroboration. Rather the corroboration can be done by other means proving that an event is consistent with the circumstances of the veteran service, lay statements, other things kind of that circumstantially indicate that an issue happened in service, but if a veteran stressor does not fall into any of the categories that we discussed today, but they still have a PTSD diagnosis and they would still like to pursue benefits for PTSD, then the stressor corroboration process kind of kicks in. We talked a little bit about it before but can you kind of walk us through that?

Nick: Like you mentioned a lot of what we have talked to up to this point falls into specific camps or categories, you know, I will– often times we expect a veteran who has PTSD to have served in combat, served in a war zone to your hostile military activity. The regulations also spell out stressors related to personal assault and the regulations are written in a way that allows for relaxed corroboration like we have talked about. But at the end of the day, a PTSD stressor is something that causes actual or threaten harm to a veteran or they witness actual or threatened harm. And there are so many other circumstances in the day-to-day, you know, course of a veteran service that could result in or cause those sorts of injuries that are not going to fall into the clean categories that fall under and are described by 3.304. So oftentimes, we see situations where a veteran might be in a motor vehicle accident. They are not stationed in a war zone, you know, they are stationed stateside and they get into an accident that severely injures them or they witness something that happened to either civilians or another service member that cause them that personal trauma in the same way that of a more traditional combat stressor would. But in those situations, VA oftentimes will not just accept the veteran statement to concede the stressor. They are going to need some additional information.

So we tend to look for any outside information that we can use to corroborate that the incident occurred. In the case of a motor vehicle accident, there might be service record showing that the veteran received treatment for the injuries, even if the accident itself is not necessarily documented. So service medical record showing treatment after an injury occurred can serve as a valid basis for that corroboration, but there might be external sources not related to the military like police records, hospital records from a private facility, or newspaper articles documenting that an incident happened after the fact. And then at the end of the day, if a veteran cannot provide those other alternative sources, if they provide a statement that something occurred and they are able to find somebody else who witnessed that same event and they provide the same statement corroborating the details of it. If there are two credible statements from two different people confirming that an event occurred and there is no clear evidence contradicting the event, VA should still accept the report as credible for purposes of establishing a PTSD diagnosis.

Maura: And that part of the process reminds me of VA’s benefit of the doubt doctrine or the resolving reasonable doubt in favor of a claimant rule that they have, which is in their regulations, but kind of as Nick described, not just with PTSD claims, but with all others if there is an approximate balance of positive and negative evidence in a case. VA is supposed to be resolving that doubt in favor of the claimant. This is again, another thing that we find is not properly done a lot across the board but to Nick’s point, really if even if your stressor does not fall into the categories that are specifically mentioned in 3.304. Any information that you can provide about the event and any information you can get from a third-party or another source about the event. Even if it is not a specific, concrete picture of the event or you know a newspaper article that specifically mentions it and you know, list your name in there. Gather as much evidence as you can because at the end of the day, by law, VA is supposed to be recognizing that and giving it some weight even if it is not, you know overwhelmingly confirmed that the stressor occurred. So I wanted to close out with some any of additional practical tips that you have Nick or Alyse. I think one of the things we have talked about a lot is the value of a detailed stressor statement and the value of any details that you can provide that are not in the record. Do either of you have any other tips that we did not get to talk about specifically with respect to statements or gathering evidence or even the process of going through a compensation and pension exam or a medical exam for your PTSD? Nick, I will start with you.

Nick: Just again to highlight the importance of lay statements not only from the veteran themselves, but also family members and friends who knew them either before during and after service, especially when it comes to cases involving personal assault. Statements regarding the veteran’s change in behavior as soon as they returned home from service can help to establish that those behavioral changes that a VA examiner would look to for the purposes of marker under 3.304. And again the veteran might not necessarily be able to provide external sources that are not lay statements to corroborate an event. But if a person was there, they saw something, they are competent to report that they saw and witnessed the event. There is no reason why VA cannot just accept that statement as that second piece of evidence corroborating the veteran’s report.

Alyse: Keep track of the lay statements that you are sending in to VA, especially if you are dealing with specifics and make sure that you are staying consistent with what is being said to VA. Sometimes there will be very minor inconsistencies and you will get caught and his credibility trapped maybe at one point, you said it the assault just for example occurred in early June and then later you say occurred in I do not know, the spring. Make sure– excuse me. Make sure that you are staying consistent with those statements because really, you know, that is such a minor thing and maybe not even actually inconsistency VA could potentially deny your claim for that. So anytime you are dealing with a lot of lay statements like this, it is really important to try and avoid those credibility tracks. So yes, be as detailed as possible but also stay as consistent as you can. If that means do not– not getting overly detailed then that might be what you need to do.

Maura: That is a great point. And I think another thing is that do not feel like you cannot win your case. If you remember details over time that you did not provide before or if you remember things to have happened differently as one of you mentioned before, I think it was you, Nick, we are talking about events that sometimes have happened decades ago. Memory loss is something that is associated with mental health conditions, particularly PTSD, and also the passage of time, it is not possible for anyone whether they have memory loss or not to really remember all of the details in every instance. So anything that can kind of explain where you are coming from, why you might be changing your position or changing a very minor detail that in the long run probably should not matter anyway. I think statements and explanations are your best weapon and really can be very useful and kind of explaining where you are coming from. Again VA runs into the problem a lot where they are trapping you in minor credibility problems or they are looking for outside evidence. But at the end of the day, keep trying with the lay evidence that you can get because it really should be sufficient in a lot of these instances that we have talked about. So with that thank you both so much for joining me today and thank you to everyone who has been able to tune in. We hope to see you next time.