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More and more often I see scenarios where a veteran with a service connection for PTSD years later has a heart attack or a stroke. When he tries to get a service connection for the heart attack or stroke, the VA denies his claim. A related situation is where a veteran who is service-connected for PTSD suffers a heart attack or stroke and dies. His widow then files a claim for service-connection for the cause of death, but VA denies her claim as well.
A common fact pattern with these situations is the total absence of any symptoms of heart disease during service or for many years after they were in the military. Any veterans disability lawyer will tell you that the VA uses the lack of documentation in the service treatment records and the number of years before symptoms appear as justification to deny a VA appeal. When VA denies a claim, these two factors are – 9 times out of 10 – cited as a basis for rejecting the claim.
It would help many veterans and their widows if there was a way to link heart and service connected PTSD. However, the challenge is answering the question, “What evidence exists that establishes a secondary relationship between PTSD and heart disease or stroke?”
We now have the evidence to answer this question. But before diving into the evidence, let’s first address what PTSD does inside the human body. When you have a PTSD episode, there is a sudden release of catecholamines from the adrenal glands in response to the perceived threat. This is essentially the fight or flight response and Catecholamine release results in a transient but significant increase in pulse, sweating, glucose, and blood pressure.
This spike in blood pressure can be enough to burst the wall of the artery –depending on arterial condition, the presence of a clot, an arterial aneurysm, or arteriovenous malformation. So, if there is arterial wall damage or a clot, you are at risk for a stroke.
But how does this arterial wall damage or clot take place in a veteran with PTSD? Researchers have explained that PTSD results in inflammation and lipid changes that lead to arterial wall damage. Moreover, physicians also know that PTSD is associated with platelet dysfunction which can contribute to the formation of a clot. In a study that demonstrates the link between PTSD and heart disease, the researchers state,“Cardiovascular alterations associated with autonomic arousal and cardiovascular health outcomes have long been reported to be associated with PTSD or wartime traumatic exposure Persons suffering from PTSD and chronic PTSD have been shown to have increases in basal heart rate and blood pressure and increased heart rate and blood pressure in response to stimuli such as loud sounds and visual slides that remind them of the trauma.”
The bottom line is that we now know that PTSD which is considered a psychiatric problem contributes to physical problems including heart disease and stroke. For instance, in a study that included 32 Vietnam veterans with combat-related PTSD and 26 Vietnam era veterans without combat exposure found that those with the combat-related PTSD had significantly higher heart rates. Elevated blood pressure is an established risk factor for cardiovascular disease, according to the scientific literature. So, as one study observed, the link between PTSD and hypertension may explain the reported associations between PTSD and heart disease. (See McFarlane, AC. World Psychiatry 2010 Feb; 9(1):3-10.)
Therefore, if you are service-connected for PTSD and develop heart disease or have a stroke, the scientific evidence supports a secondary relationship between the PTSD and the cardiovascular event. If you are a widow and VA has denied your claim for DIC, you may also be able to link a terminal heart attack or stroke to your husband’s service-connected PTSD.
The VA is notorious for denying physical disability claims that result from psychiatric conditions. To an uninformed observer, the connection between the mental and physical may not be apparent. But as a veterans disability attorney with many years of experience, I can recount many cases where we established a link between a service-connected psychiatric disability and a physical disability.
For example, I represented a widow whose husband was service-connected for PTSD. He suffered a gastric hemorrhage and died. She filed her DIC claim, trying to service-connect the cause of the veteran’s death. The VA denied the claim repeatedly for almost 10 years. She finally retained our veterans benefits law firm to represent her. We successfully got her claim remanded from the U.S. Court of Appeals for Veterans Claims. On remand we obtained an expert medical opinion that conceded that there was no known linkage between the PTSD and the gastric incident. But, we discovered that the veteran was taking non-steroidal anti-inflammatory medication (“NSAID”) along with an SSRI medication. The SSRI is a selective serotonin reuptake inhibitor. The VA had prescribed the SSRI to treat the PTSD. It’s a psychiatric medication.
We further learned through our investigation that combining an SSRI with an NSAID increased one’s risk for a gastric hemorrhage. In other words, the two classes of medications work together to cause an increased risk of gastric hemorrhage. Our medical expert explained this concept thoroughly. As a result, the Board granted service-connection for the cause of death. So, it is clear that PTSD can cause many other physical health problems, and you should undertake a thorough investigation of the possible link between service-connected PTSD and any other medical issues.
Admittedly, winning some of these cases requires top-notch medical experts. Such experts are hard to find if you are trying to handle your case on your own. So, if you are trying to win a secondary service connection claim, it is wise to hire a veterans disability lawyer who has built relationships with experts on the medical issues of veterans.