The Combat Veteran from World War II to the Present
INTRODUCTION TO THE POST TRAUMATIC STRESS DISORDER:
Some people feel that personal experience is needed when dealing with PTSD cases, many others feel it is not a factor at all, just a situation. During my experience as a Veterans Service Officer, I have been told by an overwhelming majority of my PTSD clients that they relate better to a person who has actually experienced a stressor.
As a person who personally experienced a violent stressor, I have found it is easier for me to relate to a veteran who is under stress at the time. However, it has been my experience that the person who assists the claimant needs compassion and empathy as well.
POST TRAUMATIC STRESS DISORDER
The essential feature is the development of characteristic symptoms following a psychologically traumatic event that is generally considered to be outside the range of usual human experience.
The developed characteristic symptoms involve re-experiencing the traumatic event; numbing of responsiveness to, or reduced involvement with, the external world; and a variety of autonomic, dysphoric, or cognitive symptoms.
The stressor producing this syndrome would evoke significant symptoms of distress in most people, and is out of the range of such common conflict. The trauma may be experienced alone (rape or assault) or the company of groups of people (military combat). Stressors producing this disorder include natural disasters (floods, earthquakes), accidental man made disasters (car accidents with serious injuries, airplane crashes, large fires), or deliberate man made disasters (bombing, torture, death camps). Some stressors frequently produce the disorder (e.g. torture) and others only occasionally (e.g. car accident). Frequently there is a concomitant physical component to the trauma which may even involve direct damage to the central nervous system (e.g. malnutrition, head trauma). This disorder is apparently more severe and longer lasting when the stressor is of human design. The severity of the stressor should be recorded by professionals and the specific stressor is noted on Axis: IV.
The traumatic event can be re-experienced in a variety of ways. Commonly the individual has recurrent painful, intrusive recollection of the event, or recurrent dreams or nightmares during which the event is re-experienced. In rare instances there are dissociative like states, lasting from a few minutes, to several hours, or even days, during which components of the event are relived and the individual behaves as though experiencing the event at that moment. Such states have been reported in combat veterans. Diminished responsiveness to the external world, referred to as psychic numbing or emotional anesthesia, usually begins after the traumatic event. A person may complain of feeling detached or estranged from other people, that he or she has lost the ability to become interested in previously enjoyed significant activities, or that the ability to feel emotions of most types, especially those associated with intimacy, tenderness, and sexuality, is markedly decreased.
After experiencing the stressor, many develop symptoms of hyper-alertness, exaggerated startle responses, and difficulty falling asleep. Recurrent nightmares in which the traumatic event is relived and which terminal sleep disturbance may be present. Some have impaired memory and difficulty concentrating. Symptoms are often intensified when activities resemble the actual trauma (e.g. cold snowy weather or uniformed guard for death camp survivors or hot humid weather for Vietnam veterans).
Associated features: symptoms of depression and anxiety are common, and in some instances may be as severe as to be diagnosed as an anxiety or depressive disorder. Increased irritability, unexpected explosions of aggressive behavior, with minimum or no provocation. Impulsive behavior also can create problems such as unexplained trips, unexplained changes in life styles. Symptoms may begin immediately or soon after the trauma. It is not unusual, however, for the symptoms to surface months or years later following the trauma.
The appearance of apparent psychotic symptoms is interpreted by many professionals as psychosis; but, is actual symptoms of PTSD in a normal person.
DISGRACED BY OUR OWN
Early in 1990, one of my clients came into my office to discuss his VA claim for Post Traumatic Stress Disorder. After we reviewed the stressor letter regarding his being 50 meters from a falling helicopter, which exploded upon impact, killing all aboard, two on the ground (his comrades) and knocking the veteran several steps back while being singed by the fire from the blast; and, the VA stated: " that was not a life threatening situation, out of the normal range of human emotion", etc. He gracefully presented me a bill from the VA Out Patient Clinic in Columbus, Ohio. The bill totaled $129.0 0, including interest and fees, for his PTSD, which the VA had determined was non-service connected. Of course, we all know the VA had treated many veterans for nervous disorders for years with no mention of cost to the veteran. We have accepted that the treatment for a combat veteran, be automatic according to law, well, we were wrong. Even a combat veteran, with the proof and stressors to go with his proof, did end up paying for his treatments, prior to the claim being service connected.
Now some of our fellow comrades may think if the veteran makes enough money to be in category B or C, he or she should be able to afford the charges. Well, this is not necessarily true. Often, the veteran may have insurance the VA can bill for the treatment; but, not always. The veteran was disabled due to his PTSD in combat, and as a result his insurance was not in force at that time. He had been placed in category C by the VA due to his prior years income, which had ceased. Even if he still worked, the idea of the VA charging a combat veteran for PTSD treatments should make us ill. I asked one of my contacts in the VA why the charges could not be processed on the Agent Orange provision passed by the Congress (HR 1961 Radiation/Ionization- Agent Orange Act) and signed by former President Ronald W. Reagan. He asked: "could we do that? Agent Orange doesn't cause nervous problems, does it?" My response to him was there is scientific evidence that dioxin contamination creates anxiety problems in animals and possible in some humans. This was enough for a change in the policy at that time. I was then told: "we are going to have to change the Agent Orange processing of claims anyway, due to the new rules on what the VA will accept as Agent Orange residuals". This was stated to me by a contact who wished to remain anonymous, and to this day he still remains that way. Again, why subject a veteran to insurance claims and probably alert his/her employer to the fact he/she needs treatment for mental hygiene conditions and risk more prejudicial treatment at work and make it worse than it was before.
This veteran was finally rated as service connected for PTSD at 10%. This could be looked at in the context of DSM-IV, in advance. The veteran had witnessed the helicopter crash. He was not on the chopper, he witnessed the crash.
BASIC STRESS PROBLEMS: FRUSTRATION
The major characteristics of frustrated behavior are aggression, regression and fixation. Each of these has been experimentally produced in the laboratory. Another symptom which is called RESIGNATION is frequently found in case studies. Since the attitudes developed through frustration gives the situation an interpretation which justifies the action to the person involved, he considers his action reasonable. This explains why it is so difficult to explain or convince such a person their behavior is out of reality. These symptoms may show in mixed form and may be difficult to detect.
Aggression in behavior represents some kind of attack. The attack may be one of furious physical violence against the innocent, as he just stepped in line ahead of the subject, it may well be directed against an object; such as, he kicks his car because it won't start (after the kick, it still won't start). Aggression is also verbal in form and the result is taking the frustration out on another person or object; such, as someone being angry and cursing an object or even as far out as blaming an innocent person and knowing the innocent person was not involved.
Regression is a breakdown of constructive behavior and represents a return to childish action. Extreme cases result in infantile behavior and must be treated as babies. Speech and cleanliness may also be that of a baby. Some of the traits are longing to return to the past as a place of refuge and be unwilling to face the future; reflect regressive or childish attitude; easy influence over the subject, or suggestibility; follow the leader, even if the subject knows the leader is wrong; the refusal to delegate responsibility, for fear of losing complete control; blind loyalty, which in the past has destroyed nations.
Fixation is a compulsion to continue an activity that has no adaptive value. The action is repeated over and over; despite the fact the person knows it will accomplish nothing. The subject will literally beat his head against the wall. A common illustration is panic, in a burning building people persist at pushing at barred exits knowing the exit is blocked, fear has created fixation. This shows why unfavorable attitudes are difficult to change.
Resignation is the most severe of the degrees of frustration as the person has given up. The fight for survival is gone, the "I don't care" attitude prevails, he surrenders; thus, "all is lost". This is the form dictators will use to take control of the mind. It may be a dormant situation and most people do not realize it is there. People in a state of resignation obviously have low morale and will remain socially neutral unless their mental condition changes.
The causes of the differences in behavior undoubtedly depend upon personality differences, cultural differences, and to some extent, intellectual differences. Many differences may be heredity. Acquired differences depend on previous experience: develop emotional adjustments, learning cooperation, feelings of insecurity and social status within the group.
The various individual differences complicate predicting behavior; however, the general effect of frustration will cause change in the behavior pattern. Some have said "the Desert Storm veteran is frustrated", now we know why.
In review of the essay Basic Stress Problems: Frustration, please indicate any of the conditions that have appeared in your life since your discharge from active service.
Please list each situation you have experienced and what triggered that experience.
Please list as many specific periods as possible that it has happened to you.
Did you have any guilt of the reactions you may have had, and did the situation remind you of your stressor?
COP AN ATTITUDE
I remember when I was a small child going to the theater and watching war movies. I saw great films such as BATTLEGROUND, GO FOR BROKE, SANDS OF IWO JIMA, and many others. It was patriotic and important to every kid in the neighborhood that America was right and we would win. The entire country was behind our war veterans; but the experiences on the battlefield still had terrible toll on the combat veteran. The combat veteran, even with the community and national support, suffered the nightmares and the pain. The issues were attempted to be addressed in the late 1940s. Time soon passed and America forgot the few who still suffered.
Then came Korea. This is a story in itself, quite unusual. It appeared the populace was behind the Korean combat soldier, sailor, marine and airman. However, after the war wound down, it seemed as if the populace was far behind. The Korean war known to some as a conflict or police action became the forgotten war. Those who served in Korea seemingly were shuffled into the background and that was the end of their story, or was it? Today we have many Korean war veterans attempting to regroup and step forward to be recognized. We also have a large number of Korean war veterans in Post Traumatic Stress Disorder programs. They join the WWII and Vietnam veterans in dealing with PTSD. Many people have fluffed off the residual problems of PTSD. It is a severe problem; as long as we have violence and war, this condition will be with us.
Today it seems as if it is very popular, in some scenes to be a war veteran; but it is still far from popularity as we watch and observe. Exploitation is possibly the oldest reason to care, profit! Many dollars are being made on the sweat and blood of the war veteran. Millions upon millions of dollars have been made by the sale of T-shirts, hats , jewelry, as well as billions of dollars on movies, TV, records, tapes, CDs and the like. The profits hardly shared with veterans (if any). During WWI and the Korean war we had MOVIETONE NEWS as well as several other newsreels to show us a limited amount of the desolation that occurred. We also had movies in the early 1950s that hinted of the PTSD problem. However, the American Psychiatric Association chose not to address the issue. After all the veterans were (in their minds) no longer serving their nation. After all, they thought (the APA) there are only a few this affects Why dont they just put this behind them and get on with their lives. Sound familiar? We hear the same rhetoric today! It generally comes from someone who was not a combatant. I do not think I have ever heard a combat veteran make a remark of that nature. I have heard a few veterans make remarks as such, but they were not combat veterans.
The same TV networks that bring in war entertainment, for very large profits, are the very same networks that brought you the Vietnam war and its protests, with their criticism of the armed forces of that period. The people who avoided the war by deferments found time to go into business, get ahead and start a home. The terror of war was only on the TV screen. Others who aggravated the situation of the returning Vietnam veteran, by aiding and abetting the disgusting show of hate and evil anger in the hippie and so called peaceful flower power demonstration of rock throwing, flag and draft card burning to let the veteran know just how important they were. The networks never once, failed to show the world, the popularity status of the Vietnam war was taken out on the nations finest. It was supported by the majority, according to the commentators of the airwaves. Yet when the peace candidate was nominated, America did in fact, by secret ballot completely dispel the myth of peace at any price. Yet as the war wound down, the popularity of the Vietnam veteran was so low, that many veterans did attempt to deny they were even involved in the war effort. Many just tried to forget, while anti war protestors, movie stars, TV personalities, political leaders and school teachers, went on about their lives and carved out respectable livelihoods. Seemingly all war veterans, after their discharge, would enter the market areas only on a much smaller scale. In the big time, big money positions the veterans find themselves represented by such people as Sly Stallone , or the TV anchor Dan Rather, who did go to Vietnam as a correspondent.
Is it any wonder we have problems with our returned heroes? Yes, they are real live heroes. Many forgotten, a few remembered. I have looked in every corner I can find to see if John Wayne served in any war. So far it has been only on the silver screen. This is not a put down of a super patriot, who has a Congressional medal struck in his memory. It is a comment of how popularity is controlled by the media. The undisputed greatest hero of WWII was Audie Murphy. Audie only starred in one successful modern war movie. That movie was TO HELL AND BACK; it was the Audie Murphy story. Yet this true genuine hero of WWII never reached the glory of John Wayne or Stallone. Nor do other highly decorated heroes such as Neville Brand, the second highest decorated WWII veteran Mr. Brand starred in the TV series Laredo. Another highly decorated hero is Charles Durning, who in the 1990s TV series Evening Shade supported Burt Reynolds. Again, the true hero takes a back seat. Remember, both candidates Mr. Clinton defeated for president were real war heroes. Just look at Mr. Clintons draft status during Vietnam!
Sly Stallone of Rambo fame was never in Vietnam, he claims the throne of "hero of the Vietnam war", yet he is only a high paid pretender. The real heroes came back to America and were blended into society quietly and mostly never heard from again. Why? Because the war was so bad, so distressing, so depressing, that it was just easier to go along with the crowd upon return and just try to forget it. The problem was and still is: you just cannot forget it; it just will not go away. The same people who were highly critical of the individual soldier are now in positions of high authority. We have watched a steady stream of anti-war protestors take charge of America, and the Vietnam veteran had to hibernate to forget the pain of it all. The blending seemed to have worked for a while. Then suddenly and unexpectedly we saw headlines in papers throughout the land, of Vietnam veterans who were crazy and committing crimes, such as robbery and murder. These crimes were on the TV evening news, daily newspaper headlines and even movies to depict the Vietnam veteran as a crazed lunatic about to explode. It is no wonder that it was so hard for many of the returning veterans to find a niche in the local community. The people feared an outbreak by this person who served in an unpopular war. The popular war theory always has fascinated me anyway. Why would any war be popular in the first place? That we go to war is for the defense of our nation and its policies and ideals, coupled with treaties that we are bound to for common defense. The questions seem endless with no true answers.
The Desert Storm veteran is simply ignored. Nothing is pressing their issues. No special organizational push. Just business as usual. With the "old timers" complaining "they want it all handed to them!"
It seems as if we have forgotten the years of struggle of the preceding generation of veterans. These too found a strange welcome home. Upon their arrival they were met with very unfavorable reaction and many questions. Each common sense answer always seemed to have another common sense answer that was the exact opposite. The thoughts became very intrusive; the war seemed as if it had never ended. The veteran could now relive the war in his or her mind. It became never ending dreams, nightmares and flashbacks. All so real and all so misunderstood. Many veterans chose suicide as the way out. Others chose to seek professional help. The route of suicide of course did not cure anything but the ceasing of life. The psychiatric help was not all that great either, as many members of the profession did not recognize the problems for what they were. Most in the profession felt the Vietnam veteran was shameful and wrong in their action and very little was done in the late 60's or early 70's to correct the problems that beset the beleaguered Vietnam veteran. The American Psychiatric Association did not address the issue until 1980 when the all out effort on the part of a few became a part of history. The Diagnostic and Statistical Manual of Mental Disorders was revised and included the condition we know as Post Traumatic Stress Disorder. We saw the actual revision in 1981 and recognized PTSD as a condition that explained the actions and reactions of a significant segment of the Vietnam veterans. The year 1994 saw another edition of the Diagnostic Statistic Manual of Mental Disorders (fourth edition) DSM-IV, a second revision in a seven year period. It would be of great help for anyone interested in this anxiety disorder to read carefully the section 309.89 Post Traumatic Stress Disorder. One will find the true criteria to show this condition as defined today. This is not to say the book is final and ultimate, it is based on 10 year old information and studies. After all, the others were revised as well. Effective November 6, 1996 the Rating Board was directed to use DSM-IV replacing the DSM-III-R. This will be a positive for many Desert Storm veterans. This will allow the VA to rate some claims as service connected, that would have been denied under the old criteria. This seems to be a very positive step forward in bringing favorable justice to those who serve.
In the very latter part of 1988, the Veterans Administration, now the Department of Veterans Affairs finally admitted to part of the dilemma that faces veterans of war. Post Traumatic Stress Disorder is experienced by much higher numbers of veterans than projected in the past. The Associated Press article entitled Stress Disorder Found To Affect 15 Percent Of Viet Vets indicated that a four year study ordered by Congress concluded more than 15 percent of the men who served in the Vietnam war are suffering from post traumatic stress disorder. It also went on to say that about 20 percent had sought treatment. The VA also admitted that 30.9 percent had suffered the full disorder at some time and an additional 22.5 suffered partially. The same study also shows the Vietnam war women veterans have suffered from the condition of PTSD. Currently 8.5 percent of the women who served in Vietnam have the disorder. The report states the women who have suffered the full disorder are at 26.9 percent and 21.2 percent as a partial disorder. We are years past Desert Storm and no significant studies have shown the PTSD affect upon these troops.
Why not address the real issue: Post Traumatic Stress Disorder. PTSD has existed and was the reason for the inability to adjust for a large group of Vietnam veterans. This was not the first time our government had just walked away from a conflict. It was at least the third time. First, it was the Korean Conflict, and then the ill fated Bay of Pigs, Cuba, incident was so secret that the President was unaware of the involvement of the U.S. Navy and the average American did not know what actually happened. Vietnam was very different. It was brought into the living room of America. Walter Cronkite, David Brinkley, and Chet Huntley, all gave us graphic details of what our sons had done to these seemingly wonderful peaceful people. It seems as if the networks had totally forgotten that the people of that geographical area had warred with one another for many decades prior to our arrival. The operation in Desert Storm was even more vividly projected into our homes. It seemed as if CNN had a camera on every target. They were in the middle and so was America. Many of the Desert Storm veterans were exposed to various stressors. The action in Kosovo is now bringing the triggers to the forefront on many veterans. Some are angry at the lack of direction by our national political leader. However, the current administration may well have a plan to win and end this newest of the small wars.
The VA study shows a significant number of veterans who suffer from PTSD, yet, the VA makes it so difficult for the veteran to prove a claim. Many give up and walk away. Some have, no doubt, died as a result of poor treatment or no treatment in the past. In handling many claims for PTSD, I have found that very often the claim must go to the Board of Veterans Appeals in order for the veteran to win his or her claim. The VA will deny the claim, even when their own doctors have diagnosed the condition and the service records show significant combat and records of valor. The VA excuses range from: not enough proof of unusual life threatening conditions, or, the VA may state the veteran was not in a MOS that matches their criteria. To expand on that thoughtless position of the VA, I represented a veteran for PTSD in 1983 who was a member of the Marines. His MOS was not considered a combat position. He was in operation Starlight. During this operation, he was wounded in action; he also earned the Armed Forces Expeditionary Medal. The veterans DD 214 clearly states: #25 Specialty number and title 0311 Machine gunner. The original VA letter to my client was a denial, which included a sentence "your MOS was not clearly of a combat position". How utterly wrong can the VA be? Needless to say, we appealed and won the case with a large amount of back pay to the veteran. This was not all well and fine, the veteran was forced during those years to live on the streets and in the VA hospitals, until justice was done. An obvious ploy by the VA to have the veteran to just give up and quit. The veteran had decided to quit when I begged him to keep with me on the claim. In 1986 we finally saw the fruits. After, much abuse of society, as well as bureaucratic red tape which continued to plague him as well as all other veterans who are suffering from this disorder.
Now we have hope that this issue will be forever resolved with the acceptance of DSM-IV as the guide. Now an acceptable stressor is to include trauma being invoked on someone close to you, possibly your comrade is killed or seriously wounded. As a result you have nightmares, flashbacks, sleeplessness and a valid claim. In October 1996 you would have been denied. Today you have the opportunity to be fairly rated for the first time in the PTSD process.
Once the veteran has established the condition, the VA begins its three year cycle of cutting the percentage or removing the veteran from the program. I have represented several veterans who suffer from PTSD and unable to work at any type of employment. Verified by VA doctors, the veterans were found to be less than 100% by schedule; however, over the 60% minimum required to be granted Individual Unemployability (IU). Because of policy, the nervous conditions were exempt from the IU allowances and the veterans were continually denied. In early 1992, we found victory at last in this area. Many promises, to most veterans, have not been honored.
Yes, we have some solid doctors in the VA system. Their diagnosis are as often overlooked as a combat record. Which again is no longer going to be a major issue? The VA needs to look at its structure of the rating criteria; rather than trying to silence their critics, as the VA had often attempted. The answers are there if the VA would only listen.
We have come a long way since the day of the closest diagnosis being that of: Anxiety Disorder, adult situational reaction. Let us all attempt to understand the plight of our fellow veteran who suffers from PTSD, after all, their war continues on, even today.
Many more than one would think, will visit with me and tell me some of the reasons they feel something is wrong. "I don't know what it is Dave; but, my life just doesn't work like everyone else". I will ask them a few questions to warm up for our one on one discussion. During the critical questioning, we must come to the question of family. Often, very often, the veteran has been married five, six or even more times. The siblings have rejected the veteran, and the veteran has become isolated from the world. Parent rejection is difficult for the veteran to accept and this often occurs. The veteran will strike out at the nearest loved one, even though he knows the cost: a loss of another relationship. Why? He knows what will happen, another rejection, loss, but he cannot help it, the inner control is not his, it belongs to stress. More specific, Post Traumatic Stress Disorder. Not everyone who has the aforementioned problems has PTSD; however, this is a warning sign.
The veteran with PTSD finds he no longer has a trust for his friends; close relationships soon are a part of history. The former social activities are no longer interesting. He does not actually make new friends, as the trust is gone. Where can the veteran turn? To the VA? A part (in his mind) of the system? He thinks "I can never trust those people! thus, we arrive at the point where we must guide our client properly. We must assist the veteran to choose either the VA Medical Center, its Post Traumatic Stress Disorder Clinical Team, or the VA Outpatient Clinic that will afford him the opportunity to receive therapy to overcome his stress. The Vet Center(s) offer help; valuable counsel is available to the veteran at no cost.
When many of the veterans returned to America, they faced the cruel adverse judgment of certain veterans organizations. Many, if not most, heard the phrase, "we don't need your kind in our post, and you are not real veterans". It was several years before this barrier was broken. It took strong leadership in the organization, coupled with strong Vietnam veterans to break this seeming impasse. When the veteran was rejected by his peers of the preceding wars, the problem of rejection became anchored into the mind. Then to be told the infamous words, "that was not a real war". Some of the violators were Vietnam Veterans.
Today, we recognize some of the problems that exist, no person has all the answers; but, the attempts to help are at hand. The VA is long and slow in answering the needs of the veteran; but, as a result of legislation passed in Congress, help is on the way.
We still find in America a "love/hate" relationship with the veteran and their relation with the community. There are those who strongly feel the veteran has been short changed in their readjustment benefits and allowances over the years. There are a growing number of others who actually feel the veteran who asks for the readjustments are crybabies, and expect more than what is deserved. Most of us, in the veteran community feel we should have certain rights as veterans, and we most certainly do, in fact. However, for many to collect their rights, the path was very rough indeed. There were and still are many obstacles in the path that are very difficult to over come, due to the fact that many of the protesters of the Vietnam war are now in policy making positions in government, business, education, industry as well as the VA!
Prior to 1981, the term Post Traumatic Stress Disorder did not exist, except in a very limited area of some psychiatrists researching trauma reaction. Most articles one reads today will refer to the World War I condition known as shell shock; or, the World War II/Korean Conflict term combat fatigue, as types of the condition Post Traumatic Stress Disorder. To assume that shell shock and PTSD are one and the same is to err. Combat Fatigue may be a form of psychosis; but, it is not necessarily the same as PTSD in development or the ultimate reaction. A person who suffered shell shock or combat fatigue may well have incurred PTSD; but, this condition did not always result.
For several years, the VA has recognized the condition of PTSD as service connected disabling condition, if the PTSD meets certain criteria. The prominent cases which were first recognized included the combat veteran of Vietnam and former prisoners of war (POW) who applied under the special POW legislation. Although the hard fought battle for recognition of the condition was allowed in 1981, very few veterans could meet the rigid standards set forth by the VA. To understand the position of the criteria of the VA, which has become more flexible in the past decade, is difficult for the layman. It seems to be the opinion and policy of the VA, combat is not enough to indicate the required stressor for a claim of service connected disability PTSD. One of the basic requirements is a life threatening situation out of the normal realm for human reaction and emotion.
The VA has now found WWII and Korean Conflict veterans who were not POW's to have PTSD to varied degrees. This condition is not limited to Desert Storm or Vietnam veterans, although the Vietnam veteran rate of incident is far greater as are the reasons. To complicate the process that is required to establish PTSD, the VA has a special examination that is used in the rating procedure. To be honest, the preparation for the examiner gives enough information to understand the veterans dilemma. The major problems have been the examiner not being familiar with the subject of combat stress or first hand knowledge of how much stress can be placed on veterans who were involved in an unpopular war; also, who were brought into action literally overnight and swept back into civilian life with no adjustment time at all. The veteran is seen on a regular basis by an assigned VA psychiatrist, who knows the veteran and the problems on a first hand basis. However, when the time comes for the deciding examination the veteran is seen by a doctor; who usually has not seen the patient before. They do the examination sometimes in less than ten minutes. Thus, the entire future of the combat veteran, who already has a great distrust of the system, is in ten minutes, diagnosed by a person who has never before seen the veteran. The months and years of treatment by the attending physician may or may not be considered. In nearly every case, the ten minute examination carries the weight. There are several areas of concern for the veteran and the development of the claim. First and foremost there must be a diagnosis of PTSD and a stressor of life threatening situation. Without these two basic factors, there is no claim for PTSD.
In order to prepare a claim, the service record must be reviewed. Prior to filing the claim the evidence must be assembled. To order the records a SF 180 must be submitted. A request for the records should be: Army, the DA form 20; Navy, the Enlisted record of Transfers and Receipts, Administrative Remarks and/or Officer Data Card; Air Force, AF form 7, Officer AF 11; Marines, NAVMC 118 (3) (9) (17); Coast Guard, Endorsement on Order Sheet.
PTSD can exist without the condition being service connected. In several cases, we have the diagnosis as PTSD, yet, the condition is non-service connected due to the absence of actual stressor while on active duty. We must be constantly reminded that even when the condition is apparent, the reason may be other than what we expect. Prior to filing the claim, a complete review of the psychiatric treatment must be considered, hand in hand with the military history. We must expect discomfort on the part of the veteran as well as his representative in this very long claim process. This is not an easy task; the representative must listen well and ask questions that lead the veteran into a full disclosure of the traumatic event as well as the reactions after the event.
Remember, we are still in a learning process, PTSD was only recognized as a mental disorder in 1980. In order for the representative to have a firm grasp on handling claims for PTSD veterans, he/she should become familiar with DSM-III-R, Post Traumatic Stress Disorder, section 309.89.
SAGA OF THE MORGUE or, A man during Desert Storm.
Raymond was a reservist called on active duty during Desert Storm. He was assigned to the morgue at the Dover AFB. Raymond did not desire to be assigned to morgue duty, nor did his MOS in any manner resemble that type of duty. He was a Material storage and handling specialist, yet he found himself handling every corpse of those Americans killed in the Desert Storm operation. Raymond did not want that job, but as things go in the Army, that was his job.
As a result of that duty, Raymond suffers all of the symptoms found in DSM-IV for PTSD. The criteria are met line by line, in the newest DSM. However, the VA did grant benefits after the acceptance of DSM-IV.
VETERANS VS. WANNABEES
It seems as if intelligent beings as we are, and with compassion that we allegedly have within our souls. The VA would be able to consider PTSD as a condition that can exist without combat being a prerequisite; but, it is not exactly the way we want it; nor, it is not the way it should be. It is very difficult to convince the VA that a person's PTSD is service connected without the benefit of a combat MOS, such as 11B in the Army or 0311 in the Marines, etc. or the recipient of a medal for valor.
Let us use a case in point. A veteran has filed a claim for PTSD, Chronic, delayed. The veteran has a documented diagnosis from a qualified physician, who is a psychiatrist. The veteran has presented a stressor, which is a life threatening situation, out of the normal realm of human experience. This veteran is a clerk, who is assigned to the headquarters unit in a normally safe area. During a rocket attack on the post, the veteran is in a storage area that is the brunt of the rocket attack. The veteran is not physically harmed, has not been discovered to be in an unauthorized area, has not performed any act of courage, in other words, this veteran has done nothing to get their name logged into a military report. Thus, we have a stressor that is very real, very terrifying, and very undocumented in scope. This leads us to the unfortunate situation of not being able to prove the stressor to the VA. Why is this so? Is there not the "buddy statement" to be considered? The answer is yes, there is the good ol' buddy statement to be considered. The problem is they are not given much credence by the Rating Boards of the VA. Why? Well, one reason is the overwhelming fabrications that have come about in the past several years, especially since being a veteran has become popular. There is a group know as "wannabees", who have made life very difficult for those that actually have borne the battle. The people who are called "wannabees" often were in the service; but, as a result of some factor, did not achieve the degree of heroism they desired. They add to their saga and now are able to compete in the war stories at the local post or tavern. Just as tragic as the "wannabees" are those who actually did the claimed situations, but cannot prove it. Today, we find people who were never in the service falsifying someone elses DD-214 to join veterans organizations or attempting to gain benefits from the VA or other governmental agencies.
When a veteran has requested their military personnel file and the file does not produce the required documentation for a stressor, such as there is no combat MOS, there is no mention the veteran was in or near a rocket attack, is the veteran to just quit? The answer is definitely, No! The resources are available; send a letter to the U.S. Army Environmental Support Group, and request "unit data" being sure to give the complete and exact identification of the unit involved. You must also ask for "After Action Reports" as well as "Lessons Learned Reports" and the "Duty Officers Log" When you have the unit records at your disposal you can then start trying to locate more than one "buddy" to get statements from to prove the event actually happened. The After Action, Lessons Learned reports, or the Duty Officers Log, will often give you the information sought.
Even with this information to document the veterans statement, the VA is often unwilling to yield on the stressor. We need to firmly plead our case before the VA in person, taking as much documentation as possible. I have found with all of the above data in hand, the Hearing Officers will give positive consideration to the veteran.
INSTRUCTIONS FOR PTSD DEVELOPMENT SHEET AND STRESSOR LETTER
Attached is a PTSD Development Sheet. Due to the intricate work of this type of claim, I found several years ago that in order to obtain the proper statements and serve the veteran, myself, and the VA, the attached form needs to be completed. I tell everyone the same thing; there are no exceptions when it comes to PTSD. To better express myself, I want you to know that I used to sell insurance and when I first started to sell insurance, the company made me memorize what I told my clients. At first I did not understand why, but after a while by telling everyone the same thing it left no margin for error. I want you to use the PTSD Development Sheet by printing and using only black ink. Be sure to answer every question that applies. Please do not ask another person to complete this form for you, except your spouse (partner), may assist.
When I first developed this form one of my clients came in and asked me who was the moron that made this form. I was embarrassed, but I told him: "it was me." Since that incident I tell everyone, this is my form. After completing the questions on the back page, you will come to the no BS clause. BS means bull shooting. Everything that is listed on this form must be the truth; it may be used in your claim development. Any fabrication that is intentional dissolves our working arrangement.
Finally, we need a stressor letter. The guideline helps you remember many things you had forgotten. Stressor means life threatening situation in combat that is out of the normal range of human experience. Complete the form and return to your veterans service officer.
PTSD DEVELOPMENT SHEET
Branch of service_______________ service #________________________ Highest rank ______________
Rank during combat_____________ Rank at discharge_________________ VA claim # ______________
MOS__________ Combat duty assignment ___________________ Describe duty ___________________
During combat were you mainly on: Base ____ Field ____ Ship ____ describe_______________________
While in a combat situation area, how often did you:
(choose the word that best fits: never, rarely, often)
fire your weapon at the enemy _____ kill the enemy ______ see someone killed ________ observe death_____, was it our side or their side? _______.
Were any of your comrades killed? ____ Who ______________________________________________ rank ____
Were you in firefights? _____ What did you do?
Did you handle body bags? _______ Describe your inner feelings
Did you or your unit receive sniper, mortar or rocket attacks? _____ What and how many? ___________________
Describe how you survived
Before proceeding further, please describe a situation(s) you thought you would not survive (stressor).
Do this on a separate sheet and submit with this form.
This is extremely important and a major factor in a PTSD claim. It is required.
Considering the incident circle that which applies most
somewhat stressful moderately stressful extremely stressful
Did you use drugs or alcohol during your stressor event? _____ if so which? ________
Since your stressor how often do you have: nightmares ____ flashbacks ____ prolonged memories ___
Were you injured or wounded? Yes____ No _____ describe ____________________________________
List your combat medals or ribbons ________________________________________________________
Do you seem to shut out the world? Yes____ No _____
How have your emotions changed?____ describe ______________________________________________
Do you avoid some things you enjoyed before your stressor? _____________________________________
List the date of the traumatic experience_____________
Do anniversaries of the incident bother you? Yes____ No _____ If yes explain _______________________
How has your interest in activities changed since the trauma? ___________________________________
Are you estranged from others? Yes____ No _____ Explain _____________________________________
Do you have loving feelings?____ Toward who?_______________________________________________
Have your arousal symptoms changed (example: anger, mellow out)? Yes____ No _____ Explain
Do you have irritability or outbursts of anger? Yes____ No _____ Explain _________________________
Are you on constant alert? ____ Do you feel someone is about to jump you? _____ Why? ______________
Are you jumpy? _____ Exaggerated startle response, tense, goosey? ______
What are your plans for the future?_________________________________________________________
When a person files for Post Traumatic Stress Disorder, the Rating Board, of the Department of Veterans Affairs requires several mandatory conditions. We cannot assist any veteran in completion of a successful claim without these conditions being met. We must have a diagnosis competent medical authority, a psychiatrist; record of proof of a stressor. You must be in treatment for the condition and you must meet the criteria stated in DSM IV. You must furnish a written stressor in detail. You need to give approximate dates and names of those killed if involved in your stressor. We will assist you in research for the pertinent data.
Please understand this is a long claim process. You must notify this office upon receipt of letters or phone calls from the VA. You must keep all mental health appointments.
Every veteran filing a claim through this office is expected to give accurate information. We need facts with no exaggeration. Intentional deceit voids this claim. The veteran will not be mislead and the Veterans Service Officer expects the same in return. In signing this form you agree to the above conditions.
Signature of the veteran__________________________________ date _______________
VSC March 1, 1984
REVISIONS: April 17, 1986, October 25, 2001