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 reexperiencing 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 reexperienced 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 reexperienced. 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 so 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.
Impairment may be mild or affect every aspect of life. Phobic
avoidance of situations or activities that resemble the trauma are common and
often create occupational or recreational impairment. Psychic numbing often
interferes with interpersonal relationships, such as family life. It often leads
to self defeating behavior sometimes including suicide. Substance disorders are
common.
The appearance of apparent psychotic symptoms are interpreted by
many professionals as psychosis; but, are 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
complicates 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.
REVIEW QUESTIONS
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 1940’s. 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, CD’s 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 1950’s
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 don’t 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 Nevill 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 1990’s 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. Clinton’s 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, 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.
REVIEW
QUESTIONS
Please describe how attitudes of the general public affect
VA policies, keeping in mind VA policies are actually a result of congressional
action.
How important do you feel a persons MOS would be in
determining a claim for VA compensation involving PTSD? Why?
SOMETHING'S
WRONG!
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, 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!
It is rare indeed, to
find a Veterans Service Officer who will admit that prejudicial attitude shown
during the 70's; but, we all know it did exist. Today's school teacher may well
be the student of the streets in the 60's. The teacher may teach the facts of
the Vietnam war or the Desert Storm in their opinion, not ours, as she/he sees
it, not as it actually happened. This problem will haunt the PTSD patient for
many years to come. We have watched a decline in Veterans Day celebration
involving children. Few are ever brought to the parades. Few schools have
programs to honor veterans, Most, seem not to want to be involved in the healing
process. The first answer to the dilemma is the healing process. The process
that should have started upon their return, but didn't. The PTSD victim who
becomes a client of the Veterans Service Officer has seen the two faced, double
talking system at work. It now becomes paramount to open an honest line of
discussion. This must be an opportunity for the veteran to tell his story, his
way, his words. The very last thing the veteran needs is someone to tell them to
watch their language or "you must be nice now". We must again be reminded the
problem is not only the Desert Storm, and the Vietnam veteran; but the Korean
conflict veteran, the WWII veteran and some of those in actions in between, now
have PTSD problems.
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 else’s 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.
APPENDIX I 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.
