A Military Veterans Guide To Disability Compensation and Pension Benefits - Conditions - PTSD

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Post-Traumatic Stress Disorder (PTSD)

History

It's likely that PTSD has been an outcome of human warfare since the first man made a decision to fight with another man.

Throughout the history of what is called PTSD today, the underlying cause and symptoms have remained largely unchanged. The names and treatments have often shifted to reflect the times.

Reading a 2005 USMC pamphlet tells us that Adverse Combat/Operational Stress Reactions "will usually get better with sleep, rest and replenishment and talking with someone you trust". Other disorders similar to what we term PTSD today were Railway Spine, Combat Stress Reaction, Traumatic Hysteria, Soldier's Heart, Battle Fatigue and Shell Shock.

United States Army - Let There Be Light
AVA04168VNB! - PMF 5019 - 1946

About 20% of all battle casualties in the American Army during World War II were of a neuropsychiatric nature.

The special treatment methods shown in this film, such as hypnosis and narcosynthesis, have been particularly successful in acute cases, such as battle neurosis. Equal success is not to be expected when dealing with peacetime neuroses which are usually of a chronic nature.

No scenes were staged. The cameras merely recorded what took place in an Army Hospital.
This movie is part of the collection: FedFlix
Much of the filming was shot at Edgewood State Hospital, Deer Park, Long Island, New York.
Producer: U.S. Army - Written and Directed by John Huston 1946
Audio/Visual: sound, color
Language: English
Keywords: FedFlix; ntis.gov
Creative Commons license: Public Domain

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No matter the name that hangs on the condition, humans are often adversely affected by trauma whether they participate in combat, witness the event of another's death in a personal way or suffer the indignities of personal physical assault.

Americans and the United States government have a history of denying that there are lasting scars from combat and other intense episodes of military service. As far back as 1946 the federal government was attempting to provide a view of what happened to soldiers that would shine a more positive light on the success of treatments aimed at returning war ravaged psyches back to a more normal civilian life.

One such effort was the film directed by the legendary John Huston while he served in the Signal Corps. That film, Let There be Light, was made at the War department's psychiatric hospital on Long Island, New York. Patients at Mason General Hospital were filmed as they returned from war, shell shocked, often unable to speak coherently and in obvious distress.

The film was apparently considered too controversial to release (The official reason given was to protect patient privacy) and was archived and relegated to secrecy until 1981.

One review of the film states, "Unlike fictional Vietnam veterans, the G.I.s of World War II were rarely shown to be anything less than psychologically fit. This celebrated and heartrending documentary vividly shows how not all World War II vets remained untouched by their combat experiences. In fact, the viewer is informed at the outset that "about 20 percent of all battle casualties in the American Army during World War II were of a neuropsychiatric nature."

It appears that the reality of war hasn't changed even as the label for the psychological trauma of battle has.

The Examinations of PTSD

When a veteran applies for a VA disability compensation rating and claims that PTSD is the condition, the burden of proof on the veteran is seemingly more onerous than with a physical condition.

As defined by the National Institute of Mental Health, Post Traumatic Stress Disorder is, "an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened."  The NIMH statement furthers declares that; "Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat."

The Veterans Benefits Administration instructs its employees that in addition to combat related PTSD, a veteran may suffer PTSD from events unrelated to combat.

In the M21-1MR  instructions under the heading of Mental Disorders we note that;

Potential non-combat-related stressors include, but are not limited to

• plane crash

• ship sinking

• explosion

• rape or assault

• duty

• on a burn ward

• in graves registration unit, or

• involving liberation of internment camps

• witnessing the death, injury, or threat to the physical being of another person not caused by the enemy

• actual or threatened death or serious injury, or other threat to one’s physical being, not caused by the enemy.

Applying for a physical disability condition is often clear cut. An event occurs, a bone is broken, x-rays are taken, medical and surgical treatments are performed and the disability is measured by the residual physical effects of all that.

The veteran and the examiner are confronted with a dizzying array of required documents, psychological testing and interviews from the outset.

The Initial Evaluation For PTSD seems written to intimidate the examiner; "NOTE: Service connection for post-traumatic stress disorder (PTSD) requires medical evidence establishing a diagnosis of the condition that conforms to the diagnostic criteria of DSM-IV, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. It is the responsibility of the examiner to indicate the traumatic stressor leading to PTSD, if he or she makes the diagnosis of PTSD."

The examiner must specifically address 11 points of pre-military history, 14 points of military history and 15 points of post military history. While reviewing all of the above the examiner is invited to use the CAPS trauma assessment (30 items) and the social-industrial survey for reference to ensure that it will all conform to the diagnostic criteria of DSM-IV.

Therapy

Here's a link to an outstanding knol by Ilona Meagher Her Combat PTSD (Post-Traumatic Stress Disorder) - An overview of the prevalent psychological injury of war is a must-read for any veteran or professional with an interest in PTSD.

PTSD - Veterans, Family and Friends

Rhonda Walsh

04/10/2008

My work is dedicated to the families desperately looking for answers, and assistance for their loved one who has now come home from combat with symptoms of PTSD.

He or she may not trust the VA, and refuse treatment there. They may be in denial that there is anything different about them. There may be withdrawal from everyday life, and reluctance to go outside, or return to work. Whether or not he/she had been involved with “action” is of no consequence. PTSD is about feelings, and coping with a traumatic situation that requires constant hyper vigilance (on guard behavior) of which there is never any let up of this need. They must prepare for the event that they could be in the middle of action at any moment without any advance warning. This hyper vigilance may become ingrained in them when they come home. They may exhibit behaviors such as locking down the house, and being the last one to retire to bed, walking the perimeter of the house, and other behaviors similar to keeping them safe. This is normal. They are trying to protect you, and are still in that hyper vigilant state of mind.

Every person handles situations a little differently; however, the feelings are the same. The people that we love are in a foreign country, they do not have a “safe” place like they have at home to go when they are upset. At home, they can go out for a drive, or to the pub, or where they are known. In combat/conflicts/war/peacekeeping or whatever “the government” is calling what your son/daughter/husband/wife, mom or dad’s jobs are during their service to the country the situation is the same: they are in a fox-hole, or a base-camp, or a fire station, they are also far away from home, and the chance for any peace of mind is slim. If they do have any down time they use it to sleep. Most of their days are filled with the constant state of alertness and readiness just in case something happens, and so when they do have a minute to rest, they sleep. Some sleep standing up, because they are so fatigued from that constant on guard awareness. This is how PTSD is formed over time.

When your loved one comes home he or she may self-medicate to try and stuff their feelings. This is a symptom of PTSD. This is normal. It is still a big red flag that they need help. They may resist, and they may deny that they need this help. They may also be suicidal. They may feel guilty that they survived, and their friend/s did not. The best thing that people who love this veteran can do is to first learn everything that is out in print about this illness. The book I recommend is: Matsakis (1998) Trust After Trauma A Guide to Relationships for Survivors and Those Who Love them, Oakland, CA: New Harbinger Publications. This book is a must have for survivors of any kind of trauma, and those that love them. Through education, and through your dedication to attending support meetings for PTSD, the loved one can grow, and flourish, and become better than the person who they were before they went away to serve.

My mentor, Dr. Robert Fournier, Suicidologist, and PTSD Specialist, Hyannis Massachusetts VA Primary Care Clinic, began the pilot program for wives of combat veterans, and he gave me the following list at one of my first support meetings. Some do’s and don’ts:

1. Don’t tell the trauma survivor to “let go,” or “forget the past,” or “get a life” or “get over it.”

2. Don’t call the trauma survivor a “cry baby,” a “psycho case,” “a sicko” or a “whiner”

3. Don’t blame relationship problems on the trauma or traumatic reactions. For example, don’t say, “We can’t have a good relationship because you have all these triggers,” or “You and your damned war history,” or “I can never have fun with you because you freak out all the time.”

4. Don’t interpret emotional coolness on the part of your trauma survivor as a sign of disinterest.

5. Don’t expect your trauma survivor to respond to a death or illness in the family or another important loss as others do.

6. Don’t press the trauma survivor for details of the trauma or for details of his or her therapy. Respect the trauma survivor’s need not to disclose certain aspects of his or her past and his/her treatment.

7. Don’t press the trauma survivor to solve a problem or do something if she/he clearly indicated that she/he has reached her or his limit and feels like exploding or is starting to shut down.

8. Don’t tolerate emotional, physical, or sexual abuse of yourself or others.

9. Don’t try to be your survivor’s therapist or magic rescuer. You can be supportive without making your survivor your “project” or your entire life.

10. Expect that there will be times the survivor doesn’t trust you and needs to be distant from you.

11. Don’t mock him or her for his or her symptoms.

12. Develop a support group for yourself.

13. Work together with the trauma survivor to create a plan for handling predictable difficult times, such as anniversary dates of the trauma.

14. work together with the trauma survivor for an “emergency plan” for unpredictable times when the survivor may feel out of control, extremely depressed, or about to relapse into addiction. This emergency plan should include the names and phone numbers of doctors, therapist, hospital, friends and family members.

15. Know the signs of impending suicide and take immediate action.

16. Find a balance between taking care of yourself and the needs of your trauma survivor.

17. Be honest with yourself and the trauma survivor.

There is hope of successful adaptation after traumatic life events, according to Dr. Bob. He states, “In order to adapt successfully in life after traumatic life event, a person must accomplish three significant life tasks or “steps” (Fournier, 2002). The steps are stabilization, restoring control, and establishing a safe environment. First one must get off drugs and alcohol, and begin to heal the body to become stable. They must also regain control to maintain this sobriety by either attending AA, or some form of therapy. Finally, the safe environment means that the people that are in the circle of friends are also maintaining sobriety and following the do’s and don’ts list above.

Dr. Bob also says that the veterans must retell their story. They must either write the events in a ledger, or somehow face what happened to them. Then they must go through the process of “mourning” for that loss of their time, and what happened to them. Grieving is an important step toward recovery. This work is almost never constructed alone. One must have a support group, and an education group to understand what happened to them, and how to go through the steps toward reintegration.

There is so much more that I want to tell all of you seeking the answers for your veterans, and I would welcome a format where questions could be asked by email.

Yours in recovery, Rhonda E. Walsh rwalsh33@gmail.com


WORK IN PROGRESS

VBA M21-1MR http://www.warms.vba.va.gov/admin21/m21_1/mr/part4/subptii/ch01/ch01_secd.doc


Through the story of Herold Noel, a homeless Iraq war veteran suffering from Post Traumatic Stress Disorder, this touching film reveals a systematic breakdown of the way veterans are treated in the US.
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