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Understanding PTSD after the event and daily Triggers!
By David Barker
Department of Ohio 2002
Many people (more than one would think) will 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 or she knows what will happen, another rejection, loss, but he cannot help it, the inner control is not his, it belongs to stress. More specifically, 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 or she does not actually make new friends, as the trust is gone. Where can the veteran turn? To the VA? A part (in his or her mind) of the system? He or she 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 the VA Medical Center, its Post Traumatic Stress Disorder Clinical Team, or the VA Outpatient Clinic that will afford the veteran the opportunity to receive therapy to overcome their stress.
The Vet Center(s) offer help, and valuable counsel is available to the veteran at no cost. When many of the veterans were separated from active duty, 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 organizations, 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." Many of the violators were Vietnam Veterans. Still in the year 2002 there are veterans who only recognize those who went “across the pond” as their peer. How tragic, that some must place themselves in a vacuum.
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 has been long and slow in answering the needs of the veteran; but, as a result of legislation passed in Congress, help is now available to most.
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 they see 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 their story, their way, their words. The very last thing a 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 Vietnam veteran; but the Korean conflict veteran, the WWII veteran and many 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. It is a well known fact that many women were sexually traumatize before WWII and thereafter and the issue was swept under the carpet. Today's woman is not going to allow that to exist again. During the mid 1980's to the present I have represent several women veterans who had legitimate stressors regarding sexual trauma. The cases have been unusually difficult to prove. However it can and must be done. It seems as if the incidents are not recorded by the perpetrator; but the victim often has needed records to prove the stressor. If she does not have documentation the case becomes exceedingly difficult. We must contact comrades who would know of the issues and obtain verification.
It is important also to remember that males were also sexually assaulted. Their situations are no less stressful than those of females. Men have a tendency to hide those issues from everyone including themselves. 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, a violent incident 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 to themselves (or a close relative or comrade) 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, or sexually assaulted or being in a fire or accident.
Often veterans 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. The examiner does the examination sometimes in less than ten minutes. The entire future of the veteran, who already has a great distrust of the system, is in ten minutes, diagnosed by a person who has previously not 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, Administrative Remarks page 13 and/or Officer Data Card; Air Force, AF form 7, Officer AF 11, with performance reports; Marines, NAVMC 118 (3) (9); Coast Guard, Endorsement on Order Sheet. These records will not show rape, accidents or earthquakes. They may show indicators of combat, possibly major fires and possible, but rarely aircraft crashes.
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.
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