POST TRAUMATAIC STRESS DISORDER
What Is It?
“I’ve seen bodies ripped to pieces by bullets, blown into millions of scrapes by bombs, and pierced by booby traps. I’ve smelled the stench of bodies burned. I’ve heard the air sound like it was boiling from rounds flying back and forth. I’ve lived an insanity other’s should never have to live”.
- Dennis Tenety, “Fire in the Hole”
Post Traumatic Stress Disorder (PTSD) has been around for a very long time. Military medicine has recognized this condition with a variety of labels. During the Civil War the condition was called “Soldier’s Heart”. By WW-1, it was re-named “Shell Shock, and during WW-II, it was “Battle Fatigue”. Korean War veterans were diagnosed with “War Neurosis”, and “Vietnam Syndrome” for that generation of veterans. The VA was service-connecting former combatants with a “Nervous Condition” or some other type of disorder prior to the advent of PTSD.
Post Traumatic Stress Disorder is a condition recognized by the American Psychiatric Association (APA). Criteria for diagnosing PTSD are published in the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM-iv). PTSD first appeared in this manual, published by the APA in 1980 after significant research studies with Vietnam combat veterans. PTSD may occur after a person has been exposed to a traumatic event in which the person experienced or witnessed an event that involved death, serious injury, or mass destruction. This could include events that occur in war, natural disasters, acts of terrorism, crime or abuse. For veterans, in particular, stressful traumatic events include combat zones, peacekeeping missions, training accidents disasters, medical emergencies, and assaults. These events cause the survivor to react with intense fear, helplessness hopelessness and horror.
Symptoms of PTSD include, but are not limited to:
- Recurrent, intrusive, and distressing thoughts about the event.
- Recurrent dreams, nightmares (sometimes called “night terrors) about the event.
- Flashbacks (a sense of reliving the event).
- Distress caused by reminders of the event (sight, sounds, or smells).
- Alienation, isolation, and avoidance of people and places.
- Emotional numbing.
- No sense of a future.
- Survivor guilt (for having survived when others did not, or for behavior required for survival).
- Difficulty concentrating or remembering.
- Hyper-vigilant or survivalist behavior.
- Exaggerated startled response (usually to loud noises).
These symptoms and emotions may lead to substance abuse or other self-destructive addictive behavior.
Who get’s PTSD?
Anyone can experience PTSD symptoms after being exposed to a traumatic event. PTSD is NOT a sign of weakness or malingering, but rather a very normal reaction to a horrific situation. There is no way to predict who will and who will not develop PTSD symptoms because it depends on how people perceive a situation, and other experiences they have had in the past. Some people may be more affected than others based on their perceptions and learned views of the world. Current research shows that there may also be genetic or biological factors that influence how a person will react to extreme stress.
In the military, there are many dangers that service members are trained to deal with, and usually they are able to function during a traumatic episode. However, when the war is over or the crisis resolved, and troops have deployed home, then psychiatric problems can begin to appear. It is not unusual for problems to appear months or years after the initial trauma. Sometimes symptoms are brought on by experiencing another stressful situation like job or martial problems, or even military retirement.
Often during deployments, the service members families have had to get along without them, so when they come home, they often feel out of place and not needed. Military reunions are glamorized in the media, and although joyous, they can be very stressful. Families are also affected by PTSD. Living with someone who has PTSD symptoms can be stressful. Many spouses of Vietnam veterans have reported feeling as if PTSD is contagious. Children will mimic the behavior and attitudes of their parents.
If PTSD symptoms have led to violence in the home, then another generation of PTSD sufferers have been created. Family counseling is always recommended when a family member has been diagnosed with PTSD. If you are still on active duty, and experiencing domestic violence or child abuse, you should contact the Family Advocacy Program (FAP) for assistance or the Mental Health Clinic.
Do I have PTSD?
A natural first question is whether the symptoms really are due to PTSD. Stress symptoms are not always due to PTSD, and it is helpful to know if they are specifically the result of psychological trauma and if they are the full condition of PTSD. Such symptoms may be due to other conditions created by stressors other than trauma (for example, work or financial pressures), medical problems such as heart conditions or diabetes, or other psychological conditions such as depression or anxiety.
PERSONAL AND SEXUAL TRAUMA’S
For many military women sexual harassment, assault, and rape are the cause of their PTSD. Unfortunately, the number of female veterans reporting these crimes is very high. However, these incidents often go unreported because the women are usually of lower rank than their assailants or are in their chain of command. If they report, they are at risk of being shunned or losing their jobs. There are many other complicating factors that effect military women who have been raped that are different from the Civilian community. Military women are faced with issues of betrayal, role identification (Soldier/Victim) and loyalty to their service after being assaulted. This can be even more difficult if the rape occurred in a combat zone. In response to the needs of victimized sailors, the Navy operates the Sexual Assault Victim Intervention (SAVI) Program. If you are the victim of an assault, rape, domestic violence, mugging, stalking or hate crime, and never reported the crime, the following is alternative evidence you can use to support your claim:
- Private civilian medical records.
- Treatment records for a physical injury for the assault, but not reported as such.
- Civilian police reports.
- Reports from Crisis Centers.
- Private civilian medical records.
- Treatment records for a physical injury for the assault, but not reported as such.
- Civilian police reports.
- Reports from Crisis Centers.
- Testimonial statements from friends (civilian and military) Family, co-workers, clergy.
- Personal diary or journal.
- Requests for changes in military assignment.
- Increase in sick call or leave slips.
- Change in military prescription and over-the-counter meds.
- Substance abuse and/or other compulsive behavior.
- Request for a pregnancy test.
- Request for HIV test or counseling for sexually transmitted disease.
- Counseling Statements in personnel file.
- Breakup of marriage or relationship.
- Photographs.
If you are still on Active Duty **REPORT THE CRIME!!!
HELP ORGANIZATIONS AND HOT LINES
Domestic Violence Hotline 1-800-787-3224
Mental Health
Mental Health Association 1-800-433-5959
National Alliance for the
Mentally Ill-Veterans Network 1-303-241-9426
Social Security 1-800-772-1213
How to file a VA Claim for PTSD
If your PTSD is related to your time in the service, then you might be eligible for a service-connected disability rating from the VA. You should contact the Kings County Veterans Service Office to find out more about your veterans benefits, regardless if you got out of the service years ago or are currently in the process of transitioning. You will need your DD-214, military records, personnel file(201), and any poof of combat awards or other reports that document your trauma (report of a plane crash, ship sinking, explosion, rape or assault, duty on a burn ward or in graves registration, or POW status). If available, your own diary or a witness statement from a friend, roommate or the clergy can be very effective as evidence. You will need to have a VA PTSD assessment screening with a diagnosis for PTSD. There are VA Hospitals, or Vet Clinics with qualified personnel in Fresno who can help you with your PTSD.
What Can be done?
There is help available. Whether you were in the military many years ago or if you are still in uniform, there are trained professionals who understand military trauma and PTSD treatment. The VA has over 170 Vet Centers and Sexual Assault Treatment programs nationwide. The Vet Centers were started for Vietnam veterans, but now offer service to veterans from WW-II, Korea, Panama, Lebanon, Grenada, Persian Gulf, Haiti and Somalia. You can contact your local VA Hospital or Veterans Service Office, to find out what services are available closest to you, and if you are eligible. The Vet Centers offer group therapy, individual counseling, marriage and family counseling.
The VA also has inpatient PTSD programs, residential treatment, and day hospital programs. In addition, the VA has specialized programs for substance abuse, homeless veterans, and women’s coordinators for female veterans. The VA also has inpatient PTSD programs, residential treatment, and day hospital programs. In addition, the VA has specialized programs for substance abuse, homeless veterans, and women’s coordinators for female veterans.
There are also many private clinicians or not-for-profit agencies that offer specialized treatment for PTSD similar to care provided by the VA. There are clinicians-psychiatrists, psychologists, social workers-who are Certified Trauma Specialist (CTS) who are very qualified to treat PTSD. Interview potential therapists to be sure you feel they can help you. Get recommendations from other people, and do not be afraid to “shop around”.
If the symptoms are particularly severe and persistent, medication might be necessary. A psychiatrist should be consulted. You should have a complete exam to be sure there are no other conditions that re contributing to the problem.
Twelve step programs, like Alcoholics Anonymous, can be helpful. These self-help groups offer emotional support. There are meetings held all over, and at various times of day. Many groups are specifically for active duty service members and
There are a variety of military and veteran groups and chat rooms on the Internet. You can access the VA at http://www.va.gov for medical and benefits information.
Substance Abuse
Alcohol Anonymous 1-800-356-9996
National Cocaine Hotline 1-800-262-2463
Drug Abuse Hotline 1-800-662-HELP
Child Abuse/Domestic Violence
Child Protection Hotline 1-800-633-5155
Child Abuse Hotline 1-800-422-4453
Domestic Violence Hotline 1-800-787-3224
Mental Health
Mental Health Association 1-800-433-5959
National Alliance for the
Mentally Ill-Veterans Network 1-303-241-9426
“….the voice I learned to hear in the (Vet) Center whispers. It tells me that I am wrong. It tells me that the cruel equations of weight and temperature and humidity were more powerful than a 19 year olds image of self and Corps. It tells me with logic cool and clear that the memory that will never go away is undeserved punishment, and that in that hour of that day I did the best a man could do and should be proud”
- Ron Zaczek, “Farewell Darkness”
Naval Institute Press
UNDERSTANDING THE VA PTSD RATING SCHEDULE
If you are going to file a claim for VA compensation for PTSD, you should understand the way the VA rating schedule works. PTSD (Code 9411) is classified as a Psychoneurotic Disorder in the Code of Federal Regulations (CFR) 38, SECTION 4.130, 4.131, AND 4.132. If service connection is granted, you will be assigned a percentage of disability ranging from 0% to 100%. If you are already service connected for another condition, then your new rating will be combined, not added, with the previous rating. Additional Compensation may be provided for dependents, so be prepared to submit marriage and birth certificates of dependents. If you disagree with your rating you can appeal your case through the Board of Veterans Appeals and ultimately the Court of Veterans Appeals. You should do this only as a last resort and with the help of your local Veterans Service Office.
38 CRF General Rating Formula for Psychoneurotic Disorders!!!!
100% -- The attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community. Totally incapacitating psychoneurotic, symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment
75% -- Ability to establish and maintain effective and favorable relationship with people is severely impaired. The psychoneurotic symptoms are of such severity and
50% -- Ability to establish or maintain effective or favorable relationships with people is considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment.
30% -- Definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency, and reliability levels as to produce definite industrial impairment.
10% -- Less than the criteria for the 30%, with emotional tensions or other evidence of anxiety productive of mild social and industrial impairment.
0% -- There is neurotic symptoms that may somewhat affect relationships with others, but which does not cause impairment of working ability.'
If you are a COMBAT veteran, and received any of the following individual decorations you can submit them as evidence of a stressful event:
- Medal of Honor
- Distinguished Service Cross
- Navy Cross
- Air Force Cross
- Silver Star
- Bronze Star
- Distinguished Flying Cross
- Air Medal with “V” Device
- Purple Heart
- Joint Service Commendation Medal with “V” Device
- Army Commendation Medal with “V” Device
- Navy Commendation Medal with “V” Device
- Air Force Commendation Medal with “V” Device
- Combat Action Ribbon (car)
- Combat Infantryman Badge (CIB)
- Navy Expeditionary Medal
- Marine Corps Expeditionary Medal
- Parachutist Badge with Bronze Service Star
Fresno Veterans Clinic
3636 North 1st Street
Suite 112
Fresno, CA 93726
(559) 487-5660 Office - Chris
(559) 487-5399 Fax |
“Veterans who think that they may qualify for PTSD should contact the Kings County Veterans Service Office so that a PTSD screening with the Veterans Clinic can be scheduled. If you wish to schedule your self please contact Chris at the Veterans Clinic in Fresno for an appointment”.
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