Mentioning war can be activating to our veterans and service members, please read with caution.
In 2008, I began providing compensation and pension examinations in psychology as a contracted provider. As a practitioner with 25 years of experience understanding PTSD, I wanted to be available for combat veterans from Iraq and Afghanistan to have a reasonable C & P examination and get access to healthcare for PTS recovery as needed. For five years, I waited for OIF/OEF combat veterans to show up for examinations. A few showed up, but not many. Stigma was a huge barrier.
In 2013, OIF veterans began to report PTS symptoms associated with their combat deployment in 2003. They had landed in Kuwait or Bahrain and marched into Iraq from the south and west. They encountered resistance from enemy combatants. Artillery was used to clear their path. Artillery does not discriminate between combatants and civilians, so they witnessed atrocities of warzone explosions that decimated the bodies of any Iraqi within range. The roads were littered with blown out vehicles and horrifying casualties. Vivid moments in time frozen in time continued to haunt them since their deployments. Their sleep patterns were fixed, 4-6 hours max per night for a decade. Their relationships and employment had been affected by PTS symptoms for over 10 years. They never talked about it. It was only the beginning of 20 years of warzone exposures for our troops..
I saw this pattern for the next 10 years.
Combat veterans worked with their PTS symptoms for 10 years post deployment, and then knew they were fighting an internal battle without vital skills to win. In almost every situation, a spouse or fellow veteran convinced them that PTSD was a real problem. In 2014, I heard stories about the first battle of Fallujah, fought in 2004. In 2015, it was the second battle of Fallujah fought in 2005. In 2016, the warzone theater was Ramadhi or Basrah in Iraq, Kandahar and Mazar-i-Sharif in Afghanistan, and so on, until I examined some service members who were present for the pull out from Afghanistan in 2021.
Reviewing records is a key feature in establishing a military injury, but I found little to nothing in their military medical records about PTS symptoms. If they were troubled by the war, they didn’t consult with behavioral health during service. To do so would have exposed them to ridicule. They felt their PTS response to war was a sign of weakness. If they consulted regarding sleep disturbance, that was the only thing noted in the record. If they reported nightmares, they were diagnosed with Nightmare disorder. If there was marital conflict, they were diagnosed with Partner-relational problem. If they drank alcohol to cope with PTS symptoms, they were referred to alcohol cessation programs. If they were diagnosed with PTSD, they were likely placed on a medical board to evaluate whether they were fit for duty. If they reported what was really happening to them, they could lose their enlistment or commission. They could be discharged.
Perhaps in response to this significant barrier to reporting PTSD, the VA initiated an evidentiary standard for PTSD claims on July 12, 2010, referred to as the fear easing standard. The prior standard necessitated evidence of diagnosis with PTSD prior to being examined for compensation and pension. In fact, for claims for injuries sustained during service, there has to be evidence of those injuries in the military medical record. This fear easing standard provides that NO evidence is required in the military medical record for PTSD due to exposure to hostile military activity. During a VA examination, if the examiner finds symptoms warranting diagnosis with PTSD due to combat exposure, VA authorized the following forensic statement regarding causation of combat related PTSD:
While there is no record of treatment for or diagnosis of PTSD during service, the Veteran is a combat veteran.
Therefore, the Veteran’s statement that his or her disability was incurred in or aggravated by combat is accepted as sufficient proof as it is consistent with the circumstances, conditions or hardships of combat service even though there is no official record of such incurrence or aggravation in the veteran’s service treatment records. The Veteran’s current disability is at least as likely as not consistent with the circumstances, conditions or hardships, of his or her military service.
ASK .. TELL .. PTSD does NOT make you unfit for war. Combat-related PTSD makes it challenging to live outside the warzone. Coming home from war requires detoxing from violent warzone exposures. It’s not easy but it’s doable. You’re going to need a buddy and some new skills to get through to the other side.