Post Traumatic Stress Disorder can happen to normal people who have witnessed a traumatic event. Military training does not cause a person to be immune from trauma. War, by its very nature is a series of traumatic events.

Problem: Military men and women who are in active combat do have mental health clinics available to deal with trauma while “in theater”, however they are often discouraged to use these facilities because it could:

a) look bad on their personal military record, or

b) if they are determined to be suffering from a mental health issue, it could be reason to start orders to separate (in civilian words, or fire) the soldier. This means that all income would end (just like getting fired in the civilian world).

Possible Solutions: 1) Require all military members who have witnessed traumatic Solutions: events to debrief with appropriate onsite (in theater) Critical Incident Stress Debriefing (CISD) for which there are many models available (used by police and fire departments, FBI, etc. to debrief after traumatic events) that are off the record.

2) Provide and Assign a CISD case manager who will serve along side the chaplain to review level of trauma reported and suggestions for soldiers off the record onsite (in theater).

3) For soldiers who show significant signs of PTSD and who voluntarily accept intervention as determined by a CISD case manager and/or chaplain, provide off the record intervention with pay, onsite (in theater) that may defuse the trauma enough to remain in theater and not interrupt pay or military status (for up to two weeks).

4) For soldiers who show significant signs of PTSD and who are unable to return to active duty, provide a transition plan that will allow for immediate intervention stateside with pay until disability status is determined.

Currently, 1/3 of the veterans returning from current conflicts are suffering from some form of mental health disorders. Left untreated, the long-term effects include:

  • Increased relationship problems and divorce
  • Increased violence in the home, thus a legacy of intergenerational violence and abuse.
  • ¼ of currently incarcerated individuals are veterans
  • ¼ of current homeless people are veterans
  • More Vietnam Veterans have died from suicide than the 55,000 killed in the war.

The VA System – Opportunities for Improvement

As with most large bureaucracies, 90% of the challenges are process problems and not people problems. The VA Medical and Benefits programs are full of wonderful, qualified, caring people, but many of the processes have opportunities for improvement that will honor the injured veteran and family in more efficient and less stressful ways.

1) Registration for VA Medical Benefits

Many people, even veterans, assume that VA Medical Benefits and Care are automatically in place upon return home from active duty. This is not the case. Each veteran must physically enter a VA Medical Center in person and complete an intake before he/she is registered. Additionally, National Guard and Reserve military who have served in active duty have limited time lines for registry and benefits.

Often, a returning veteran with symptoms of PTSD may find a VA facility as a trigger (without even knowing that is what is happening) and have an aversion to going to a facility.

Opportunity for Improvement: Mandatory, immediate and automatic registry for VA Medical Benefits that every veteran that returns home from active duty.

2) VA Medical Facilities Environment

Veterans with PTSD are triggered by environments that seem incidental or go unnoticed by civilians such as soldiers walking around in uniform, magazine articles laying around with articles about the war, televisions playing with news about the war, and crowded spaces.

Opportunity for Improvement: Physical environments that are less stressful and that replicate civilian medical facilities in terms of crowd and noise level and are inviting and safe in contrast to feeling threatening and unsafe.

3) VA Medical Facilities Operations

Many people think that the VA Medical facilities have assigned physicians and run just like the civilian sector medical facilities. This is not the case. Physicians are ever changing and the continuity, consistency and personal attention required for trust reduce confidence level and trust.

In addition, veterans do not make appointments for return medical treatment. They are assigned appointments often through automated systems. Often appointment letters are received and the veteran does not know what it is for, and has to schedule their time when the appointment is available.

Finally, while VA Medical centers do disperse medications for veterans, many medications are not approved. If a veteran needs a certain medication that is not on the approved list, they may be able to get it, but must go through a lot of effort to obtain it.

Opportunity for Improvement: Immediately assign every veteran to a case manager/social worker who will be the personal contact for the veteran and with whom all appointments and treatment plans can be discussed. Case Managers/Social workers could be the “conduit” for establishing consistent, continuous and personal care, even if physicians, etc. are changed. Broaden the medications available to be equal to civilian health care plans.

4) Filing for VA Disability Claims

The most recent Government Accountability Office VA Disability Benefits report indicated that the average claim is taking 127 days (2006), 16 days more than at the end of FY 2003. It is common knowledge that most VA Disability Claims are denied on the first filing. It takes an average of 657 days (2006) to file an appeal. If the veteran does not get rated during the first claim and then is rated in the appeal, this is 784 days or over 2 years to begin to receive financial assistance.

Veterans who are sick are separated (fired) from the military. When they are separated, they no longer receive income. Potentially, a sick veteran could not receive any income for over 2 years and that is IF the veteran is capable of filing the complex paperwork and following through with it. Many, many sick veterans are not able to understand or complete the lengthy process of filing for disability. It is often thought that the high numbers of homeless and incarcerated veterans are by products of this cumbersome and untimely system.

Opportunity for Improvement: Assign every veteran a benefits case manager/social worker immediately upon return from duty. The case manager/social worker would be responsible for helping veterans initiate everything from education benefits to disability benefits. A “VA Benefits” laminated card could be given to every returning veteran with his or her pre-registered medical benefits information and benefits information (case managers and phone numbers) before returning to civilian status.


We learn something from every war. From WW2, we learned about shell shock that was later named PTSD. From the Vietnam War, we learned that veterans needed each other as support systems to deal with the aftermath of trauma and the Vet Centers were born. From the Gulf War, we learned than no matter how long a war lasts, there are casualties from emotional, physical and biological contaminants that affect the veterans and their families for a lifetime.

It is our hope, that the legacy of OEF/OIF is one that recognizes the need for traumatic intervention in theater and the need for creating new and more personal and efficient processes for the VA Medical and Benefits branches.

With growing mental health statistics, homelessness, incarceration and the financial impact to the veterans, their families and our country, we can’t afford not to change.

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