Our Lives With Post Traumatic Stress Disorder and Traumatic Brain Injury

TBI

Memory Issues Related to PTSD

Brain There have been many studies related to memory issues related to Post Traumatic Stress Disorder. This particular study, a literature review by Kirstin W. Samuelson entitled: “Post-traumatic stress disorder and declarative memory functioning: a review” looks at the association between “everyday memory problems with emotionally neutral material”.

Studies have shown that many PTSD patients complain of memory problems, aside from those symptoms that are part of the diagnostic criteria (intrusive thoughts, difficulty remembering parts of the trauma, etc.). This study focuses on declarative memory – that is memories that can be consciously recalled, like facts and knowledge. This type of memory can be broken down into two aspects: semantic memory which stores factual information and episodic memory which includes specific personal experiences.

The author notes “It should be emphasized that overall, decrements in memory performance due to PTSD are subtle, […] still, the findings are clinically meaningful when they represent a change in functioning before and after trauma”. She goes on to say that “the pattern of memory deficits reveal that PTSD most significantly impacts the initial acquisition and learning phases of memory, as opposed to the retention phase”.

In plain English this is a great big “duh!” to those of us with PTSD. We deal with this every day. We forget the simple things, we give up on school because learning seems so much harder than it used to be before…before our world changed. Things that once seemed a piece of cake are now complicated and hard to remember.


A New ‘Leash’ on Life for the Invisible Wounds of War

In a nation who has been at war for more than a decade, the rate of service members diagnosed with Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), and the frequency of suicide, has radically risen. The backlog of veterans waiting to receive benefits has also dramatically increased. This is leading to longer waiting times for diagnosis and treatment. To date, no authority seems able to find a viable and expedient solution to any of these problems. Yet, nationwide, some veterans are finding a solution. They have discovered the healing power of a service dog. While this is not a cure for PTSD or TBI, it is extremely beneficial to those who have chosen to utilize this tool in their recovery.

september-11th-photoSince the attacks on the World Trade Center and the Pentagon on September 11th, 2001, the United States has been at war. To date, approximately 1.64 million (Rand) U.S. service members have deployed in support of Operations Enduring Freedom (OEF, Afghanistan) and Iraqi Freedom (OIF, Iraq), many have deployed multiple times. Of the nearly 60,000 U.S. casualties, 6,778 have lost their lives (iCasualties.org).  This means approximately 50,000 have returned home with injuries from minor to catastrophic. Many of these casualties would not have survived in previous wars but thanks to better protective equipment, medical advances, and the ability to rapidly evacuate the injured to medical facilities both in country as well as in Europe and the United States, service members are routinely surviving wounds that would have formerly been fatal. This decrease in fatalities is leading to an increase in veterans returning with traumatic amputations of one or more limbs, TBI’s, and PTSD seeking compensation and treatment through the Veterans Administration.

PTSD and Traumatic Brain Injury (TBI) have been called the signature wound of the War on Terror. “Although these invisible wounds would appear less severe than the amputations inflicted by the IEDs, they affect many more service members and can have as much impact on the casualty’s future as the loss of limbs” (Kreisher). According to a recent report, nearly 30% of OEF and OIF veterans are being diagnosed with PTSD (Reno). Compare this number to The National Center for PTSD which has “estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%” (Gradus). Part of this massive difference is likely due in part to many service members serving multiple combat tours in their careers.

PTSD is a condition that has been around since the invention of war. It has been called many names: Nostalgia, Homesickness, Soldier’s Heart, Neurasthenia, Shell Shock, Combat Stress, and finally in 1980 the American Psychiatric Association called it Post-Traumatic Stress Disorder and added it to the Diagnostic and Statistical Manual of Mental Disorders. PTSD is comprised of a set of symptoms which include re-experiencing the traumatic event, avoiding places, events, or objects that remind one of the trauma, and hyperarousal. Most people feel many of the symptoms of PTSD after a traumatic event, but those symptoms fade with time. To be diagnosed with PTSD, the symptoms must last longer than 6 months.

PTSD can be extremely debilitating, leaving veterans homebound and isolated, suffering from co-occurring mental health issues and symptomsaddictions (generally caused by self-medicating their symptoms). Add to these issues a Traumatic Brain Injury and you have a recipe for disaster. TBI’s can range from mild to severe, even resulting in death. The symptoms include loss of consciousness, memory or concentration problems, headache, dizziness, sensory problems, fatigue, convulsions, and emotional disturbances.  “According to a Rand study, about 19 percent of troops surveyed report a probable TBI during deployment” (Williamson). Many symptoms of PTSD and TBI mimic each other, making definitive diagnosis difficult for some patients. How much of the patients symptoms are related to PTSD and how much to TBI? Patients and doctors are often left in a guessing game as to whether the symptoms require therapy, medication, or both.

The great influx of veterans returning home from the current conflicts has caused a massive backlog for the Veterans Administration. Currently, “401,000 claims remain officially backlogged, meaning the applicants have been waiting at least four months” (Glantz). Many of these are waiting a year or more for appeals related to service connected disabilities. This means veterans, who are too injured to continue their military service and unable to achieve successful and meaningful employment in the civilian work force are waiting for their disability compensation for a year or more, putting them and their families in financial peril. The stress of dealing with gathering the enormous amount of information required to fill the claim, the aggravation of having your claim misplaced, delayed, or denied only adds to the problems already being endured by the veteran.

The stress of dealing with PTSD and fighting the VA’s red tape backlog is lending itself to the suicide epidemic plaguing our veterans. Senator Bernie Sanders said, “Without being overly dramatic, let me state that we are losing 22 veterans every day from suicide. This is a tragedy that we must address. I know that no one in the VA, no one on this committee, wants to add to that tragedy, because of unnecessary delays that could extenuate the problems that veterans express” (Johnson). In 2012, the suicide rate of active duty personnel outpaced combat fatalities. “Access to care appears to be a key factor, […] once a veteran is inside the VA care program, screening programs are in place to identify those with problems and special efforts are made to track those considered at high risk” (Maze). The veteran suicide rates are outpacing that of the civilian population. In reports from 48 states, the suicide rate among veterans is 30:100,000 compared to civilian rates of 14:100,000. This is more than twice the rate of the average American citizen and is increasing at double the rate (Hargarten). Traumatic Brain Injuries can increase the propensity toward suicide, as can the overwhelming symptoms of Post-Traumatic Stress Disorder. According to Hargarten, “concussions also are a chronic risk factor leading to suicidal thoughts, […] because head trauma makes people more vulnerable to suicidal thoughts” (Hargarten).

Over the years, countless studies have been published promoting the health benefits of owning a pet. Pets can, lower blood pressure, encourage exercise and socialization, improve mood and reduce stress. Is it any wonder they are being trained to assist disabled veterans struggling with the effects of PTSD and TBI?  Training dogs to assist with disabilities is not a new concept. Most people are quite familiar with service dogs for blind or wheelchair bound individuals. However, those with invisible disabilities can also benefit from a service dog.

Psychiatric Service Dogs can be trained to assist their handlers in many ways. They can be trained to retrieve assistance during a disabling episode, either a nearby person or by using a special K-9 rescue phone to dial 911. They can be trained to answer the door and lead first responders to their handler. They can provide balance during episodes that potentially cause dizziness and help their handlers up off the floor. These dogs can be trained to alert to increasing anxiety levels so their handler can more effectively handle the symptoms before they become overwhelming and disabling. They can pull their handlers from dissociative episodes, or flashbacks, wake their handlers from nightmares, provide deep pressure therapy during panic attacks, and give their handlers a sense of ‘crowd control’. In short, these animals are giving back to veterans something they lost when they left the service…a battle buddy – someone who has their back twenty-four hours a day.

The legal definition of a service dog, according to the Americans with Disabilities Act, is a dog that is “individually trained to do work or perform tasks for people with disabilities” (ADA). These dogs and their handlers are granted public access by federal law, meaning they must be allowed wherever the handler would normally be allowed without the presence of their dog. There are some restrictions such as sterile environments, such as operating rooms or burn units, and private property. They are allowed in stores, restaurants, hospitals, and anywhere else the general public goes. This protection enables veterans who had previously been home bound to return to the world without the crushing effects of PTSD plaguing their every movement.

Jason axle 2United States Marine Corps Captain Jason Haag, credits his service dog Axel with saving his life. “I’ve led 150 Marines into combat three times. I couldn’t walk out of my […] house to buy a pack of gum. I couldn’t go to sleep without a gun underneath my pillow. That’s how bad my PTSD was” (HLN). Captain Haag states that after returning from Afghanistan he began drinking heavily, having angry outbursts at his family, unable to leave his basement and on 32 different medications. “Axel hit the reset button for me” (HLN). Since graduating from K9s for Warriors more than a year ago, Captain Haag has radically decreased his medications – to 2 per day, he now regularly participates in family activities, and has even been to Capitol Hill, advocating for service dogs for veterans with PTSD (Haag).

Captain Haag’s story is not an anomaly. Most graduates have returned to a new ‘normal’ of doing the everyday things that most take for granted, such as walking through the grocery store or visiting their children’s school.

K9s for Warriors is just one of many non-profit organizations who are training service dogs for veterans with PTSD and TBI. These organizations train and place service dogs with disabled veterans, often at little to no cost. They are filling a gap left by the Veterans Administration, when they discontinued a congressionally mandated study on the efficacy of service dogs for veterans with PTSD.

There is still reason for optimism, though. Two bills have been introduced into the House of Representatives this year with the intent of expanding the availability of service dogs for disabled veterans.  H.R. 183 – “Veterans Dog Training Therapy Act”, introduced on January 4th, 2013 directs the VA to begin a pilot program to research the efficacy of service dog training and handling in the treatment of PTSD. H.R. 2847 – “Wounded Warrior Service Dog Act” would direct the “Department of Defense and the Veterans Affairs to jointly establish the K-9s Companion Corps program for the awarding of grants to assist nonprofit organizations in establishing, planning, designing and/or operating programs to provide assistance dogs” (govtrack.us). Should these bills pass, perhaps in time the studies will confirm what those veterans who already have service dogs know.

According to Sandi Capra, the Director of Development for K9s for Warriors, of their more than 100 graduated teams, 92% of graduates had reduced or eliminated their need for medications, and 94% have reported reduced symptoms of PTSD (according to the Harvard PTSD standards). At one year from graduation, 95% of teams recertify successfully. These achievements are not an isolated occurrence. A simple online search of service dogs for PTSD returns more than 286,000 results. You will find countless news stories about homegrown veterans reclaiming their lives thanks to their new ‘battle-buddy’, veterans attesting to the lifesaving partnerships they’ve found in a service dog and web pages for scores of organizations who train these dogs for our disabled veterans.

These stories are not the ‘too good to be true’ paid endorsements for the latest fly-by-night “cure” for PTSD. They are not random coincidences. They are the stories of recovery from a devastating and debilitating invisible injury. These dogs are not a cure. They are a tool in their handler’s arsenal for coping with and overcoming some of the obstacles associated with PTSD and TBI. There is a reason they are referred to as “man’s best friend”. They are the heroes on four legs and they are giving a new ‘leash’ on life to veterans who suffer from the invisible wounds of war.

Works Cited

Capra, Sandi. K9s for Warriors. Director of Development. Personal interview. 13 November 2013

Glantz, Aaron. “Overtime, New Computer System Put Sizable Dent in VA Benefits Backlog”. The Center for Investigative Reporting. 11 November 2013. Web.

Gradus, Jaimie L., “Epidemiology of PTSD.” National Center for PTSD. n.d. Web. 24 November 2013.

Haag, Jason. Personal Interview. 13 November 2013.

Hargarten, Jeff, et.al. “Suicide Rate for Veterans Far Exceeds That of Civilian Population”. Center for Public Integrity. Web. 30 August 2013.

“HLN Stories of Courage – K9s for Warriors”. Headline News. Television. 11 November 2013.

iCasualties.org, Coalition Casualties by Year, n.d. Web. 24 November 2013

Johnson, Bridget. “Sanders: VA’s Massive Claims Backlog Could be Contributing to Vet Suicides”. PJ Tatler. PJ Media. Web. 13 March 2013.

Kreisher, Otto. “Biding the ‘Invisible Wounds’.” Brainlinemilitary Brainline.org. n.d. Web. 24 November 2013.

Maze, Rick. “18 Veterans commit suicide each day” Army Times. Web. 22 April 2010.

Reno, Jamie. “Nearly 30% of Vets Treated by V.A. Have PTSD.” The Daily Beast Presents: The Hero Project. The Daily Beast. 10 October 2013. Web. 24 November 2013.

“Service Dogs.” ADA.gov. Web. 12 July 2011

Williamson, Vanessa and Mulhall, Erin. “Invisible Wounds – Psychological and Neurological Injuries Confront a New Generation of Veterans”. Iraq and Afghanistan Veterans of America. Issue Report, January 2009. Web.


Battle PSTD, Not Each Other

In the PTSD community there seems to be a discord between those who’s PTSD was caused by combat action and those who saw no direct enemy action but were deployed and lastly, those with PTSD who never deployed. It is a longstanding view in the military that those who have never deployed are somehow less of a soldier than those who have and that lends greatly to this problem, but what about the group who has deployed but never once had to fire their weapon?

I will readily admit that I am a part of the second group. I deployed with a Combat Support Hospital. I never once fired my weapon; not that we were ever issued ammunition to defend ourselves if we had to…in fact, for my entire deployment, I never had a single round issued to me, even while I was outside the wire in Iraq (but that’s an entirely different story, the majority of my PTSD symptoms are related to multiple mass-casualty incidents throughout my career and an MST in 2002).

Excluding TBI, the symptoms of PTSD are the same, regardless of what the stressor was that caused the disorder. Some cases are much more severe and debilitating than others. That should not change the way we support each other. With all that we have endured, all that we still endure (our own demons, respect and common courtesy from our chains of command, the fight for our hard earned benefits, VA backlogs, etc) we should find a way to come together. The fact that we do have PTSD should be a uniting factor, not an issue that further divides us. We need to come together, support each other and work toward finding a way to heal, to remove the stigma, remove the barriers to effective treatment, fix the VA’s backlog and staffing issues, and to work to find a way to help those who will come behind us. Our predecessors have set the stage for us, it is up to us to carry that torch forward, but we cannot be divided in doing so. Its time for the pissing matches to come to an end. Its time to form a unified front and fight that battle that lies before us… The fight against PTSD.


When Life Changes

Most people weather life’s changes with little more than some slightly elevated stress levels. For someone with PTSD, however, even the smallest of life changes can make them feel like their life has been turned upside down.

Right now, I am three days from a major life change. In three short days, I will get on an airplane and fly to Florida where I will meet my service dog for the first time. His name is Chaunsey, the beautiful golden retriever in this picture. We will train together to learn what it means to be a team. I will learn what his ‘alerting’ behaviors are, and he will learn how to perform tasks that mitigate my disabilities. This is a huge step. This will be the longest I have been away from my family in, well… ever. I have never been away for even a night without at least my husband, if not my kids. This is something totally new to me. I will be hundreds of miles away from my support system and that thought scares me to death. The ONE thing that is keeping me from canceling the entire thing is this single simple fact…I will be gaining a new tool to add to my support system. A tool that will allow me to do something as simple as going to the grocery store alone, or taking my children to the park without having to worry about freaking out (though I will admit, most of the time they keep me pretty grounded to the present).

I also know that my life will continue to change once I’m home. No longer will I be able to hide away in my bed when depression is rearing its head because Chaunsey will need exercise and potty breaks. He will need to be fed and brushed, but most of all he will need attention. His needs will require me to come out of myself and engage in the world around me instead of hiding in my computer and isolating myself away from the world.

There are so many things that Chaunsey and I will do together that they would be impossible to list them here. But there is something I would like to share. If you, or a loved one, think you would benefit from a service dog, and you are a post-9/11 veteran, I encourage you to check out K9s for Warriors. Without their generosity, I would not be getting ready to enter this new chapter in my life.  They are a non-profit group based in Florida that provides these dogs to post 9/11 veterans at no charge. Also, if you think you may need help with transportation to and from Florida (its a three weeks of training, lodging is provided), I encourage you to check out Veterans Airlift Command. These generous pilots volunteer their time to fly veterans and their families all over the country.

I will do my best to update everyone about our progress over the next three weeks. As I have said earlier, I am terrified right now…but I am also hopeful. I feel as if the light at the end of the tunnel is finally turning on and the darkest hours of my PTSD may soon be behind me. I know this isn’t a cure. I know there will still be bad days or weeks, but, I know with Chaunsey, I will have a life long battle buddy that will be with me 24/7. Everywhere that I go, he will go. When I have a bad day, he will be there. He will bring me out of the flashbacks, interrupt the panic attacks and help me with mobility. I will be his forever human. Neither of us will ever be alone again, we will be battle buddies, we will be a team.


Physiological Changes in PTSD

PTSD causes many things to change. These changes are all encompassing. Physical, psychological and social changes can affect every aspect of our lives. In this article I want to share what some of those changes are and how they affect someone with PTSD.

First, lets look at the physical changes. Studies have shown that there are structural changes that occur in the brains of people with PTSD.

It is known that sensory input, memory formation and stress response mechanisms are affected in patients with PTSD. The regions of the brain involved in memory processing that are thought to cause these changes in PTSD include the limbic system (amygdala, hippocampus) as well as the frontal cortex. While the heightened stress response is likely to involve the thalamus, hypothalamus and the locus coeruleus.

Limbic System: The limbic system, sometimes referred to as the “emotional brain,” is a group of brain structures located deep within the cerebrum. It is composed of the amygdala, the hippocampus, and the hypothalamus. These three structures are involved in the expression of emotions and motivation, particularly those related to survival. Such emotions include fear, anger, and the “fight or flight” response. The limbic system is also involved in feelings of pleasure that reward behaviors related to species survival, such as eating and sex. In addition, limbic system structures have functions related to memory storage and retrieval, particularly memories related to events that invoked a strong emotional response.

Amygdala: The amygdala contains some of our most primal instincts. One of these physical events associated with fear is often called the “fight or flight” reaction:  increased heart rate and force of each beat (“pounding heart”); increased muscle tension that can even cause tremors; sweaty but cold palms; and even nausea and diarrhea.  Another aspect of fear is a physical “conditioning”, so that even a minor stimulus can bring on the whole fear reaction. The amygdala seems to respond to severe traumas with an un-erasable fear response. It seems to be genetically different and “wired” for a higher level of fear in some individuals, such as those with panic disorder or PTSD.

Hippocampus: The hippocampus is part of the limbic system and is responsible for transferring information into autobiographical and fact memory. It may function as a memory “gateway” through which new memories must pass before entering permanent storage in the brain. Hippocampal damage can result in anterograde amnesia (loss of ability to form new memories, although older memories may be safe). Thus, someone who sustains an injury to the hippocampus may have good memory of his childhood and the years before the injury, but relatively little memory for anything that happened since. MRI studies have shown marked changes in this area of the brain in those with PTSD. These changes are thought to be caused by increased exposure to cortisol (the ‘stress’ hormone).

Hypothalamus: The hypothalamus is an area of the brain that produces hormones that control body temperature, hunger, moods, sex drive, sleep, thirst and the release of hormones from many glands, especially the pituitary gland. The pituitary gland is a critical part of our ability to respond to the environment most often without our knowledge.

Prefrontal Cortex: This area of the brain controls cognitive behavior, personality, decision making, and the orchestration of thoughts and actions in accordance with internal goals as well as appropriate social behavior.

Is it any wonder, since PTSD effects so many areas of the brain that every case is very different? Looking at the various symptoms of PTSD, you can begin to see the correlation to the various parts of the brain. Memories, avoidance, hyperarousal can all be linked back to physical changes in the brain.

When you really look at the physiological changes, you can see the reasons behind the reactions in a person with PTSD. These aren’t things that we choose to happen. Our brains have been traumatically rewired. The way thoughts and experiences are processed are vastly different than those without PTSD. The slightest trigger can cause a ‘fight or flight’ response that we cannot control. Adrenaline surges through our bodies at inappropriate times (such as someone accidently dropping a box, what would normally cause a simple startle reaction instead causes us to reach in a much more visceral way).

Perhaps as the medical community continues to learn more about brain function as well as the effects of PTSD and TBI on the brain, more treatments and preventative measures can be discovered. Until that time comes, we continue our fight against PTSD.


Fighting PTSD?

Are you or a loved one fighting PTSD? We’d love to hear from you! 

We are currently looking to add guest bloggers and contributors who have experience with PTSD and/or TBI. Are you a professional who treats PTSD? We’d love for you to share your expertise with various forms of treatment. Please send us a message on twitter (@fightingPTSD). If you already have a blog of your own relating to military with PTSD, please let us know so we can add you to our blogroll.

The fundamental purpose of this blog is to show others that there is hope when dealing with PTSD. By showing that this is a fight and that with hard work, patience and a strong support system, we can over come. We may never be ‘cured’ but we can continue to fight PTSD. This blog offers various viewpoints, veterans with PTSD, PTSD and TBI as well as the spouses views. The more aspects we can share the more we can offer the kind of hope that lets people know they are NOT alone.

 


Scary S**t

Traumatic Brain Injury is a hell of a scary thing.  But it really wasn’t even thought of in the beginning of the war, the invasion and the year or two after. And unfortunately, for a lot of troops this term didn’t even come into play until it was to late. The commanders, the doctors, everyone, just weren’t prepared to deal with the type of head injuries that were coming out of Iraq and Afghanistan.  What it boiled down to was if you weren’t bleeding then you weren’t hurt.

Im sure when it happened, it just kinda started, 2010 when I went to AFghanistan, because I didn’t hear about it in Iraq in 07, 08 and damn sure not in 03, but they started giving head trauma a number, Grade I, II, and III. Grade I being the mildest and grade III being the worst. If you had a level I you couldn’t go outside the wire for 24/48 hours. If it was grade III it was 7 days. Now in theory this sounds like it might be an ok plan. But…..based off my experience and the “doctor” who was assigned to my battalion in Afghanistan, she had no business grading any type of Traumatic Brain Injury let alone trying to diagnose one. I Found out later she was a damn dermatologist for christ sake. Now I understand you can’t have a neurologist at every Forward Operating Base (FOB) but we had a level III Army trauma Center there which could have easily done more test on EVERYONE hit by IED’s. Even small IED’s, a measly 5 lbs of explosives  will completely destroy a humvee. What do you think that will do to your brain?

Yes we wear helmets, yes they have gotten better since the beginning of the war, but they can’t really protect you from an explosion. The blast goes everywhere, your head goes up, down, to side, your brain slams inside your skull. In my battalion, on my last go round, we had the three strike rule, if you were in or around an IED blast 3 times,  you were out. You weren’t allowed to go out again. In theory this sounds like a good plan, and trust me I understand the man power issue more than most (having to help build and structure a battalion to go to war). But research has already shown that after suffering a bad concussion, a TBI, you are more susceptible to more, basically means even less trauma could give you a worse TBI. So you could get a grade I or your first IED strike but getting hit again at the same level or even less could push you to a grade II or III. Again, the adage of if your not bleeding (on the outside) your ok. We destroyed Marines and Soldiers and didn’t even know it.

Take me for example, I lost consciousness on numerous occasions from different blasts in different years and spread out. But now, like I’ve said in previous posts, I can’t remember shit. I lose my train of thought during the most mundane conversations, I forget what I walked into a room for, hell Ive forgotten where I’m at for gods sake.

I will say its gotten better, the treatment and the help, but its still a huge ass pain to try and get help. I can’t imagine what  its like for our junior troops.  I can’t say what they are doing in country now, i haven’t been back since 2010.  But I hope its better than before….


Stressor Letter for PTSD VA Claims

In filing a claim with the VA compensation for PTSD, every bit of evidence can help. One such item is a Stressor Letter. This is a letter from you listing all the stressors that you feel contributed to your PTSD. This letter will likely be the hardest thing you have ever had to write in your life and potentially the most important asset in your claim.

There are three components to a stressor letter. Life before the military, life during the military (this is generally where your stressors will be detailed) and life after the military (where you will describe how PTSD has altered and effected your life. I’m going to describe to you how I wrote mine. My stressor letter ended up being eleven pages long and took me several days to complete.

The first stage is to write out your ‘Before the Military’ section. Begin by describing how you grew up, activities in which you took part and enjoyed. Anything that can serve as a contrast to the ‘After the Military’ section needs to be listed here. What did you enjoy doing before that you are no longer able to do? What was your outlook on life then that PTSD has changed? You will likely find as you work on the rest of the letter that you think of more items to include in the ‘Before’ section. You’re basically trying to give a snapshot of what you were like before your stressors occurred.

The hardest part of the letter is the stressor section. The ‘During the Military’ section will not be easy to write and I suggest doing it in stages. Begin by simply listing a timeline of events. Do not get into all the specifics of each event. Simply create an outline of the events that you feel contributed to your PTSD, include all physical injuries as well. Once this is done, begin to go back through your letter. Select one of the stressors and begin to add details of the event. For right now, only add details, don’t include your reactions. The idea is to get the chronological listing of all the events. Who else was involved, dates, being evacuated for an injury, etc. You’re simply telling the story of what happened. Continue to add this information for all the events listed in your outline. The final step is the hardest. This will be the part that requires you to really dig deep and be completely honest with yourself. No more denial here. Before you begin this section, make sure you have someone you can call on to keep you grounded. This part will hurt and you need to know you have a resource to back you up if you need it. At this point, you need to go through each item and add how it made you FEEL. Let it out! Put it on the paper. Did you feel helpless? Guilty? Were you terrified? Hopeless? This is the hardest part because too often we take all those negative feelings and shove them down deep where we think they can’t bother us anymore, but they need to be documented for this to truly be an asset in your claim. This was the part that took me the longest to complete and was the majority of the eleven pages.

The last step isn’t quite as hard. This is the ‘After’ section. In this part you are simply spelling out how PTSD has changed your life. What is different about you now? What are the symptoms you have to deal with daily? This is a good time to look up the signs and symptoms of PTSD and list out how each one effects your life. Don’t embellish here…keep it honest. If you don’t have nightmares, don’t list them. Not every one has every single symptom of PTSD. Make sure you explore every area of your life. How is it effecting your work? Your family? Your thought process, outlook on life, ability to function in society, etc. List your triggers, the things you can no longer tolerate doing such as walking through a grocery store without anxiety. This is where you show how PTSD has changed who you were before. Refer to your ‘Before’ section and see if there is something you listed that has changed and vice versa. You will find that going through the ‘After’ section, you will remember things to add to the ‘Before’. Don’t be surprised if you find yourself editing both sections as you go along.

Once you have written out your letter and you’re sure you’ve included enough emotional information to get your point across find someone you trust and ask them to read it over. Ask them if its concise, if it makes sense, does it get the point across. Perhaps ask someone from a veterans group to read it, a Veterans Service Officer can likely give you some pointers on how to improve your letter.

Above all, realize that as much as its going to hurt to write this letter, its going to help you in the long run. You can also ask friends and family members to write letters stating how PTSD is effecting your ability to lead a ‘normal’ life. These can also add weight to your claim with the VA. Remember, don’t let yourself get offended by what you may read in these letters. The person writing them needs to be brutally honest about how they see PTSD effecting you and its likely not going to be something you want to hear. They may see something that you don’t, some personality change that you haven’t noticed or have denied. Remember, they aren’t writing these things to hurt you, they’re trying to help you with your claim.

As I said earlier, this will likely be one of the hardest things you’ve had to do, but it will absolutely help your case. With this letter in your file, you don’t have to worry as much about getting a doc who doesn’t believe you writing a bad report for the exam. Your words will already by part of the file along with the letters from friends and family members. The more ammunition you include in your file the better. These letters, along with your doctors reports will give the bureaucrats making rating decisions a better idea of the true picture.

There are many websites giving advice on writing Stressor Letters, what I have provided here is basically a short synopsis of what those sites suggest along with my personal experience writing my own letter.


Veterans Courts for Those Still Serving?

In an article in the New York Times titled ‘In Military Courts, Considering Alternative Punishment for Trouble Service Members‘, Mr. James Dao discusses the implementation of Veterans Court’s into the military judicial process. He discusses the various benefits as well as potential hurdles that would need to be addressed before something of this magnitude could be implemented across the entire military judicial structure.

Veterans court is a ‘special court’ that hears cases of veterans charged with minor offenses, particularly those diagnosed with service related injuries and illnesses such as PTSD or TBI. These courts have the ability to offer a suspended sentence in lieu of completing a rigorous treatment program to address the issues that led to the veterans presence in the court, rather than simple incarceration. Since its implementation in Buffalo, NY in 2008 there are now more than 80 such courts nationwide.

Mr. Dao argues that if the military were to take a similar approach, offering treatment in lieu of confinement and a less than Honorable Discharge the military could potentially prevent these future veterans from ending up in the civilian legal system. Veterans who leave the service with a Less than Honorable or Dishonorable Discharge are denied the very services that could help them the most by the VA such as mental health care. By treating the underlying cause of the offense, and offering the ability to receive an Honorable Discharge at the end of their treatment program, the military can take an active roll in reducing the burden of the civilian court in the long run.He did point out, however, that there are some hurdles that will need to be addressed before any such implementation can take effect on a large-scale level.

Some military bases lack the essential services needed to ensure the service member receives the very care he needs as a part of the program. Not all bases have Mental Health clinics capable of offering the type of in-depth care necessary for PTSD and/or TBI. Some of this could be outsourced to the local civilian population, however there are bases in locations where the resources simply are not available. Even so, there is the potential for these issues to be worked out. This is hardly an insurmountable task.

Implementing this system, in the long run, will only benefit the military and the future veterans who encounter this program. It will also go far in removing the stigma held by many civilians in regards to veterans with PTSD. Additionally, the veteran will also feel less hesitant to seek treatment from the VA because the denial of a problem will already have been surmounted as well as any potential fear of treatment.

These programs aren’t a joke. Its not a ‘get out of jail free’ card. It takes a lot of hard work to complete the rigorous requirements. Participants are generally required to continue working, meet their financial obligations, be compliant with taking their medications, therapy, and drug or alcohol rehabilitation. You can’t fake your way through these programs, the consequence of attempting to do so is the original sentence is levied. That, in and of itself, can be a very motivating factor in seeing the plan through to completion. In completing the program, the service member could either be returned to duty or separated with an Honorable Discharge. Its a win-win for both the military as well as the service member.

While a diagnosis of PTSD or TBI is not synonymous with predicting indications of committing a crime, it is a sad fact that most service members who are separated under less than honorable conditions will have trouble finding gainful employment. Couple this with the debilitating effects of untreated PTSD and you are more likely to see problems that can escalate to criminal charges. When you consider that approximately 20% of our service members have or will develop PTSD, that is a potentially staggering increase in the number of veterans who may one day find themselves in court. Heading this off while they are still within the service is paramount to their success in the future.

This isn’t a new concept. The article discusses the history of such actions dating back to President Andrew Jackson. If its been done before, there is little reason it could not be done today. Our veterans need this desperately. Today service members make up 1% of the total population but account for more than 20% of all suicides. I wonder how many of those veterans decided to end their lives rather than face pending criminal charges. We may never know the answer to that question. However this program has the potential to effect service members lives for the better. Doesn’t it seem like common sense to implement it on as large as a scale as possible?


TBI and why it sucks….

As you can see from my profile, I suffer from PTSD, TBI and a GSW. I am only going to talk about the TBI right now. M graciously asked me to be apart of this awesome blog and I jumped at the chance, to try and get people to understand what we go through. This is a challenge that I’m more than happy to accept…even if i can’t remember what the hell I’m doing half the time.

Traumatic Brain Injury or TBI, sounds bad because it is. Here is the basic definition thrown out by doctors:

“Traumatic brain injury (TBI) is a non degenerative, non congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

The definition of TBI has not been consistent and tends to vary according to specialties and circumstances. Often, the term brain injury is used synonymously with head injury, which may not be associated with neurologic deficits. The definition also has been problematic with variations in inclusion criteria” http://emedicine.medscape.com/article/326510-overview

This is the basic nonsense that I have heard every time I have gone to see a doctor. Basically what it means is its not a disease, you don’t get it like a cold and supposedly it doesn’t worse (horses shit) and they can’t do really tell you have it until you die. If you have followed the NFL at all you will see the same basic functions, in the fact that you can not truly test for a Traumatic Brain Injury or the most common theme the “concussion” until you are dead. The most recent example of this in the NFL is Travis Henry and quite possibly Junior Seau, which they aren’t sure about yet.

But most Vets with multiple blast exposures exhibit the same symptoms NFL players with multiple concussions do. Horrible headaches, memory loss, motor function loss, sleep loss and several other symptoms. I can attest to all of those. The headaches I have are debilitating, memory loss is ridiculous; I walk into a room and forget why I’m there. I won’t tell you how many times that i have left my keys in the ignition and the truck running at work, only to come out at lunch and realize what I did.

The worst part of TBI at least for me is the headaches and the memory loss. The headaches hurt like hell, and when i get them, if i do not catch them in time i have to waste half a day in the ER waiting on a shot to make it go away.  The memory loss does not physically hurt, but its extremely unnerving (which doesn’t help with PTSD) and very frustrating.  I have forgotten numerous “special” things I have done for my wife over the years, i.e. when i have given her a piece of jewelry or something like that and obviously that sucks. Most people would say I do that all the time…but most have some sort of memory of the event, a snippet here or there, for me, its gone. All of it, nothing there. I will pose this scenario to you, and let you dwell on it. This is my life and what i have had to deal with for the last 8 years, and its only gotten worse, after each successive blast exposure. Walk into a bathroom in gas station, or any where for that matter, or go somewhere where you can not see the outside, walk out and have no idea where you are or how you got there….tell me how you would feel. That’s half the reason I stay in basement, or carried a gun for so long. Being scared out of your mind or thinking about being scared out of your mind, because you don’t know the next time its going to happen is….debilitating. Think about that…till next time.