Our Lives With Post Traumatic Stress Disorder and Traumatic Brain Injury

VA

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.

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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.


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.