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  • Disabled Vets


    What's Not Talked About?

    Throughout the history of warfare, service members have been placed in unimaginable situations, often situations in which they have to make difficult decisions. Frequently, decisions made during deployment have lifelong consequences. Many Veterans have expressed a desire to be the person they were before they experienced trauma, and they often try to suppress or avoid memories of the trauma they have lived through. However, the use of avoidant coping strategies has been found to be counterproductive in the long run. By attempting to avoid the traumatic events service members have experienced, they end up exacerbating the intensity and frequency of their trauma memories and the sequelae and symptoms of those memories over time.

    Some Veterans are able to move past trauma with minimal dysfunction in their lives; however, for others, the traumatic event creates havoc and chaos. Trauma symptoms can become so problematic that they result in family discord, divorce, social dysfunction, significant substance use, employment difficulty, physical health difficulties, legal problems, and more. And the disruption of service members’ lives as a result of trauma symptoms is hardly uncommon. Due to the dysfunction and negative impact of trauma and its symptoms in the lives of service members, the VA has recognized and developed the VA disability rating system. The disability rating system considers both physical and mental health-related conditions. The more areas of a Veteran’s life that are impacted (i.e. social and occupational difficulty or physical limitation and/or pain), the more financial compensation that Veteran potentially could be warranted. I am a firm believer that Veterans are entitled to every dollar that they are afforded and then some...Many can argue that the lifelong implications and symptoms that Veterans have to endure cannot be quantified or compensated with a dollar amount. The VA does its best to equitably compensate Veterans based on their level of dysfunction. However, if the Veteran could eliminate the disabling experience that initiated their impairing symptoms, it is possible that they could exceed the amount of their VA compensation by functioning optimally in the civilian sector. Essentially, they would be able to have a greater positive economic impact and earn a higher living wage if they did not experience disabling symptoms. Given the high level of training military members receive, the values, discipline, and structure instilled by military training and service often lead most Veterans to make dependable, hard-working, and effective employees.

    Disability Rating System

    According to the VA Disability Rating System, in the year 2000, the average compensation provided to Veterans through the disability rating system was about $20 billion for 2.3 million Veterans. In 2013, that number rose to 3.5 million Veterans receiving $54 billion in compensation. This number has continued to rise over the last several years and will hopefully continue to do so, enabling Veterans to receive the compensation they deserve. A major reason for the spike in Veterans receiving compensation is the continued 14-year wars in Iraq and Afghanistan. When service members are sent to war and later return home, there are often significant consequences to service—economics being one of them. Unfortunately, many Veterans who are still in need of services and compensation for VA benefits have not taken advantage of the services offered. Many factors impact Veterans’ decisions not to seek care— a main one being stigma. Two examples of stigma are: one, a Veterans’ hesitation to seek mental health services due to being perceived as “weak” or “vulnerable;” and, two, the possibility of having negative career or job implications as the result of potentially impairing symptoms. As I have said in a previous blog, it takes a nation to build a military and go to war. And, it takes a nation to welcome them home. Compensating our Veterans for their service is the first of many steps that should be afforded to Veterans for their sacrifice. If we send people to war, it is a fundamental imperative that we take care of them when they come home. The tide is changing, and the VA has gone to great lengths to decrease wait times for compensation and pension evaluations so that Veterans are streamlined through the process. There is no perfect system, and the pendulum has and is continuing to shift in the right direction so that our brothers and sisters in arms are taken care of.

    To specify the rating system with an example, if a Veteran diagnosed with PTSD has a 50 percent service-connected disability rating and they have a spouse and one child, they would receive $978.64 each month. Yearly, that is roughly $11,745. The pay for a Veteran that is 100 percent serviced-connected increases significantly. They would approximately $3200 monthly. Although this money is not taxed, many Veterans still struggle to make ends meet. Anecdotally, there is a misconception that if a Veteran receives a 100 percent service connection, they will be able to live a “lavish” lifestyle. That is simply not true. This money can definitely help decrease financial distress, however, many Veterans still struggle to pay for things they and their families need.

    Once a Veteran receives a disability rating and compensation is provided, there can be fear that the disability rating might be decreased or taken away if the VA finds evidence the Veteran’s symptoms have improved to a more manageable level. Once Veterans receive a service-connected percentage of disability, it is not a fixed rate for life—although it could be. The VA has the right to decrease the compensation rate if the Veteran shows material improvement in their ability to function in daily life whether that be in relation to a physical or mental health-related condition. According to the Department of Veteran’s Affairs Service Connected Disability website (2017), if a Veteran has less than a 100 percent disability rating, has been receiving compensation for less than five years, and has shown medical and social improvement, the VA can reduce the percentage of disability and compensation based on the evidence found. However, if a Veteran has been receiving benefits for longer than 20 years, it is considered a continuous rating and the VA cannot lawfully reduce the rating. At 10 years, a Veteran’s rating cannot be terminated, but it can be reduced. If a Veteran’s disability rating is reduced, a Veteran has the option of requesting a reexamination, and they should contact a Veterans’ Service Organization representative to advocate on their behalf.

    The VA provides great and well-needed services, and they save lives every day. Unfortunately, some Veterans walk away from the VA dissatisfied and displeased. There is no perfect mental health and medical system, and the disability rating scale is not perfect either. There is no one program that provides a “fix all” solution. What it will take is public and private partnerships moving forward in order to maximize reach and expand access, frequency, and quality of care.

    Many Veterans who receive benefits fear their benefits may be taken away at any point in time. Unfortunately, this fear of disability ratings potentially being lowered if there is substantial evidence that the Veteran has made improvement deters people from seeking and fully engaging in well-needed treatment. For instance, if a service-connected Veteran engages in an evidenced-based trauma-focused treatment for PTSD that has been shown to reduce symptoms upon full completion, and as a result of that treatment their overall dysfunction decreases, that Veteran could be at risk of decreased disability ratings if that improvement is documented and gathered during a medical evaluation. Veterans who know the disability rating system may be deterred from seeking care at the VA because of that potential. The more dysfunction one has, the more money they receive; so increased symptomology is incentivized and reinforced. If Veterans struggle with employment and optimal functioning, it makes sense that those Veterans may not want to show improvement. This is one lens to look through.

    Unfortunately, there is no perfect solution to this problem. However, there has been plenty of debate about possible solutions. One solution discussed would be to extend the time period between the rating system from the initial evaluation and reevaluation. This solution could assist with decreasing stigma and reducing the fear of losing a percentage rating with the potential benefit of encouraging people to fully engage in well-needed treatment. This would allow Veterans to seek a high standard of care, receive benefits, and practice their skill-sets learned with a longer time to adjust for life stressors that may continue to exacerbate symptoms. If there is no reoccurrence of symptoms, then one may experience a reduction in compensation. If there continues to be notable impairment, then the percentage of disability rating could stay the same or increase. Another potential solution is to continue the private-public partnership so that Veterans can receive care outside of the VA. If Veterans fear that making progress would jeopardize their disability rating when seeking care at the VA, those concerns are potentially lessened with treatment in the private sector. These issues about disability ratings and improvement in functioning are only a few of the many issues debated in the current Veterans’ issues climate. Although they are hotly debated, the pendulum is moving in the right direction by placing our Veterans first.


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  • Low Ball


    The day was just like any other day. Until you checked your mail. The big brown envelope was in it, with the VA logo in the upper left corner. You knew it was your VA PTSD Rating Decision. It’s about time – you filed yourPTSD service-connection claim18 months ago. “Why does the VA take so long,” you think. “It shouldn’t be that hard for the VA to service connect PTSD.”

    You tear off the envelope open expecting to see a 70%, or 100% rating. That dude in your unit who was there that day – and saw the same things you did – got a 70%, and he seems to be having an easier go of life than you.

    Part of you is excited. That extra compensation is going to make a difference. You are struggling to make ends meet as it is. You got fired from the last job for getting upset with your boss. The job before that you quit because all the people moving around that place wanting to talk made you jumpy and anxious.

    When you read the letter, your heart sinks. Then, a wave of anger and frustration.

    10%. That’s what they gave you. The same rating they give to every Veteran with tinnitus.

    Where do you go? What do you do?

    First, it is important to know that you are not alone – the VA is not out to get you, and didn’t do this as retaliation against you.

    I’m serious about that: the VA is just plain incompetent when it comes to rating most medical conditions. Most of their raters try to do a good job – many are Veterans themselves – but the VA doesn’t give them training. VA management has created a culture of hostility and back-stabbing where all problems are blamed on the “unions.”  Don’t let me go down THAT rabbit hole.

    A lot of Veterans – some worse off than you, some better off than you – have a diagnosis of service-connected PTSD and find themselves “low-balled” with a rating that is much lower than that of their peers and that does not reflect the severity of their medical condition and the affect it is having on their lives.

    When it comes time to appeal that low rating though, most Veterans have something else in common: they don’t have the tools to adequately challenge the low VA PTSD rating and don’t know where to start even if they did.

    I’m going to give you some ideas to deal with the lowball VA PTSD rating.

    The #1 thing to consider when your VA PTSD Rating is low-balled.

    There is nothing wrong with getting a professional to help you.

    VA PTSD claims can be really tough, even on straightforward facts. Recently, I talked to a Vet who witnessed some horrible, horrible things during the invasion ofPanama that messed him for a long time and put him on a path to opioid abuse and homelessness. The VA denied him service connection for PTSD.

    At my own firm, I’ve gone to theVeterans Court many times to straighten theBVA out on low-balled VA PTSD ratings. I’vestopped them from symptom hunting. I’ve seen ratings so bad that the Veterans Court found the BVA’s actions “disconcerting.” And we stopped the BVA from an absurd decision that gave a 30% PTSD rating to a Veteran who had regular hallucinations due to his trauma.

    These cases are hard to fight – there are so many traps for the unwary that just add stress and anxiety to a situation that probably already has too much.

    And I’m here to tell you, if I was fighting the VA on my own PTSD claim, there is only one attorney I would get to help me:Matt Hill.

    I don’t recommend people very often on the Veterans Law Blog® – it’s not what we are trying to do here. I”m trying to educate Veterans, not shill for other businesses. I’ll tell you about lawyers, and experts, but I rarely make suggestions.

    I’ve known Matt for almost 10 years now, and he knows his stuff when it comes to PTSD claims.Click here to watch a quick interview with him a couple years back– use the form on that page and it will email him your info and ask for a consultation. And you can absolutely tell him that Chris Attig said he was the best.

    But don’t let me pressure you: if you want to handle your own VA PTSD rating appeal – and many, many Veterans do so successfully without having to pay an attorney or stress out over a non-responsive VSO – the rest of this post is a good place to start figuring things out.

    So, I’m going to walk you through 9 Things that might help you get the VA PTSD rating you are entitled to.

    These are  not the ONLY 9 things, and every case is different. Let’s get started.

    Understand where your VA PTSD rating fits in the 4 Pillars.

    When we talk about a VA Claim, we talk about simplifying it bybuilding the 4 Pillars.

    The 4 Pillars are the 4 things that every Veteran, in every VA claim, needs to prove before they will recover service-connected disability compensation.

    Impairment ratings – or the way that the symptoms of your service-connected condition are equated to a percentage and a dollar value – are the 3rd Pillar.

    The VA PTSD rating table is a little intimidating at first. It’s a jumble of sentence fragments, a massive list of symptoms, written by government bureaucrats that have long since forgotten how to communicate with earth people. Take a look:

    Low Ball 02

    That right there, my friends, is the definition of “impenetrable jargon.”

    Here are 9 pointers to help you evaluate the rating in yourVA PTSD claim.

    #9: Did you File your VA Claim – theRight Way?

    The 2 biggest errors that Veterans make in their VA Claims – and the 2 errors that cause them to get stuck in the VA backlog for longer and longer periods of time, are these:

    1. They filed their claim and expected the VA to do the work – or to do the RIGHT work – in developing the claim.
    2. They didn’t “connect the dots” for the VA in a simple straightforward way that made the VA Rater WANT to grant the claim.

    What does that mean in the context of a VA PTSD rating? Usually, it means the Veteran dumped 3, 5, or 10 years of mental health treatment records, and a couple handwritten statements on a VA Form 21-4138, on the VA and hoped the rater would see how bad things were.

    Remember, they don’t get training. And they see so darn many claims that they aren’t going to spend but a few minutes deciding your VA PTSD rating.

    You can avoid those solutions byFiling Your VA Claim – the Right Way – from the very start.

    It’s a simple fact that if you put the RIGHT evidence into your claim, and explain in a very clean and basic way how that evidence shows your sleep apnea is service connected, your claim will go quicker.

    And you will probably get better results.

    When you are ready to start learning How to File Your VA Claim the right way, click here & read this  post.

    #8:  The best-kept secret in a VA PTSD Rating are the Bankhead and the Mauerhan cases.

    The Code of Federal Regulations – before listing the PTSD rating criteria in DC 9411 – says that when rating PTS, the VA should consider symptoms “such as” those listed.

    That’s key language – as the Courts told us in Mauerhan.

    You don’t have to find  ALL the factors on the list to qualify for a particular rating.  You just have to make a case for your symptoms being similar to the symptoms listed at the rating level you believe you are entitled to.

    And what the Courts told us in Bankhead is that the VA is supposed to look HOLISTICALLY at your medical condition when assigning a rating for PTSD. I’m not going to get into Bankhead in too much detail here. I write a blog to help lawyers learn Veterans law, and have written about Bankhead.

    #7: Occupational Impairment factors are more important for VA PTSD Rating purposes.

    I’ve reviewed hundreds, if not thousands of Veterans C-Files.

    When the VA PTSD rating is too low, a common reason I have seen is that the Veteran focused on the social impairment factors, and not the occupational impairment factors.

    Take a look at all the factors in the 50% category for PTSD.

    In addition to equating those symptoms to your social life (home, family, friends and social interactions), relate them to your ability or inability to get or keep a job.

    #6:  The VA PTSD rating criteria is NOT a complete list of PTSD symptoms.

    Remember that the list of symptoms on this list are not meant to be every possible symptom.

    If you have symptoms, or manifestations of symptoms of your PTSD that are not on this list (and there are plenty), see which ones on the list are similar to yours. And then make that argument – that your symptom is like such-and-such a symptom of the 70% rating.

    The list of symptoms in the table above is not as a comprehensive listing of PTSD symptomatology. Think of it as an objective tool that was supposed to help make sure Veterans get rated as consistently as possible when PTSD affects them in similar ways.

    #5: Did the VA examiner consider the frequency, severity and chronicity of PTSD symptomatology?

    This is one thing that C&P Examiners overlook the most often. They hunt-and-peck through your medical records for a symptom that matches the one on the rating list, and if they don’t find it, they move on and give you a 10% rating. This is called “symptom-hunting” and it misses the whole point of Bankhead, discussed above.

    To make a “holistic analysis” of your mental health condition’s impact on your life, the VA rater must consider the frequency, chronicity and severity of your PTSD in work and social settings.

    Rarely do C&P exams for Veterans with a PTSD claim discuss how long the symptoms last or the length of any periods of “remission”. Sometimes, they discount the resilience/remission factors so much so that they change the Veteran’s diagnosis altogether.

    For example, we were able to get one Veteran a higher PTSD rating by showing that her “resilience” was not as high as one might thing from frequent periods of remission: because of the nature of her symptoms, she still had significant social and occupational impairment limitations during the “remission” period.

    #4:  Did the VA considerALL of the evidence in the record?

    Far too often, VA C&P examiners focus on the most recent symptomatology.   The doctor has to look at the whole of the evidence of the record.

    One thing you can consider doing is making a copy of any medical recordrelating to your PTSDout of your C-File.

    Organize those documents from your C-File in chronological order, and type up an EASY to read outline of the chronology of your symptoms – keep it to 1 page, double spaced, so it’s easy to read.

    Share it with your C&P Doc, and ask them to put the chronology in your C-File when they are done.

    Don’t argue your position, just hand it to the doc and say “Here’s the chronology of my condition, if it helps you, use it.  If not, just put it in my C-File.”

    This is really hard to do if you don’t have your C-File – here’show to get a copy of your C-File.

    #3:  What is theGAF scale?

    TheGAF scale is a subjective rating, on a scale of 0 to 100, for a doctor to “evaluate” a Veteran’s overall psychological, social and occupational functioning.  The higher the score, the more ability the Veteran has – in theory – to function in a wide range of activities.

    Problem is,GAF scores are nonsense. Seriously, ask a psychiatrist or psychologist how they come up with aGAF score. They pick a number out of thin air that “feels right.” One doctor could give you aGAF score of 30 (low functioning). Another could give you aGAF score of 60 (reasonably high functioning). For the same symptoms.

    So, in DSM-V, the medical profession threwGAF scoring to the crap-pile.

    Even still, I see many, many PTSD ratings that give heavy consideration toGAF scores over actualobjective medical and lay evidence of PTSD symptomatology.

    In current claims, theGAF score is no longer used – however, many VA Raters still wrongly use theGAF score and in some claims, the appeal is based on the law at the time of the denial, which may have involved use of theGAF Score.

    This is CRITICAL: if you have a claim or appeal filed afterAugust 14, 2014, and the VA orBVA is usingGAF scores, they are very likely rating your claim wrong.

    #2:  Don’t let the VA rate you based on the ABSENCE of factors for a particular level.

    I really think that if the VA wouldget away from using “negative evidence”, 80% of the backlog would be cleared out.

    Seriously – I think I see this error in nearly every case I look at.  The VA cannot usually consider the absence of evidence as proof of anything.

    If your VA PTSD rating talks about how youDON’T have certain symptoms or problems, you need toget in touch with a lawyer ASAP.The way to fix this is a legal argument, coupled with a long-term appeal strategy.

    Find out how tochoose the best attorney for your VA appeal in this free eBook.

    #1:  Did you downplay your symptomatology at the C&P Exam?

    Many Veterans get dressed up in their “Sunday best” for their Comp & Pen exam, believing that they are more persuasive when they “present” well.

    Other Veterans refuse to shower, shave, or wear clean clothes, based on the suggestion of some random Veteran in a facebook group.

    BOTH approaches are wrong.

    Remember, doctors can assess the symptoms in your records –AND the symptoms they observe.  When itcomes to your appearance at the C&P exam, BE your symptoms.

    More importantly, don’t downplay your situation.

    Let the doctor see, and hear, how bad your PTSD is affecting you.

    Vietnam Veterans out there tend to be serious hard-asses, and refuse to tell people when they are hurting.

    I’m not judging at all – I am saying that the time to downplay your symptomatology is NOT during your PTSD C&P exam. (By contrast, you don’t want to exaggerate your symptoms either).

    The Veterans I see with PTSD ratings that are too low (or that later face ratings reduction problems because they were over-rated) all have one thing in common – they failed to follow the Golden Rule of PTSD C&P Exams: Just be yourself.

    Here are some more tips for getting through a VA PTSD C&P exam – or any C&P exam for that matter.


    These tips for evaluating your VA PTSD Rating are worthless unless you have your C-File.

    Without your C-File, youcan’t know how much weight the VA is wrongly putting on arbitrary GAF scoresfrom 10 years ago, whether all of your medical records made it into the VA’s hands, or whether there is something really damaging in your file (like some VA C&P examiner down in Florida who finds every Veteran is malingering, over-reporting, or under-reporting symptoms without explaining what those terms mean, medically).

    Here’s where I show youmy Firm gets C-Files from the VA.

    I hope these tips helped – let me know if you have any thoughts or questions.


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  • Justice 006


    ROCHESTER, N.Y. U.S. Attorney James P. Kennedy, Jr. announced that Michael Pecka, 33 of Fairport, NY, pleaded guilty before U.S. District Court Judge Charles J. Siragusa to making a false official statement. The charge carries a maximum penalty of five years in prison, a fine of up to $250,000, or both.

    Assistant U.S. Attorney Craig R. Gestring, who is handling the case, stated that Pecka filed a claim for VA Disability Benefits in 2011 claiming that he had Post Traumatic Stress Disorder (PTSD) from witnessing the suicide of two fellow soldiers while deployed to Kuwait in 2004-2005 with the Army Reserve. In support of his claim for PTSD, the defendant described in detail the two suicides that he claimed to have witnessed to include his distance from the soldiers, the manner in which they each committed suicide, his observation of the bodies, and his role in the investigations. As a result of this claim, Pecka received a high disability rating and was awarded tax free disability benefits of $3,167 per month. The defendant filed the initial claim while he was an inmate in federal prison for an unrelated bank fraud conviction.

    Pecka repeated his false claims about observing the suicides on Official VA Forms, signed under penalty of perjury, in 2011 and 2014. However, an investigation by Special Agents of the VA Office of Inspector General determined that the defendant lied about being present for either suicide, lied about observing either suicide, lied about being involved in the investigation of either suicide, and in the case of one of the soldiers, was not even in the same country at the time he committed suicide. Pecka repeatedly stated under oath that he watched this soldier commit suicide, when in fact, the defendant was stationed over 6,000 miles away in Kuwait when the soldier committed suicide near Ft. Drum, NY.

    On May 24, 2018, Pecka provided statements to an undercover VA Office of Inspector General Special Agent whom the defendant believed to be a VA Field Examiner conducting a routine file update for his compensation claim. During that meeting, Pecka falsely told the agent that he personally witnessed the suicide of one of the soldier, now claiming that it happened while they were “on a mission” together. Pecka described the incident stating that soldier shot himself with his pistol without warning, and that he reported the incident to his First Sergeant. None of that was true. Regarding the second suicide, the defendant falsely claimed that he saw the muzzle fire from the discharge of that soldier’s rifle, discovered that victim in his vehicle, and then reported the suicide to Military Police. This too was a lie.

    After making these statements to the undercover VA-OIG Special Agent, Pecka completed a new VA Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Form, in his own hand. In that statement, the defendant again falsely claimed that he saw both soldiers shoot themselves.

    As a result of his false statements to the VA, Pecka received over $92,000 in tax free VA Disability benefits to which he was not legally entitled.

    According to the National Center for PTSD, Post-Traumatic Stress Disorder is a mental health condition that some people develop after experiencing or witnessing a life-threatening event, like combat. The condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions. Symptoms may include nightmares or unwanted memories of the trauma, avoidance of situations that bring back memories of the trauma, heightened reactions, anxiety, or depressed mood. For further information on PTSD, treatment options, and how to obtain help from the Department of Veterans Affairs, please go to

    The plea is the result of an investigation by the United States Department of Veterans Affairs, Office of Inspector General, Criminal Investigations Division, Northeast Field Office, under the direction of Special Agent-in-Charge Sean J. Smith.

    Pecka also has a pending violation of his supervised release conditions from the prior federal bank fraud conviction.

    The defendant was ordered detained pending sentencing on both cases, which is scheduled for January 24, 2019, at 10:00 a.m. before Judge Siragusa.


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  • PTSD Key


    Veterans who have symptoms of PTSD often ask us for help, as do their families. The National Center for PTSD provides education and conducts research on trauma and PTSD. We do not provide diagnosis or treatment of PTSD.

    For direct care, see both of the following:

    Below are the answers to some questions about PTSD that are often asked by Veterans and their families.

    Do I have PTSD?

    A natural first question is whether your symptoms might be due to PTSD. A good place to start learning about PTSD is the PTSD Basics page on our website. You should know, though, that having symptoms does not always mean that you have PTSD. Some reactions to stress and trauma are normal. Since many common reactions look like the symptoms of PTSD, a doctor must decide if you have PTSD

    Also, stressors other than trauma may cause symptoms that are like those of PTSD. For example, work or money problems can lead to symptoms. Medical problems such as heart disease or diabetes, or mental health problems such as depression or anxiety, can have symptoms that look like PTSD. That is why you should see a provider who is trained to know which of your symptoms might be PTSD.

    If I have other problems, can I also have PTSD?

    Veterans with PTSD often have other types of problems. They might have other stress, medical, or mental health problems. Sometimes PTSD is overlooked when other problems seem very pressing. If you have questions, ask your doctor if PTSD also needs to be treated.

    Am I eligible for VA services?

    All Veterans could possibly be eligible. Here is a brief list of factors that make up whether you are eligible:

    • You completed active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II).
    • You were discharged under other than dishonorable conditions.
    • You are a National Guard member or Reservist who has completed a federal deployment to a combat zone.

    You should also be aware that:

    • Health care eligibility is not just for those who served in combat.
    • Other groups may be eligible for some health benefits.
    • Veteran's health care is not just for service-connected injuries or medical conditions.
    • Signing up for health care is separate from signing up for other benefits at VA.
    • Veteran's health care facilities are for both women and men. VA offers full-service health care to women Veterans.

    For Veterans who served in a theater of combat operations after November 11, 1998, some benefits have been added. In January, 2008, the period of eligibility for free health care was extended from two to five years.

    VA operates a yearly enrollment system that helps make sure that Veterans who are eligible can get care. For information, see VA Health Care Eligibility & Enrollment. Your DD 214 is used to enroll for VA services. If you have trouble locating this form, VA Enrollment can still assist you.

    What help is there for me (or my Veteran family member)?

    PTSD is treatable. Many places within VA provide PTSD treatment. General programs that provide mental health services include VA medical centers, community-based outpatient clinics (CBOCs), and Vet Centers. Use the VA Facilities Locator to find the closest VA facility.

    An extra note about Vet Centers

    Offered through the Readjustment Counseling Service, Vet Centers are located in the community. They provide information, assessment, and counseling to any Veteran who served in a war zone. This includes conflicts such as in Somalia, Iraq, or Afghanistan.

    Vet Centers also offer services to families of Veterans for military-related issues. There are no fees or charges for Vet Center services, and services are confidential. That means no information will be given to any person or agency (including the VA) without your consent. Most of the staff are Veterans themselves.

    During normal business hours, you can call 1-800-905-4675 (Eastern) or 1-866-496-8838 (Pacific). The Vet Center program also has a 24/7 hotline, with all calls answered by combat Veterans: 1-877-WAR-VETS (1-877-927-8387).

    VA special PTSD clinics and programs

    VA also has special PTSD clinics and programs that can help eligible Veterans. For more on these programs, see our fact sheet PTSD Treatment Programs in the U.S. Department of Veterans Affairs.

    What to expect when you see a VA provider

    When you see a VA provider, he or she will first assess whether or not you have PTSD. If you do have PTSD, remember that it can be treated. Several types of education and treatment are helpful to Veterans and their family members. These include:

    • Classes on dealing with stress, anger, sleep, relationships, and PTSD symptoms
    • One-to-one, group, and family counseling
    • Medications

    For more information, please see Treatment.

    I think I am disabled due to PTSD caused by military service. What can I do?

    Service-connected disability for PTSD is determined by the Compensation and Pension Service. C&P is an arm of VA's Veterans Benefits Administration:

    Compensation. This decision is not made by the providers who care for you in VA's PTSD clinics and Vet Centers. The process for making the decision involves several steps:

    • A formal request (claim) must be filed using forms provided by the VA's Veterans Benefits Administration.
    • After all the forms are submitted, you must complete interviews about your:
    • social history (a review of family, work, and education before, during, and after military service).
    • psychiatric status (a review of past and current mental health symptoms and of traumas gone through while in the military).

    The forms and information about the application process can be obtained from Benefits Officers at any VA medical center, outpatient clinic, or regional office.

    The process of applying for a VA disability for PTSD can take several months. It can be confusing and quite stressful. Veterans Service Organizations (VSOs) can help Veterans and family members with VA disability claims. VSOs provide Service Officers at no cost. Service Officers know all about every step in the application and interview process. They can provide practical help and moral support. Some Service Officers are experts in helping Veterans with PTSD disability claims.

    Even if you have not been a member of a given VSO, you still can ask for help from a Service Officer of that VSO. To find a Service Officer to represent you, just contact the local office of any VSO. You may also wish to ask other Veterans who have applied for VA disability what they would suggest. A mental health provider at a VA PTSD clinic or a Vet Center may also have some tips.

    My claim for a VA PTSD disability has been turned down by the Benefits Office, but I believe I have PTSD due to military service. What can I do?

    A Veterans Service Officer can explain how to file an appeal. The Service Officer may be able to help you gather the information you need to make a successful appeal. You may want to contact a Service Officer who is an expert in helping Veterans who have PTSD-related claims.

    I can't get records from the military that I need for my disability claim. What can I do?

    Veterans Service Officers can help you file the paperwork needed to get your military records. If your Service Officer is not able to help you get needed records, ask him or her to direct you to another Service Officer who has more experience in getting records.


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  • Ntl PTSD Treatment


    If you have been through a traumatic event, you may find it hard to talk about your experiences. But, it can be helpful to tell your doctor or a counselor about any symptoms you have. Witnessing or going through a trauma can lead to both emotional and physical problems.

    The checklist below can be a good start to talking about your symptoms following a trauma. You can print this page, complete the checklist, and show it to your doctor, therapist, or someone who can help you find care.

    Sharing this information will help a health care provider know you better and plan the best treatment for you. Not everyone who goes through trauma will get PTSD, but keep in mind that good treatments are available even if you only have some PTSD symptoms.

    Brief checklist of trauma symptoms

    Check the symptoms below that you experience. Include symptoms you have even if you are not sure they are related to a traumatic event.

    I experienced or witnessed a traumatic event during which I felt extreme fear, helplessness, or horror.

    The event happened on (day/month/year) _______________.

    What happened? ________________________________________.

    1. I have symptoms of re-experiencing or reliving the traumatic event:
    • Have bad dreams or nightmares about the event or something similar to it
    • Behave or feel as if the event were happening all over again (this is known as having flashbacks)
    • Have a lot of strong or intense feelings when I am reminded of the event
    • Have a lot of physical sensations when I am reminded of the event (for example, my heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I'm going to lose control)
    1. I have symptoms of avoiding reminders of the traumatic event:
    • Avoid thoughts, feelings, or talking about things that remind me of the event
    • Avoid people, places, or activities that remind me of the event
    • Have trouble remembering some important part of the event
    1. I have noticed these symptoms since the event happened:
    • Have lost interest in, or just don't do, things that used to be important to me
    • Feel detached from people; find it hard to trust people
    • Feel emotionally "numb" or find it hard to have loving feelings even toward those who are emotionally close to me
    • Have a hard time falling or staying asleep
    • Am irritable and have problems with my anger
    • Have a hard time focusing or concentrating
    • Think I may not live very long and feel there's no point in planning for the future
    • Am jumpy and get startled or surprised easily
    • Am always "on guard"
    1. I experience these medical or emotional problems:
    • Stomach problems
    • Intestinal (bowel) problems
    • Gynecological (female) problems
    • Weight gain or loss
    • Pain, for example, in back, neck, or pelvic area
    • Headaches
    • Skin rashes and other skin problems
    • Lack of energy; feel tired all the time
    • Alcohol, drug, or other substance use problems
    • Depression or feeling down
    • Anxiety or worry
    • Panic attacks
    • Other symptoms such as: ______________________________

    Summing it up

    If you checked off some of the symptoms above, it is important for you to let your health care provider know. This information helps providers plan your medical treatment. It can also help them connect you with services you may need.

    If you think you may have PTSD, print this checklist, fill it out, and take it to a health care provider, or someone you trust.


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  • Marine Col Turner


    Jim Turner was a decorated Marine who served his nation with honor. But the transition to civilian life proved to be too difficult and like 19 other Veterans every day he took his own life.

    ST. PETERSBURG — On Dec. 10, retired Marine Col. Jim Turner put on his dress uniform and medals and drove to the Bay Pines Department of Veterans Affairs complex. He got out of his truck, sat down on top of his military records and took his own life with a rifle.

    Aside from leaving behind grieving family and friends, Turner, 55, of Belleair Bluffs, left behind a suicide note that blasted the VA for what he said was its failure to help him.

    "I bet if you look at the 22 suicides a day you will see VA screwed up in 90%," wrote Turner, who was well-known and well-respected in military circles. "I did 20+ years, had PTSD and still had to pay over $1,000 a month health care."

    Turner’s death marked the fifth time since 2013 that a Veteran has taken his life at Bay Pines. There were more suicides there during those five years than at the rest of the VA hospitals in the state combined. There were none at the James A. Haley VA Medical Center in Tampa.

    It's unclear how many other Veterans killed themselves during that period at VA facilities around the nation. The government’s second-largest bureaucracy declined a federal Freedom of Information Act request by the Tampa Bay Times for that information last year. In an email Friday afternoon, VA spokeswoman Susan Carter said the agency only started collecting the information a month after the denial.

    From October 2017, to November 2018, there have been 19 suicide deaths at VA facilities around the United States, Carter said. The vast majority of Veteran suicides are off campus and 70 percent of those who take their lives hadn’t sought treatment from the VA, according to VA statistics.

    As for why it keeps happening at Bay Pines, officials there say they don’t have an answer.

    Long before he became a statistic — one of 20 Veterans who die by suicide every day — James Flynn Turner IV was a young man from a wealthy Baltimore family who joined the Marine Corps and reveled in his service to the nation.

    “My brother’s identity was being a Marine,” said Jon Turner.

    Jim Turner flew F-18s and then became an infantry officer, taking part in the invasion of Iraq in 2003. He later served in Afghanistan and spent a decade working at U.S. Central Command at MacDill Air Force Base.

    He left “an enduring legacy of professionalism, commitment and superior leadership which served as a guiding force for all service members whose lives he touched,” said Edward Dorman III, a recently retired Army major general who worked with Turner at Central Command for a decade. “That’s a life worth emulating.”

    When Turner retired, he lost his identity and began to struggle, his younger brother said.

    Those problems exacerbated some of the mental health issues Turner was experiencing from his time in the Marines, said his ex-wife, and led to the dissolution of their 27-year marriage,

    “He came home seemingly fine,” said Jennifer Turner. “It was a couple of years later that he just got more aggressive.”

    It was never anything physical, she said. “He just got agitated very easily. He had nightmares, where he would wake up screaming military stuff.”

    The problems reached a crescendo as Turner was retiring in 2015, his ex-wife said.

    The couple decided to separate. In January 2016, while Jennifer Turner was out of town, Turner grew angry at his son and chased him out of the house with a gun. Pinellas County Sheriff’s deputies responded and detained him under the state’s Baker Act.

    Jennifer Turner believes her ex-husband may have taken his life because he was refused treatment at Bay Pines. Both she and Jon Turner say it was quite possible he became frustrated with having to wait and left without being helped.

    The VA did not comment, citing privacy concerns.

    Others who lost a loved one to suicide at Bay Pines have different theories on why they chose to end their lives there.

    Vietnam War Navy Veteran Jerry Reid, 67, may have driven to the VA to take his own life on Feb. 7, 2013, because he lived alone and didn’t want to have his body found weeks or months later, said his friend, Bob Marcus.

    Joseph Jorden, 57, a medically retired Army Green Beret, likely took his life at Bay Pines on March 17, 2017, not because of poor treatment, but because he felt safe there, said his brother, Mark Jorden.

    But Gerhard Reitmann, 66, who served with the Marines in Vietnam and later as a guard for President Richard Nixon at Camp David, “felt like the VA wasn’t really taking care of him” when he ended his life at Bay Pines on Aug. 25, 2015, said his brother, Stephan Reitmann.

    The mother of Esteban Rosario, 24, who ended his life at Bay Pines on May 8, 2013, could not be reached for comment.

    Regardless of why he took his own life, Turner left behind family and friends, many of whom gathered for a memorial service Friday afternoon in Largo, still struggling with the aftermath.

    "Both of his heartbroken children are currently in school and they have lost their main means of financial support,'' his sister-in-law, Katie Turner, wrote on a GoFundme site set up to help them "In lieu of flowers, the family has humbly requested donations for the children's continued educational expenses. "


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  • PTSD Vets Sue


    A federal judge in Connecticut ruled Thursday in favor of thousands of Veterans seeking to sue the federal government alleging they were discharged due to infractions related to untreated mental illnesses and denied Veterans Affairs benefits as a result.

    The Associated Press reports that Senior U.S. District Judge Charles Haight Jr. ruled Thursday that the Veterans, who were given less-than-honorable discharges after service in Iraq and Afghanistan, could move forward with a lawsuit against Navy Secretary Richard Spencer.

    The less-than-honorable discharges, the Veterans allege, made it harder for Veterans who were discharged to receive care for their mental illnesses developed as a result of their service in America's wars.

    The lead plaintiff in the case, Marine Veteran Tyson Manker, sharply criticized the Department of Defense in a statement Thursday following the initial ruling.

    “The fact that the Court has now recognized this class of Veterans is further evidence of the Department of Defense’s disgraceful violation of the legal rights of the men and women who have served their country," Manker said in a statement obtained by the AP.

    “This decision is a victory for the tens of thousands of military Veterans suffering from service-connected PTSD and TBI (traumatic brain injury),” added Manker, who says he was dishonorably discharged after serving in Iraq due to a single use of an illegal drug.

    Students from Yale Law School are reportedly representing the Veterans and have filed a similar suit against the Army, according to the AP.

    Connecticut-based Veterans group National Veterans Council for Legal Redress, another plaintiff in the suit, celebrated the judge's decision in a statement Thursday.

    “We filed this lawsuit to make sure that the Iraq and Afghanistan Veterans with service-connected PTSD do not suffer the same injustices as the Vietnam generation,” group director Garry Monk told the AP.

    “We are thrilled with the court’s decision and look forward to creating a world where it doesn’t take years of wading through unlawful procedures for these Veterans to get relief.”


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  • Outdoors


    Nearly 50 years have passed since Gerry Barker last set foot on a battlefield. But even now, on his farm in Metcalfe County, the sights, sounds and overwhelming feelings of combat return all too easily.

    “I’ll hear an explosion,” he says, something loud, that shakes his whole body, “and nobody else has heard it.” Or he might be driving along the Cumberland Parkway and see 122 mm rockets shooting toward him, the same kind he saw in Southeast Asia when he was a scout with U.S. Army Special Forces.

    “My heart stops,” he says. “All of these are over in a second. I take stock and realize what happened, and go on.”

    And go on he has, enduring symptoms of post-traumatic stress disorder (PTSD) while completing a 22-year Army career, earning a master’s degree, teaching history, working as an administrator, publishing dozens of articles and writing four books.

    All the while, Barker has grappled with hallucinations, nightmares, depression, anxiety and guilt.

    “I just overloaded on war,” says Barker, a consumer-member of Farmers RECC.

    For all the efforts as a society to honor Veterans, the truth is that those of us who’ve never gone into battle for our country have little understanding of the toll it takes on those who have, a toll evidenced by the alarming rate at which American Veterans take their own lives.

    According to the U.S. Department of Veterans Affairs, Veterans (a term that includes active-duty service members) make up only 8 percent of the U.S. adult population, but they account for 14 percent of the suicides. On average, 20 Veterans die by suicide every day.

    The problem is particularly acute in Kentucky, where the VA finds the state’s suicide rate among Veterans is 34 percent higher than the national average.

    The VA has launched a national campaign (#BeThere) to raise awareness and provides a crisis line for Veterans and their loved ones—(800) 273-8255, press 1 or text 838255. The agency provides counseling at its medical centers in Louisville and Lexington and at some of its clinics and other facilities in more than 20 communities around the state.

    The VA also is rolling out video telehealth programs. The Kentucky Department of Veterans Affairs provides social workers to serve Veterans’ mental health needs at its four nursing homes. It also works with organizations like the Disabled American Veterans, American Legion and Veterans of Foreign Wars, and to help Veterans receive all their entitled benefits from the VA.

    And yet, our Veterans’ needs remain greater than all of those efforts put together. At Kentucky Living, we wanted to get a sense of how Veterans across the state are dealing with the suicide crisis. We found that in addition to traditional treatments like psychotherapy and pharmaceuticals, many Kentucky Veterans are taking it upon themselves to find their own paths to healing, both for themselves and their fellow Veterans. In many cases, those paths are leading them to start their own organizations and to get out of doors and into nature.

    Mindful adventures

    Cassie Boblitt earned a scholarship to Purdue University out of high school, but instead left her hometown of Lebanon Junction to join the Army in 2000. “I wanted adventure,” she says. “I wanted to see the world.”

    She says the military gave her that. It also gave her a greater openness to different kinds of people, more awareness of her own strength and resourcefulness, as well as a sense of connection to her fellow soldiers—“my brothers and sisters”—that she says will never be broken. She forged those bonds serving with a Patriot missile air defense artillery unit during the invasion of Iraq in 2003. On those convoys, Boblitt says, “We’d get trapped in towns and people would surround our vehicles. You don’t know who could be a suicide bomber.”

    There’s a psychological impact from the constant vigilance of a war zone and the proximity to combat. “You never feel safe. You never are safe,” she says. “You numb yourself to everything. Stay focused and do what you’re trained to do.”

    She felt lucky when she left the Army seemingly unscarred. Moved on. Played professional basketball. Learned Spanish. Got an MBA and a good job. The symptoms came later.

    Boblitt lives in the Nelson County community of Boston and says sometimes she’s driving on Interstate 65 and suddenly, “I won’t have any idea where I am. Where am I going? This doesn’t look familiar.” She often feels hypervigilant and hyperprotective of those around her. She insists on driving because “I feel trapped if I ride with other people driving.”

    Boblitt’s found multiple ways to cope. She started her own business, Mindful Movement, in 2016, teaching movement and games to children and yoga to combat Veterans from World War II as well as the present. She’s one of the founding members of the performing troupe Shakespeare with Veterans (see sidebar below). But one of the best treatments she’s found for the claustrophobic feelings associated with PTSD is to hit the hiking trails. Her Army training helps, “I can go camping in Yellowstone by myself for a month and a half. My mom says, ‘Anything could happen to you out there by yourself.’ But the way I look at it, nobody’s trying to kill me. So I’ll probably be all right.”

    Boblitt recently started Mindful Adventures, a new business venture in which she helps lead extended wilderness excursions. She’s primarily focused on children, but has plans to offer outings for Veterans.

    Going into the forest and working with kids and Veterans has helped Boblitt feel a sense of purpose and comfort. “It’s through these connections that we heal,” she says.

    The idea of time in nature as a source of healing isn’t new, though the scientific research supporting the idea is. According to a 2016 National Geographic article that surveyed recent studies, “A 15-minute walk in the woods causes measurable changes in physiology.” The article also references a 2015 report published in the journal Psychological Science that says, “Imagine a therapy that had no known side effects, was readily available, and could improve your cognitive functioning at zero cost. Such a therapy has been known to philosophers, writers and laypeople alike: interacting with nature.”

    Boblitt’s passion for the wilderness was kindled by joining a Sierra Club Military Outdoors tour. The Wounded Warrior Project’s website also talks about “using nature and recreation to heal the spirit” through its Project Odyssey program.

    Camp Brown Bear

    Former U.S. Navy SEAL Steve Brown participated in a Project Odyssey outing in 2015. He’d recently retired after a 20-year career and his PTSD hit him especially hard at night. “There were times, my wife was changing our bedding out two-three times a night because I was sweating through the sheets,” he says. He also suffers from traumatic brain injury (TBI), the byproduct of combat, hard falls and proximity to explosions while conducting more than 250 high-risk operations, mostly, he says, “to places I wouldn’t want to go on vacation.”

    TBI, which often affects memory function as well as concentration, sleep and mood, is part of his everyday life. “If there’s something important I need to do tomorrow, I have to write it down today or I won’t remember it,” Brown says. He also doesn’t like crowds, even small ones: “I feel like I’ve got to know who every person is around me. It’s really draining.”

    His wife, Sabrina, says they’ve had to adjust the way they communicate. “It’s very hard for a person with TBI to argue because they can’t remember what’s been said,” she explains. “Sometimes we go to text messaging so he can read over the conversation.” Sabrina Brown is an associate professor of epidemiology at University of Kentucky and is writing a book about their experiences. She says one challenge for Veterans like her husband is that “they’re used to being the hero, leading the command. Now, they can’t remember if they’ve taken their medicine. There’s a self-esteem issue.” In his darkest time, she says, “Sometimes Steve wouldn’t get out of bed for days.”

    Steve found comfort and solace on the Wounded Warrior retreat, both from being in nature and being with fellow Veterans who understood what he was experiencing. He’d had a dream about opening a camp that would serve children, but now he realized he should create a camp for Veterans as well. He found a property for sale north of Frankfort that at one time was home to a church camp. The Browns, consumer-members of Blue Grass Energy, bought it and created Camp Brown Bear, a 501(c)(3) non-profit that’s part of a larger operation, Kodiak Camps and Outfitters.

    He welcomes Veterans’ groups for weekend retreats every three months or so. Their daytime activities include hiking, kayaking and canoeing. Sometimes they hunt with bow and arrow. They journal and share stories around a campfire at night. The Veterans also help renovate the cabins on the 120-acre property so Steve can eventually open the camp to the other population he wants to serve: middle school-aged boys growing up in disadvantaged circumstances. He usually invites a local pastor as well as professionals to lead yoga, meditation and other activities. He’s developing a more robust curriculum for Veterans based on the National Intrepid Center of Excellence at Walter Reed National Military Medical Center.

    Brown tries to keep in touch with alumni of the camp, building a social support network. To his fellow Veterans, Brown says, “Don’t struggle in silence. There are people out there who want to help, and who are dealing with the same things you are.”

    A Soldier’s Heart Bluegrass and Muddy Waters

    One of the most enthusiastic testimonials on the Camp Brown Bear website reads, “By far, this is the best therapy I’ve had over the years of fighting PTSD.”

    Those are the words of Jeremy Wallace, who lives in the Marshall County community of Gilbertsville and is a member of West Kentucky RECC. He’s a former National Guardsman who spent 15 months in Iraq providing convoy security and combat patrol. Wallace says his unit lost only one of about 80 guardsmen to combat. Since coming home, they’ve lost at least three to suicide, and nearly lost a fourth.

    “And I was suicidal,” he says. “Killing myself seemed like the logical answer. It kept running through my head like a CD skipping and repeating itself.”

    What kept him from pulling that trigger?

    “My wife and kids,” he says.

    Wallace has founded his own outdoor retreat and outing non-profit, A Soldier’s Heart Bluegrass and Muddy Waters. The retreats are entirely free and Wallace covers expenses by organizing fundraising concerts and from other private donations. “I was on about 17 different medications,” he says. “Since I started this getting out in nature, now I’m down to three.”

    There are many other examples of Veterans finding healing in Kentucky’s great outdoors. The Kentucky-based charity Active Heroes has a retreat center with cabins in rural Bullitt County. The state’s Veterans Center in Hazard takes residents (some of whom served in World War II) on field trips to nearby Jenny Wiley State Resort Park.

    For some, the interactions with nature focus on animals. The Louisville-based Veteran’s Club is one of several organizations with an equine program. Veteran’s Club was founded by Veteran Jeremy Harrell, who was recently named the male 2018 Kentucky Veteran of the Year by the Epilepsy Foundation of Kentuckiana (Story here). Army National Guard member and Afghanistan Veteran Deborah Sawyer enjoyed one of the club’s recent equine sessions in Shelby County.

    “The horses didn’t need any explanations about who I was or what I could do. They just accepted me,” something she says she doesn’t always feel from civilians who can be “very judgmental and ask a lot of questions.” Overall, Sawyer says, “It was encouraging to watch the trust being developed between my brothers and the other horses.”

    There’s no one answer to addressing the complex mental health challenges like PTSD, TBI and other conditions that contribute to Veterans’ suicide rates. It’s also worth noting that not all Veterans have served in combat and not all experience PTSD or experience it to the same degree. Some Veterans respond well to talk therapy, to pharmaceuticals or some combination of these. Clinical help is still the recommended first stop for anyone struggling with mental health issues, especially thoughts of suicide.

    Still, in a battle as fierce, complicated and necessary as the one our country is fighting against PTSD and suicide, we have to take our victories where we find them and use every tool that gives our Veterans an advantage, no matter how unlikely the form.

    Gerry Barker understands that. He tends to self-medicate too often with bourbon and solitude, he says. But even after all he’s been through, he’s still around, at 74.

    He says one reason for that is the farm where he’s lived for 21 years. There, his companions have included his wife, Maria, as well as a collection of animals that sounds like something between Old McDonald’s farm and Noah’s Ark. “We had 22 horses at one point. 40 ducks. We had oxen. I loved them. I could work oxen all day,” Barker says, lamenting that these days, “We’re down to just 21 goats.”

    Then this man who overloaded on war calls his goats, “great friends.”

    “The other day, one just came over to me and put her head on my lap. They’re a delight. They have a wonderful, calming effect.”

    Seek help here

    Shakespeare with Veterans co-founder Fred Johnson has written about his experiences before, during and after serving in combat in his book Five Wars.

    PTSD information and resources:

    Veterans Crisis Line: (800) 273-8255, press 1, text 838255, or web chat; deaf or hard of hearing call (800) 799-4889,

    Here are the websites of the Veterans’ organizations in the story:


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  • PTSD Key


    Post traumatic stress disorder (PTSD) is a recognized psychiatric disorder that a person may develop after exposure to a traumatic event. For many years, PTSD went widely undiagnosed or was not recognized as the serious condition it is. Thanks to advancements in research and the breakdown of social stigmas, we have more information about the condition than ever before. We know that the majority of people who are exposed to traumatic events do not develop PTSD, and we know that veterans of the U.S. military are disproportionately affected by PTSD when compared to American civilians.

    This blog post is intended to serve as a brief breakdown of the required criteria for a diagnosis of PTSD as defined by the fifth edition of the Diagnostic and Statistics Manual of Mental Disorders (DSM V), published by the American Psychiatric Association.

    Criterion A: Stressor

    In the context of PTSD, the stressor is the traumatic event that leads to the development of PTSD. The precise definition of “traumatic event” is contested, but the DSM V requires exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. This exposure must have occurred in one of the following ways: direct exposure; witnessing the trauma; learning that a relative or close friend was exposed to the trauma; or indirect exposure to details of the trauma, often in the course of professional duties (for example, a paramedic treating victims of a serious motor vehicle accident would be indirectly exposed to the traumatic event of the motor vehicle accident even if she did not witness the accident herself).

    Criterion B: Intrusive symptoms

    Not everyone who is exposed to a traumatic event will develop PTSD. In order for a person to receive a diagnosis of PTSD, the DSM-V requires the person to show at least one intrusive symptom. Intrusive symptoms can manifest in sudden upsetting memories; nightmares or bad dreams; flashbacks to the traumatic event; emotional distress after reminders of the traumatic event; or physical reactivity following reminders of the traumatic event (for example, an increased heart rate after exposure to reminders of the traumatic event).

    Criterion C: Avoidance symptoms

    The third criterion for a PTSD diagnosis is avoidance of reminders of the trauma. This could be an avoidance of thoughts or feelings about the event or avoidance of trauma-related reminders altogether. A person who suffered sexual assault may display avoidance of thoughts and feelings of the assault and do their best to never think about the event. Someone who witnessed a person drowning may avoid trauma-related reminders and stay away from pools or bodies of water. For a diagnosis of PTSD, the presence of at least one of these symptoms is required.

    Criterion D: Negative alterations in cognition and mood

    A person who receives a diagnosis of PTSD must display at least two of the following symptoms following the stressor: inability to recall key features of the stressor; overly negative thoughts or assumptions about oneself or the world; exaggerated blaming of self or of others for causing the trauma; negative affect (having a flat or depressed mood); decreased interest in regular activities; feelings of isolation; or difficulty experiencing a positive effect (having a hard time feeling happy).

    Criterion E: Alterations in arousal and reactivity

    For a diagnosis of PTSD, at least two of the following symptoms that began or worsened after the stressor must be present: Irritability or aggression; risky or destructive behavior (for example, driving recklessly); hypervigilance (for example, not being able to relax for fear that something bad will happen); increased startle reaction; difficulty concentrating; or difficulty sleeping. These alterations in arousal and reactivity are a defense mechanism for preventing further trauma.

    Criterion F: Duration of symptoms

    Even if a person fulfills all the required criteria, a diagnosis of PTSD requires persistence of the symptoms for more than one month. A person may fulfill all criteria immediately following a traumatic event but two weeks after the event may display fewer or none of the required symptoms. Although the criteria were present for a time, the person would not meet the duration requirement.

    Criterion G: Functional significance

    The PTSD symptoms experienced by the person with the diagnosis must create distress or functional impairment in a person’s life. For example, a veteran who suffers from PTSD and currently works in an office setting may find that his job performance is impacted by difficulty concentrating or increased irritability with his coworkers. A college student who experienced sexual assault at a party may find that their friendships are affected by their negative affect, hypervigilance, and their avoidance of other social events.

    Criterion H: Exclusion

    In order to meet the criteria for a PTSD diagnosis, the symptoms must not be caused by medication, substance abuse, or any other illness.

    This is an extremely simplified discussion of PTSD intended to provide clarity to a frequently-discussed condition. Follow-up blogs will address specifications of the diagnosis as well as the issue of PTSD as it relates specifically to veterans seeking service connection.


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  • Wild Tiger


    Energy drinks like Rip-It and Wild Tiger may be essential fuel for hard-charging U.S. service members, but they’re only exacerbating mental health issues and behavioral issues, according to a new study in Military Medicine.

    • The research found that soldiers who consumed at least two energy drinks a day were far more prone to “mental health problems, aggressive behaviors, and fatigue,” with high consumption reported in one out of every six soldiers months after the end of a high-stress deployment.
    • Most alarmingly, however, is the assertion that ongoing energy drink consumption and the resulting aggressive behaviors “are associated with being less responsive to evidence-based treatments for PTSD” — a conclusion that suggests soldiers are mortgaging their long-term health for their short-term performance downrange.
    • This conclusion was based on a survey of 627 male infantry soldiers, mostly junior enlisted between the ages of 18 and 24, seven months after the end of an unnamed combat deployment in order to gauge long-term impact.
    • The problematic behaviors recorded in Military Medicine include extreme irritability (66%), sleep issues (35%), alcohol abuse (29.8%) and depression (9.6%), as well as a higher rate of post-traumatic stress disorder (11.2%), following the end of a deployment.
    • It’s important to note that most of these behaviors aren’t a product of the energy drinks themselves, but a long-term impact of an abnormal sleep cycle: “Interestingly, energy drink use was associated with fatigue,” the authors note. “This relationship suggests that energy drink use may potentially exacerbate, rather than alleviate, fatigue.”


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  • Spiritual Approaches


    Mental-health professionals and military specialists increasingly rely on these tools to combat the after-effects of war.

    As Veterans from the Iraq War and other conflicts continue to face a mental-health crisis that is claiming an average of 20 lives by suicide each day, mental-health professionals and military specialists are increasingly turning to spiritual approaches as a way of combating Post-Traumatic Stress Disorder and other after-effects of war.

    “We welcome our men and women who have served back in airports and in coffee shops. We applaud them. But then we have nothing to do with helping them get back on track,” said Mark Moitoza, the vice chancellor for evangelization for the Archdiocese for the Military Services.

    An estimated one out of every five Iraqi War Veterans has Post-Traumatic Stress Disorder (PTSD). Among Vietnam Veterans, the figure is nearly one in three, according to the National Institutes of Health.

    The need for a faith-based approach is especially clear when it comes to healing from a condition known as “moral injury,” which is related to PTSD but distinct, in that it refers to the wounds to the soul that occur when a soldier in an active battlefield commits acts that go against his values, either on the orders of a commanding officer or on his own accord, according to Moitoza.

    Even if someone acted with justification to kill an enemy combatant, he likely will still have deep misgivings and discomfort with what was done. “Whether the bad guy was bad or not, when you kill, it does something to humans. It’s not natural to kill another person. It’s more justifiable when it’s an extreme terrorist putting a bomb into the school, but it doesn’t change the fact that I killed him. That scars you,” said Damon Friedman, a lieutenant colonel for U.S. Air Force Special Operations and president of SOF Missions.

    SOF Missions is a Florida-based nonprofit that provides a holistic approach — incorporating the body, mind and soul — to helping Veterans cope with PTSD and moral injury. (SOF stands for Shield of Faith.)

    Friedman recently appeared on a panel at a Nov. 29 event on spiritual health and suicide prevention at the Heritage Foundation, a Washington, D.C.-based think tank. The event included a screening of a documentary recently released by SOF Missions, Surrender Only to One.

    The documentary presents Jesus as the one who brings peace and wholeness to Veterans. While they may no longer be engaged in physical combat, the documentary reminds Veterans of their calling to engage in spiritual warfare, Friedman said.

    Wounds Only God Can Heal

    This spiritual approach is aimed at PTSD and moral injury.

    “I would argue that when it comes to moral injury, there’s only certain injuries that God can heal. There’s only certain wounds that God can heal, and that’s why it’s really important to understand the psychological realm and the spiritual realm and how they can work collectively together,” Friedman said.

    The program that SOF Missions offers to Veterans is tailor-made to the needs of individual and includes physical fitness, mental-health care professionals and spiritual counselors. The program also invites participants to identify with the stories of biblical figures like Peter or Elijah.

    Commanders struggling with battlefield decisions might relate to someone like King David, while a soldier dealing with guilt over a particular killing may find comfort in the story of Paul, who presided over the murder of the martyr St. Stephen, according to Friedman.

    Although SOF Missions hails from a conservative evangelical background, its approach is more ecumenical than denominational, and it has team leaders on staff who are Catholic.

    One former military official who is not at the Heritage Foundation says the Department of Defense and Veterans Affairs need to do more to incorporate these spiritual approaches into their treatment for both Veteran and service members.

    Steven Bucci, a former Army special forces officer and now a visiting fellow at the Douglas and Sarah Allison Center for Foreign and National Security Policy at Heritage, says both federal departments need to work with nonprofits like SOF Missions, making their kind of program more widely available. He said the Department of Defense and Veterans Affairs need to better utilize their chaplains, as well.

    “Then we can begin to address this problem and maybe get that darn 21 people a day number down a lot lower than it has been,” Bucci said, citing one estimate for the daily number of Veteran suicides.

    Bucci, who is Catholic, said he can personally attest to the importance of faith in dealing with his experiences in the military. “It’s foundational. I know who my strength comes from, and that’s the Lord Jesus; and I have always been very open with my faith, even with my troops,” Bucci said. “I could not have gone through the things I have and still have my same wife and family and sanity if it had not been for my relationship with the Lord.”

    Chaplain’s Perspective

    For chaplains, one of the first steps is listening to the experiences of Veterans and journeying with them as they process their experiences, according to Father Andrew Sioleti, the chief chaplain at VA New York Harbor Health System in Manhattan.

    Veterans’ chaplains offer the sacrament of reconciliation and retreats as additional aids for Veterans. Another spiritual tool is more active: “One way of healing from your trauma and your pain and your moral injury [is] to start doing good things,” Father Sioleti said.

    He said volunteer work had been particularly helpful to one Veteran haunted by a battlefield killing of a young boy who was the same age as his son. The boy was among a group that was rushing a military position that did not stop when warned to do so. The killing was justifiable, according to military rules of engagement, but the Veteran continued to struggle with that outcome.

    Father Sioleti said the Veteran dealt with his guilt by becoming involved as a fundraiser and public speaker for a charity that ministers to children affected by war and violence.

    Moitoza said there is more that can be done to help Veterans with PTSD and moral injury. In his recently completed dissertation, which focuses on sacramental healing for moral injury, he recommends a communal examination of conscience followed by the administration of the sacrament of confession. He says the anointing of the sick is another remedy that should be applied to both PTSD and moral injury.

    Community Responsibility

    According to Moitoza, the broader Catholic community also has a responsibility to welcome Veterans back into the community. Individual parishes, he said, should reach out directly to Veterans, assisting them even in smaller, mundane tasks, like arranging appointments with therapists.

    “Returning Veterans are frequently hailed for possessing courage and strength as they entered into harm’s way, but some who return feel lost, hopeless and morally conflicted. Those overwhelming feelings contribute toward a sense of being unworthy to approach God or the Church, creating soul wounds,” Moitoza said. “A communal embrace of returning Veterans with moral injury helps to reconnect them with a new sense of courage, allowing them to rise above the images, guilt and shame that endure.”


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  • Suicide Data


    The suicide rate among Vets has not improved and remains a deeply disturbing problem, despite work by the VA and others, according to a VA analysis and statistics obtained by Fox News.

    Last week, the VA released findings from a years-long investigation into Veteran suicide data from 2005-2015 in all 50 states and the District of Columbia. The findings are clear: the suicide rate is constant.

    Veterans are more than twice as likely to die by suicide as non-Veterans, according to the VA report. Additionally, VA researchers found the number of Vets who take their own lives each day “remained unchanged at 20.” And even more-recent data obtained by Fox News suggests things may not be much better in 2018.

    Even for the mother of a U.S. Marine who took his own life after battling PTSD, and who has since dedicated her own to preventing Veteran suicides, the numbers are stunning.

    “I had no idea it was that bad,” said Janine Lutz. “That’s really lighting a fire under my butt to work harder."

    The Veterans Crisis Line provides 24/7 support to Veterans in distress, as well as concerned friends and family members. Staffers are available by phone at 800-273-8255 (Press 1), online at, and via text at 838255.

    The volume of phone calls the Crisis Line receives is staggering. The VA told Fox News that since October 31, 2017, the Veterans Crisis Line has fielded approximately 222,000 calls from Veterans who are having thoughts of suicide. That is in addition to the 49,000 calls from family members or friends who are concerned about a Veteran who is considering suicide.

    That breaks down to nearly 950 calls from Veterans (or nearly 40 calls per hour) every day since Halloween, and more than 200 calls a day from friends and family.

    "The mother of all battalions"

    Lutz, who lives in Florida, is affectionately referred to by many in the Veterans' community as “the mother of all battalions” for her efforts to bring Veterans of all stripes together, and prevent more Veteran suicides, via the LCpl Janos V Lutz Live To Tell Foundation.

    Lutz started Live To Tell to honor the memory of her son “Jonny,” a Marine who took his own life while under the influence of a cabinet’s worth of medication for his PTSD. Since then, she has sued the government for her son’s death, eventually winning a settlement out of court, but her work didn’t stop there.

    “About five months after [Jonny’s] death, I woke up one day and I was mad,” Lutz told Fox News. “I was mad knowing that my son wasn't the first to die like this. And I said why didn't somebody tell me… why aren't we doing more as a community? And it was then I decided that I was gonna be the voice, and fight for those who fought for us.”

    It was only a year after her son’s death that Lutz made her first foray into advocacy, organizing a motorcycle rally that brought out an unexpectedly large number of people from across the country. She was excited about the hundreds of supporters who turned out, but unsure of what to do next.

    That was until Lutz’s niece played a song for her that she says “grabbed me by the chest,” and inspired a plan to save the lives of Veterans across the country:

    Buddy Up

    “It’s time to buddy up ‘cause yup, this is wrong.


    Surviving battle, but die when we’re home.

    Yeah it hurts, that’s why I made this song.

    It’s time to see the signs, like the lights when it’s on.”

    Those lyrics are from the song “Red Flags” by Soldier Hard, an artist whose real name is Jeff Barillaro and who also happens to be an Army combat Veteran. Barillaro dedicated himself to creating music that gives a voice to Veterans, and the issues they experience along with their friends and families. When Lutz heard the lyrics to his song, she says she knew immediately what she had to do.

    “He said ‘you all need to buddy up’… and he was talking to the Veterans out there,” Lutz says. “When I heard that, I said that's it. I'm gonna get these guys together, build local communities, facilitate – I don’t know how, but that’s what I’m gonna do.”

    Using Soldier Hard’s song as inspiration, Lutz has since established two “Lutz Buddy Up” social clubs, one in Florida and one in Massachusetts, and this summer she’s touring the country in the hopes of establishing even more. The concept is simple: bringing Veterans together (and even first responders) so they can support one another while sharing a meal, playing a game or two, or just chatting.

    “We welcome our Veterans just as they are, wherever they are,” Lutz says. “Whatever mindset they're in, we welcome them. All we want to do is connect them with their peers, and it's just been a great success. Dozens and dozens of success stories.”

    Lutz says membership has skyrocketed from just a handful back in 2014, to well over 500 in 2018 – including Veterans from every U.S. armed conflict since the Korean War.

    Asked what she would tell Veterans who might be suffering in silence, or friends and family who might be concerned about a Veteran they know, Lutz says to remember that connecting with peers is the key.

    “They need to speak to their peers, someone who has walked in their shoes,” Lutz says, before pointing out that this is the exact philosophy soldiers employ on the battlefield.

    “That's what they fight for, to keep the guy next to them alive… Yeah, they have a mission, but the biggest part is making sure the guy right next to you is alive and well,” Lutz says. “You're watching each other, and that’s what they have to continue when they get home…

    “So if you don’t have any local buddies you know, find some in your community because they're everywhere, and they're looking for help too,” Lutz says. “Reach out to other Veterans in your communities because that is your best medicine - your peer who has walked in your shoes.”

    If you are a Veteran in crisis or having thoughts of suicide, or if you are someone who knows a Veteran in crisis, call the Veterans Crisis Line for confidential support 24 hours a day, seven days a week, 365 days a year at 800-273-8255 and press 1. You can also chat online at, or send a text message to 838255.


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  • Recovery is Working


    Compensated Work Therapy

    Compensated Work Therapy (CWT) is a Veterans Health Administration clinical vocational rehabilitation program offered at every VA medical center. The mission of CWT services is to provide support to Veterans living with mental illness or physical impairment with barriers to employment to secure and maintain community-based competitive employment.

    CWT programs strive to maintain highly responsive long-term quality relationships with business, government agencies, and industry promoting employment opportunities for Veterans with physical and mental health challenges.

    Hundreds of VA employees work hard every day to make these opportunities happen for Veterans. We recognize these employees during CWT Vocational Rehabilitation Recognition Week, which occurs annually during October, National Disability Employment Awareness Month. Every year, the exceptional CWT staff members are honored. As we observe this year’s Recognition Week (October 21-27), let’s take a look back at the Excellence in CWT Award winners from 2017.

    Congratulations to Beverly Maier from the North Chicago Compensated Work Therapy (CWT) program was selected as the 2017 Excellence in CWT Service Delivery award winner.

    Maier would take a fifteen-mile ride to spend an entire day, in below freezing temperatures, to travel about the local community seeking vocational options for a Veteran who had no other means of transportation to support his employment goal.

    She secured employment for 32 Veterans, many of whom have required multiple jobs. Her entire caseload was comprised of those Veterans coping with persistent and serious mental illness.

    In 2015 she was nominated for the Rehabilitation Counselor of the Year Award and was promoted to the position of CWT Coordinator. She immediately revised the CWT discharge follow up survey utilizing statistical software. The goal is to expand this survey into a formal VHA research project to determine which vocational interventions best support sustained employment outcomes.

    Maier is a tireless advocate for mental health recovery and vocational rehabilitation.

    Congratulations to Kenneth Weber, CWT Manager at the Edward Hines, Jr. VA Hospital and Mr. Rodger Woeppel, at the Black Hills Health Care System who were both selected as 2017 Excellence in CWT Leadership award winners.

    Weber is an inspiring leader whose achievements over the last nine years as Hines’ CWT Program Manager have been monumental and include transforming a struggling CWT program into a world-class vocational Rehabilitation system of care, expanding the CWT program from serving only 48 Veterans in 2008 to 1,467 in 2016.

    His CWT office has continued to expand services and access for Veterans to the Veterans Career Center which includes instructions in online job application processes, USA Jobs Account Setup and development of an Internet Cafe concept to allow Veterans to utilize the free patient access Wi-Fi to log in with their own personal devices.

    Weber organized job fairs at Hines attended by as many as 600 Veterans and 27 employers (including FBI, DEA, Comcast, Marriott, and UPS).

    As the Assistant Chief of the Mental Health office noted, “Ken has an impressive list of achievements, but perhaps more remarkable are the ‘little things’ he quietly does every day to encourage staff and Veterans, to handle difficult conversations, and to gently but persistently guideCWT forward.”

    Army Veteran a Licensed Professional Counselor and charismatic presenter

    The Black Hills Health Care System (BHHCS) covers a vast rural area with four reservations, nine Community Based Outpatient Clinics and two hospital facilities at Fort Meade and Hot Springs, S.D.

    As program leader, Rodger Woeppel has made a name for himself in the communities served. An Army Veteran committed to serving Veterans, he is a Licensed Professional Counselor able to provide an array of services.

    He is a charismatic presenter who provides excellent information, integrating recovery-oriented programming in a way that encourages others to do the same. In one presentation he introduced The Seven Bands of the Lakota using Lakota phrases and American translations.

    In addition to his many duties, he manages transitional residence programs located in Sturgis, Rapid City, Hot Springs and Pine Ridge, S.D. He also manages the Domiciliary Care for Homeless Veteran program in Hot Springs and the operation of the Therapeutic and Supported Employment Services programs in McLaughlin, Eagle Butte, Ft. Meade, Rapid City, Hot Springs and Pine Ridge, S.D.

    His presentations include the importance of community involvement and how he successfully created, developed, and manages a Mental Health Advisory Group made up of Veterans in a variety of professional fields and expertise.

    Woeppel has integrated suicide prevention into Therapeutic and Supported Employment Services training and has excellent relations with the Suicide Prevention Team. Rodger recognizes his staff and Veterans for a successful transition to permanent employment and knows this saves lives. His commitment inspires his staff to provide excellent services each day.

    CWT programs are located within all VA medical centers. Review the CWT Locations page to find site specifics.


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  • TBI Vets


    James. A. Haley Veterans’ Hospital (JAHVH) in Tampa, Florida, has been designated a Headache Center of Excellence (CoE) by VA. JAHVH is one of seven facilities throughout the Veterans Health Administration to receive the designation.

    “We’re very lucky because we probably wouldn’t have it if we didn’t have this awesome Polytrauma Center,” Dr. Georgia Kane said. “It means we can offer so much more to our patients. Everybody’s highly excited.”

    Kane, a neurologist and head of the Chronic Headache Management Program (CHAMP), said the designation was due in large part because of the hospital’s Polytrauma program.

    Veterans with a history of polytrauma or traumatic brain injury commonly experience headaches. Headache management for Veterans with TBI and multiple co-morbid conditions is challenging and is best managed by an interdisciplinary team. That’s precisely what CHAMP has been doing for several years.

    “We started an interdisciplinary team about four years ago,” Kane said of the five-week outpatient program. “We noticed that with people with headaches, it’s difficult to treat just the headache, so occupational therapy, psychology and me, we all work together and we meet weekly on patients to maximize their care.”

    Program participants are required to keep a diary, noting the time a headache starts, what they were doing, what they were eating and other aspects of their lives that can be critical to understanding what might be triggering the headaches.

    Options other than medications

    “The number one thing is education. Once you know more about what is affecting your situation, we can then teach options that are other than medications,” Kane said. “Medication will do a certain percentage, but if you only relied on medications to help your situation, then you would be discounting the fact that you’re not sleeping well, or to distract yourself with relaxation techniques or biofeedback that we do to try and get your mind to think of something else.”

    CHAMP participants meet once a week for lectures and other forms of treatment that includes recreation therapy, Botox injections and precise injections in the neck if needed. Botox is used to relax muscles that, when tensed, can cause headaches. The treatment is very effective, Kane said.

    About 60 people are in CHAMP at any given time, including those patients who are followed after discharge.

    While many of the TBI patients with headaches tend to be younger, chronic headaches are non-discriminatory, affecting men and women, young and old, and the additional funding that comes with the Center of Excellence designation will allow the CHAMP staff to add additional treatments for them.

    They hope to work with the lighting in the treatment areas since lighting can affect headache sufferers. Equipment for neck injections, electrical stimulators, and virtual reality equipment are a few of the items Kane said she hopes to procure for the program. Headache treatment is offered to all Veteran patients at all VA medical centers. Patients can get referred to any Center of Excellence but because not all centers offer the same thing Veterans should confirm with their VA health care team and the Center of Excellence that they will receive the specific treatment they need.

    Patients should keep in mind that this is an outpatient program. Patients come once a week for five consecutive weeks – plus the follow-up after they complete the treatment – which is not always easy if referred from a distance.

    “Becoming a Headache Center of Excellence means that we can expand and do more, to be able to offer more things, more physical therapies, recreational therapies, art therapies,” Kane said. “When we were presented with this, it was one of those truly amazing moments.”


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  • West LA PTSD


    Dov Simens said he was “playing Rambo” in a homeless camp on Wilshire Boulevard 34 years ago when he stumbled on a therapy group for combat Veterans with post-traumatic stress disorder.

    Through weekly sessions on the West Los Angeles Veterans campus, Simens, 75, a member of the military’s secretive Phoenix interrogation and assassination program in Vietnam, was able to marry, have children and buy a house in Sherman Oaks, he said.

    Buoyed by his success, he took a break. But anger and depression drove him back to the “group of my peers.”

    “I have PTSD and I know that there is no cure,” Simens said. “There is no pill or opioid that will make what I did disappear.”

    Now he and other Veterans say the U.S. Department of Veterans Affairs has soured on long-term therapy and started dismantling the West L.A. PTSD program, which has helped thousands of former service members heal the invisible wounds of war.

    Before August, about 20 groups, each with five to 30 members, had been meeting on the medical campus for a total of 40 hours a week of therapy, said Leslie Martin, the former PTSD therapy program director. The combat Veterans group shut down this fall after refusing the VA’s order to move to cramped quarters with no privacy, she added.

    Two other groups have stopped meeting or relocated since summer; others merged and participation is dropping, Martin said. Martin filed a whistleblower complaint over the service reductions before retiring last month. The complaint accused the VA of reassigning her to work as a clerk as retaliation for her support of Veterans protesting the changes.

    Citing the federal Privacy Act, VA spokeswoman Nikki T. Baker said she couldn’t address Martin’s employment.

    Baker said the number of groups varies depending on demand for therapy. Seven focused on PTSD continue to meet on campus, she added.

    But in a September letter protesting the shift, Rep. Ted Lieu (D-Torrance) said he understood the group therapy program was being replaced by “evidence-based” treatment — 12-week courses of specialized talk therapy that have been shown to be effective for PTSD treatment. Once open-ended, the groups would be available only for the duration of the courses, Lieu said.

    “It is important that we maintain a host of treatment options for our Veterans suffering from PTSD,” he said.

    The secretary of Veterans Affairs, Robert Wilkie, responded that the group therapy program was being “rebranded,” not ended. But he also questioned the effectiveness of group therapy for Veterans with PTSD.

    “Despite the popularity and long history of support groups as routine care for Veterans with PTSD and trauma exposure, there is no strong evidence that this modality is an effective treatment,” Wilkie said in a letter to Lieu.

    The outcry comes at a difficult moment for the Veterans agency, which is experimenting with privatizing mental healthcare while also grappling with staffing shortages and a suicide crisis — 20 former service members a day take their own lives.

    Several former clinicians have complained to the VA about an exodus of as many as 50 psychologists and psychiatrists from the Greater Los Angeles VA Health Care System, which includes the Sepulveda and West L.A. campuses.

    The VA says PTSD affects 8% of Veterans. The agency initially relied on medication to treat the condition, but now is turning to short-term, evidence-based therapies, including cognitive processing, prolonged exposure and eye movement desensitization and reprocessing.

    Cognitive processing helps Veterans recast negative thoughts about their trauma. Prolonged exposure guides Veterans into reliving traumatic events to diminish their fear and anguish, and eye movement desensitization and reprocessing helps Veterans recall their trauma while focusing on external motion or sound.

    Each therapy course generally runs for three months. Martin said VA officials made it clear they like evidence-based treatment because it’s short and saves money. VA leaders called the therapy groups “social clubs” and said Veterans who need more support should take each other’s phone numbers, Martin said.

    Evidence-based therapies can be tough on Veterans, who may have spent years trying to forget the very memories that the sessions dredge up. In his letter, Lieu said only 50% to 60% of Veterans complete evidence-based therapies.

    Peter Erdos, 35, said he tried medication and evidence-based therapies with minimal success after his return from Iraq.

    “Medication is something that the VA was OK with me being on for the rest of my life,” said Erdos, a member of the combat Veterans group. “Coming back in my 20s and hearing that was just soul-crushing. What worked for me was camaraderie with the guys.”

    Research on the effectiveness of group therapy to treat combat Veterans with PTSD is inconclusive. Carl Castro, director of USC’s Center for Innovation and Research on Veterans & Military Families, said the VA should have studied the groups before squeezing them out.

    “The VA has gobs of money to do research,” Castro said. “It was a unilateral decision and goes against patient-centered therapy.”

    “For a lot of Veterans involved in group therapy, just the fact they’re engaging in it is therapeutic for them,” said Paul Brown, adjutant of the American Legion, Department of California. “If it makes a difference in even one Veteran’s life, we’re going to push to have it continued.“

    Members of the PTSD combat support group have continued meeting in a room they rent at a Westside senior center. Martin is volunteering to facilitate.

    Before a gathering last month, a dozen Veterans described the group as a lifeline. The men are black and white, former officers and draftees, and at least one attended West Point. Some spent years battling alcoholism or substance abuse. Some worked as lawyers, company executives or architects.

    Several said they had PTSD symptoms — anger, anxiety, depression — for decades before seeking treatment.

    “It only took me 47 years,” said Steven Goldstein, 71, a U.S. Army infantry Veteran who served in Vietnam. “I had no joy in my life.”

    Randy Kline said he was drafted out of Inglewood in 1967 “to participate in crimes against humanity“ — a moral injury that experts increasingly consider to be as damaging as a gunshot wound or other combat trauma.

    Arnold Hudson said that as a black man from South Los Angeles, he saw no future as a convicted draft dodger. So he reluctantly answered the call to Vietnam, where he saw his friend “incinerated before my eyes.”

    AHudson said the group gave him his life back after years of drug addiction.

    “I’m 69 years old and I lost a whole lot of life,” he said. “When they announced we were disbanding I thought, why in the world is the government who vowed to take care of us cutting us off at the knees?”

    The Veterans said they want to return to the VA campus, where the next person home from Afghanistan or Iraq could wander in and find the support that only comes from shared experience.

    “We’re a band of brothers. We have a duty to all Vets,” Simens said. “We’re just asking for a 400- to 500-square-foot room, for two hours, once a week.”


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  • Veterans Issues


    SANTA FE COUNTY, N.M. - A parade and ceremony Sunday in Santa Fe honored our nation's Veterans.

    KOAT Action 7 News spoke to Veterans about the issues they face today and why more still needs to be done.

    Hundreds braved the cold weather in Santa Fe, marching in the annual Veterans Day parade despite the snow and rain.

    Air Force Veteran James Lamb said events like these are important for Veterans to know how much their service means to people.

    And it's not something that only has to happen once a year.

    “Thank a Veteran. Just come up and say thank you and they'll thank you for your support,” Lamb said.

    Lamb also said Veterans need to take advantage of assistance programs.

    “This state offers a lot of great services for Veterans so take advantage of them, from tax discounts on your housing to healthcare and all kinds of things like that,” Lamb said.

    After the parade was over, everyone gathered at the Bataan Memorial Building for a Veterans Day ceremony.

    Vietnam Veteran Doug Gomez believes availability of care is a big issue Veterans face.

    Because there is not a Veterans Affairs hospital in Santa Fe, he has to drive to Albuquerque for treatment.

    But he said the issue of seeing a VA doctor when you need one is something that is happening across the U.S.

    “It's pretty extraordinary that so many Veterans have to wait for such a long time to get an appointment,” Gomez said.

    Gomez said a lot of promises were made this election season about improving care for Veterans.

    Now he wants to see something done.

    “Politicians, not only in New Mexico, but around the country, who talk about Veterans as a talking point, take it to the next level and actually help us,” Gomez said.


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  • PTSD 002


    With the headlines of U.S. Navy Fleet Commander Scott A. Stearney’s untimely death earlier this month, it is just another tragic reminder of the toll combat takes on these brave men and women even after they come home.

    The numbers are mind-blowing. The Department of Veterans Affairs recently reported that more than 20 Veterans and active duty service members, guardsmen and reservists commit suicide every day in this country. That’s nearly one suicide every hour, and more than 80 percent of them are Veterans.

    There aren’t enough people and systems to help Veterans, and they keep falling through the cracks. I consider these people a vastly underserved and unreached community.

    The effects of combat-related trauma run deep, down to the warrior’s very heart and soul. I know this from personal experience, having served four tours in Iraq and Afghanistan.

    War keeps you running at full speed, always on guard, ready to fight at a moment’s notice. After enduring such extreme conditions for long periods of time, returning to the normality of civilian life is not easy.

    When I came home, nothing felt real to me. Watching TV with my wife didn’t feel real. Walking through the aisles of the grocery store didn’t seem real. My feelings were not easy to identify at first. I just felt “off,” but I didn’t always know why. I didn’t know what was happening to me.

    This is common among Veterans who struggle after returning home. We can’t always draw a straight line from how we feel back to the experience of combat. We don’t want to     believe that the fighting affected us.

    I was in denial. I didn’t want to acknowledge the strange sensations for what they were. But eventually, I couldn’t ignore what was happening. I was struggling with the after-effects of combat.

    Everyone experiences this differently. There are, however, a few classic signs — anger, insomnia, obsessive-compulsive behavior and flashbacks. At one point or another, I have suffered from all of them.

    Eventually, I got help, and there are some wonderful organizations that help Veterans, but many Veterans aren’t as fortunate as I was. Typical interventions such as clinical treatments and group therapies are inadequate and usually ignore the spiritual dimension to trauma. The spiritual dimension to trauma includes topics such as grief, guilt, and shame. It can manifest through things that the warrior has experienced or done on the battlefield.

    Many Veterans dealing with these challenges isolate themselves from friends and family. They don’t think that people understand what they’ve been through. It’s hard for Veterans to communicate to non-Veterans about combat experiences and post-combat struggles. A common complaint from family and friends is, “I can’t reach him or her” or “They won’t talk to me.”

    Veterans do want help. But sometimes they just don’t know how to communicate it. And once they’re able to speak out, they don’t always know how to connect or who to connect with. That’s why it’s very important that when Veterans reach out, especially to a church or nonprofit, the organization is ready to receive them.

    These organizations should have a program to get the Veterans connected with a small group of people who understand and appreciate the Veteran and his or her family. Belonging to a community with a sense of camaraderie is key. It’s something Veterans had while in the service and something they are looking for when they get out.

    It is crucial that when our Veterans return home that they have available to them a support group that will help them walk through everything they have experienced on the battlefield. Even more so, these groups are imperative to helping these brave men and women begin the healing process, pointing them in the right direction to restore broken relationships and begin to knit together the wounds of the heart. Ultimately, that is what will assure a successful transition back into mainstream society.


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  • Website Updates 002 

  • PTSD Treatment


    The only way to know for sure if you have PTSD is to talk to a mental health care provider.

    The provider will ask you about your trauma, your symptoms and any other problems you have.

    Talk to Someone You Trust

    After a traumatic event, it's normal to think, act, and feel differently than usual. Most people will start to feel better after a few weeks. If your symptoms last longer than a few months, are very upsetting, and disrupt your daily life, you should get help. Whether or not you have PTSD, treatment can help if thoughts and feelings from the trauma are bothering you. Talk to:

    • Talk to your family doctor.
    • A mental health professional, such as a therapist.
    • Your local VA facility or Vet Center, if you are a Veteran
    • A close friend or family member who can support you while finding help
    • A clergy member
    • Fill out a PTSD questionnaire or screen (see below).

    Take a Self-Screen for PTSD

    A screen is a brief set of questions to tell you if it is likely you might have PTSD. Below is the Primary Care PTSD Checklist for DSM-5, or the PC-PTSD-5 screen.

    Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:

    • a serious accident or fire
    • a physical or sexual assault or abuse
    • an earthquake or flood
    • a war
    • seeing someone be killed or seriously injured
    • having a loved one die through homicide or suicide

    Have you ever experienced this kind of event? YES / NO

    If no, screen total = 0. Please stop here.

    If yes, please answer the questions below:

    In the past month, have you...

    • had nightmares about the event(s) or thought about the event(s) when you did not want to? YES / NO
    • tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? YES / NO
    • been constantly on guard, watchful, or easily startled? YES / NO
    • felt numb or detached from people, activities, or your surroundings? YES / NO
    • felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? YES / NO

    If you answer "yes" to any three items (items 1 to 5 above), you should talk to a mental health care provider to learn more about PTSD and PTSD treatment.

    Answering "yes" to 3 or more questions on the PC-PTSD-5 does not mean you have PTSD. Only a mental health care provider can tell you for sure. And, if you do not answer "yes" to 3 or more questions, you may still want to talk to a mental health care provider. If you have symptoms that last following a trauma, treatment can help - whether or not you have PTSD.

    Seek Help

    It's common to think that your PTSD symptoms will just go away over time. But this is unlikely, especially if you've had symptoms for longer than a year. Here are some of the reasons why you should seek help.

    Early Treatment Is Better

    Symptoms of PTSD may get worse. Dealing with them now might help stop symptoms from getting worse in the future and lead to a better quality of life for you.

    It's Never Too Late to Get PTSD Treatment

    Treatment can help even if your trauma happened years ago. And treatment for PTSD has gotten much better over the years. If you tried treatment before and you're still having symptoms, it's a good idea to try again.

    PTSD Symptoms Can Affect Those You Love

    PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your relationships.

    PTSD Can Be Related to Other Health Problems

    PTSD symptoms can affect physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health.

    It May Not Be PTSD

    Having some symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms of other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. And, different problems have different treatments.

    When you seek help, your mental health care provider can determine whether you need treatment for PTSD, or another type of treatment.

    Find the Best Treatment for You

    Today, there are several treatment options for PTSD. For some people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense.

    You can learn about effective PTSD treatment options using our PTSD Treatment Decision Aid. It includes videos to explain how the treatments work.

    You can also build a chart to compare the treatments you like most. Both psychotherapies (also called talk therapy or counseling) and medications are included in the decision aid.


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    The decision to get care for PTSD symptoms can be difficult. You are not alone if you feel nervous. It is not uncommon for people with mental health conditions like PTSD to want to avoid talking about it. But getting help for your symptoms is the best thing you can do. PTSD treatments can work.

    Why is it important to seek care for PTSD?

    There is no need to suffer with PTSD. There are good treatments that can help. You don't need to let PTSD get in the way of your enjoyment of life, hurt your relationships, or cause problems at work or school. Learn from Veterans who talk about living with PTSD and how treatment turned their lives around: AboutFace.

    "Getting better" means different things for different people, but people who get treatment improve their quality of life. In many cases, PTSD treatment can get rid of your symptoms. For some, symptoms may continue after treatment, but you will have learned skills to cope with them better.

    Treatment can also help you:

    • Make sense of the trauma
    • Learn skills to better handle negative thoughts and feelings
    • Reconnect with people you care about
    • Set goals for activities, like work or school, that you can handle

    What are barriers to care?

    There are many different barriers, or things that might stop you from seeking help for PTSD. Part of PTSD is avoiding thinking about the trauma. So, it makes sense that people with PTSD may want to avoid getting treatment. But there are other reasons people might not seek care right away. Research points out some examples:

    • Believing you will get better on your own
    • Problems getting care, like finding a therapist, transportation, or cost
    • Not knowing that PTSD treatments work
    • Thinking that services are for other people, not you
    • Stigma

    What Is Stigma?

    Stigma is when you feel judged by other people because of some personal quality or trait. You may feel stigma because of negative things people say about you, or because they treat you differently. An example of stigma related to PTSD is a belief that people with PTSD are dangerous or unstable, which is not true.

    Some examples of stigma include:

    • Negative labels or stereotypes that assume all people with PTSD are the same
    • Discrimination at work, at school, or finding housing because of your symptoms
    • Being denied chances to succeed because of a PTSD diagnosis

    Because of concerns about stigma, you may try to hide the problem or not admit you need care. You may start to feel that you deserve to be treated badly because of your symptoms. But PTSD is not something to be ashamed of. The best thing you can do for yourself is to take control and get help.

    Barriers specific to military context

    When you are in the military, there are other things that may get in the way of seeking help. Military members may worry that talking about PTSD with doctors, other soldiers, or commanding officers will hurt their career. You may think if people in your unit learn you have PTSD they will see you as weak, or not trust you to be able to protect them. Or, you may feel that your medical records will be opened for other people to see.

    Being afraid that seeking treatment will damage your career leads you to avoid getting help at a time when you need it most. Many don't get help until their return from deployment, or when their family tells them there is a problem. But you don't have to wait.

    You may think that avoiding your PTSD is critical to keeping your job. But if your PTSD symptoms are getting in the way of doing your duties, it is better to deal with them before they hurt your military career. Getting help for PTSD is problem solving.

    How can I overcome barriers to care?

    There are always reasons for people to put off seeking help, especially with PTSD. It is hard to find a therapist, hard to get time off from work, and hard to find the money to pay for treatment. Facing your problems can be scary. It is even harder if you don't know what to expect.

    But if you learn about PTSD treatments, find social support, and get started in treatment, you can feel more in control. You can't change what others think about PTSD, but you can stop it from getting in your way.

    Here are some steps you can take and resources to get help for PTSD:

    • Learn about PTSD and treatments. Knowing that treatment helps and your options is important.
    • Take the first step and find out where to get help. See our Where to Get Help for PTSD page.
    • Talk to someone you trust. Whether you talk to a family member, doctor, chaplain or clergy, or another service member or Veteran, getting support is key to getting better.


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  • Women and depression


    Imagine having feelings of worthlessness or helplessness. Imagine being unable to sleep, feeling restless and irritable much of the time, or even hiding under the covers afraid to face the day. Many who suffer from depression may not be able to concentrate at work or perhaps even get to work. Those experiencing high- and low-functioning depression know such feelings all too well.

    But for women, there are certain times in their lives when a depression diagnosis is more common. Research has shown that hormonal changes at three stages of life—puberty, post-pregnancy, and during perimenopause—may trigger clinical depression.

    Dr. Nancy Skopp, research psychologist at the Psychological Health Center of Excellence, described clinical depression, or major depressive disorder, as a depressed mood lasting at least two weeks and marked by a loss of interest in things that once were pleasurable. She noted that this period would contain a clear change from previous functioning. If someone isn’t completing work duties, shows up late for work, or experiences profound fatigue and avoids interaction with family and friends, depression could be the cause.

    “Depression symptoms in women often occur around a reproductive event,” said Skopp, adding that there is some evidence that suggests women may have a chronic and recurrent course with longer and more frequent episodes than men.

    Skopp cited statistics from the National Institute of Mental Health showing that 50-80 percent of new mothers may experience the “baby blues,” which usually appear about a week after giving birth and include feeling down, irritability, sleep problems, anxiety, and eating too much or too little. The difference is that the symptoms are mild and usually resolve in a week or two.

    Postpartum depression is much more serious, Skopp said. Between 10 and 20 percent of new mothers experience depression, according to NIMH statistics. Symptoms of extreme sadness, anxiety, and exhaustion may make it difficult to complete daily activities as a new mother.

    During perimenopause, usually between the ages of 40 and 50, when the ovaries gradually begin to make less estrogen, depressive symptoms combine with menopausal symptoms. Women may also experience other life challenges, such as the demands of caring for aging parents, a change in marital status, health problems, or negative attitudes about aging. Skopp said although men may experience similar stresses at midlife, the hormonal changes experienced by women may compound such stresses. “It’s a very challenging time,” she said.

    Approximately 12 million women in the United States experience clinical depression each year, with one in eight experiencing depression in her lifetime, according to NIMH research. This rate of depression corresponds to hormonal changes in women, particularly during these three life stages, suggesting that female hormonal fluctuations may be a trigger for depression. Another trigger may be gender differences between women and men, which may be genetic or involve life stressors and coping styles.

    Skopp says research shows women may have a greater tendency to internalize in the face of depressive symptoms. Men appear to be more likely than women to cope with such symptoms through behavioral distraction, such as doing something that takes the mind off depressive feelings. The result appears to be that more active distraction in men may shorten or prevent a depressive episode whereas internalization in women may prolong it. The Centers for Disease Control and Prevention reports that between 2013 and 2016, 10.4 percent of women experienced depression compared to 5.5 percent of men.

    “Being in the military can magnify the depression triggers one might experience in the general population,” said Navy Cmdr. Paulette Cazares, associate director for mental health at the Naval Medical Center San Diego.

    “The benefit of seeing depression as any other illness allows service members to realize the necessity of early treatment, and the ability to stay focused on career and personal goals,” Cazares said. “Psychotherapy or antidepressant medications are first-line options to treat depression and reduce chances of a relapse. Meditation and yoga as therapy have also been used successfully to alleviate depressive symptoms.”

    If you have symptoms of depression, talk to your health care provider. A loved one showing symptoms should be encouraged to speak to a health care provider as well. Military OneSource also has resources and information available for service members and their families.


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  • Women Veterans Stress


    Despite good food, bright lights, and cheer, the holidays come with stress. The pressures, particularly on women, to cook special meals, give gifts, and decorate can be too much. If you are a woman Veteran who has recently left the service, the strain of it all can be particularly tough.

    Holiday stress and readjusting after deployments and long absences from home can be hard. But VA is here to help. Vet Centers across the U.S. offer readjustment counseling services. Here, there is no shame in getting the help you might need.

    Here are a few VA resources that offer support:

    • Readjustment counseling services are available at Vet Centers nationwide for combat Veterans, service members, and their families. This includes family counseling for military related issues, bereavement counseling for families who experience an active duty death, military sexual trauma counseling, and referrals.
    • VA Self-Help Apps, such as PTSD Coach, PTSD Family Coach, and Mindfulness Coach, can help you cope with symptoms related to PTSD and depression. Visit the VA App Store to learn more:
    • 877-WAR-VETS (877-927-8387) Combat Call Center is a 24/7 confidential service connecting Veterans with combat Veteran staff so you can speak in private with someone who understands your challenges.

    If you need to talk to someone this holiday season, VA is here to help. For additional information about VA’s readjustment services, contact the Women Veterans Call Center at 1-855-VA-WOMEN (1-855-829-6636). To find a Vet center near you, visit


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  • PTSD Women


    There are far more men than women Veterans in the VA system. For this reason, many women Veterans are not aware of resources offered just for them. Many women Veterans prefer treatment with other women.

    Research shows that people often do better in treatment with others that are more like them. As a result, mental health services just for women are offered in many VA’s across the country.

    VA Women Veterans Program Managers

    Every VA Medical Center in the country has a Women Veterans Program Manager. This person is your advocate. She can help you get to VA services and programs, state and federal benefits, and resources in the area where you live.

    If you need help:

    If you have questions about your VA care, you should first go to your Women Veterans Program Manager. During normal business hours, you can also contact:

    • The Department of Veterans Affairs Center for Women Veterans at (202) 273-6193
    • The Veterans Health Administration Women Veterans Health Strategic Health Care Group at (202) 461-1070

    Types of VA programs for women

    The following list describes some of the mental health service programs offered by VA for women Veterans. To find out more, see VA PTSD Treatment Programs. The fact sheet links to a list of VA PTSD treatment programs. The list includes programs for women, with contact information. For other help locating a program or service, you should ask your Women Veterans Program Manager.

    • Women's Stress Disorder Treatment Teams (WSDTTs). WSDTTs are special outpatient (not live-in) mental health programs. They focus on treatment of PTSD and other problems related to trauma.
    • Specialized inpatient and residential programs for women. These are live-in programs for women Veterans who need more intense treatment and support. While in these programs, women live either in the hospital or in a residence with other women. For help locating a program, ask your Women Veterans Program Manager.
    • Cohort treatment or separate wings for women. These programs are like the live-in programs discussed above except these programs accept both men and women. Some programs accept women in groups that start treatment together on a certain date. Sometimes the program has a space set apart for women.
    • Women Veterans Comprehensive Health Centers. Complete health centers for women Veterans are located in many VA's around the country. Many of them provide outpatient mental health services to women Veterans. Check with your local Women Veterans Program Manager to see if there is a women's health center that provides mental health services near you.
    • Women Veterans Homelessness Programs. The Women Veterans Program can help you find shelter if you are homeless or at risk of being homeless. Certain VA locations have programs for homeless women Veterans and homeless women Veterans with children. Contact your Women Veterans Program Manager for resources near you. You can also contact the Social Work Services department at your local VAMC. For more information, go to Homeless Veterans.

    For more information

    To learn more about women and traumatic stress, please see this section of materials Specific to Women.


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