Transition Manual 1
You Are Stronger Than You Think You Are:
A Straightforward Transition Manual
B.A. Completion Program Thesis New College of California Advisor C. Silverman August 12, 2007
Transition Manual 1 Table of Contents
Chapters 1. The Do’s and Don’ts of Welcome Home
2. Getting Plugged In
3. Go Get Your VA Card Now
4. Time to Think About School
5. Applying For the G.I. Bill Can Be Broken Down Into Four Steps
6. Disability: Why to Apply
7. What is Vocational Rehab?
8. A Physical and Mental Health Overview
9. Traumatic Brain Injury| TBI
10. Post Traumatic Stress Disorder| PTSD
11. Military Sexual Trauma| MST
Appendixes A. Transition Manual Survey Synopsis
B. List of Bad Conversation Starters
C. PTSD Checklist
Transition Manual 2
You Are Stronger Than You Think You Are: A Straightforward Transition Manual The recruiting slogan “Army of One” never really made sense to me. “Veteran of One” is a feeling you may know all too well. The resources available for new U.S. military veterans are insufficient. The goal of this manual is to be a portable and accessible reference both in the beginning and throughout your transition from active duty. Navigating the transition process can be very challenging. I will never forget the green and white pamphlets in the VA hospital lobby. Printed in the 1970’s, PTSD was explained through goofy cartoons. Lacking other resources, I grabbed about ten, handing them out to family, my boss, and my roommate in an effort to explain why I was acting “crazy.” I didn’t just come to the VA for cartoons; they offered group therapy for female vets too. Each week I’d trek out there to mingle with old guys sucking oxygen and nicotine on my way to the mental health clinic. Six months later and I was at community college trying to see the face of the VA liaison over the stacks of papers on his desk. He had my G.I. bill check somewhere, just couldn’t find it yet…. Today, as you return from Iraq or Afghanistan, I guarantee there are resources out there for you. Just in the six years I have been out, many positive changes have been made to vet and active duty services. Whether through the VA or through other veteran service organizations (VSOs) not connected with the government- help is available. Finding it and deciphering it is another story. The goal of this manual is to give you a starting point from which to navigate your transition. A network of veterans helping veterans is out there and you need to get connected. These connections will make a huge difference in getting you set up with your benefits and for transition into civilian life.
Transition Manual 3 The Do’s and Don’ts of Welcome Home A girl walks into a party. She joins a group of people talking and overhears that one of the guys is a vet. The first words out of her mouth are, “Was it awful over there, I mean did a lot of people die?” Everybody gets a little quiet and the vet says, “Yeah, it got pretty bad but you know.” From there, the girl keeps asking questions until the vet excuses himself and goes out for a smoke. Have situations like this happened to you before? It can get awkward and uncomfortable. Maybe you can identify with some of the awesome conversation starters below: 1. So, did you kill anyone? 2. What do you think of the war? 3. Are you okay (mentally)? 4. My mom told me not to date a vet. 5. Does it suck? 6. Did you see any action? 7. That must have been hard… 8. Was it cool? 9. Did you see a lot of dead people? 10.Can we trust you? (Anonymous, 2007). Now, here are some friendly suggestions for friends, family, and potential make-out partners on what to say: 1. “Thank you for serving.” 2. “People need to be aware of the context of the question and answer. If you wouldn’t ask it at your family dinner table, don’t ask it at a social function to a complete stranger. Judge the level of comfort. General questions like, ‘What was Iraq like?’ will only get you an hour-long discussion that might make you feel uncomfortable. Building rapport: Asking questions that can get factual answers i.e.: ‘When did you get back?’ ‘What unit were you with?’ ‘What branch?’ Good!” 3. “Welcome back. Thank you. How’s it going? How are you transitioning?” (Anonymous, 2007). For additional information on the transition process that is specifically for your family, check out this guide put out by the National Center for PTSD in 2006. You can download or print the PDF at
Transition Manual 4 http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/nc_manual_return warz_gp.html. It is only eleven pages and very well laid out. Along with the reunions and sometimes-awkward conversations, initial transition is hard! If out-processing left you with a lot of questions, you are not alone. Some areas you may need transition assistance with might include, but are not limited too: adjustment with loved ones, PTSD and other mental health issues, employment, finances, medical benefits, and school. It is okay to be angry and frustrated and to not know where to begin. Take that frustration and get something done. Throughout this section and for the rest of the manual, other vets will share some of their personal thoughts alongside the advice of the “experts.” A summary of the vet interviews I did is included as Appendix A at the end of this manual. A full excerpt of one of the interview questions is included as Appendix B. I guarantee something in this manual will help with your transition. The first step now is to get you set up, registered, and plugged in. Step 1: Getting plugged in “The hardest part was getting answers for the questions we didn’t know to ask. Our debrief was about 2 minutes long. No one in my whole unit knew any of the services out there” (Anonymous, 2007). “I feel that the out-processing and job service program wasn’t emphasized enough. I feel that veterans’ benefits was not made available to all exiting service members…” (Anonymous, 2007). “I would have liked contact information to actual people in my hometown area for the VA, Vet centers, etc. My separation class should have been done at least 6 months before I got out instead of 2 weeks” (Anonymous, 2007). Whether you live in a big city or a rural community, it is possible for you to stay connected with other vets. Check out Vets4Vets at their website http://www.vets4vets.us/ or the Iraq Veterans Project run by the San Francisco based VSO Swords to Plowshares. “The Coming Home Project” and Military.com are also great places to get connected and find resources. Both Vets4Vets and “The Coming Home Project” run retreats and workshops that they will fly you out to. These workshops are places where you can meet other vets and share your experiences, both good and bad. Along with similar OIF/OEF
Transition Manual 5 memories, other vets can give you tips on the GI bill or applying for disability, which helps you with your own process. Inside tips can never hurt, so get involved! Step 2: Go get your VA card now “My out-processing was much shorter and briefer than the usual classes so I lost a lot of info. One thing I remember they didn’t say was to check in at the VA hospital at once. Location of Vet Centers would have been useful since they have all the info we needed” (Anonymous, 2007). At the time that I got out of the military, you didn’t see many young vets. When I went to the VA hospital everybody assumed I was a dependent or a spouse. To get my VA card I had to literally scream at the VA hospital worker because she was refusing to give it to me. Yelling a medical diagnosis at the top of your lungs as proof that you need medical services is not fun. I did get my card; but I struggled over the next few years with speaking up for myself and being my own advocate. The care that I received, however, was very good and I would not be where I am today if I hadn’t made myself register. The initial steps are hard, but once you get through the registration, screenings, and wait time, there are people there to help you with your health problems. I don’t care if you think you are fine, in perfect health, or just hate the government. Go get your card. You have a small window of time to register and then you lose your eligibility. Poof. Gone. So go into your nearest VA hospital or Vet Center and register. You can find the medical center nearest you by going to http://www1.va.gov/directory/guide/home.asp?isFlash=1. VA Healthcare is your right. You earned it. If you have serious health problems, you may find that you have to really fight to get all of the treatment you deserve. Passionate individuals are out there trying to change the system and policies to make this process easier and honestly, more fair. For now, just bite the bullet and register with the VA. Suck it up and go.
Transition Manual 6 Step 3: Time to think about school “No information on educational options (I only recently found out that if I had returned to my home state, I could have obtained a 1-4 year degree free of charge)” (Anonymous, 2007). “I wish my G.I. bill was available longer than 10 years.” (Anonymous, 2007). A lot of veterans get started with school right when they get out. It is great to stay motivated; but I highly recommend that you get connected with other vets and get your VA card first. Registering with the VA is just one less headache. Personally, I waited a year before starting to use my GI bill. I needed to get my feet under me financially, so I worked two jobs until I could pay rent and afford a car no problem, then added school to the mix. With loans, scholarships, and the GI bill though, it is possible to get right to work on your education without directly joining the civilian workforce. Note: Please be careful with loans- do some recon before you sign on the dotted line. Choices. That is something you are going to have to get used to now that you are out of the military. The options of what you can do with your life are endless, but all that freedom can be overwhelming. If you choose to go to school, check out the vet resources out there. Along with going on to the VA website to at least download forms, many VSOs have created guides and fact sheets to help you through the process. Legislation, rules, and other technicalities are changing all the time, so you may find more current info than what is published in this manual. I have gathered some useful education tips from several sources including: Swords to Plowshares, Military.com, and the VA website. As I am sure you have heard, Military.com is a very useful website in a variety of areas for active duty, veterans, and families. They do, however, have very active sponsors and the information is slightly influenced by those sponsors. Check out their link: http://education.military.com but please keep your eyes open.
Transition Manual 7 Applying for the G.I. bill can be broken down into four steps: 1. Choose your school (i.e. community college, university, state, private, apprenticeship, etc.) and make sure they accept the G.I. bill- most do. 2. Fill out the application: VA Form 22-1990, which your chosen school should have in the registrar’s office or in the VA/G.I. bill liaison’s office. This can also be done online at http://www.gibill.va.gov/GI_Bill_Info/How_to_Apply.htm. Remember, if you are applying for the Disabled Veterans Application for Vocational Rehabilitation (Form 28-1900) you must turn that in to the VA- not your school. (Voc Rehab is covered later in this manual). 3. Submit the application. You should be able to do this at your school; but if you want to do the application and set up your G.I. bill before choosing your school, then submit it online directly to the VA Regional Processing Office. Remember, the VA requires detailed information, so they might not give you the green light until they get additional information. 4. The VA will start sending you money, which is awesome! Please remember that you have to check in every month so they know you are still in school. If you do not do this, they will terminate your money. Dial 1-877-823-2378 or log in online at https://www.gibill.va.gov/wave. I just programmed the number into my cell and checked in that way. There is more to using the G.I. bill than applying. Learn about eligibility, attendance requirements, address changes, withdrawal, the payment rates, and how you can use it for certification tests and job training/apprenticeships. I seriously suggest checking out both the military.com website and the Swords to Plowshares website at http://swords-to-plowshares.org/iraq-veteran-project/ and the VA website as well. This manual would be huge if I went into detail about all of this- so please, do more personal school research. I used my G.I. bill at community college to get my AA. My friend is using his to go to law school at Berkeley. What does the Air Force say? “Aim high.” Do it!
Transition Manual 8 Step 4: Disability: Why to Apply When asked about difficult adjustments in getting out of the military and back to the States, some of the veterans I interviewed responded: “Lack of guidance on filing a claim and help available through VSOs, I only recently became aware of the whole appeal process and who to contact for help” (Anonymous, 2007). “Always being on edge. Not being in charge of what happens next. Having to wait on services such as the VA. Not having that close-knit group of people around to help out in the tougher situations” (Anonymous, 2007). Over the last six years I have stubbornly not applied for disability from the VA. My reasons have been 1) I am in my twenties so how can I be disabled; and 2) I can cope and hold a job so I don’t really need disability…right…? The truth is, yeah, I can cope. I have made it through school, worked since I got out of the military and navigated several relationships. But in doing all of this, I have also lived with post traumatic stress disorder (PTSD) the whole time. In community college I had a note taker because I would end up having flashbacks in class and miss half of the lecture. I struggle using public transportation because of frequent panic attacks. My coworkers and friends have an ongoing joke about how jumpy I am. I am always on edge. I also have rarely slept a whole night through without the help of a sleep aid in the last six years. Have I proven to myself that I can live with these symptoms? Yes. However, I got PTSD through serving my country and even with therapy and medication, it’s not going away. So I am now in the process of applying for disability and for me, it’s scary. Applying for disability is teaching me who to go to for help. Take these tips from me and other vets and apply for your benefits- don’t wait six years. Although worded for those with PTSD, the National Center for Post Traumatic Stress Disorder (NCPTSD) provides information that is applicable for all disability claims. In addition to what NCPTSD recommends, Swords to Plowshares is another great VSO to help you with your disability claim. They have counselors free of charge as well as legal staff to help you. Also, Vet Centers often have free help once a week on a drop in basis. The following is from the NCPTSD website:
Transition Manual 9
A formal request ("claim") must be filed by the veteran using forms provided by the VA's Veterans Benefits Administration. After the forms are completely submitted, the veteran must complete interviews concerning her or his "social history" (a review of family, work, and educational experiences before, during, and after military service) and "psychiatric status" (a review of past and current psychological symptoms, and of traumatic experiences during military service). 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, and can be both complicated and quite stressful. The Veteran's Service Organizations (VSOs) provide "Service Officers" at no cost to help veterans and family members pursue VA disability claims. Service Officers are familiar with every step in the application and interview process, and can provide both technical guidance and moral support. In addition, some Service Officers particularly specialize in assisting veterans with PTSD disability claims. Even if a veteran has not been a member of a specific Veterans Service Organization, the veteran still can request the assistance of a Service Officer working for that organization. In order to get representation by a qualified and helpful Service Officer, you can directly contact the local office of any Veterans Service Organization -- or ask for recommendations from other veterans who have applied for VA disability, or from a PTSD specialist at a VA PTSD clinic or a Vet Center. (NCPTSD, 2007)
Transition Manual 10 Step 5: What is Vocational Rehab? “Members of the military are often put in positions of tremendous responsibility at a much younger age than their civilian peers. Due to high turnover rates, a service member may find himself in charge of anywhere from 15-45 people, whom he/she is responsible for bringing home alive. Many service members feel deep frustration and longing for a sense of purpose when they return home and civilian jobs available to them do not offer the same level or responsibility. Some feel offended and at odds with civilians whom they feel do not trust them with the same responsibility or autonomy in their job duties” (Anonymous, 2007). The VA’s webpage for vocational rehab is very wordy and a little confusing; however, it does have useful information, so check it out at http://www.vba.va.gov/bln/vre/vrs.htm. It explains that to be eligible for these benefits, you must have a discharge that is other than dishonorable and have a service-connected disability. To find out more about what exactly a service-connected disability is, go to the website- just do it. The folks that work for the Vocational Rehabilitation and Employment (VR&E) Program can help you get job counseling, apprenticeships, and enrollment in colleges or technical schools. Depending on your disability, you can also get assistance with independent living services. In order to be admitted into the program, you do have to go through an eligibility and evaluation process. I know this is frustrating because you’ve already “earned it,” but you are going to have to get used to jumping through hoops to get your bennies- at least under the current system. Also important to note: the period of eligibility for the program is twelve years from the date you stop being active duty or from the date the government notified you of your disability status. Remember, there are VSOs specializing in disability claims and postmilitary job training. Swords to Plowshares has legal personnel on staff, experts in VA forms, and employment resources all free of cost. Helmets to Hardhats is also a great organization if you are looking for a career or job in the construction industry. You can read more about what they do at http://info.helmetstohardhats.org/content/faq/. Nonprofit and government resources are ready and available if you want or need them.
Transition Manual 11 A Physical and Mental Health Overview “Those of us who get back from the war zone are different people. People need to give us time to get acclimated to being home. We might be very quiet or socially awkward. Civilians should be very careful when telling us about their problems, we might react very angrily because of the severity of things we have gone through. Most of us aren’t looking for a pity party or an excessive amount of praise. We just want to be respected” (Anonymous, 2007). Now in its fifth year, the Iraq conflict is not a war of death for U.S. troops nearly so much as it is a war of disabilities. The symbol of this battle is not the cemetery but the orthopedic ward and the neurosurgical unit. The men and women inside those units have come home alive but missing arms and legs, many unable to see or hear or remember who they were before being hit by a roadside bomb. Survival clearly represents as much of a revolution in military medicine as does the dominance of the suicide bomber and the roadside bomb in the age of ‘shock and awe.’ But now both the medical profession and the country are left to play a terrible game of catch-up.(Glasser,2007). The following pages will touch lightly on health issues you or others you know may be facing. Learning some basic definitions and symptoms of common injuries may help you recognize something you or a friend is currently facing. Included in these sections will be helpful resources for you to find out more information or to get help. The physical and mental health subjects that will be covered are: traumatic brain injury (TBI), post traumatic stress disorder (PTSD), and military sexual trauma (MST). The Department of Veterans Affairs has a program called “Disability Compensation for Sexual or Personal Trauma.” This particular disability claim is for veterans with PTSD and those who have “lingering physical, emotion, or psychological symptoms” from traumatic events including: rape, physical assault, domestic battering and stalking. The application is titled, “Veterans Application for Compensation or Pension,” and the form is VA form 21-526. To find out more details about this specific disability claim, you can call 1-800827-1000 or go to the VA website: http://www.va.gov (DVA, 2004).
Transition Manual 12 Traumatic Brain Injury| TBI "We can save you. But you might not be what you were.” Neurosurgeon, Combat Support Hospital, Balad, Iraq About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch… Blast waves causing TBIs can leave a 19-year-old private who could easily run a sixminute mile unable to stand or even to think… Military physicians have learned that significant neurological injuries should be suspected in any troops exposed to a blast, even if they were far from the explosion. Indeed, soldiers walking away from IED blasts have discovered that they often suffer from memory loss, short attention spans, muddled reasoning, headaches, confusion, anxiety, depression and irritability.(Glasser, 2007) The rate of combat-related brain injuries in service members returning from the current conflicts in Iraq and Afghanistan appears to be higher than in previous conflicts. Nearly 30% of all patients with combat-related injuries seen at Walter Reed Army Medical Center from 2003 to 2005 sustained a TBI. Blast injuries are a significant cause of TBIs. TBI is often associated with severe multiple trauma, post traumatic stress disorder (PTSD) or undiagnosed concussions. Screening patients who are at risk for a TBI is important in order to ensure that TBIs are identified and appropriately treated. (Deployment Health Clinical Center [DHCC],2006) The following information is from the National Institute of Neurological Disorders Stroke (NINDS). It is the most thorough and to the point resource I could find and is current as of February 2007. The NINDS defines traumatic brain injury as follows: Traumatic brain injury (TBI), also called acquired brain injury or simply head injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, 12
Transition Manual 13 or severe, depending on the extent of the damage to the brain. A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. (NINDS, 2007) Treatment is available and is designed around the patient on a caseby-case basis. Rehabilitation can include: occupational, physical, and speech therapy; physiatry; counseling; and social services. I watched a documentary about some hospitals giving palm pilots to their patients to help with the memory loss component of TBI. Spouses and family are also a vital part of the healing process. To learn more about TBI go to the NINDS website at http://www.ninds.nih.gov/disorders/tbi/tbi.htm and check out the Deployment Health Clinical Center which has relevant information and useful links at http://www.pdhealth.mil/.
Transition Manual 14 Post Traumatic Stress Disorder | PTSD “The system should assume due to the current conditions of today’s current conflicts, that PTSD is inevitable. And that counseling should be made mandatory after deployment” (Anonymous, 2007).
“I was rushed out, but at that point it was what I wanted. I wanted to distance myself from the military a much as possible, as quickly as possible. It was emphasized to me that I should keep many DD214 copies. I’d just gotten back from Iraq so my head was in a strange decompressing state. I was still anticipating attack” (Anonymous, 2007). Post traumatic stress disorder scared the living hell out of me. I started experiencing PTSD symptoms while I was still on active duty and stationed stateside. I started having flashbacks, loss of sleep, and hyper vigilance that made no sense to me and was very scary. One month I was healthy and then gradually my quality of life rapidly deteriorated. After my honorable discharge I bit the bullet and registered at the VA hospital. Registering was a frustrating process but after that was over I did receive help from the clinics there. The biggest challenge for me was having to explain to people what I was going through. I felt like I was crazy. I was not comfortable talking to my family and friends about it. As you read more about PTSD in this section, please remember that having PTSD is not something you should be ashamed of. Not learning coping skills or avoiding treatment will make your life and transition harder than it needs to be. Please use these pages as a starting point to help yourself. The following is put out by the Madison Institute of Health. Their website Facts for Health has a comprehensive and straightforward section on PTSD: As the name implies, posttraumatic stress disorder occurs only after (post) an extremely stressful event (trauma). The more severe the trauma and the longer the person is exposed to it, the greater the likelihood of developing PTSD. PTSD is only diagnosed after a) a person has been exposed to an extreme trauma, b) symptoms develop that last at least one month and c) the symptoms create extreme distress and dysfunction. Three or more of the following characteristics are usually present:
Transition Manual 15 • • • • •
numbing, detachment or absence of emotional response reduced awareness of surroundings (being dazed) sensation that surroundings are distorted or unreal the feeling that you are different, strange or unreal an inability to remember parts of the trauma.
In addition to three or more of these five characteristics, the traumatic event is relived repeatedly. This can take the form of recurrent images, thoughts, dreams or "flashbacks" of the event. Even reminders of the event can cause extreme distress, so many people go out of their way to avoid places or events that resemble the traumatic event in some ways. Many experience increased anxiety, restlessness, sleeplessness, irritability, poor concentration, hyper vigilance or an exaggerated startle response. Some are even plagued by feelings of "survivor's guilt," because they survived when others did not or because of certain things they may have had to do to survive. This complete set of symptoms is obviously very disruptive and stressful to the victim as well as their family and loved ones. It can even impair job performance and social functioning. There are three main categories of PTSD symptoms, and all three must be present for the diagnosis of PTSD: experiencing the trauma: examples include flashbacks, nightmares, intrusive memories and exaggerated emotional and physical reactions to triggers that remind the person of the trauma. emotional numbing and avoidance: examples are feeling detached, losing interest and avoiding activities or places that remind you of the trauma. increased arousal: symptoms like difficulty sleeping, irritability, hyper vigilance and exaggerated startle response. (Madison Institute of Medicine, n.d.) Another organization providing useful information on PTSD is PTSD Support Services. They have provided a checklist/survey on their website because it is sometimes difficult to talk about your experiences or symptoms. By filling this out before going for treatment at the VA or elsewhere, it may be easier for you to express what you need without feeling uncomfortable. This checklist has been included at the end of this manual as Appendix C. Again, after making the decision to seek treatment, don’t be uncomfortable about asking all sorts of questions of medical and
Transition Manual 16 psychiatric professionals. Questions such as, “How will treatment help me?”; “How is PTSD counseling or group different from just regular therapy?”; “So what’s the deal with medication…”; “Do you have any pointers on discussing this with my family or my boss?” If you choose to take one or more medications, ask a lot of questions. Pills are not magic. They don’t just make PTSD go away. You cannot take all meds in the morning or on the way to work because they will knock you out. Others should not be mixed with other medications. Even sleep aids are different. So ask questions. Doctors at the VA hospital can give you medication in addition to setting you up with counseling. Educate yourself about what you are being prescribed. PTSD Support Services also talks about how the VA evaluates you for PTSD. The Facts for Health pages are a general overview about diagnosing PTSD. The criteria the VA uses to diagnose is specific in some areas. Please check out the PTSD Support Services link at: http://www.ptsdsupport.net/whatis_ptsd.html and http://www.ncptsd.va.gov The National Center for Post Traumatic Stress Disorder (NCPTSD) is part of the Department of Veterans Affairs website, which as you may know is huge. From the main page of the NCPTSD you will find links to fact sheets, educational materials, and resources for your families. If you haven’t already, check out Military One Source. They have all kinds of resources for active duty and veterans, including a hotline for locating mental health services. The number works 24/7: 1-800-3429647. I have not personally used Military One Source, but have heard good things, so check them out. PTSD can be extremely frustrating for you and your family. I have been living with PTSD for six years. I have good days and bad days. Some of my friends and family members have been really supportive. Conversely, some will never really understand what I am going through. I give simple explanations of my panic attacks or reasons for why I am so jumpy and they look at me with blank stares. I have accepted that I have friends that are just for partying with, and the PTSD part of me I just keep to myself. If I am having a flashback while I am with certain people, I just tell them I have to go to the bathroom and excuse myself. I used to wish that PTSD gave you purple spots so that it was obvious to people when I got out of the military that something had changed. However, what people think or understand about me does not bother
Transition Manual 17 me like it used to. If someone is going to discriminate against me for symptoms I have no control over, then I donâ€™t need to be around them or, in some cases, date them. Remember, it is possible to go on with your life while living with PTSD. It is also possible to ignore the symptoms until your health and relationships suffer the consequences. By reading this material you have made yourself more aware about what you and/or others around you may be facing.
Transition Manual 18 Military Sexual Trauma | MST “I wish more info/counseling had been available and presented publicly about Military Sexual Trauma (MST)” (Anonymous, 2007). “…It’s difficult to explain an experience that is so alien to a civilian, I think that they are mostly uncomfortable around me especially in a liberal town. That I am opposed to the war but wholeheartedly support our troops. I’m not an overtly aggressive girl who’ll kill them if they look at me wrong” (Anonymous, 2007). A study done by the Veterans Affairs Long Beach Healthcare System found that female veterans “…with MST had significantly higher clinician symptom ratings and more difficulties with readjustment than those without.” They concluded that, “These preliminary data suggest that MST in OIF/OEF women seeking mental health services appears to be a significant factor for predicting symptoms and difficulty with readjustment to civilian life” (Women who served in Iraq, n.d.). Military Sexual Trauma (MST) is a very real part of military service affecting the careers and health of active duty and veteran women and men. There are resources about MST; but programs helping survivors are still growing and are sometimes hard to find. Civilian rape crisis centers are equipped to counsel and help with the sexual assault aspect but are often not prepared to fully understand and address the military component. Entering a government facility after surviving rape, harassment, or physical abuse can be terrifying; yet VA hospitals are some of the only facilities I have found with people trained in or specializing in MST. I strongly advocate going to the VA’s women’s clinic and mental health clinic to seek counseling and groups specific to PTSD and MST. The fellow survivors that you meet can also aid you in the healing process. Amy Street, Ph.D. and Jane Stafford, Ph.D. (NCPTSD, 2007) have written a very approachable article on MST that you can find in its entirety at http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/iraq_ clinician_guide_ch_9.pdf. Based on their research, this section covers MST facts and talks about the ongoing struggle to stop sexual violence in the US military. The US military includes harassment and sexual assault in its definition of MST. Sexual harassment is defined by Drs. Street and Stafford as the following:
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unwelcome verbal or physical conduct of a sexual nature that occurs in the workplace or an academic or training setting. Sexual harassment includes gender harassment (e.g., put you down because of your gender), unwanted sexual attention (e.g., made offensive remarks about your sexual activities or your body) and sexual coercion (e.g., implied special treatment if you were sexually cooperative).(Street & Stafford,NCPTSD, 2007) They go on to define sexual assault as the following: any sort of sexual activity between at least two people in which one of the people is involved against his or her will. Physical force may or may not be used. The sexual activity involved can include many different experiences including unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object, and/or sexual intercourse.(Street & Stafford,NCPTSD, 2007) MST is unique in that the victim often already lives and works with the perpetrator and oftentimes must continue to do so after the trauma occurs. The perpetrator may be the victimâ€™s same rank, below, or a superior. Due to close quarters and focus on unit cohesion, coming forward with allegations can be really scary and laced with retribution. Consequently, many cases of sexual assault and harassment are not reported. Being blamed and ignored often has significant negative consequences to a survivorâ€™s recovery and adds to the trauma.
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The following are main points from the powerful testimony of Christine Hansen, Executive Director of the Miles Foundation, Inc., which was presented at the Military Culture and Gender Conference 2005: •
A survey conducted within the Veterans’ Administration system has assessed sexual assault at 30 percent of female veterans. … the researchers found that 14 percent of the victims were gang raped and 20 percent of the victims were raped more than once (Sadler, et al, 2003). Among women veterans seeking VA disability benefits, 69 percent of combat veterans and 86 percent of noncombatant veterans reported in-service or post-service assault. Sixty-six percent of victims display symptoms of post traumatic stress disorder (PTSD) referred to as rape trauma. Ninety percent of sexual assault victims experience the onset of PTSD within one month of the assault. (Hansen, 2005)
Hansen concludes with this message, “Women who chose the profession of arms deserve respect. They also deserve institutional mechanisms to provide for their safety and, in the worst case scenario, their treatment for trauma as a result of sexual violence associated with the US Armed Forces.” (Hansen, 2005).
Transition Manual 21
Journaling When asked about difficult adjustments coming home, one of the vets I interviewed responded, “I didn’t know what to do with myself because I had free time. I’d sit there anxious because I felt like I needed to be active but had not idea what to do.” (Anonymous, 2007). One suggestion to dealing with pent up energy or emotion is to write about it. At a recent retreat put on by Vets4Vets, one of the attendees brought journals for everyone and held sessions where she gave us prompts to write about. I was a little skeptical whether people would participate. However, this activity proved to be a highlight for many people; both men and women kept writing even without her prompts. Journaling can be a great way to write down what is hard to say. It is also a good tool for your memory. My PTSD has changed the way I remember things so that sometimes the past is so clear and other times I completely black things out. The times I have kept a journal, it has created a constant for me, or a point of reference. Writing may help you sort things out, remember, let stuff go- or even function as a healthy distraction and place to vent. I have included some suggestions in the next few pages to help you get started. Give journaling a try; if you are skeptical you might just be surprised. Writer Lori Ritchie (2003) has some useful tips on journaling. She suggests skipping the first page if beginning your journal becomes overwhelming. Dedicating your journal to someone can mean a lot to you and maybe help sort through some memories. Pasting pictures into your journal can inspire you to write, or sometimes say more than even words. Copying lyrics from songs you have a memory associated with are a good addition. Writing about history, politics, or current events can help give you a point of reference when re-reading your journal later. Including poetry you have written can also add another dimension.
Transition Manual 22 The following are journal prompts from me to help you get started. Remember, you don’t have to buy a blank notebook and fill it up. Take out a piece of paper and try one prompt- at least one… 1. What’s on your mind? 2. How have things changed for you since coming back from Iraq or Afghanistan? 3. Do you miss parts about being on active duty? 4. Did you lose any friends in Iraq or Afghanistan? If so, what memories do you have of them? 5. What are some of your strengths? What are some of your weaknesses? 6. Write about the transition process- what has your experience been like? 7. What were some of your dreams as a child? 8. List three goals you have now. 9. Look at a photo. Write about that moment. 10. Is there something you want to say to someone that you never had the chance to?
Transition Manual 23
Conclusion Seamless transition is not seamless. With the poor planning of this war, our country is not prepared for the numbers of new veterans. In an article entitled, “Forgotten Heroes,” Newsweek addresses the lack of services for returning troops with the following: How well do we care for our wounded and impaired when they come home…We send young Americans to the world’s most unruly places to execute our national policies. About 50,000 service members so far have been banged up or burned, suffered disease, lost limbs or sacrificed something less tangible inside them…stories are raising concerns that the country is failing to meet its most basic obligations to those who fight our wars… (Childress & Ephron,2007,p.30) Serious questions are being raised as to how the military can change its methods of out-processing and how educational and health benefits can be made more accessible to those who have earned them. This project has not attempted to tackle these issues of policy; however, it has been my intent to raise awareness. Basic necessities like applying for a VA card, to school, and learning about some health concerns were my focus. As I continue with this project, there is much I will add. We need to discuss transitioning specifically, and the many adjustments coming home. Families need resources on how to start the process as a unit or couple. Groups like the Coming Home Project are doing awesome work in this area; and as a nation we need to build on what they are doing. This is just the beginning to service revision for both the government and non-profits for this new wave of veterans. This is the time for new ideas and strategies. I have been through the transition process you are going through, and there is a lot I am still learning. Many of the vets I have quoted are just getting started like you. The best thing I did to help myself was to get plugged in with other veterans. We have a responsibility as veterans of any era to share what we’ve learned from experience. I hope these pages will help you and that you may help other vets. I truly wish you the best. Sincerely, Tia Christopher
Transition Manual 24
References Childress,S., & Ephron,D. (2007). Forgotten Heroes. Newsweek, 29-37. Christopher, T. (2007, April). [Interview with 16 anonymous U.S. military veterans]. Tucson, Arizona and San Francisco, California, pp. 1-6. Coleman, P. (2006). Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War. Boston: Beacon Press. Crown, E., National Nacal Medical Center Public Affairs. (2006, September 30). Traumatic Brain Injury Summit Convenes on Military, VA Combat Care. Navy Newsstand. Retrieved April 12, 2007, from http://www.news.navy.mil/search/display.asp?story_id=25825 Department of Veterans Affairs. (2004). Disability Compensation for Sexual or Personal Trauma. [Brochure]. http://www.va.gov Deployment Health Clinical Center. (2006). Traumatic Brain Injury. Retrieved April 12, 2007, from http://www.pdhealth.mil/TBI.asp DeploymentLINK: Deployment Health Support. (2002). Researchers study PTSD in Women. Retrieved February 10, 2007, from http://deploymentlink.osd.mil/news/feb03/news_020303_001.shtml Fratangelo, D. (2007, May 7). Military sexual trauma- the new face of military PTSD. Retrieved May 15, 2007, from http://www.msnbc.msn.com/id/18494197/ Glasser, R. (2007, April 8). A Shock Wave of Brain Injuries. Washingtonpost.com. Retrieved June 26, 2007, from http://www.washingtonpost.com/wpdyn/content/article/2007/04/06/AR2007040601821.html Hansen,C. (2005). A Considerable Sacrifice: The Costs of Sexual Violence in the U.S. Armed Forces. Military Culture and Gender Conference at the University of Buffalo. (pp. 1-7). Buffalo, NY: The Miles Foundation, Inc., The Baldy Center for Law and Social Policy. Helmets to Hardhats. (2007). Information Center. Retrieved June 6.2007, from http://info.helmetstohardhats.org/content/index.jsp Katz, L., Bloor, L., Cojucar, G., & Draper, T. (n.d.) Women who served in Iraq seeking mental health services: Relationship between military sexual trauma, symptoms, and readjustment. Long Beach, CA: Veterans Affairs Long Beach Healthcare System. Madison Institute of Medicine. (n.d.). Factsforhealth website. Retrieved April 12, 2007, from http://ptsd.factsforhealth.org/ Military.com.Benefits. Retrieved June 6,2007, from:http://www.military.com/benefits
Transition Manual 25 Military Sex Assault Reports Rose by 24 Percent. (2007, March 21). Retrieved May 15, 2007, from http://www.msnbc.msn.com/id/17725659/ National Center for Injury Prevention and Control. (2006). Traumatic Brain Injury. Retrieved April 12, 2007, from http://www.cdc.gov/ncipc/tbi/TBI.htm National Center for PTSD. Department of Veterans Affairs. (2006). Returning from the War Zone: A Guide for Families of Military Members. Retrieved June 6, 2007, from www.ncptsd.va.gov National Institute of Neurological Disorders and Stroke. (2007). Traumatic Brain Injury Information Page. Retrieved April 12, 2007, from http://www.ninds.nih.gov/disorders/tbi/tbi.htm Perlin, J. (2006). Under Secretary For Healthâ€™s Information Letter: Screening and Clinical Management of Traumatic Brain Injury. Washington DC: Department of Veterans Affairs, Veterans Health Administration.
Ritchie, L. (2003, August). 20 Ways to Fill Page One. WritersDigest.com. Retrieved July 5, 2007, from http://www.writersdigest.com/articles/fill_page_one.asp Ruzek, J., & Swales, P.(2007, May 9). Coping with PTSD: Fact Sheet. Retrieved June 6, 2007, from PTSD Support Services: http://www.ptsdsupport.net Street, A., & Stafford, J. Military Sexual Trauma: Issues in Caring for Veterans. Retrieved May 2, 2007, from National Center for PTSD fact sheet: http:// www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/military_sexual_trauma. html Swords to Plowshares. Iraq Veterans Project. Retrieved May 2, 2007, from http://swords-to-plowshares.org/iraq-veteran-project/ The Coming Home Project. (2007). The Coming Home Project. Retrieved April 12, 2007, from http://www.cominghomeproject.net/cominghome/ United States Department of Veterans Affairs. National Center for Post Traumatic Stress Disorder. (2007, May 31). National Center for PTSD Fact Sheet. Retrieved July 1, 2007, from http://www.ncptsd.va.gov/ncmain/ncdocs/ fact_shts/fs_what_is_ptsd.html United States Department of Veterans Affairs. Vocational Rehabilitation & Employment Program Services. (2007, March 14). Vocational Rehabilitation & Employment Program Services. Retrieved June 20, 2007, from http://www.vba.va.gov/bln/vre/vrs.htm Vets4Vets. (2007). Vets4Vets Home Page. Retrieved April 12, 2007, from www.vets4vets.us/ Williams, K. (2005). Love My Rifle More Than You: Young and Female in the U.S. Army. New York: W.W. Norton & Company.
Transition Manual 26 Appendix A
Transition Manual Synopsis of Interviews By Tia Christopher, Iraq Veterans Project intern The idea for doing these interviews came out of casual conversations with my other vet friends. Tossing stories around turned into a great brainstorming session where we came up with some pretty innovative ideas to veteran issues we are all facing. I wanted to get other vets involved in the conversation but didn’t want to set up a focus group or make people feel like they were being studied. Asking people to share their thoughts, frustrations, and needs seemed more appropriate. I wrote up some questions and handed them out at a vet retreat I went to. This resulted in approximately sixteen interviews really well thought out and candid. Their anonymous answers shaped the direction of this manual and helped me stay focused when I became overwhelmed at the scope of issues facing OIF/OEF veterans. Throughout the manual you have read pieces of these interviews, and I hope that you could identify with some of their comments. I would like to thank all those who participated in my interview project, this manual would not be what it is without you.
1. If you could list off the top ten things you do or do not want people to say when you get back, what would those things be? ( ex: “So how many people did you kill?” is not a good conversation starter.) The most common “bad conversation starter” was “Did you kill anyone?” or variations of it. Other answers varied from, “Was it cool?” to “My mom told me not to date a vet” or “You guys are a mortgage risk.” One participant put it very bluntly, “Buy me a drink and don’t say a damn thing to me.” Having a random stranger or even family member ask about their mental health, for battle stories, or contrived empathy are very real and frustrating topics for these returning vets. Many voiced the experience of people wanting to explain their political views to them, or asking for “a vet’s perspective” on the war. One person put it, “People telling me their views on the war when they meet me. I don’t care.” There was a common communication that anything more than “Thank you for serving” or “Welcome home” was not welcome unless coming from another veteran.
Transition Manual 27 1.b. Some took the initiative to write down what they wanted people to say to them. Asking a simple “How’s it going?” or “How are you transitioning?” was okay with one vet. Many just wanted a simple thank you. I think one answer put it very well, “People need to be aware of the context of the question and answer. If you wouldn’t ask it at your family dinner table, don’t ask it at a social function to a complete [stranger]. Judge the level of comfort. General questions like ‘what was Iraq like?’ will only get you an hour- long discussion that might make you feel uncomfortable. Building rapport: Asking questions that can get factual answers i.e. ‘When did you get back?’ ‘What unit were you with?’ ‘What branch?’ Good!” The purpose of asking for conversation starters people are hearing is to get a grasp on the scope of the transition process. Fighting for benefits and looking for a job are one half of the equation; but the other is integrating back into civilian society. By assuming that they can ask personal or insensitive questions of these vets, communities are making the transition process that much harder. 2. What are some of the most difficult adjustments for you between military and civilian life? The most difficult adjustments are not surprising: finding a job, reconnecting with friends and family, relaxing, change of status, and missing the comradery of military life. Some miss the structure, some find networking frustrating, navigating or finding out about their benefits is a complaint across the board, and a few are having an “identity crisis.” A few answers are as follows: “People don’t understand why we fight.” “The fact that civilians don’t have a clue what we go through during transition.” “Going from a position of leadership and responsibility to being a clerk.” “Finding people that know about resources and who understand the issues I am facing.” “I didn’t know what to do with myself because I had free time. I’d sit there anxious because I felt like I needed to be active but had no idea what to do.” So many voiced things they missed about the military. They are not getting the friendships, support, and structure that they had while in. There is an obvious distrust is accepting assistance or friendship from non-vets and from those who are perceived to not understand what they are going through. The issue of status stuck
Transition Manual 28 with me. Regardless of which job you have, the military has rank too. If you are a nurse and an officer in the Army, you are saluted by the enlisted. In the civilian world, many nurses are treated horribly, and definitely without respect. This dilemma will be explored further in the “us vs. them” section. Aside from needing resources for education, employment, and counseling, adjusting to living with civilians is not a “cliché issue.”
3. Do you think there is an “us vs. them” attitude between military and civilians? How would you explain to someone unfamiliar with the military what it’s like to have that training and responsibility? What do you most want them to understand about you? Answers to this question differed from some not feeling an “us vs. them” attitude themselves or from others, to a lot of hurt and anger. Not all felt that this division or discrimination was intentional. A few think that active duty and veterans project this wall more than civilians do. Depending on where these vets live geographically affects the degree of welcome they feel in the society they came home to. From the women responders, I found that all expressed this sentiment to some degree. This question received the longest responses. Some answers are as follows: “Civilians don’t know what it is like to have someone else’s life in your hands. They could be a safety inspector or other like that but to really be a the point where any move I make could literally mean life or death for someone I really care about. I don’t think it’s ‘us vs. them.’ They just have absolutely no knowledge of responsibility for other human beings’ lives as I did a at a young age.” “I do, Sometimes I think civilians believe we are bad people for what we’ve had to do to serve.” “Members of the military are often put in positions of tremendous responsibility at a much younger age than their civilian peers. Due to high turnover rates, a service member may find himself in charge of anywhere from 15-45 people, whom he/she is responsible for bringing home alive. Many service members feel deep frustration and longing for a sense of purpose when they return home and civilian jobs available to them do not offer the same level of responsibility. Some feel offended and at odds with civilians
Transition Manual 29 whom they feel do not trust them with the same responsibility or autonomy in their job duties.” Just as this mentality hurt the Vietnam vets, the “us vs. them” mentality will prove to plague these vets long after they have registered at the VA. The in depth response I received on this particular question points to the need for greater public education and sensitivity training. 4. What information or services do you wish you had getting out? Would any info or training or assistance have made your transition easier? Feel free to comment positively or negatively on your outprocessing- what worked/ what didn’t. All that answered this question found their out-processing lacking. Most surveyed wanted more information (getting out and presently) on employment, finances, and education. Several also mentioned wanting resources for their families, specifically counseling. Here are a few of their responses: “Family counseling should be given when vets come home to readjust with their families, also so that families can readjust with vets.” “The hardest part was getting answers for the questions that we didn’t know to ask. Our derief was about 2 minutes long. No one in my whole unit knew any of the services out there.” “I would have liked contact information to actual people in my home town area for the VA, Vet Centers, etc. My separation class should have been done at least 6 months before I got instead of 2 weeks.” “The out-processing had no intention of getting us help going back into society.” The comments had the scope of people feeling the military didn’t want them to leave, so didn’t prepare them, to wanting help integrating their military training and expertise into a civilian career. The level of responsibility these individuals had in Iraq and Afghanistan needs to be recognized. Funneling them into dead end jobs is not the answer. However, I think that many if not all are being extremely hard on themselves and want to keep going at 150% when at the same time they need help readjusting and
Transition Manual 30 recovering from what they’ve been through. Of course life doesn’t stop, but there has to be a way to create a buffer time period where returning soldiers and marines are not all funneled directly into a job or school, but can take time to start healing.
5. Additional Comments or advice: “Fuck the Corps!” “God Bless America.” “Those of us who get back from a war zone are different people. People need to give us time to get acclimated to being home. We might be very quiet or socially awkward. Civilians should be very careful when telling us about their problems, we might react very angrily because of the severity of things we have gone throough. Most of us aren’t looking for a pity party or an excessive amount of praise. We just want to be respected.” “Allow vets time to cool off and determine for themselves when they would like to seek counseling. Make it readily available fro them, but don’t force them if they’re not ready.” The comments in this section really focused on needing time and space to transition in their own time and on their own terms. The interviewees did, however, appreciate comradery with other vets. These vets want resources and information on everything, but request respect and sensitivity. Outreach and VSOs will be greatly appreciated, but will also need to be accepted and sought at individuals’ own terms and when they are ready.
Transition Manual 31 Appendix B
The following is a complete list of bad conversation starters to ask a returning OIF/OEF veteran compiled from written interviews from a vet retreat in 2007. Although some of the answers are humorous, they also illustrate the serious social disparity in this country due to civilians’ ignorance about what these men and women have been through. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
So what was going to war like? What was it like? What do you think of the war? Did you see anyone (people) die? Did you kill anyone? Would you go back? Why did you go, if you knew people would die? How was it? What plane did you fly? You’re a pilot!!! Are you opposed to the war? Thank you for your service. Are you okay (mentally)? Did you see a lot of dead people? Are you traumatized? I hear you’re quick to anger… Can we trust you? How can you be proud of your training? So you were a baby killer, eh? My mom told me not to date a vet. You guys are a mortgage risk. Why are you all so rebellious? Does it suck? Are you experiencing PTSD? Buy me a drink and don’t say a damn thing to me. Did you see any action? Was it cool? Do you have emotional problems? So how was Iraq? That must have been hard… Thank you for what you did. (instead of welcome home) Did you lose any friends? Anything besides “welcome home” unless they are a vet. So how many people did you kill? People wanting to hear a story about an incident and saying “cool.” People telling me their views on the war when they meet me. I don’t care. Talking about “why” we shouldn’t be “there.”
Transition Manual 32 Appendix C PTSD Checklist
Check the symptoms below that you experience (that may or may not be related to a traumatic event) and make notes as needed: 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 re-living the traumatic event: • Bad dreams or nightmares about the event or something similar • Behaving or feeling as if the event were actually happening all over again (this is known as having flashbacks) • Having a lot of emotional feelings when I am reminded of the event • Having a lot of physical sensations when I am reminded of the event (e.g., my heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I'm going to lose control) 2) I have symptoms of avoiding reminders of the traumatic event: • Avoiding thoughts, conversations, or feelings that remind me about the event • Avoiding people, places, or activities that remind me of the event • Having difficulty remembering some important part of the event 3) I have noticed that since the event happened: • I have lost interest in, or just don't do, things that used to be important to me • I feel detached from people; I find it hard to trust people • I feel emotionally "numb" and I find it hard to have loving feelings even toward those who are emotionally close to me
Transition Manual 33 • • • • • •
I have a hard time falling or staying asleep I am irritable and have problems with my anger I have a hard time concentrating I think I may not live very long and feel there's no point in planning for the future I am jumpy and get startled easily I am always "on guard"
4) I experience these medical or emotional problems: • Stomach problems • Intestinal problems • Gynecological problems • Weight gain or loss • Chronic pain (e.g., in my back, neck, pelvic area (in women)) • Problems getting to sleep • Problems staying asleep • Headaches • Skin rashes and other skin problems • Irritability, a quick temper, and other anger problems • Nightmares • Depression • Lack of energy, chronic fatigue • Alcoholism and other substance use problems • General anxiety • Anxiety (panic) attacks • Other symptoms such as: ______________________________ (Ruzek & Swales, PTSD Support Services, 2007).