If you feel that you could use some assistance when filing for PTS or MST I may be able to help. Any assistance on my part is voluntary. My email address: email@example.com
I volunteered with American Combat Veterans of War, or ACVOW, for eight years. It was formed by Vietnam Marines in 2001, and the main thrust of the organization is dealing with PTS. Website: acvow.org. My prime focus was assisting vets filling out VA form 21-0781. I assisted by helping many compose Word documents to submit as attachments to their filings. The office I helped man is Room 1549 at the La Jolla VAMC, San Diego, CA. Many separated and retired service members of all stripes fequent this facility. I will no longer write statements but am glad to assist anyone working to complete his or her statement. The statement may be filed along with the 21-0787 form as a supplement. I wish you the best and thank you for serving.
If you are filing for combat stress or a different form of PTSD or MST that occurred while you were serving Uncle Sam, you may be aware that many of the symptoms and manifestations are similar, regardless of how you were afflicted. Be aware that it is best to use a veteran service officer; someone probably more familiar with the VA and who may be better versed in completing paperwork and can file for you. You will be directed to give that person, or organization, your power of attorney to represent you, so be sure that you feel comfortable with the person or org that you select to speedily and efficiently honor your filing.
The recommendation is to submit a Word document that is two pages or less in length. Slightly longer is okay but bear in mind that the rater has lots on his/her plate. You might think in terms of three parts:
(1) Brief self introduction – Introduce yourself with full name as it appears on your DD-214 and last four of SSecurity, dates of service, and whom you served with, and dates when you were in country, if that applies. Additionally, you might list your training and your prime duties as they relate to your stressor/s. Be brief.
(2) Stressor/s – Need not be in any particular order. Dates and Names and Operation, if there was one, are valuable (either be accurate or give an approximate date and time). The onus is upon you to solidify your statement. Be descriptive. Have the reader/rater understand what it was like for you then and now. Don’t be shy to name names. If you have not talked about this before, say so. Be totally frank and let it pour out. State where and when you were in country and what it was like, if that applies. Again, be descriptive and let the rater know how it was and how the trauma/s continue to affect your being and family and daily life.
(3) Effects – Where you are today as a result of the occurrences. (Following this will be thoughts by a Vietnam veteran and Army Medic who is a psychologist). Thoughts below will contain many symptoms that you might think about including in your statement.
(Layout I have used:)
To Whom It May Concern:
Brief self intro
I certify to the best of my ability that the above is true.
Name and last four
Thoughts from the aforementioned psychologist and veteran of Vietnam War as a Medic. His info regarding PTS, and importantly, screening and follow-up questions that clinicians would ask in order to make an accurate diagnosis.
Trauma and Stressor-Related Disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as diagnostic criteria, such as Post Traumatic Stress Disorder (PTSD). [DSM-5pp. 271-280].
- What is the worst thing that ever happened to you?
- Have you ever experienced or witnessed an event in which you were seriously injured or your life was in danger, or you thought you were going to be seriously injured or endangered?
If yes, ask:
- Do you think about or re-experience these events?
- Does thinking about these experiences ever cause significant trouble with your friends, or family, or work, or in another setting?
If yes, proceed to PTS criteria.
- Post Traumatic Stress Disorder
- Requires exposure to actual or threatened death, serious injury, or sexual violation.
- The exposure can be firsthand or witnessed.
- In addition, a person must experience at least one of the following intrusion symptoms for at least one month after the traumatic experience.
- Memories: After that experience, did you ever experience intrusive memories of the experience when you did not want to think about it?
- Dreams: Did you have recurrent, distressing dreams related to the experience?
- Flashbacks: After that experience, did you ever feel like it was happening to you again, like in a flashback where the event is happening again?
- Exposure distress: When you are around people, places, and objects that remind you of that experience, do you feel intense or prolonged distress?
- Physiological reactions: When you think about or are around people, places, and objects that remind you of that experience, do you have distressing physical responses?
- In addition, a person must experience at least one of the following avoidance symptoms for at least one month after the traumatic experience.
- Internal reminders: Do you work hard to avoid thoughts, feelings, or physical sensations that bring up memories of this experience?
- External reminders: Do you work hard to avoid people, places, and objects that bring up memories of this experience?
- In addition, a person must experience at least two of the following negative symptoms for at least one month.
- Impaired memory: Do you have trouble remembering important parts of the experience?
- Negative self-image: Do you frequently think negative thoughts about yourself, other people, or the world?
- Blame: Do you frequently blame yourself or others for your experience, even when you know that you or they were not responsible?
- Negative emotional state: Do you stay down, angry, ashamed, or fearful most of the time?
- Decreased participation: Are you much less interested in activities in which you used to participate?
- Detachment: Do you feel detached or estranged from the people in your life because of this experience?
- Inability to experience positive emotions: Do you find that you cannot feel happy, loved, or satisfied? Do you feel numb, or like you cannot love?
- In addition, a person must experience at least two of the following arousal behaviors.
- Irritable or aggressive: Do you often act very grumpy or get aggressive?
- Reckless: Do you often act reckless or self-destructive?
- Hypervigilance: Are you always on edge or keyed up?
- Exaggerated startle: Do you startle easily?
- Impaired concentration: Do you often have trouble concentrating on a task or problem?
- Sleep disturbance: Do you often have difficulty falling asleep or staying asleep, or do you often wake up without feeling rested?
- The episode is not directly caused by a substance or by another medical condition.
The individual’s symptoms meet the criteria for Post Traumatic Stress Disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either Depersonalization or Derealization [DSM-5 p.272]
- With delayed expression:
Use if a person does not exhibit all the diagnostic criteria until at least six months after the traumatic experience.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, DC, American Psychiatric Association, 2013.
Also below are several on line references: