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Tommy Slotcavage
Professor Henderson
Cas 138T
16 April 2015
Lending a Hand to Veterans
With thousands and thousands of veterans going undiagnosed and untreated for
post traumatic stress disorder, there needs to be a change made. This change needs to
occur on a large scale in the form of a complete policy amendment.
Post traumatic stress disorder is a mental health condition that is triggered
by a terrifying event, or an event that is extremely traumatic in ones life (Mayo Staff
Clinic). This can be caused by either being a part of the event or merely witnessing
it (Mayo Clinic Staff). Such events often cause fear, and that fear often generates a
fight or flight reaction because the person wants to avoid danger. In the case of
PTSD, this fight or flight reaction occurs much more often, even when there is no
immediate danger (Mayo Clinic Staff).
There are a number of symptoms that are associated with PTSD, and many
of them are used in the diagnosis of a person with PTSD. The first set of symptoms
occur when the person re-experiences symptoms, such as flashbacks of the original
traumatic experience, bad dreams, and frightening thoughts. Avoidance symptoms
are another set of symptoms that occur, which include avoiding places, events, and
objects, feeling emotionally numb, feeling depressed, losing interest in previously
enjoyable tasks, and finding it difficult to remember the traumatic event. The third
category of symptoms are called hyperarousal events which often include being

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easily startled, feeling tense or on edge, and having difficulty sleeping and/or having
angry outbursts (Mayo Clinic Staff).
Currently, for a person to be diagnosed with PTSD, the person has to meet
certain criteria. The patient has to exhibit at least one of the re-experiencing
symptoms, three of the avoidance symptoms, and two of the hyperarousal events.
In order for the person to be diagnosed with PTSD, these set of symptoms must last
for at least over a month (Mayo Clinic Staff).
In terms of therapy, there are a great number of options and many things that
are being done. The first method of treatment is psychotherapy, or talking therapy.
Within psychotherapy, there are three categories of therapy: exposure therapy,
cognitive restructuring, and stress inoculation therapy. In addition to these, there are
a number of medications that can be taken to combat PTSD, which include Zoloft
and Paxil, as well as benzodiazepines, antipsychotics, and other antidepressants
(Mayo Clinic Staff).
As the symptoms seem to show, living with Post Traumatic Stress Disorder is
a daily struggle. Many of its victims have daily flashbacks to the event and they
experience extreme stress and anxiety extremely frequently. The PTSD problem
becomes even more serious when considering that nearly twenty two veterans
commit suicide everyday due to the emotional wounds that they suffered ( Veterans

Statistics: PTSD, Depression, TBI, Suicide). This amounts to somewhere between

five thousand and eight thousand veteran deaths per year. In addition to all of these
deaths, nearly twenty percent of the 2.7 million veterans from Afghanistan and Iraq
are currently suffering from PTSD, incurring a greater suicide rate among veterans
than the general population of the United States ( Veterans Statistics: PTSD,

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Depression, TBI, Suicide). Although twenty percent of veterans from those wars are
diagnosed with PTSD, it is also believed that there are nearly 400,000 veterans that
are afflicted with post traumatic stress disorder and have neither been diagnosed nor
treated (Veterans Statistics: PTSD, Depression, TBI, Suicide). This poses issues in
terms of not only suicide, but also the mental stability of returning veterans. With
many veterans returning home mentally unstable, their marriages, home lives, work,
and various other aspects of their personal lives are harmed beyond imagination.
This is even more detrimental when considering nearly 400,000 veterans go
undiagnosed and untreated, making it nearly impossible for them to recover from
their injuries (Veteran Statistics).
All of this was made extremely real to me when I visited the Veterans Victory
House in Lancaster, Pennsylvania. The house is a place where veterans are given
housing, clothes, and food while the workers there try their best to get the veterans
back on their feet. Most of the men and women that are there were homeless at
some point, had lost their jobs, or were personally troubled in other ways. One of the
veterans, a sixty year old man that fought in Vietnam, explained his situation to us.
I got back from the war and didnt know what to do with myself. I couldnt
stop seeing what I saw there; it played over and over again in my mind, and I
woke up from nightmares almost every night. My wife didnt get it. She left
me not too long after I got back. I spent years working jobs and losing jobs,
until I wound up broke and homeless, living out of my car. I still had the same
nightmares and anxiety every single day. And then, I found out about this
place.

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He further explained how Veterans Victory House provided him a place to
stay, clothes to put on his back, and warm meals to fill his stomach. Not only that,
but they helped him get the counseling that he needed to overcome the PTSD he
suffered from his wartime experiences. PTSD ruined his marriage, his financial
status, and various other aspects of his life, but thanks to counseling, he was able to
slowly get his life back.
Although PTSD is a massive issue, especially in terms of those that served
the United States Military, Navy, Air Force and others, there is no policy that helps
veterans and requires them to get help. In an Army Medical Command Policy Memo
published in 2012, the current Military attitudes toward PTSD are detailed as well as
what should be done about it. The policy details that when a veteran returns to visit
a physician or psychiatrist seeking help with PTSD, the doctor must follow a policy
released in 2010, the Army Medical Command Policy Memo, to properly manage the
situation. The PTSD checklist must be adhered to, as well as meeting the other
criteria for PTSD. The benefit of the current policy lies in the care that veterans
receive. Veterans should be offered an A-level treatment option, the best level of
treatment that they can receive (United States). With this plan, they are offered
narration, cognitive restructuring, in-vivo exposure, various approved medications,
antipsychotics, and many more options (United States).
These options are extremely helpful for veterans, but neither in this policy, nor
in their contracts, are veterans required to go through Post Traumatic Stress
Disorder testing. This, in itself, may not seem to be an issue -- many would feel that
if veterans are worried about themselves or feel that they need treatment, they will
utilize the A-level treatment that they are provided. This program, though, has not
succeeded. As mentioned, it is believed that there are approximately 400,000

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veterans that have PTSD and have not been diagnosed with it. In addition to that, of
the many veterans that actually have been diagnosed with PTSD, nearly 50% of
them do not seek help or treatment, and instead suffer daily because of this choice
(Veterans Statistics). Not only does this affect their mental health, but it also often
affects their relationships, making it more difficult for them to find support in loved
ones. Veterans that suffer from PTSD are twice as likely to get a divorce, are three
times as likely to marry two or more times, and statistically have shorter relationships
("Partners of Veterans with PTSD: Common Problems.").
This begs the question, what is the solution to such a problem? First of all,
there needs to a policy change in terms of the diagnosis and treatment of veterans.
In terms of the diagnosing of patients that come to clinics, there do not need to be a
great number of changes made. The Army Medical Command Policy Memo
previously mentioned succeeds in laying out how to properly diagnose patients, but
the issue is getting veterans in to clinics to diagnose them. There remain those
400,000 veterans that have PTSD but still have not been diagnosed and thus, will
not receive A-level treatment. The real issue lies with diagnosing these veterans that
have not been diagnosed and are not being diagnosed.
In order to combat this issue, the VA and the military need to work together.
Within the contracts that veterans are signing, there should be a clause instituted
that, in order to receive their benefits, they must see a psychiatrist at least once a
year. The psychiatrist merely needs to run through the steps clarified in the Army
Command Policy Memo to properly diagnose patient with PTSD. These visits to the
psychiatrist must occur during the persons time in the service, immediately upon
being discharged, as well as every year after the person has been discharged.

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These visits must be mandatory, and if the veterans were to break their contract,
they would no longer receive their pensions, education benefits, disability
compensation, and free or low cost medical care, as well as various other benefits
("Veteran's Benefits Explained"). With the institution of this program and by making it
mandatory, this will ensure that nearly every veteran that actually has PTSD will be
diagnosed with it and treated for it.
Although this program, in itself, should be fairly effective, it is not entirely
foolproof. It has been shown that veterans that suffer from PTSD may have housing

or serious financial problems after suffering their traumatic injuries (Post-Traumatic

Stress Disorder). In addition to the yearly checkups, the financial, marital, and housing
status of returning veterans should be monitored and taken into consideration by
psychiatrists (Post-Traumatic Stress Disorder). The government already keeps track of
the financial, marital, and housing status of all constituents of the United States, so this is
in no way an infringement on the rights of veterans. These statistics should be looked at
for veterans to see if any one of those statuses changes greatly. If so, it is certainly
possible that the person is suffering from PTSD, and that person should be required to see
a psychiatrist within the next month to screen them for it.
The combined effort of these two policy changes will decrease the number of
undiagnosed cases of PTSD, but it may not change the negative effects of PTSD. As it is
today, 50% of veterans that have been diagnosed with PTSD refuse to seek treatment.
This is another issue that needs to be tackled.
In tackling this issue, there is one solution. When a veteran is diagnosed with
PTSD, that person must go through one of the A-level treatments that is afforded to them.
They must have monthly checkups with a psychiatrist or therapist to make sure that they

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are either taking their medication or going through the narration treatment that they are
offered. This also must be written into their contracts with the penalty of losing their
benefits if they do not go to treatment. In their treatment, though, the veterans should be
able to elect which type of treatment they would prefer: psychotherapy or medication. In
allowing them to choose, they will be even more likely to attend the therapy sessions, and
it is also a more cost effective way of treating them ("Counter Notes and Sources").
This policy change may seem extremely expensive, but as compared to the total
federal military budget, it is small. The current budget for defense spending is $813.9
billion (Chantrill). This is compared to only $3.3 billion that is spent on PTSD per year,
a mere .4% of the entire defense budget. Currently, the average cost per patient being
treated for PTSD is about $1,622 per year if the patient actually chooses whether he or
she would prefer psychotherapy or medication (McElroy). With those 400,000 afflicted
veterans being accounted for, that would be an increase of about $650 million to the $3.3
billion that is currently being spent. Also, if the 50% of the 540,000 veterans that have
been diagnosed with PTSD were to be treated, this would cost about an additional $440
million. Incorporating all of those aspects, the cost would still only be about $4.4 billion,
a mere .54% of the annual defense budget and about .28% of the nearly $1.6 trillion spent
on US efforts in Iraq and Afghanistan ("Counter Notes and Sources"). If all of that
money is being poured into the defense program and those that are fighting for the United
States, it seems only fair and logical that money should be invested into the very people
that are defending this country. Many of those veterans were out risking their lives in
foreign countries to protect US soil, and if the constituents of the US were willing to put

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forth over $800 billion to protect the country, they should be obligated to spend a little
more than half a percent of that to protect those who risked their lives in defense.
It also may seem difficult to implement and enforce the policy. If the stipulations
mentioned above were written into the contracts of the veterans, they would essentially
be required to go through diagnostic tests as well as treatment if they were to be
diagnosed. It would be unlikely that the veterans would be willing to give up their
pensions as well as the benefits they receive from having served the country. It seems
harsh, but it is a way of protecting those who have served our country and can no longer
look out for themselves. Those 50% of diagnosed veterans could be much more mentally
stable if they were required to go to therapy, but because they are not mandated to, they
will not. This negatively affects not only them, but all people around them.
Although no policy is foolproof, this policy is cost-effective way to ensure that
veterans are diagnosed and properly treated for PTSD. With the institution of this policy,
veterans will be taken care of and be able to better function in society, benefitting not
only veterans, but all those that surround them.

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Works Cited
Chantrill, Christopher. "Government Spending Details." USGovernmentSpending.com.
N.p., 14 Apr. 2015. Web. 14 Apr. 2015.
"Counter Notes and Sources." NationalPriorities.org. National Priorities Project, 16 Sept.
2014. Web. 14 Apr. 2015.
Mayo Clinic Staff. "Post-traumatic Stress Disorder (PTSD)." Mayo Clinic. Mayo
Foundation for
Medical Education and Research, n.d. Web. 14 Apr. 2015.
McElroy, Molly. "PTSD Treatment Cost-effective When Patients given Choice." UW
Today. University of Washington, 28 May 2014. Web. 14 Apr. 2015.
"Partners of Veterans with PTSD: Common Problems." PTSD: National Center for
PTSD. US Department of Veterans Affairs, 3 Jan. 2014. Web. 14 Apr. 2015.
Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in
Primary and Secondary Care. London: Gaskell and the British Psychological
Society, 2005. Print.
United States. Department of the Army. United States Army Medical Command. Policy
Guidance on the Assessment and Treatment of Post-Traumatic Stress Disorder
(PTSD). By Herbert A. Coley. Fort Sam Houston: US Department of Defense,
2012. Print.
"Veteran's Benefits Explained." Military.com. Military Advantage, n.d. Web. 14 Apr.
2015.
"Veterans Statistics." Team Red, White & Blue. Rule 29, n.d. Web. 14 Apr. 2015.

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Veterans Statistics: PTSD, Depression, TBI, Suicide. Veterans and PTSD. 14 Feb.
2015. Web.
7 April 2015

Works Cited
Chantrill, Christopher. "Government Spending Details." USGovernmentSpending.com.
N.p., 14 Apr. 2015. Web. 14 Apr. 2015.
"Counter Notes and Sources." NationalPriorities.org. National Priorities Project, 16 Sept.
2014. Web. 14 Apr. 2015.
Mayo Clinic Staff. "Post-traumatic Stress Disorder (PTSD)." Mayo Clinic. Mayo
Foundation for
Medical Education and Research, n.d. Web. 14 Apr. 2015.

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McElroy, Molly. "PTSD Treatment Cost-effective When Patients given Choice." UW
Today. University of Washington, 28 May 2014. Web. 14 Apr. 2015.
"Partners of Veterans with PTSD: Common Problems." PTSD: National Center for
PTSD. US Department of Veterans Affairs, 3 Jan. 2014. Web. 14 Apr. 2015.
Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in
Primary and Secondary Care. London: Gaskell and the British Psychological
Society, 2005. Print.
United States. Department of the Army. United States Army Medical Command. Policy
Guidance on the Assessment and Treatment of Post-Traumatic Stress Disorder
(PTSD). By Herbert A. Coley. Fort Sam Houston: US Department of Defense,
2012. Print.
"Veteran's Benefits Explained." Military.com. Military Advantage, n.d. Web. 14 Apr.
2015.
"Veterans Statistics." Team Red, White & Blue. Rule 29, n.d. Web. 14 Apr. 2015.
Veterans Statistics: PTSD, Depression, TBI, Suicide. Veterans and PTSD. 14 Feb.
2015. Web.
7 April 2015