Posted: October 31st, 2016
Written by Kristin Smith (’17″) – Wake Forest School of Law Veterans Legal Clinic Student Practitioner
As the United States military continues to become more and more involved in conflicts overseas, men and women returning from deployment continue to suffer from Post-Traumatic Stress Disorder, commonly known as PTSD.
Veterans often have physical wounds, but the ‘invisible’ wound of PTSD is often harder to recognize. Symptoms of PTSD range from having recurring flashbacks and nightmares to depression like personality changes and avoidance of things one used to enjoy. Although symptoms of PTSD are often clear to the veteran and his or her family, diagnosing PTSD and determining its root cause for physicians is a more complicated endeavor.
Although this diagnosis is complicated, it is necessary for many veterans who are applying for discharge upgrades. A brief example of a client scenario will illustrate this necessity:
A 67-year-old Army veteran contacts our clinic seeking a discharge upgrade. He was discharged from the Army under “other than honorable” conditions twenty-three years ago. He had a good service record until he served a combat tour in Saudi Arabia during the first Gulf War. He comes back stateside, and begins having trouble sleeping, nightmares, and constant paranoia. In order to cope, he begins abusing narcotics. He is then administratively discharged from the Army and categorized as “dishonorable.” This characterization of discharge prevents him from getting VA benefits and medical care.
Under these facts, this veteran may be eligible for a discharge upgrade that would allow him access to additional VA benefits if he can prove that he developed PTSD as a result of his service to our nation. The evidentiary issue becomes proving that he had PTSD years ago. It is understandably harder to prove you were suffering from a disorder back then without being able to go back in time and perform a diagnostic test with a physician on your younger self.
However, new clinical findings that show a link between traumatic brain injuries (TBIs) and PTSD might give veterans a new way to create this evidentiary link. “Traumatic brain injury usually results from a violent blow or jolt to the head or body. An object penetrating the skull, such as a bullet or shattered piece of skull, also can cause traumatic brain injury.”
A study conducted by researchers at a Marine Corp base in southern California and the Veteran’s Affairs San Diego Medical center have concluded that “[e]ven when accounting for pre-deployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of post-deployment PTSD symptoms.”
This is an especially concerning conclusion given the increased occurrence of TBIs during combat in recent years.
Pervasive use of improvised explosive devices (IEDs), rocket-propelled grenades, and land mines in the Iraq and Afghanistan theaters has brought TBI and its effect on health outcomes into public awareness. Blast injuries have been deemed signature wounds of these conflicts, with an estimated 52% of deployment-related TBI cases caused by IEDs. Of Operations Enduring Freedom, Iraqi Freedom, and New Dawn service members, approximately 10% to 20% reported mild TBI or concussion, and nearly 60% of those reported exposure to more than 1 blast.
If veterans have medical records that show they were subjected to explosions or concussions during their military service, these records can be used as evidence that they likely suffered from PTSD years ago after the traumatic brain injury occurred in petitions to discharge review boards. Even if a veteran’s petition has been denied in the past, this study could qualify the evidence as “new and material” evidence that would allow the petition to be reconsidered.
If you were denied a discharge upgrade for lack of evidence of PTSD that was service related, it could be beneficial to re-examine your medical records for evidence of a TBI.
 National Institute of Mental Health, Post-Traumatic Stress Disorder. February 2016. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml#part_145373
 Jon Hamilton, War Studies Suggest A Concussion Leaves The Brain Vulnerable To PTSD, Sep 26, 2016. http://www.npr.org/sections/health-shots/2016/09/26/495074707/war-studies-suggest-a-concussion-leaves-the-brain-vulnerable-to-ptsd
 Mayo Clinic, Traumatic Brain Injury. http://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/basics/definition/con-20029302
 Yurgil KA et al., Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-duty Marines, 71 JAMA PSYCHIATRY 149–157 (2014). http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1785175
Id. at 150.