by: Elizabeth Jia
The bullet pierced through the Marine’s left ear and tunneled out of his mouth.
In the midst of the war in Iraq, Justin Constantine suffered violent head trauma. It was 2006. Constantine underwent massive facial reconstruction in Germany. His hospital pictures showed a severely swollen head. His face, disfigured. Dahlia Hamza, his girlfriend at the time, halted her graduate studies and flew to his bedside.
The Civil Affairs Team Leader routinely took charge. Now he would find the internal motivation to push through recovery. Constantine said the support from Dahlia, now his wife, sped up the healing of his physical wounds. He came home to the States and was honored with a Purple Heart medal.
He looked different on the outside, but that was temporary. Yet as his flesh and bone were mended, stitched or replaced, another wound emerged. This time the damage would be invisible. But it plagued the veteran as if he had sustained another traumatic injury. He did.
His symptoms: road rage, extreme irritability and insomnia. When he could sleep, he suffered nightmares. Dahlia would have to wake her husband up to rescue him from the dreams. When he woke up, he could not remember what happened in his sleep.
When he reached a positive recovery stage, Constantine applied for health benefits through the Department of Veterans Affairs (VA) in 2007. He collected copious medical records and wrote a detailed account of how he sustained his head injury. The VA diagnosed him with combat-related Post Traumatic Stress Disorder or PTSD.
That diagnosis took one year from start to final determination.
Meanwhile, the PTSD symptoms persisted. Constantine had to wait before the VA could authorize any treatment for this invisible wound. He did not have access to medication or counseling for his irritability or nightmares. Without the proper diagnosis, Constantine would not begin connecting with existent or emerging PTSD resources.
On September 2, 2010, Constantine sat inside a Starbucks near Pentagon City Mall in Virginia. He is physically, if not emotionally, far away from the war zone. His crooked jaw supported a mouth revealing a row of lower teeth. The former Judge Advocate for the Marine Corps talked with gusto about applying for PTSD-related benefits.
“So the process was complicated. I am lucky that I am a lawyer by trade…I’m used to writing things, and so it was a little easier for me I guess than for others to prepare a document,” said Constantine.
At the time, the veteran must give an example of a specific combat stressor or event. Only then would VA adjudicators approve that the PTSD developed from combat experience. Constantine said his face and head injuries irrefutably showed his PTSD was linked to experience in a war zone.
He worried about friends on the battlefield. He imagined the application process would be harder. For example, a Corpsman would have witnessed Constantine’s ghastly head injury. But he may have faced a tough time proving he had PTSD because he did not have physical scars to show for the incident.
In those cases the application process could drag on much longer. It was nearly a decade for a former Vietnam War platoon leader who wished to remain anonymous. He said it took him eight years from “February 7, 2000 to February 27, 2008 for the VA to recognize and make a determination on the PTSD.” He said his meticulous documentation and appeals to the VA got him the 70% benefits rating for his PTSD diagnosis.
Access to these benefits averted a potential tragedy. He said at one point, he was not thinking if he should kill himself, but how he was going to do it. But having access to a VA counselor during his darkest times meant that he did overcome.
“I’m smart enough and determined enough to make the system work. My question is, ‘What happens to some Staff Sergeant, or Sergeant or Corporal who gets the kind of treatment I did?’ That person, she doesn’t know where to go or what to do,” he said.
The results could be tragic as shown in the 2010 Veteran’s Day HBO Special on PTSD’s silent but deadly effects. Army veteran Noah Pierce placed his dog tag in between a gun and his head. He pulled the trigger. Noah’s mother showed the punched hole in her son’s dog tag. She said the military forgot to “untrain” her son after shaping him into a killing machine.
Pierce did not get diagnosed for PTSD. Armor and ammunition may help save lives. But survivors with combat experience cannot be shielded from mental trauma, according to former Army Captain Tom Tarantino, the Legislative Associate for Iraq and Afghanistan Veterans of America. Meanwhile, reports have shown one in eight veterans experience PTSD.
Until this year the VA’s procedure demanded that the Veteran bear the burden of demonstrating a “specific combat stressor or event” proving to VA adjudicators that PTSD stemmed from combat.
The VA took action to address the application hurdles. On July 13, 2010, the VA simplified the application process for access to medical benefits from combat-related PTSD. The Veteran no longer needed to identify a specific incident that proved his or her illness resulted from warfare.
As VA Secretary,[former Army Chief of Staff] General Eric Shinseki explained, “No longer focusing on documenting a stressor event, our new process streamlines the delivery of medical care and benefits to Veterans suffering verifiable PTSD resulting from combat.”
The attention on veterans’ benefits has come at a time when the VA may be facing an influx of men and women returning from service in Iraq and Afghanistan. To anticipate the hurdles veterans may face, Senate lawmakers in the 111th Congress introduced a bill (H.R.952 IH) to adjust the qualifications for determining combat-related PTSD for Veterans seeking service connection at the VA.
The bill did not need to move further. The VA took the initiative and made its own decision to ease the Veteran’s burden of proof.
“This is not just about Iraq and Afghanistan. It is a generational issue—and we aim to get it right for every generation that has gone to war for this country, and all future generations,” Secretary General Shinseki said.
He also highlighted the VA’s increased mental health budget of $379 million in 2010. The year before, the VA devoted $4.5 billion for mental health programs and launched a workforce surge to bring staffing to over 20,000.
The VA’s changes have sped up the application process for Marine veteran Brian Drayton. He said he got his PTSD diagnosis within five months after starting the process on May 12, 2010. Drayton’s access to counseling and anxiety medication helped him get back into the civilian workforce as an electrician. He said he probably would not be working if he did not take his pills.
The well-traveled veteran served tours in Japan, Korea, Bahrain, Kuwait and Iraq. Living outside the military proved a harder journey. The former Combat Engineer had completed service July, 2009. He said he experienced an unreasonably angry outburst after a friend cancelled a meeting.
He said a private counselor in Waco, Texas diagnosed him with PTSD. When he went through the VA process, he had to be interviewed by the VA adjudicator who would make a separate PTSD diagnosis.
Some like the anonymous Vietnam Veteran thought the PTSD re-evaluation as inefficient. However, Drayton said the independent diagnosis served as leverage for his case to the VA adjudicator. He also supported curbing fraud.
“I’ve ran into a few people that have been lying about their service in Iraq and Afghanistan and what happened to ’em. There are some Veterans out there, some people out there that are gonna try and abuse the system,” he said.
Moreover, not every independent counselor is trained in diagnosing combat PTSD, according to Dr. Antoinette Zeiss, Ph.D., the Acting Deputy Chief Patient Care Services Officer for Mental Health at the VA. Therefore, the VA needs its own set of adjudicators, she said.
Drayton suggested veterans go through the VA while memories remain fresh. Also, the Veteran may not have the luxury of time to devote to the VA process later with family and job duties. He said although he may have felt uncomfortable with the VA’s scrutiny of his problems, the process was worth it.
The VA has sought to give care to Veterans who fit the criteria for PTSD, Secretary General Shinseki said. He emphasized the difference between PTS and PTSD as he spoke to student Veterans adjusting to civilian life. “[T]he transition can be tough because some—perhaps more than some of you—are ‘carrying baggage.’ That’s a euphemism for P-T-S—post traumatic stress.”
Those who return from the combat zone cannot deny having some form of traumatic mental stress, said Dr. Susan Mareck, Ph.D., Clinical Psychologist at the VA. After proper diagnosis, veterans could be steered to ways of coping on the most basic level like maintaining a routine, a healthy lifestyle, and strong bonds with family.
Veterans should be proactive in managing their combat-related stresses so the illness does not become more severe, according to Allen Gill, Special Assistant to Secretary General Shinseki.
“Many, if not most, Veterans who have been in combat situations or settings experience PTS to some degree, but would not meet the full diagnostic criteria for PTSD,” Gill wrote in an e-mail.
“Even PTS may disrupt work, lives, relationships, and readjustment to civilian life, and that's why VA encourages eligible Veterans with PTS to enroll for VA care and seek health care services that may improve their lives and prevent development of PTSD,” Gill continued.
The shame and stigma associated with PTSD has pushed men and women away from seeking help. Instead, they may resort to masking the problem with unhealthy habits like alcoholism, belligerence and other self-destructive behaviors.
David Sharpe, an Air Force veteran, said he would punch walls and kick his refrigerator when he was alone. When he was out with friends, he wanted to fight strangers.
Sharpe’s family and friends suggested getting a pit bull puppy. Soon, Cheyenne came into his life. Sharpe said the dog saved his life as he struggled with depression, PTSD and a suicide attempt. Cheyenne would “lick the tears off my face,” he said. Then he would open up and talk to his dog. Eight years after his service, Sharpe started the VA process in 2010. He said he got benefits from the VA for his PTSD in four months.
The unconditional love from Cheyenne sparked an idea. In 2009 Sharpe launched P2V (Pets2Vets), an all-volunteer non-profit, offering servicemen a means to adopt a pet from a local animal shelter. P2V gives veterans a way to “feel completely at ease,” with an adopted furry friend.
Through P2V Raymond Crook, an Army veteran from the Cold War, found joyful companionship with a dog named Meyers. He had been an executive chef after leaving the military. Crook suffered from PTSD for over ten years, losing jobs, straining relationships, before reaching the brink of suicide. He almost turned the knife on himself.
Crook finally went to the VA in 2009 and got benefit access after one year. He said he wished he had reached out sooner, so he could have saved himself “ten years of hell.”
The VA’s Dr. Zeiss acknowledged that PTSD may not be completely cured, but with proper channels, the illness can be managed.
“Awesome,” Crook said of the changes in the system. He said he wished the VA would also offer a thorough debriefing program for veterans as soon as service ends to ease the mental transition from war.
“I want to assure you that VA is there for you,” said Secretary General Shinseki. He outlined the President’s 16% increase to the VA 2010 budget as the largest single-year jump in 30 years. As the VA operates on $114 billion, President Obama has proposed a budget of $125 billion for 2011.
“[The budget] will give us needed firepower to increase your access to our benefits and healthcare services, and to end the disability claims backlog,” said Secretary General Shinseki as he stood in front of student veterans at Georgetown University’s Student Veterans of America awards dinner, Oct. 2, 2010.
James Day, a recent Marine veteran, sat at one table listening to the speech. He is a husband, father to a young child, and freshman at CalState Long Beach. Several guests stopped to ask for a photograph with him. He would graciously agree to each request. He walked with cane in hand to pose for the photograph.
“I can’t complain. You always hear those horror stories, generally for years by, but I tell ya’, I love VA healthcare. It’s taking care of me.”
Day worked with chemical, biological, radiological, and nuclear weapons. While eating and chatting with veterans, he smiled and joked at the table about wanting to find a good diner like the ones in the South. A casual observer would not catch that he suffered from hyper vigilance and other PTSD issues.
“I do have family and I didn’t like who I was like that, and I most certainly didn’t want them to have to deal with me like that,” he said of his motivation for going through the VA process.
He got access to full VA medical benefits. After leaving four years of service on May 5, 2010, and started his VA benefits process on May 9, 2010. Day said other veterans with PTSD should connect with the VA:
“We all served together, we’re brothers and sisters. Really, there shouldn’t be a reason why you shouldn’t go and get help. I mean if you’re pinned down a firefight, you wouldn’t try to just take them all on your own, would you? You’d call for help. There’s no reason why right now just ‘cause you can’t see the enemy, doesn’t mean that your brothers and sisters can’t help you fight it.”
Besides the VA resources, family members have played a key role in the ongoing recovery of the veteran. Dahlia Constantine said being a caretaker without having access to outside resources put significant stress on her own health.
She said the VA had made a step in the right direction with modifying the PTSD guidelines.
“I’m sad that it took so long for it to happen. But I think as a society, we still have a lot of shame and taboos surrounding issues of mental health. Even though the brain and heart are a part of the body, and what they feel is just like a leg or an arm.”
Dahlia interpreted the change as a positive sign of a shift in military culture.
“The military environment is much more macho than the average American society and talking about your problems or your feelings isn’t supported…I’m sure it’s gonna take a couple of years for things to go a lot more seamlessly and smoothly but at least the policy, the message going out to the public now, is that people should seek help.”
See Justin Constantine and other veterans in this video.
Wartorn: 1861–2010 puts the psychological damage known as Post Traumatic Stress Disorder, PTSD, under the microscope. Soldiers and family members tell their stories of pain, depression, and suicide. The documentary illuminates the sad fact that although PTSD has plagued those in the military throughout history, the issue has not captured the attention of the military or the public to the degree that it deserves as a severely debilitating illness.
Moreover, the veteran may also think he can get over it and deny seeking treatment. So the veteran does not become aware of PTSD symptoms until it may be too late. The veteran commits suicide or copes/behaves in an unhealthy manner that inevitably hurts his/her family and loved ones.
While watching the piece, I really appreciated the back-to-back interviews from both men and women in the military who describe their PTSD issues. Breaking the silence may hopefully be cathartic.
Courtesy: James Day
I find it heart-wrenching to watch the family members of PTSD sufferers. They get their son back, alive from the serving in war. But then they realize the returned veteran is a changed person. One father lost his job after his son, Jason, killed himself. Later, the six-year sentence behind bars for Marine veteran Nathan Damigo shows how ironic and tragic life can be. He gets sentenced for armed robbery. He admits later that he has PTSD. But he will have to cope behind bars instead of getting proper medical treatment.
Moreover, Army veteran, Noah Pierce, shot himself in the head with his dog-tag pinned between his head and the gun. Noah’s mother speaks so tragically about how the military forgot to “untrain” her son after he returned home from serving as a “killing machine.”
The documentary explores the challenges facing the family unit as it tries to function under the strains of PTSD. A most compelling moment for me was seeing the gaunt, anxious, and tired look of the wife of the Marine veteran featured as the final interview. She and the kids clearly miss having an engaged husband and father. The young children in the family seem so strong and wish for their father’s affection. But the veteran cannot help being withdrawn and fixated on pictures of his experience fighting in Iraq.
The Marine veteran then becomes anxious on a shopping trip to Wal-Mart. He gets anxious walking down the aisles, so he leans on the strength of his wife and children to endure. Such mundane tasks become huge hurdles for those suffering from PTSD.
PTSD is a chronic condition that demands treatment. But the military’s history shows PTSD had not been regarded as a real illness. Gen. Patton in WWII is quoted in the documentary as describing PTSD-inflicted soldiers as weak and unable to fight.
Presently, the Army officer at Walter Reed said he is trying to change the culture within the military. PTSD-afflicted soldiers should get treatment right away, he said, just as if the soldier had a broken arm or foot. Let’s just hope this culture change gains more momentum. Veterans would benefit from top brass commanders who acknowledge PTSD and its seriousness.
James Gandolfini’s conversation with Mr. Charles Engel and the other uniformed officer gives the viewer a more humane perspective on PTSD: Although military men should be strong, if a fighter survives the battlefield emotionally unscathed, then perhaps he or she is not respectful of human life.
So PTSD may be a symptom that indicates the warrior comes home a human, just that the human needs some help. PTSD is a cry for help.
Still, veterans seem to fail to get proper treatment. The documentary makes one mention of the challenge in documenting PTSD for the Department of Veterans Affairs. In the beginning, one uniformed soldier says that it is not possible to document the one specific incident that proves you have PTSD.
In my Master’s thesis at Georgetown University’s Journalism program, I address the changes within the VA that may help to facilitate or ease the transition for soldiers who took the initiative to apply for medical benefits for combat-related PTSD.
