In our previous article on PTSD buddy letters, we touched on scenarios where a buddy letter would help with a claim related to non-combat post-traumatic stress disorder (PTSD). In this article, we want to go further and provide a few other examples of non-combat PTSD where a lay statement or buddy letter could help a veteran seek benefits.
For background, a formal diagnosis of PTSD requires the identification of a traumatic event. If there was no traumatic event, then it’s less likely that someone will be diagnosed with PTSD, although there may be another diagnosis for the same symptoms, such as depression or generalized anxiety disorder. We’ll call this requirement “Criterion A” for short. An important nuance is that the traumatic event does not have to be directly witnessed because Criterion A is satisfied where there was exposure to death, serious injury, or sexual violence due to (1) learning that a violent or accidental traumatic event occurred to a family member or close friends or (2) repeated or extreme exposure to aversive details of the traumatic event. The American Psychiatric Association is clear that this applies to personnel collecting human remains.
While a claim is pending, the VA may request more information from the claimant regarding experiencing a traumatic event. Service treatment records and personnel files may not contain all the details related to a veteran’s experience, so lay statements may be relevant. This can be in the form of a letter or written on a VA Form 21-4138 Statement in Support of Claim.
Here are some tips regarding lay statements:
- If possible, type a statement rather than handwriting them. Statements should be legible. A statement with messy handwriting might not be read.
- Try to avoid generalized statements. Provide as much detail as possible, such as names of other personnel involved, place names, dates, and a description of relevant circumstances.
- Try to sign them. Technically, this isn’t required, but as a best practice, statements of any kind should be signed. It lends credibility to the statement being made.
- The closer relationship to an event, the better. There are two types of “closeness”: one is the kind where another veteran experienced the same thing, and the other type is where, regardless of the writer’s veteran status, the writer wants to write about their observations of the claimant’s behavior, especially changes in mental state. If service connection is at issue, then statements from veterans who served at the same time and place could be given greater weight than someone who wasn’t there. However, even if someone was not there, such as a non-veteran family member, then a statement could be relevant to support the credibility and veracity of the claim and to demonstrate the severity of symptoms in the present day or what a veteran’s mental health was like before the traumatic event.
Here are a few scenarios where lay statements and buddy letters can be helpful in establishing service connection:
Responses to Humanitarian Disasters
It is not uncommon for the U.S. military to respond to humanitarian disasters abroad, and such missions carry with them the possibility that U.S. servicemembers assist in the recovery of bodies.
An earthquake off the coast of Japan in 2011 triggered a powerful tsunami that left nearly 20,000 people dead. The disaster seemed nothing less than apocalyptic. The earthquake was so powerful that certain Norwegian fjords pointing toward Japan reportedly had waves reaching up to five feet. In one gruesome discovery, 74 children were found to have died from drowning in seeking refuge inside a school. Another 100,000 children lost their homes. The earthquake left the Fukushima nuclear plant at risk of a catastrophe, as power to its coolant systems was cut off. Thousands of emergency workers suffered injuries due to exposure to nuclear material or radioactive water in Fukushima. Within a few hours, ships from the U.S. Navy were already en route to assist Japan.
Considering how many combat-related PTSD claims have been filed, it may be possible that some VA rating activities are not familiar with non-combat-related PTSD claims associated with humanitarian operations. Indeed, service treatment records and personnel files may not adequately reflect the scope of a servicemember’s experience while deploying in response to a humanitarian disaster.
Here’s an example of a lay statement by a hypothetical veteran who deployed to Japan:
When we were at Sanday airport, while we helped clear rubble and move destroyed vehicles, we came across the bodies of 3 Japanese. By that time, it was already almost a week after the earthquake, so their bodies were in advanced stages of decomposition. We had to remove the bodies from under the rubble and place them into body bags. I can’t forget the smell from that site or from the bodies. Since then, I have dreams about pulling bodies out of rubble, can’t tolerate anything messy, and avoid reminders about that place, including anything about Japan. I had a hard time falling asleep or staying asleep for a long time. For a couple of years, I would drink a six pack a day and follow that up with some hennessey to help me fall asleep. Two or three times I was late to morning formation. I was on good terms with my chain of command but I didn’t want to push the issue because they were also in Japan with me.
The statement has a fair amount of detail. The first several sentences provide background information. Importantly, the statement doesn’t end there. The statement also describes intrusive thoughts related to the crisis (“I can’t forget…from the bodies”), relevant to meeting the diagnostic criteria for PTSD. The statement also references chronic sleep impairment, a factor relevant to a rating, where the VA decides to grant service connection for PTSD. The statement also describes alcohol consumption and missing formation, which the statement acknowledges could lead to tension with the chain of command, factors that, in this case, may constitute markers of personal trauma.
Lay statements by people who did not witness an incident that a veteran’s claim has contributed to PTSD are more complicated. Laypersons are competent to report their symptoms or, more broadly, first-hand observations, but their statements as to etiology – that is, the medically explainable origin of a condition – won’t carry as much weight as a licensed medical professional, such as a psychiatrist or psychologist.
Here’s an example:
Before she joined the Navy, she was a happy go-lucky girl, very outgoing, positive, doing good in school. But after she joined the Navy and she was deployed to Japan to help with the earthquake, it affected her badly. That incident changed her going forward. She wakes up in the middle of the night from bad dreams and gets axious in urban areas. She prefers somewhere that is more open, like a farm. Certain smells bother her. Like the smell of gasoline. She gets frequent headaches, so much that she has to go into a room and shut off the lights and be away from any sounds.
Assuming that the writer of this hypothetical example knew the veteran before her military service, what the veteran’s personality and mood were like earlier in life would be relevant, because it demonstrates how the veteran changed after her experience. Importantly, under VA regulations, generally, a veteran is entitled to the presumption of sound condition.
“[I]t affected her badly” asserts etiology, but this kind of statement is not entirely peculiar. Most writers will write something like this, but many statements fall short because they often lack details of first-hand observations regarding a veteran’s pre-military and post-military mental health. References to waking up in the middle of the night, avoiding certain smells, and avoiding densely populated areas can be good first-hand observations that help describe the veteran’s state.
Mortuary operations can occur during humanitarian responses, as well as combat operations or in the aftermath of a training accident. They would typically involve search and recovery, identification, and collection points. In addition to handling bodies and body parts, efforts at identification, like fingerprinting, can be especially close and personal. Efforts could also be undertaken at a time and place where kinetic action is still underway and foreign nationals, and displaced civilians are seeking assistance from U.S. personnel, adding to an already tense and stressful situation. This burden is often placed on the shoulders of only a handful of personnel. After the 1945 Battle of Manila, for example, only 81 men recovered roughly 39,000 dead personnel.
“The related exposure to many unique psychological stressors poses a threat to the morale, welfare, and spiritual well-being of mortuary affairs personnel,” the Department of Defense acknowledged in an August 2022 update to guidance to all branches of the military.
A 2001 study published in the Journal of Nervous and Mental Disease involving 352 military personnel who participated in Operation Desert Storm found that post-exposure intrusion symptoms increased significantly compared to a control group that was not exposed to the dead. In a 2016 study of 126 mortuary affairs soldiers who had deployed to the Middle East published in Military Medicine, researchers found that 25% of study participants had probable PTSD. In addition, among their findings, the researchers found that soldiers with more symptoms and lower quality of life were less likely to attend treatment.
Recall that Criterion A for PTSD currently acknowledges that trauma can arise from “[e]xperiencing repeated or extreme exposure to aversive details of the traumatic event.” That would include mortuary personnel. Here’s an example of a hypothetical lay statement by a veteran, specifically one who did not engage in combat but participated in mortuary operations:
Please grant my PTSD claim because of my experience at Camp Wolverine in Kuwait.
This statement lacks detail related to the veteran’s mental health before the military, what they witnessed or did in Kuwait, and what their symptoms are today. In fact, from this statement, it’s unclear whether there’s even a diagnosis. If there’s no diagnosis, then there’s no claim. To be clear, a veteran could be diagnosed at the time of a C&P examination after filing a claim, as part of the VA’s duty to assist, but this statement lacks information related to symptoms, which a layperson is generally competent to describe.
Here’s an improved version for the same claim, with added language underlined:
Please grant my PTSD claim because of my experience at Camp Wolverine in Kuwait. While at Camp Wolverine, we handled bodies coming in from Iraq almost daily. For months I helped unload bodies, get them prepared fro transport back to the US, and load them back into vehicles. I kept track of their names, birthdates, units etc. When I got home I had trouble sleeping, always thinking about these people. It affected my mood, I lost interest in my old hobbies. It was hard concentrating during the day and lost a job because of that.
This statement contains much more information. It specifically mentions a place, namely Camp Wolverine, a hub in Kuwait for transporting bodies during Operation Iraqi Freedom. It provides information relevant to repeated exposure and proximity to the deceased. It also explains how this person was affected.
A statement by another veteran who was also there can help. It lends credibility to the claim and can provide further information that might not otherwise be found in the claimant’s file.
Generally, lay statements should be written by people with first-hand observations of relevant details, such as the who/what/when of an in-service incident or a veteran’s current symptoms, including whether the veteran has difficulty regarding the ability to work full time, which can be relevant to the issue of unemployability. By contrast, the “why” of how a condition came about is best answered by licensed healthcare professionals.
If a layperson can only comment on their observations of a veteran’s health before the military, it can be relevant to the issue of whether the veteran had any such problems before the military. If a layperson can comment only on the veteran’s behaviors or other observable symptoms, then it can be relevant to the issue of how severe a condition may be, but it might not answer the question of what caused it.
However, suppose a layperson can comment on the lack of symptoms prior to the military and the presence of symptoms after the military. In that case, it could be material to the outcome of a case, but such statements should not be conclusory. In other words, such statements should be detailed, not merely giving the reader an idea of what the writer thinks caused the condition. Rather, the reader should be informed of what the lay writer has observed of that condition, or the absence of it.
A veteran asserting a PTSD claim counts as a first-hand witness to the trauma they experienced, so a claimant should certainly submit a lay statement. A buddy or family member should also submit a lay statement.