PTSD and the Vietnam War’s Lasting Impacts
Veterans who served during the Vietnam War Era faced an extraordinary amount of stress and trauma. As such, many veterans who served during this time have gone on to develop Post-Traumatic Stress Disorder (PTSD). PTSD can take years to develop, so many veterans may not show symptoms until long after their service has concluded. According to the 2020 Annual Benefits Report, more than 401,000 are service-connected for PTSD, making it the third most common service-connected condition among Vietnam War Era disabilities.
What is Posttraumatic Stress Disorder?
Posttraumatic stress disorder (PTSD) is a mental health condition that occurs due to experiencing a distressing, shocking, or otherwise traumatic event. As many veterans experienced traumatic or distressing events during their Vietnam service, many veterans who served during this era have been diagnosed with PTSD.
Symptoms and severity of PTSD can range from person-to-person and may include the following:
- Intrusive Thoughts – Those with PTSD may experience repeated, involuntary memories, distressing dreams, or vivid flashbacks of the trauma.
- Avoidance – A person may feel moved to avoid people, places, activities, or situations that could trigger memories of their trauma.
- Negative thoughts and feelings – PTSD can cause a person to feel overwhelmed with negative emotions or beliefs about oneself. A person with the condition may also experience feelings of perpetual fear, horror, anger, guilt, or shame. They may feel detached from others and lose interest in activities they previously enjoyed.
- Arousal and reactive symptoms – A person may experience irritability and angry outbursts. They may also behave in a reckless or self-destructive way, could be easily started, and may have difficulty concentrating or sleeping.
Why is PTSD So Prevalent Among Vietnam War Era Veterans?
A study conducted by VA called the National Vietnam Veterans Longitudinal Study was completed in December 2013, with the purposing of assessing Vietnam War Era veteran’s physical and mental health. The study compared results of a similar study conducted in 1987 on the same set of veterans. To do this, VA asked a number of veterans to complete a self-report survey and phone interviews.
The survey went on to describe that male veterans with PTSD who were deployed to the Vietnam theater were nearly twice as likely to have died compared to those who did not have PTSD. Additionally, thirty-seven percent of these veterans also met the criteria for major depression, as well as PTSD.
There are many risk factors specific to Vietnam War Era veterans which could explain why PTSD is so prevalent among those who served during this period.
High Combat Exposure
Many veterans who served in the Vietnam theater were exposed to combat often, with little time to decompress after. The juxtaposition of combat versus returning home also caused many difficulties for veterans who had difficulty readjusting from the high-adrenaline atmosphere of combat.
Perceived Negative Community Attitudes at Homecoming
The controversial nature of the Vietnam War, which was famously protested, led many veterans to perceive negative community responses to their homecoming. This, coupled with the tumultuous transition between combat life and life at home, also may have contributed significantly to the high rates of PTSD among Vietnam War Era Veterans specifically.
Lack of Mental Health Services Available for Treatment
PTSD was not as well studied and understood as a medical condition in the 1970s as it is today. Sometimes referred to as “shell-shock” or “combat fatigue,” many veterans returned from war with PTSD and little to ease their symptoms or explain what they were experiencing.
Vietnam War Era Veterans and the Ongoing Battle with Posttraumatic Stress Disorder
Another study examined the persisting symptoms Vietnam War Era veterans faced over time, sampling a specific group of nearly 1,400 veterans. This study found that almost 30 years after returning from Vietnam, 10 percent of the veterans continued to experience severe symptoms.
The study also found that veterans experiencing severe PTSD symptoms were more likely to face worse family relationships, smoking, and less satisfaction in their lives. Importantly, veterans who experience PTSD may begin to abuse substances to cope with their condition.
Vietnam War Era Veterans and Substance Abuse
PTSD causes a host of symptoms which can make everyday life extremely difficult, such as anxiety, depression, memory loss, panic, sleeping disorders, and more. As such, some veterans turn to substances like drugs and alcohol to cope with their symptoms.
A study released in 1992 analyzing the severity of substance abuse in Vietnam veterans and the correlation with PTSD found that veterans who served in the Vietnam theater, and who had PTSD, were at a greater risk for abusing both drugs and alcohol. As such, the study indicated that PTSD can be linked to the severity of substance abuse.
Additionally, research into posttraumatic stress disorder was far less developed when Vietnam Era veterans were returning home than it is today. This meant that many veterans, unable to find medical help to cope with their condition, turned to drugs and alcohol as a means of self-medication.
VA acknowledges that 60-80 percent of Vietnam War Era veterans seeking treatment for PTSD have alcohol use problems. Specifically, veterans with PTSD may be more likely to engage in binge drinking, which VA defines as “when a person drinks a lot of alcohol (4-5 drinks) in a short period of time (1-2 hours).” Some veterans may binge drink to numb painful memories or emotions linked to their trauma. Veterans who have PTSD and are over the age of 65 are also at a higher risk for attempting suicide if they have abuse alcohol or have depression.
Service Connection for PTSD
Living with PTSD can make aspects of daily living extremely difficult. Veterans who have PTSD as the result of their military service may be eligible for VA disability compensation, although they will need to obtain service connection for their condition. To do so, veterans need to submit:
- A current diagnosis of PTSD by a medical professional;
- An in-service event, injury, or illness that led to the development of the condition; and
- A medical opinion, or nexus, linking the in-service event to the veteran’s current diagnosis.
VA refers to these PTSD-causing events as “stressors.” Stressors are categorized as combat-related or non-combat related by VA. Some examples include exposure to death or injury, the threat of great peril, or assault.
Secondary Service Connection and PTSD
PTSD has been linked to a number of additional conditions, such as sleep apnea, GERD, and IBS. If a veteran’s posttraumatic stress disorder causes or aggravates another condition, the veteran can establish secondary service connection. This means that the veteran only needs to prove the following:
- A current diagnosis of the secondary condition;
- Medical evidence indicating that the veteran’s secondary condition was caused or aggravated by their PTSD
How Does VA Rate PTSD?
VA assigns a disability rating ranging from 0 to 100 percent under 38 CFR § 4.130, Diagnostic Code 9411, the Schedule of Ratings for Mental Disorders. These ratings are based on the level of social and occupational impairment, as well as the frequency, duration, and severity of symptoms.
0% Percent Rating
The 0 percent rating is the lowest possible rating on the PTSD rating scale. This rating will be assigned when:
- “A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.”
Importantly, 0 percent ratings are non-compensable, meaning the veterans will not receive VA disability compensation for a 0 percent PTSD rating. However, veterans can be eligible for other benefits from VA with a non-compensable rating.
10% Percent Rating
VA’s criteria for a 10 percent PTSD rating are as follows:
- “Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.”
In this case, a veteran may experience certain symptoms that are exacerbated during periods of stress, but ultimately do not impair their ability to work in most occupations. Furthermore, the increase in severity of PTSD symptoms during periods of stress implies that the symptoms tend to be episodic otherwise.
This means that they are not always present and therefore do not significantly interfere with occupational and social functioning. Moreover, when symptoms are present, it is likely that you can control them with treatment or medication. Overall, the 10 percent rating reflects a low level of disability.
30% Percent Rating
The criteria for a 30 percent rating on the PTSD rating scale are as follows:
- “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).”
The criteria for a 30 percent PTSD rating outlined above are meant to represent mild PTSD symptomatology. In this case, “occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” might mean that you are starting to periodically miss work due to your lack of motivation associated with PTSD. However, your PTSD does not fully prevent you from performing and succeeding in a work environment.
50% Percent Rating
The criterion for a PTSD rating scale for a 50 percent disability rating under 38 CFR § 4.130, Diagnostic Code 9411, is as follows:
- “Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.”
The 50 percent PTSD rating criteria involve an escalation in the frequency, duration, and severity of PTSD symptoms from lower ratings, and includes several additional symptoms. If you receive a 50 percent PTSD rating, it is likely that you are beginning to display more noticeable cognitive deficits such as difficulty following instructions or making decisions that depart from past behavior.
70% Percent Rating
A 70 percent PTSD disability rating is one step below the highest schedular rating for the condition. Many veterans receive a 70 percent PTSD rating because their symptoms cause significant levels of impairment, both occupationally and socially. This rating is typically assigned to veterans with PTSD symptoms that are one step below totally disabling. The criteria for a 70 percent on the PTSD rating scale are as follows:
- “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships.”
The 70 percent disability rating criteria for PTSD are the most inclusive insofar as they represent a wide array of symptoms. Furthermore, they also reflect a progression of the symptoms included in the lower disability ratings.
Namely, a veteran who receives a 70 percent PTSD rating suffers from all the symptoms included in the 50 percent rating, but at a higher frequency, severity, and duration. Here, the veteran is almost always in a state of panic or depression that affects their ability to interact with others.
100% Percent Rating
A 100 percent PTSD rating is often difficult to obtain from VA because it requires a veteran’s symptoms to be so severe that they are totally impaired and unable to function in everyday life. While the symptoms listed in the 70 percent rating criteria involve a high level of impairment, the jump to 100 percent remains significant. The criteria for a 100 percent PTSD rating are as follows:
- “Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communications; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.”
The above-mentioned symptoms represent a substantial decline in cognitive and emotional functioning as compared to the rating criteria for lower percentages. Importantly, this decline results in a total impairment when it comes to a veteran’s work life and personal life. Specifically, a veteran may experience hearing voices or perceiving things that are not actually present. Self-injurious behaviors and suicide attempts are also consistent with a 100 percent rating.
How Can VA Help Vietnam Veterans Prevented from Working Because of PTSD?
If your PTSD significantly impairs your ability to work, you may be eligible for a total disability rating based on individual unemployability (TDIU).
TDIU compensates veterans at the 100 percent rate if their service-connected condition(s) prevent them from securing and maintaining substantially gainful employment.
VA outlines TDIU regulations under 38 CFR § 4.16, which encompasses subsections (a) and (b). Each subsection describes the ways in which veterans can meet the eligibility requirements for TDIU. In order to qualify for TDIU under 38 CFR § 4.16(a), or schedular TDIU, a veteran must have:
- One service-connected condition rated at 60 percent or higher; or,
- Two or more service-connected conditions, one of which is rated at 40 percent or higher, with a combined rating of 70 percent or higher.
Veterans who do not meet the schedular requirements under 38 CFR § 4.16(a) may still be considered for extraschedular TDIU under § 4.16(b). Extraschedular TDIU does not have any rating requirement. If veterans do not meet the criteria for schedular TDIU, VA will determine if their case should be referred to the Director of Compensation Service for extraschedular consideration.
How CCK Helps Vietnam Veterans Experiencing PTSD With Their VA Appeals
If you are a Vietnam War Era veteran, or a veteran of any era, fighting with VA for your hard-earned disability benefits, we may be able to help. Our accredited representatives can help your appeal by gathering evidence and crafting persuasive arguments in favor of your claim. Call our office today for a free case review to see if we can assist.
