Veterans Rehabilitation

Running Head: VETERANS REHABILITATION 1

Veterans Rehabilitation: Past, Present, and Future

David R. McConnell

University of Alabama BCE 626

VETERANS REHABILITATION 2

Veterans Rehabilitation: Past, Present, and Future

Presently there is a growing concern for the well-being of active duty service members

and veterans in the United States. In February 2013 the United States Army released suicide

statistics showing that more service members died from potential or confirmed suicides in 2012

(N=325), than from actual combat. The U.S. military lost 313 service members from combat

during Operation Enduring Freedom (OEF) in 2012 (Watkins & Schneider, 2013). The veteran

population is facing similar challenges. In 2007, it was estimated that 18 veterans committed

suicide per day. In 2013, the number of veteran suicides has increased to 22 per day (Jaffe,

2013). The signature wounds for veterans in the 21st century are documented as Post Traumatic

Stress Disorder (PTSD), traumatic brain injury (TBI), comorbid illness and injury (e.g.,

amputation, burns, substance abuse). This paper will explore the history of U.S. military

conflicts, and the evolution of veteran disabilities. A recommendation, supported with past

research, will show where the United States is in regards to veteran’s health care, and a holistic

proposal for the road ahead.

The Past

PTSD symptoms have been documented since the times of Homers Iliad around the 8th

century B.C (Homer). The diagnostic terminology and definition was not established until the

American Psychiatric Association published the Diagnostic and Statistical Manual for Mental

Disorders III in 1980 (American Psychiatric Association, 2012). We will begin our journey in

the 20th century after the great depression. Although there is a large amount of evidence before

then, the scope of research most applicable to the current era is of the 20th century to the present

time.


World War II (WWII) came after a time when Americans lived through a completely

different socio-economic environment than what we live in today. Americans lived through the

Great Depression, which was a very brutal time both socially and psychologically. The Nazi

takeover of Europe threatened a worldwide invasion. Ethnic cleansing of the Jewish population

by the Nazi’s was a justified cause to go to war. Nearly 16 million Americans participated in

WWII either voluntarily or through conscription. When the war was over many service members

returned to America with a sense of victory. Soldiers were greeted with great honor, celebrations,

parades, and benefits. Many of those injured during combat would not survive their injuries and

die on the battlefield. The veterans that did survive their wounds would return home, and carry

physical and emotional scars for the remainder of their lives.

PTSD was not a diagnosis in the early to mid-20th century. Veterans who displayed

symptoms of trauma were typically diagnosed with neurosis, Anti-Social Personality Disorder,

and Schizophrenia (Langer, 2011). Soldiers were treated differently in regards to mental illness.

Psychotropic drugs, therapists, and counselors were not readily available on the battlefield.

Psychiatry would perform lobotomies on individuals with severe mental illness. This was

thought of as an acceptable practice until it was later found to be ineffective and inhumane.

Individuals with symptoms of mental trauma, or as they called it combat fatigue would be cast

out of the service and deemed weak (Coleman, 2007). In 1944, General George Patton delivered

a hard-core speech to his soldiers:

Each man must not think only of himself, but also of his buddy fighting beside him. We

don't want yellow cowards in this Army. They should be killed off like rats. If not, they

will go home after this war and breed more cowards. The brave men will breed more


brave men. Kill off the goddamned cowards and we will have a nation of brave men.

(General George Patton's Speech to the Thrid Army, 1944)

Psychiatric services were not provided on the battlefield, and any signs of weakness would be

looked down upon critically by a soldier’s leadership. Soldiers would bottle up their emotions

out fear of negative appraisal. In the end, what was asked of soldiers during combat would be

significantly compensated when the war was over. A clear victory, sense of pride, and high level

of esprit de corps would prove to be a buffer against sudden onset of PTSD.

PTSD symptoms in WWII veterans were typically delayed onset, meaning symptoms did

not surface until later on in a person’s life. Researchers believe symptoms surfaced due to

distressing life events (e.g., family death, aging, Korean War, Vietnam). Veterans from WWII

were also thought to express their emotions in different ways, largely due to living through a

brutal economic depression prior to going to war, which is believed to have hardened their

psyche. Delayed onset of trauma symptoms were also thought to be a cause of boredom. From an

existential perspective developed by Viktor Frankl, an existential vacuum (i.e., boredom) left

space in the mind for PTSD to fill as people aged and retired (Frankl,1959/2006).

Nearly a decade later the United States was involved in another military conflict. The

U.S. was involved in the Korean War that was much smaller in size and scope compared to

WWII. WWII veterans were welcomed home, supported nationally throughout their deployment,

and provided benefits for unemployment, housing, and education; many Korean War veterans

faced a different reintegration. The Korean War essentially ended in a stale mate, although many

were physically and mentally injured and killed. Korean War veterans did not receive the

national support and welcome home reception the WWII cohort had. The lack of social support


and appreciation was later found to be a strong predictor of PTSD symptom severity and onset in

Korean War and Vietnam veterans (McCranie & Hyer, 2000).

By the mid-1950s, the United States began sending soldiers to Vietnam to help assist the

South Vietnamese efforts over the communist controlled North Vietnam. The heaviest of combat

continued through the mid-1960s to early 1970s, until a total withdrawal occurred in 1973. In

1973, North Vietnam defeated and won the capital of Saigon, which is the largest city in

Vietnam. The communist controlled North Vietnamese claimed victory. From a Veterans

Administration survey, 3 million Americans participated in the war and nearly half of a million

suffered from PTSD and other psychosocial issues (Vietnam war, 2013).

The Vietnam veteran population is presently in their retirement years. Many of the WWII

and Korean War veterans have passed away. Veterans of the Vietnam War experienced a harsh

homecoming where they were spit on and degraded in public for the service they unselfishly did.

Veterans were cast in a negative light of twisted public opinion and political propaganda. PTSD

prevailed in younger Americans than in the older. Age difference was a factor related to onset of

PTSD, where the older more seasoned soldiers managed and coped with stress differently. A

similar circumstance with the Vietnam War was onset of PTSD later in life. Like the WWII

cohort, delayed onset of PTSD was due in part to the publicity of the following U.S. conflicts

such as Haiti, Panama, Desert Strom and 9-11. When war began being broadcasted on every

news channel after the 1990s, veterans at home would watch and sense their past. The long-term

effects (i.e., PTSD, depression, and other psychological issues) that war has on humans should

be taken very seriously as the United States enters its 12th year of combat operations after

September 11, 2001 (Brooks, Laditka, & Laditka, 2008).


Vietnam was not only a learning point in regards to how combat batters the human

psyche, it also showed what substance abuse can do as well. Drug use was a prevalent problem

in Vietnam. Soldiers would smoke marijuana, but when it became hard to get they turned to what

they called skag (i.e., Heroin). Soldiers could acquire a $2 vial of heroin (98% pure), that would

have been $150 in the U.S (Coleman, 2007). Other substances were used frequently as well,

although the purity of heroin in Vietnam captured the attention of many. Drug screens and

policies were not in place as they are today. Soldiers reported becoming addicted to heroin after

their first try. Soldiers would trade heroin for a clean urine sample from incoming soldiers fresh

off the helicopter. The addiction would carry with them from Vietnam back to the United States.

Toppled with no social support, addiction, and psychological disorders many veterans would not

reintegrate well. Veterans who were addicted to heroin would account for the majority of arrests,

unemployment, and violent crimes compared to other veterans at the time (Robins, Helzer,

Hesselbrock, & Wish, 2010).

The war in Vietnam was a rough learning process in American history. The evolution of

war since WWII changed dramatically, and so did the veteran. After 1991, the United States

began a post-cold war era where the Soviet Union (i.e., Russia) was no longer a strategic threat.

The U.S. military now left the wintery mountain ranges of Europe, the triple canopy jungles of

Vietnam, and entered the desserts in the Middle East. From 1990 to 1991, only one year, the

United States led a coalition force against Iraq in order to stop them from invading neighboring

Kuwait. It was a small short-lived battle that consisted primarily of ships and warplanes, bombs

and missiles. Nearly 697,000 military service members deployed to the Persian Gulf. The

Veterans Administration reported in 1999 that 26% of those who served in the first gulf war met

disability criteria; compared to 8.6% in WWII, 5% in Korea, and 9.6% in Vietnam. Chronic


fatigue syndrome, gastrointestinal complications, PTSD, headaches, loss of memory, and muscle

aches are just some of the many symptoms this cohort has self-reported. The cause is still

unexplainable. Many diseases and illnesses are marked by medical signs or markers; the self-

reported symptoms from the first gulf war veterans are not (Dhillon & Boyd, 2010).

L.A. King, King, Bolton, Knight and Vogt (2008) explored associations of psychosocial

issues and physical complications from the Gulf war. The 1990-1991 Gulf war was the first of its

kind in military history where there was a strong sense of a nuclear, biological, or chemical

(NBC) threat. There was also a great deal of oil well burning where soldiers were covered in oil

rains and exposed to toxic fumes, because the Iraqi army set them on fire purposely. Presently

there is still no solid evidence that soldiers were directly exposed to biological weapons.

However, because there was a present fear of being attacked, the fear itself may have contributed

to some of the after combat symptoms. L.A King et al. (2008) assessed psychological stresses

that were highly consistent with the hypothesis that a perceived threat would be the most

prominent predictor of PTSD. Interestingly, the study concluded that psychological issues were

the prominent symptom from the perceived threat, other than medical complications (i.e., gulf

war illness). Due to the nature of this cohort, it is nearly impossible to know if a soldier was

exposed to a NBC threat. Soldiers that believed they were in danger or exposed to environmental

toxins showed more signs of psychological distress, opposed to those who did not fear anything

at all. Concluding, this cohort may be reporting manifestations rather than actual direct contact or

direct combat trauma, which has led to the high number of disabled veterans in a very short time

frame.


The Present

September 11, 2001 was a historical day in American history. The United States was

attacked by terrorists who hijacked commercial airplanes, and flew them into the World Trade

Center, Pentagon, and an open field in Pennsylvania. The United States also began a war against

terror, which began in October of 2001 with an invasion of Afghanistan. Two years later the war

carried into Iraq, and is still currently going on in 2013. Although the war in Iraq has been

drastically downsized, heavy fighting continues in Afghanistan. Nearly 1.6 million service

members, and growing, have served in either Operation Iraqi Freedom (OIF), or OEF, or both.

The signature wounds from the OEF/OIF cohort are PTSD and TBI. Since 2008, it is estimated

that nearly 22% of all combat injuries involved a type of brain trauma. Soldiers are fighting not

only a human element but an invisible one as well. Improvised explosive devices (IED) are

nearly undetectable and set up by enemy combatants. IEDs are bombs set to explode via cell

phone, trip wire, timer, or by pressure. Soldiers have never been exposed to blast trauma as they

have in OEF/OIF. 60-80% of soldiers who survive an IED blast also acquire some degree of TBI.

In addition, soldiers are also at elevated risk for PTSD when a TBI is present (Burke, Degeneffe,

& Olney, 2009).

The OEF/OIF cohort is also experiencing another issue that has not been seen since

Vietnam, suicide. In 2012, CNN reported the U.S. Army had 325 military personnel who were

confirmed or potential suicides. That total far exceeds the actual combat fatality numbers of 219

in the U.S. Army and 313 within the total military (Watkins & Schneider, 2013). Langford, Litts,

and Pearson (2013) reported that between 2006-2010 more than 1,300 military personnel

committed suicide. The rates for suicide among veterans are mixed, however many sources

indicate they maybe higher but not accurate because of accountability barriers. Substance abuse,


depression, and anxiety stem from PTSD and TBI. Given today’s battlefield, and the state of the

art technology and medical care provided, nearly 90% will survive combat injuries. In past

military conflicts, they would have died from their wounds. The increase in survival rates have

left veterans in a state that many call the walking wounded. Many of the injuries are termed

invisible, meaning in the mind. We now explore the road ahead, and the way in which

rehabilitation counselors and mental health professionals are approaching the 21st century

veteran/military individual and helping them lead a life of stability and quality.

The Future

“War is a disease that kills and maims, not just by tearing apart soldiers’ bodies, but also

by ravaging their minds” (Coleman, 2007, p. 90). The scaring effects of combat are certainly

gaining a great deal of attention in the 21st century. Twenty nine percent of returning service

members from OEF/OIF are enrolled in veterans’ health care; compared to only 10% during the

Vietnam era. With this large population of individuals who have survived the physical and

mental brutality of combat it is important for mental health and rehabilitation professionals to be

up to date on five areas. First professionals should be trained and licensed. Secondly, for the

initial diagnostic interview, choice of setting should be carefully planned. Many veterans will

seek help through outpatient care, however if they develop suicidality or comorbid psychiatric

conditions, inpatient assessment is vital. Third, finding the presence of PTSD through extensive

diagnostic evaluation is important. Fourth, research indicates that veterans are more than likely

resistant to the first line of care or treatment. Being flexible as a counselor or therapist is an

important aspect. Lastly, understanding stigma, veterans will tend to think symptoms will

diminish with time. They may also believe nothing can help them or there is an element of shame

in regards to their condition (Garske, 2011).


Frain, Bishop, and Bethel (2010) provide a roadmap for certified rehabilitation

counselors (CRCs) working with disabled veterans. Counselors must account for physical

disabilities as well as psychological ones. With technology and medical advancements, the 21st

century veteran has survived combat more so than any other generation. CRCs serve in a unique

position to help veterans reintegrate from the battlefield to civilian life. Although the

rehabilitation field receives very little attention in literature and research. A unique factor since

the war on terror began is that the U.S has used more reservists than anyother conflict. This is

because the U.S. has been in an extended conflict with an all voluntary force. Reservists only

serve for a limited time, typically 2-3 years on active duty, and than return to their prior vocation.

Their transition from the battlefield to the workplace often leads to the veteran disengaging from

the work force because of obsticles in their reintegration. CRCs can use a five pronged approach

to address the issues that military personel face when they leave the military environment and

return back to their civilan lifestyle.

A five pronged approach is recommended when providing rehabilitation services to

veterans. The first pronge is infusing veterans diabilities into rehabilitation curiculum and

training. Currently there is no extensive training or textbook literature that addresses disabled

veterans. CRCs should have the available resources and knowledge to provide three critical

things (1) preparedness to screen for and identify non-visible disabilities; (2) knowledge of

treatments, psychological and psychosocial sequelae, and symptoms of commonly experienced

disabilities; and (3) understand the military, medical, psychological, and rehabilitation systems

that veterans are most likely to be involved in (Frain et al., 2010).

The second pronge approach involves focusing on distinct employment needs for

veterans. CRCs are uniquely set up with knowledge and skills that can assist employers and


veterans in the workforce. They can provide employers with knowledge about disabilities and

things such as reasonable accomodations. Various studies have shown that reservists typically

return to their previous work place (25%) after they served their active duty time. However,

when there is a disability present, reservists typically change or do not return to work (50-75%).

CRCs have a unique skill set that allows them to help the employer understand, but also help the

veteran understand his or her abilities and limitations. For veterans with severe chronic

disabilities returning to work or prior employment maybe difficult. CRCs can help assess a

veterans’ abilities and ocupational options. Employment has long been correlated with raising

self esteem and detering secondary disabilities (e.g., substance abuse). CRCs also have the

ability to facilitate and maintain a veterans employability, especially if they have PTSD because

employment also correlates to decreased stress, financial strain, and anxiety (Frain et al., 2010).

Managing secondary disabilities through self management techniques is the thrid pronge.

Self management is critical in a veterans rahabilitation efforts, and is also the hardest.

Techniques include medication compliance, following recommended diet and exercise, and

showing up for scheduled appointments. Veterans with disabilities are prone to poor self

management techniques, and research indicates that those with PTSD are at greater risk for

secondary disabilities. PTSD in general inhibits the initiation of inappropriate self care resulting

in maladaptive responses such as substance abuse and other comorbid illness. Secondary

disabilities are the biggest barrier to long term employment, and can lead to untreated medical

conditions. Veterans will often self medicate through the use of alcohol or drugs. Another factor

with PTSD is the stigma associated with seeking care. Veterans are afraid of any care involving

mental health. They are affraid of lossing their job, or being labeled negatively by their peers,

family, and leadership. CRCs should have the ability to assess an individuals level of self


management, and address short comings early to contain secondary disabilities (Frain et al.,

2010).

The fourth prong approach developed by Frain et al. (2010) is using a family resiliency

model to address the holistic needs of veterans and their families. This is a very important step,

because often times it is not only the veteran effected by war injury or illness, it also involves his

or her social structure. In 2011, of the entire active duty military (N = 1,411,425), 68.8% (n =

789,067) were married (Department of Defense, 2012). Although these statistics are for active

duty military alone this model is very applicable for veterans as well. Veterans face numerous

challenges when they leave the active military role. PTSD, TBI, and polytrauma can result in

diminished problem-solving skills and resource obstacles for both the veteran and his or her

family. CRCs can help in three essential areas: (a) identify appropriate resources, (b) improve

problem solving skills and coping skills, and (c) reframing disabling conditions. Improving

family support and their understanding has been correlated to decreasing PTSD symptoms. In a

survey of 114 veterans enrolled in outpatient trauma recovery through the Veterans

Administration (VA) Batten et al. (2009) found that PTSD was the leading cause of family

distress. Over three fourths of the participants would like to see their family and friends

participate in their PTSD treatment. Gibbs, Clinton-Sherrod, and Johnson (2012) explored the

intrapersonal conflicts of married soldiers upon their return from deployment. They found that

although many military families find positive meaning in deployments, some face challenges,

hurdles, and obstacles when soldiers return home with physical, mental, and substance abuse

disorders. The family stress theory suggests that reactions to deployment will be mediated by the

families interpretation of the event (e.g., meaningfully challenging or a catastrophe). Immediate

post deployment assessment is necessary to screen for potential inter and intra communication


conflicts. PTSD, negative health changes, depression, and substance abuse have been shown to

cause marital and family distress. Therefore, it is important that CRCs also recognize the

veterans’ family, because they can play an important role in their rehabilitation efforts, and can

be the make or break variable for future success.

The final prong of the rehabilitation roadmap is an immediate call for the rehabilitation

field to develop researchers that focus on veterans’ issues. The rehabilitation field has lagged

behind compared to other mental health professions in regards to veteran’s rehabilitation.

Specialized researchers have to look towards the future, and show that the rehabilitation field is

dedicated to the ever-changing issues of the 21st century veteran population. Issues such as

stigmas, PTSD, TBI, poly-trauma, substance abuse, and vocational rehabilitation have to be

researched extensively. Grants, funds, journal space and literature have to show that the

rehabilitation field is leading the way (Frain et al., 2010).

Another aspect of veteran’s rehabilitation is improving veteran’s quality of life,

employability, and decreasing PTSD symptoms through educational programs (i.e.,

undergraduate/graduate education, technical school, certification, and licensure). The Post 9-11

G.I. Bill is a federal education benefit awarded to military service members. A criterion for

eligibility is that veterans must have an honorable discharge from the military. The 9-11G.I. Bill

provides tuition assistance, housing allowance, and pays for books and supplies while the veteran

is enrolled in a vocational school, 2-4 year university, graduate school, or technical/certificate

training. The goal is that veteran’s use the Post 9-11 G.I. Bill to support their educational needs

and facilitate their reintegration through educational attainment that leads to employment.

Looking at why people join the military there are two main incentives. First, people join the

military for technical/vocational training in their active duty assignment; secondly, they join for


post-service educational benefits. PTSD is the signature illness in veterans of the current era; it is

important to note that universities are seeing more veterans on campus. Although, many veterans

are having a difficult time adjusting to the environment of an educational setting. Supported

education is a good way to help veterans through the transition from military life to student life.

Many universities have very limited resources when it comes to assisting veterans with severe

mental illness. Supported education is essentially where the VA or a mental health agency roots

itself into the student support services on campus. This has been shown to be one of eight

rehabilitation techniques that individuals with PTSD can benefit from (Smith-Osborne, 2012).

The system is in place for veterans with injuries of all kinds; it is only a matter of getting them

the proper support when they enter the system and begin their journey.

Lastly and most importantly is the stigma associated with seeking care for mental

health/substance abuse issues. These issues must be addressed by rehabilitation counselors, or

mental health professionals. Stigma is the single biggest barrier in terms of soldiers and veterans

seeking care for their illness or injuries. If a soldier, or veteran, cannot get treatment for mental

health or substance abuse issues; then everything discussed earlier will not apply. The good news

is that veterans from OIF/OEF are less likely to be homeless than prior veteran generations.

Although, those that are homeless from the OIF/OEF cohort are more likely to have PTSD than

any other prior generation (DeAngelis, 2013). In an article called, “Thinking about aids and

stigma: A psychologist’s perspective,” stigma was defined as “an enduring condition, status, or

attribute that is negatively valued by society and whose possession consequently discredits and

disadvantages the individual” (Gregory, p. 595). SAMHSA defines stigma as “a barrier that

discourages individuals and their families from seeking help” (Substance Abuse and Mental

Health Services Administration, 2003, p. 1).


Rae Olmsted et al. (2011) conducted a study to find perceptions of stigma associated with

treatment seeking. Rae Olmsted et al. found that stigma was not only present in those seeking

treatment but also very prominent in those already in treatment. This finding indicates that not

only is there a barrier to treatment seeking but also a higher likelihood of treatment failure. The

biggest concern for active duty soldiers seeking treatment, or already in treatment, is peer and

leadership appraisal. Soldiers are afraid they may be treated, or viewed differently if their peers

or leadership discovers they are in treatment for mental health or substance abuse problems. Job

security and peer appraisal are major factors in soldiers’ lives, which can be a difficult barrier to

overcome when they need help.

Over the past half-decade, the United States military has changed in the way leaders treat

their soldiers. The military psyche was an alpha male bulletproof philosophy. This has changed

over the past few years to a more caring and compassionate approach. The cause of this change

is the growing number of active duty and veteran suicides per year. The military recognizes that

the leadership of soldiers is the first line of defense against suicide, and identifying psychological

distress. The way in which leaders can facilitate caring in stressful situations and being

supportive towards their soldiers’ needs have been shown to reduce the impacts of traumatic

events (Wood, Foran, Britt, & Wright, 2012). Officers in the military were found to be the

primary buffer to PTSD symptoms. In the military, soldiers are not afforded the patient

confidentiality, that by law, civilians are protected with when seeking mental health care. Mental

health professionals in the military are required to notify a soldier’s leadership if a soldier is in

mental health or substance abuse treatment. Lack of confidentiality is a concern for many

soldiers because they fear being cast out of the group. Therefore, increasing confidentiality can

reduce stigma barriers if the military can develop a pilot program that provides some


confidentiality. If confidentiality is not plausible, military leadership has to change negative

perspectives’ towards seeking treatment for mental health and substance abuse issues

(McFarling, D'Angelo, Drain, Gibbs, & Rae Olmsted, 2011).

The military as a whole is more manageable, and easier to implement policies in regards

to reducing stigmas and getting soldiers the help they need. When soldiers discharge from active

duty accountability and available resources’ diminishes. Many veterans will enter into the VA

health care system, and some may not. There are measures that can be used to help track

reintegration and reduce stigma associations for veterans, which can reduce PTSD symptoms and

increase quality of life. Many veterans leave the military in hopes of leading a new life but many

find themselves longing for their prior unit, and those whom they served with during a time of

hardship.

Forgetting about the past and breaking ties with associated traumas is common. People

would rather just forget, or brush the event under the carpet. Severing relationships can be a bad

approach for veterans beginning a new life in the civilian world. R. Hinojosa and M.S. Hinojosa

(2011) described the importance of using strong bonds between soldiers to facilitate their social

lives after the military in the Journal of Rehabilitation Development and Research. Prior

literature has leaned towards breaking bonds that soldiers have to their prior unit, because some

researchers believe it to be a barrier to reintegration. This is true to a certain degree, although if

the bond between a soldier and his or her comrades is used strategically it can be that more

beneficial to their reintegration. The United States has long understood the uncommon bond that

soldiers share with their comrades:

I now know why men who have been to war yearn to reunite. Not to tell stories or look at

old pictures. Not to laugh or weep. Comrades gather because they long to be with the


men who once acted at their best; men who suffered and sacrificed, who were stripped of

their humanity. I did not pick these men. They were delivered by fate and the military.

But I know them in a way I know no other men. I have never given anyone such trust.

They were willing to guard something more precious than my life. They would have

carried my reputation, the memory of me. It was part of the bargain we all made, the

reason we were so willing to die for one another. As long as I have memory, I will think

of them all, every day. I am sure that when I leave this world, my last thought will be of

my family and my comrades... such good men (Norman, 1991, p. 293).

It is difficult for a soldier’s immediate family to understand the bonds formed while their loved

ones were serving. It may also be difficult for them to think of those bonds as an extended family

of the soldier. Veterans will reunite whether it is in an informal or formal setting. Veterans have

been reuniting since the Revolutionary War to the current wars in Iraq and Afghanistan. WWII

veterans would meet at the beaches of Utah and Omaha in Normandy for the anniversary of D-

Day. Veterans would meet at Pearl Harbor, Japan, and the Vietnam memorial for anniversaries;

or at a local VFW on Memorial Day and Veterans Day. Non-profit organizations such as the

Wounded Warrior Project and Veterans Helping Veterans’ understand these bonds and they do a

good job at maintaining them, and helping civilian culture understand. In many cases, it takes a

veteran to understand a veteran, and that is where a strategic plan can be used to help facilitate a

veteran’s reintegration.

Conclusion

Exploring the evolution of veteran’s disability is a very important aspect in understanding

veterans from different conflicts. We can go beyond WWII and find that PTSD has been around

since the dawn of humankind. The name may be different today, and the treatment has certainly


come a long way but the signs and symptoms have not changed. War shapes American culture

economically, socially, and psychologically. The WWII cohort was labeled, The Greatest

Generation, which was an accurate label for veterans and civilians who had a triumphant victory

over a deadly Nazi regime in Europe. Veterans returned home to parades and lavish veterans’

benefits. Vietnam proved to be a disaster with the lack of social support and American distaste

for the war itself. The war in Vietnam left many veterans unappreciated and in a dark corner by

themselves. Legislation began to pass through Congress and the Oval office when disabilities

from war became a clear concern.

The Americans with Disabilities Act (ADA) enacted by Congress in 1990 provides

discrimination protection for individuals with disabilities:

The ADA is a civil rights law that prohibits discrimination and guarantees that people

with disabilities have the same opportunities as everyone else to participate in the

mainstream of American life -- to enjoy employment opportunities, to purchase goods

and services, and to participate in State and local government programs and services.

Modeled after the Civil Rights Act of 1964, which prohibits discrimination on the basis

of race, color, religion, sex, or national origin, the ADA is an "equal opportunity" law,

not a benefit program entitling you to specific services or financial assistance because of

your disability (U.S. Department of Justice, 2010).

In 1998, President Bill Clinton signed into law amendments to Section 508 of the 1972

Rehabilitation Act. The amendments acted to strengthen section 508, which provides access to

electronic and information technology assistance to people with disabilities, provided by the

federal government (Section 508 of the Rehabilitation Act of 1973, as amended 29 U.S.C. § 794

(d), 1998).


It is important that CRCs and other mental health professionals understand the laws

provided to those with disabilities. It is empowering and equally important for veterans and

people with disabilities to understand them as well. Veterans with disabilities can be provided

vocational opportunities, and those with physical injuries (e.g., amputation) can have technology

assistance that provides a higher quality of life. Technology and legislation has come a long way

since WWII, and that is true of the battlefield as well. We live in an era where more service

members are surviving traumatic injuries than ever before leaving a large number of walking

wounded.

As the wars in the Middle East, North Africa, and Western Asia begin to wind down in

the coming years it is important for the health care arena to understand that the effects of war can

linger on for decades after. In the book entitled Flashback: Posttraumatic stress disorder, suicide

and lessons of war, Dennis Fisher was a Vietnam veteran who ultimately committed suicide long

after his service. His wife Marylyn accounts her experience with her combat torn husband:

“After twenty two years of chaos and destructive misery… Dennis took his own life…. This war

isn’t over. It’s 1999, and my husband just died from the Vietnam War” (Coleman, 2007, p. 164).

From a political perspective, leaders have to be aware war causes both physical and psychiatric

casualties. Concerning the current era, it would appear the lessons learned from prior wars have

not been taken into account. Mental health and rehabilitation professionals are in a constant

game of catch up, limited funding, and a losing battle against the coined invisible wounds of

combat.

From a personal perspective, I remain optimistic that the wars will end, and the disabled

will be triumphant. I see this happening not through policy makers, or establishment politics, but

through non-profit organizations and the strongest of those traumatized. I see the strong leading


the weaker to prosperity, and an enhanced quality of life. I have been war torn as well, and in the

first years of the war on terror, I walked on the same battlefront that many soldiers still walk on

today. Upon my honorable discharge from active service in 2007, I fell flat on my face. I faced

the economic and social hurdles that so many have to endure. I utilized every resource for

veterans that included VA Vocational Rehabilitation and the Post 9-11 G.I. Bill. Both have

sustained my life in order for me to have health benefits, educational attainment, and soon

gainful employment. Although not one minute of the process of reintegration was easy for me,

and I have my critical critiques of the system, I can still find positive aspects. Since my

discharge, I still talk to my comrades and seek advice from them, as I would have when I was on

active duty. The biggest complaint I hear from my veteran friends is their therapist, psychiatrist

and family (i.e., wife, mother, father, cousins, uncles and children) just do not understand. They

do however appraise health professionals and family members for trying. As more veterans

return home with TBI, PTSD and amputation, they will continue to defy the odds. Individual

who are resource driven will lead the way for the entire disabled population and provide an

image of hope and resiliency that many will emulate. Perhaps this era will not continually be

called another generation of troubled vets. Perhaps down the road America will look back and

say this was the greatest generation of the 21st century.


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Healthcare

Veterans Rehabilitation