I’ve been a medical transcriptionist for about 30 years. Some of the more interesting types of medical documents I’ve transcribed have been histories and physicals for patients, because they tell a story. Not just broken bones and radiographs, but personal experiences from psych to orthopedics.
A few years ago, I began transcribing from home for the Veterans Administration. I type appeals for veterans who have been denied benefits for whatever reason. Three elements are necessary to establish service connection for benefits. First, that there is a current diagnosis, the second is that it happened in service, and the third is a link between the two. It is a non-adversarial courtroom-like setting with the veteran, an accredited representative, and a judge. With covid, the hearings are now virtual. Most of the reports I type, sadly, are veterans returning to the courts seeking benefits for post-traumatic stress disorder or acquired psychiatric disorders, depression and anxiety. In earlier conflicts such as World Wars I and II, and even the Vietnam War, it wasn’t considered honorable to seek benefits for mental conditions. In addition, PTSD was not an established term that we understood for the most part.
One veteran says he did not want to be a “malingerer,” so when a plane ran over his foot and collapsed his steel-toed shoe, breaking the bones of his foot, his staff sergeant told him to put a Band-Aid over it and get back to fueling the planes. He says, “You didn’t go to sick call; you sucked it up.”
The stories flow from my headphones to my fingers, as I type the tragic experiences told by these veterans — from Korea, Vietnam, Afghanistan and Desert Storm — harrowing stories that left these soldiers with severe mental handicaps that often led them to unemployability and eventual homelessness. Tragically, many veterans are only recently receiving benefits for service-connected mental conditions, and the process is still tedious and lengthy. A number of veterans are unaware of entitlement to VA benefits and have let their conditions, physical and mental, progress through the years thinking they could not afford treatment. The judges and representatives at the hearings are respectful, but sometimes when the veteran gets emotional about his or her experience, the job of the attorney is to get the bare facts, and they can seem unfeeling or uncaring, as the veteran sobs retelling a story.
The attorney tells the veteran that in order to find out the level of entitlement for PTSD, a complex formula and rating system is utilized. Tap-tippy-tap — statistically, the attorney figures the vet is 70% disabled from said mental disorders. In this case, the attorney questions the veteran through a list asking him to explain the severity of occupational and social impairment in areas such as work, school, family, judgment, thinking or mood.
Attorney: Do you ever think about or consider suicide?
Veteran: Yes, sir.
Attorney: Can you expand on that? How many times does it occur?
Veteran: Oh, gosh. One to three times a year maybe.
Attorney: Do you have any obsessional rituals that you maintain?
It goes on like that for 10 pages — depression, anxiety, panic attacks, forgetfulness, impaired impulse control, neglecting personal hygiene, startle reflex, etc. The veteran explains that he gets up repeatedly during the night to ensure the house is secure. He walks around the house, locks the doors and relocks them, looking behind curtains to make sure no one is there. The attorney asks if he has any other rituals. The veteran starts crying and explains that he separates himself from his wife and sits outside by his wood burner drinking beer for hours having conversations with his dead relatives. “I talk to them and they talk back to me.” He goes a week or two without a shower and his wife has to remind him to brush his teeth. He sees no one except his wife and says, “I’m in a relationship with my wife because I love her.” His voice cracks. “And she needs somebody.” He attributes his problems to his time in the military in what he describes as a MASH-like unit where American soldiers and their allies were brought in with blown off legs and hands and bullet holes in their limbs and bodies. “Dead soldiers coming in,” he says. “Just the recurring nightmares that I have thinking about the dead people and what I could have done to save them.”
Death and destruction
Another veteran begins, noting an event called the Cuban Missile Crisis in 1962.
He and his unit were flown from California to Tampa, Florida where they were sequestered without knowing what was going on. They were put on alert and all of our U.S. planes were sent to MacDill Air Force Base in Tampa. His job was to load coordinates into a computer directing the trajectory of the dropped bombs. For 10 days his group was on 24/7 alert to be able to launch a nuclear bomb within 15 minutes. It was only when he was rotated back to California that he found out that they had been sitting at Defcon2, which is the next stage before firing and actually dropping weapons. He and his group were sixth down from the chain of command from the president that would have a first-strike death estimate worldwide of 400 million people. “I didn’t know where these coordinates were. They were just numbers to me.” He was a 19-year-old kid doing his job and left the military developing severe PTSD when he realized the magnitude of the possibilities. He’s angry, can’t express himself and cannot have relationships with people, explaining that it’s not like he didn’t try. He was married eight times.
The same veteran recalls that in 1965, his entire wing was flown to secure the site after an airplane crashed in Wichita, killing 107 people onboard and 23 on the ground. With the site still smoldering they were sent to look for survivors. “They had a set up a temporary morgue and gave us orange flags and we’d go through the site and mark the bodies and pieces.” He tells of being surrounded by death and destruction, people burned beyond recognition.
This veteran suffers from PTSD, anxiety, depression and panic attacks. In the 10-page document that I transcribe, he recounts his many traumas during military service. Another time he and his buddies were driving to Wichita and got bumped from behind by a carload of guys. Another carload swerved in front and pinned them in. Men jumped out of the two cars with baseball bats and tire irons. While spitting on them and calling them baby-killers, they smashed this veteran’s windshield and dented his car. A McConnell AFB sticker in the back window identified them. The veteran managed to pull out and said his 6-cylinder Chevy laid rubber like never before. He ended up replacing the 6-cylinder with a V8 and never sits with his back to a door.
One trauma after another
One traumatic story after another — I type them. A woman describes being sexually assaulted, but when she complained to the platoon sergeant, she was forced out of the barracks and sent to a remote site where there were 30 men and she was the only female. She continued to be harassed until she was discharged at the soonest opportunity, though her plan had been to retire from the military after a successful career. Instead, she returned home with suicidal thoughts, depression, and a startle reflex that would send her into a state of panic with each slam of a door.
Many of the veterans were exposed to toxic chemicals like Agent Orange during the Vietnam and Korean wars. Toxic herbicides were sprayed around the perimeter of the bases to keep the foliage down around the demilitarized zone. One veteran describes having to crawl into contaminated water to put tanks in the swampy water, his boots and clothing remaining wet and toxic for the remainder of the day until they dried in the hot, sultry Vietnamese sun. He never got a change of clothing. Years of contaminated water at the Marine Corps Base in Camp Lejeune in South Carolina has left many soldiers with developing presumptive illnesses. The laws have changed on this with a presumptive list growing every year — from bladder cancer to brain tumors, to heart disease and everything in between.
Many veterans developed foot problems in service from wearing combat boots and running in them for hours. The boots had no padding and were sometimes ill-fitting. Not exactly Nike running shoes. Shin splints, flat feet, knee problems. Another common claim is for hearing loss or tinnitus — ringing ears. Hearing protection is a luxury only afforded to today’s soldiers. Not so fortunate were those veterans in years past who were consistently exposed to the noise of explosions, grenade fire, and rifle ranges with no hearing protection, as well as working in the noisy hum of the flight line. Pilots in Desert Storm flew up to 150 hours a month with the steady loud roar of a C141.
Case of a broken face
And here’s a tragic case where a benefits application was submitted in 1978 for a veteran who was 20 years old at the time. He received a Le Fort fracture II — the result of a 300-pound ship hatch slamming into the vet’s face knocking him unconscious after a rogue wave suddenly tipped the ship. His head was pressed between the hatch side and the steel hatch door and the side part the hatch closes into. Another service member pulled him back. His mother was called and brought to the flight line to meet her son after he spent three days in a coma.
The attorney explains, “The maxilla covers your teeth, goes all the way up and around and covers all of this part of the face from the lower part in a pyramidal shape.” Basically your face cracks apart with a Le Fort fracture; the bone literally comes apart. In 1978, they didn’t have the ability to repair this fracture, as they would have had to break his face in half and then repair it, which would have killed him. They couldn’t repair what had happened to him or figure out how to put his face back together again — glue him together. What happens with a Le Fort fracture is that it never really heals. The bones grow in an effort to repair themselves. In this case, the bone grew all the way up into his sinus cavity, cutting off 90% of his air supply on one side which resulted in a collapsed lung that required two 5-hour surgeries. He lost all his teeth. When a victim of this type of fracture is found, the first responders immediately check to make sure the throat is clear of broken teeth because you can choke to death on your own teeth.
The judge and attorney argue — the attorney says the VA changed his classification for a PTSD rating and turned it into something else to deny the existence of the PTSD — complicated stuff — a blame game, and the attorney goes on and on about how the vet was wronged. Raising his voice, the attorney keeps saying, “with all due respect,” until the judge gets angry and tells him to stop with the “all due respect.” The judge tries to simplify and ask exactly what they are looking for. This is the last straw for the attorney and he says he “finds the hearing abominable, but ‘with all due respect,’ your honor…” The attorney demands benefits backdated to the injury to 1978; restore the percentage of disability for PTSD as the veteran has serious PTSD. He goes over statistics and expounds on various opinions of medical experts. Then he says angrily, “Do you understand where I’m going here?” At this point, I thought the judge was going to toss him out on his ear for his irreverence and insolence. The judge says sarcastically, “I understand that you are not a psychiatrist. You’re trying to substitute your expertise in psychiatry…”
This sets off a tirade from the attorney and he disrespectfully yells at the judge. “Your honor, this hearing is over! Your behavior is shameful and you’re not listening. Your handling of the case is abysmal — you are unprofessional and lacking in proper attitude. We are going to be meeting again at a disciplinary hearing filing charges!!”
Disappearing for 45 years
The veteran’s mother steps in. She explains that she has watched her son slowly disappear for 45 years. She describes episodes where her son withdraws from his family and even from her, his mother. “On the tarmac when I came to him, his head was bandaged and his face swollen. He could not open his mouth. I had to take my 20-year-old son home and feed him baby food.” They sent him home because they did not know if he was going to live or die, as many with this fracture do not make it. She says she sent a happy, jovial, well-adjusted boy into the Marine Corps to serve his country and he came back as a person that couldn’t stand people coming close to him. “He could not stand to hear a door slam. He could not stand to have me drop something in the kitchen. He was a different man when he came back.”
While many personnel leaving the military may initially experience some uncertainty and a loss of confidence, most make the adjustment successfully. At other times, the problems may not go away — and for some, become progressively worse. Those leaving the military with service-related problems such as chronic ill health, injury, post-traumatic stress disorder, anxiety disorders, chronic pain or depression may experience additional adjustment difficulties. The military has a unique culture, one that is very different to civilian life. I can only imagine the “culture shock” vets face returning home to loved ones that can’t possibly know what they have gone through. I type these hearings with humble compassion.