September is CPTSD Awareness Month, making it an appropriate time for healthcare professionals who work with veterans to consider how trauma can influence a medical evaluation.
The nature of military service repeatedly exposes people to highly traumatic events such as combat, sexual assault, serious injuries, violence and death. Some have also experienced additional trauma in their civilian lives, which adds another layer of complexity to the mental health picture.
As a provider conducting VA disability evaluations, you aren’t responsible for helping veterans process the realities of what happened to them. However, it’s still beneficial to understand how the ripple effects of trauma can affect behavior, memory, communication, and self-image, so you can approach these encounters with the compassion and sensitivity they deserve.
Understanding Complex Trauma
Though complex post-traumatic stress disorder, or CPTSD, isn’t a separate diagnosis according to the American Psychiatric Association’s DSM-5-TR criteria, the World Health Organization’s ICD-11 recognizes it as a distinct condition.
Like PTSD, it can involve vivid flashbacks, nightmares, avoidance, and an inability to relax. However, CPTSD also includes difficulties involving emotional regulation, negative self-image, and maintaining relationships. These patterns often emerge after exposure to prolonged or repetitive events that are difficult or impossible to escape.
Not every veteran who has experienced repeated trauma will develop PTSD or CPTSD. Still, in your daily work with these courageous men and women, it’s helpful to recognize that trauma’s effects aren’t always immediately obvious.
Trauma Doesn’t Have One Appearance
The lingering effects of traumatic events affect people in dramatically different ways. Some veterans may become visibly agitated and cry during their compensation and pension exams, while others will mask their distress behind a calm, detached façade.
Beware of making assumptions based solely on outward emotions – or lack thereof. A veteran’s initial demeanor won’t necessarily give you an accurate idea of how profoundly their experiences have affected them.
Talking About Trauma Can Be Painful
Military culture prizes people who can compartmentalize their distress and keep functioning after encountering profoundly disturbing and frightening things. As a result, many veterans spend years trying to suppress their memories and emotions. They may become evasive or try to change the subject if you ask them to discuss symptoms or events they’d prefer to leave in the past.
A trauma-informed approach will set a positive tone for your interactions with veterans. Instead of pushing your patients to recount every painful detail, be patient. Hesitation doesn’t automatically mean a veteran is deliberately being uncooperative.
VA guidance for healthcare providers recommends maintaining privacy, showing interest and concern, acknowledging distress, and avoiding assumptions about the effects of someone’s traumatic experiences. It also advises providers who aren’t responsible for specialized mental health evaluation or treatment against unnecessarily eliciting detailed trauma accounts or challenging a patient’s report.
Clinicians conducting disability evaluations have one specific objective – obtain the information you need to complete a thorough, accurate assessment while staying within the appropriate scope of the examination.
Create a Professional Environment Where Veterans Can Speak Honestly
The tone you set during your evaluations can make it more comfortable for your patients to discuss thorny topics. Calmly explain the purpose and structure of the evaluation, listen without judgment, and give your patients plenty of uninterrupted time to answer. Don’t jump to conclusions about what they should feel or how severely a particular experience “should” have affected them.
Most importantly, remember that your patients are human, not checklists of symptoms. A respectful clinical environment can make it easier for veterans to accurately describe their functional limitations resulting from a service-connected medical condition – information that can be highly relevant to your evaluation.
Screening vs. Diagnosis
Screening tools can identify people living with the effects of trauma, but they are no substitute for an official psychiatric diagnosis. VA guidance recommends further assessment when screening indicates probable PTSD.
Stay within the scope of each evaluation you perform. Remember, your responsibility isn’t to solve every problem a veteran brings into the room. It’s to perform your assigned clinical responsibilities carefully, objectively, and compassionately.
Clinical Expertise and Compassion Can Coexist
Working with veterans requires more than medical knowledge. It requires listening carefully to people whose experiences may be very different from your own.
Warrior Vets clinicians provide focused medical evaluations that contribute to the VA disability claims process. Providers can apply their expertise in meaningful, mission-driven work while helping ensure veterans receive thorough and respectful evaluations.
Our exam-focused model also offers flexible scheduling, reduced administrative responsibilities, and no ongoing case management, preserving your work-life balance and allowing you to concentrate on the work in front of you.
Bring Your Skills to a Mission That Matters
You don’t need to be a trauma expert to appreciate the value of trauma awareness. For veterans living with the aftereffects of military service, your patience, professionalism, objectivity, and willingness to listen can make a genuine difference.
If you’re a healthcare professional looking for flexible, purpose-driven work serving those who served our country, contact us to learn more about joining our team.