Recognizing Common Disabilities in Veterans

The rehabilitation counseling profession originated in response to the rehabilitation and employment needs of World War I military veterans. The world and the nature of war has changed dramatically since then, resulting in in an increase of Veterans with injury to the brain in addition to other body parts or systems.

Traumatic brain injuries (TBI), post-traumatic stress disorder (PTSD), and depression are typical disabilities of Veterans who served in recent wars. These disabilities are often undiagnosed in Veterans as they are frequently unrecognized until many months or years after the event(s) that caused them.

Vocational rehabilitation counselors who are prepared to screen for and identify these invisible disabilities in initial interviews can more easily create a rehabilitation plan that best serves Veterans reach their employment and quality of life goals.

Here are some tips and tools for identifying common disabilities in Veterans.

Screening for PTSD, TBI, and Depression in Initial Interviews

Example clinical screening questions for PTSD include:

Have you ever seen anyone wounded, dead or killed during this deployment?
Have you ever engaged in direct combat where you discharged your weapon?
During this deployment did you ever feel you were in great danger of being killed? (Hoge et al., 2006).

A similar three-item screen for further evaluation can be used for TBI:

Have you ever been in a blast/explosion (or close proximity), vehicular crash, or fall?
Have you ever been rendered unconscious?
Have you ever had a head trauma?

A positive response to any one of the above six questions would indicate to the counselor that more significant evaluation of the individual is needed. (Lew et. al., 2007)

Recognizing subtle signs of TBI and PTSD

These more subtle signs of TBI and PTSD could alert counselors to check for more thoroughly for these conditions:

TBI

Difficulty reading when no vision problem exists
Tinnitus
Hearing loss
Problems with auditory processing

PTSD

Accidents, arrests, and absenteeism arising from substance abuse
Emotional numbness
Sleep disturbances
Outbursts of anger

Screening Instruments for PTSD and Depression

These instruments can be used in for screening during initial interviews:

17 item PTSD Checklist-Military scale (Ismail, et al., 2002)
Beck Anxiety Index, and the Beck Depression Inventory, each of which can be given in approximately five minutes (Beck, Steer, & Brown, 1996).
Depression Self-Assessment from the U.S. Department of Veterans Affairs