F R O M C O M B AT T O C L A S S R O O M
U N D E R S TA N D I N G S T U D E N T- V E T E R A N S & S E R V I C E M E M B E R S
TA B L E O F C O N T E N T S
I N T R O D U C T I O N ...................................................................................................................... 1
G E N E R A L I N F O R M AT I O N A B O U T V E T E R A N S A N D S E R V I C E M E M B E R S ......... 3
Military Culture and the Strengths of the Veteran ............................................................................. 5
Education Benefits ........................................................................................................................... 6
U.S. Department of Veterans Affairs – Benefits Available to Veterans ................................................. 8
P O S T- D E P L O Y M E N T I S S U E S ............................................................................................ 9
Marital and Family Issues ................................................................................................................. 9
Financial Issues .............................................................................................................................. 10
School and Work Balance ............................................................................................................... 11
Driving Concerns .......................................................................................................................... 11
Missing Classes for Medical Appointments ..................................................................................... 11
Military Leave and Re-Deployment ................................................................................................ 12
M E N TA L H E A LT H A N D M E D I C A L I S S U E S ............................................................... 13
PTSD, Depression and Substance Abuse......................................................................................... 13
Traumatic Brain Injury (TBI) ......................................................................................................... 16
Sensory Difficulties ........................................................................................................................ 19
Cognitive Problems ........................................................................................................................ 19
Sleep Problems and Chronic Pain ................................................................................................... 21
T I P S F O R C O L L E G E S A N D U N I V E R S I T I E S ............................................................... 23
Working with Combat Veterans ..................................................................................................... 23
Effective Communication .............................................................................................................. 24
Common Challenges for Student-Veterans ..................................................................................... 25
Classroom Support ........................................................................................................................ 25
Creating a Veteran-Friendly Campus .............................................................................................. 27
R E S O U R C E G U I D E ............................................................................................................... 31
How to Find Your Local VA ........................................................................................................... 31
Referrals and Resources for Medical and Mental Health Issues......................................................... 31
PURPOSE
Hundreds of thousands of servicemembers have been deployed to serve in Operation Iraqi Freedom (OIF)
and Operation Enduring Freedom (OEF), Operation New Dawn (OND), and Operation Odyssey Dawn
(OOD), and many more may be deployed and return home in the coming years. Many of these servicemembers and Veterans will choose to access their military education benefits and begin the next phase of
their lives at postsecondary institutions. Some will continue to serve as Reservists or National Guards men/
women and balance this with the responsibilities of returning to school. For the purpose of this manual, we
will refer to all Service men/women and Veterans attending college as student-Veterans.
College campuses may soon see an influx of military servicemembers seeking an undergraduate education.
According to the American Council on Education (2008), campuses across the country are on the cusp of
serving more than 2 million military veterans. While many may be Veterans of OEF/OIF/ OND/OOD,
there are also other era Veterans (i.e., Veterans discharged before 9/11/2001) that are enrolled and will be
enrolling in universities and colleges across the nation. Many campuses have seen a dramatic increase in
the registration of student-Veterans returning from Iraq and Afghanistan and the numbers are expected to
increase as military personnel transition to civilian life. Colleges and universities located near VA Polytrauma
Centers have also seen a significant increase in students with disabilities according to interviews with staff
INTRODUCTION
(Church, 2009).
Educational Institutions may also be working with military family members, as military education benefits
can be transferred to dependents under certain circumstances, and benefits are sometimes granted to the
H I S T O RY
spouse and children of servicemembers who have been killed in the line of duty or who are rated 100%
This training guide represents a partnership between the George E. Wahlen Department of Veteran
disabled and unable to work according to the Veterans Benefits Administration (VBA).
Affairs Medical Center, the Brain Injury Association of Utah and many state and community agencies
and organizations that serve Veterans. This partnership includes a multi-disciplinary group of professionals
Student-Veterans face particular adjustment issues not typical of the general student population and you
with medical, mental health, legal, academic and employment expertise. In particular, the development of
play a crucial role in the effort to assist them achieve their academic goals. With the proper preparation, you
this guide has included close collaboration with the Salt Lake Community College Veterans Services Center,
will find your work with student-Veterans to be unique and very rewarding. This training guide will help
a nationally recognized model that has helped tens of thousands of Veterans achieve academic success over
equip you with the knowledge and resources you will need to embrace working with student-Veterans with
the last half-century.
confidence and respect.
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G E N E RA L I N F O R M AT I O N A B O U T
VETERANS AND SERVICEMEMBERS
last from three to fifteen months, partially depending on the branch of service and goal of the mission. Jobs and
duties performed by each servicemember are so varied it is simply impossible to list them all here. Some
jobs may require going into life-threatening combat zones and others may require staying on base providing
supportive duties. Thus, depending on the locale of their deployment and the nature of a servicemembers
duties, they may have been exposed to combat or other traumatic situations. Servicemembers not exposed
directly to combat may have experienced other high-stress situations and hardships as a result of their
EOF/IOF/OND/OOD SERVICEMEMBERS AND
deployment. It is important to note though, that to those serving in the military, deployments are not only
VETERANS ARE THE MEN AND WOMEN WHO HAVE
categorized as hardships but many speak of the positive and meaningful experiences they had while deployed.
SERVED IN OUR UNITED STATES ARMED FORCES
DURING GWOT 2001–2009 AND CONTINUOUS
OVERSEAS OPERATIONS.
WHO ARE VETERANS AND SERVICEMEMBERS?
OEF
Operation Enduring Freedom: United States conflict in Afghanistan Oct 7, 2001 – Present
O I F
Operation Iraqi Freedom: United States conflict in Iraq
Mar 20, 2003 – Aug 31, 2010
OND
Operation New Dawn: United States military presence in Iraq
Sept 1, 2010 – Present
OOD
Operation Odyssey Dawn: United States military presence in Libya
Mar 18, 2011 – Present
The United States Armed Forces consist of the Army, Navy, Marine Corps, Air Force, and Coast Guard.
You can refer to members of any of the branches as “soldiers” or “service men/women,” but each branch also
OTHER-ERA VETERANS
has its own name for its members (i.e., soldier, sailor, marine, air man/woman, respectively). You may also
other distinctions such as “Reserve,” “National Guard,” or “Active Duty.” Simply put, “Active Duty” means the
While this guide speaks directly about OEF/OIF/OND/OOD Veterans in some parts, it is important to
person is serving the military full-time, whereas “Reserve” and “National Guard” mean he/she is serving part-
note that there are many other-era Veterans who are attending colleges and universities. Much of the
time usually while holding other civilian responsibilities (e.g., jobs, school).
information provided in this guide applies to all student-Veterans regardless of when and where they served.
WHO IS AN OEF/OIF/OND/OOD VETERAN?
FEMALE VETERANS
OEF/OIF/OND/OOD servicemembers and Veterans are the men and women who have served in our United
Women make up approximately 20% of the military population and serve in many important roles. It
States Armed Forces during the United States Global War on Terrorism (GWOT), 2001-2009, and continuing
is important to note that while women are officially barred from front-line combat duty, they do serve
Overseas Contingency Operations. The majority of deployments have been to Iraq and Afghanistan, although
in active combat zones and may have been exposed to combat as well as other types of trauma, including
many servicemembers have also been deployed to adjacent areas such as Kuwait. Nearly one-third of the
military sexual trauma (MST). The information presented in this guide is applicable to Veterans of
servicemembers involved in these conflicts have been deployed two or more times. Deployments typically
all genders.
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M I L I T A R Y C U LT U R E A N D
TH E STRE NGTHS OF TH E VETE RAN
TRANSITIONING BACK TO CIVILIAN SOCIETY
CAN BE DIFFICULT FOR SOME SERVICEMEMBERS.
IT IS IMPORTANT TO UNDERSTAND THESE
While much of this guide focuses on the challenges of the post-deployment and post-military service
DIFFERENCES WHEN WORKING WITH OUR
periods, it is also very important when working with this population to consider the strengths that
RETURNING SERVICEMEN AND WOMEN.
many student-Veterans embody. Common strengths include determination, a strong work ethic, patriotism,
commitment, dedication, honor, willingness to sacrifice and loyalty. These strengths are often magnified
in situations where the student-Veteran feels respected and acknowledged. Many of these qualities translate
E D U C AT I O N B E N E F I T S
into important and valuable civilian skills (e.g., leadership, strong teamwork and excellent communication).
In college/university settings, these strengths often manifest as high motivation with a strong sense of
Members of the Army, Navy, Air Force, Marine Corps, Coast Guard and Reserve and National Guard
purpose, punctuality, dependability, and diligence, making the student-Veterans strong candidates for
members may be entitled to up to 36 months of educational benefits under the Montgomery GI Bill
academic success.
(MGIB). Benefits vary based on type of service, years served and when and where the student-Veterans
served. Benefits may also be available for dependent(s) of Veterans if transferred, due to severe disability or
When recruits enter the military, they are immersed in a world where the institutional value of the group
death of the servicemember because of their service.
is supreme to that of the individual. Recruits swear allegiance to something larger than themselves; they
fight for something more than themselves; they are fighting for their comrades, their unit, and ultimately,
Education benefits can only be used at institutions with VA approved programs, apprenticeship or on-the
their homes and families (DND, 1984). Transitioning back to civilian society can be difficult for some
job training programs. Classes taken must be required towards graduation or program completion at the
servicemembers due to the many differences between the military structure and the civilian world. It is
important to understand these differences when working with our returning servicemen and women.
ETHNIC/DIVERSITY ISSUES
Currently the ethnic makeup of the U.S. Armed Forces is similar to the ethnic makeup of the general U.S.
population. National Guard and Reserve units are more likely to reflect the ethnic make-up of the particular
state. Because of the nature of warfare the military puts emphasis on structure, hierarchy and rank. The
group culture of the military places less emphasis on group differences such as race, socio-economical
status and education compared to the civilian world. With that being said, some soldiers have experienced
discrimination and prejudice. This has been especially true for gay and lesbian individuals. Although there
has recently been a change in the homosexuality “ban” within the military, it is important to understand that
this does not necessarily constitute a change in military culture or attitude.
institution the student-Veteran is enrolled in to be eligible. MGIB and other educational benefits available
today for Veterans and their dependents are:
30 MGIB
Active duty G.I., servicemember paid $1,200.00 to qualify
Ch 31 VA Rehab
Veterans with 20% disability rating or greater
Ch 33- Veterans
Service after 9/11
Ch 33 TEB
Transfer of Education Benefits to spouse/dependents
Ch 33 FRY
Available for dependents of a parent killed in the line of duty
Yellow Ribbon Program
Ch 33-100% eligible – jointly paid between school and VA
Ch 35
For spouse/children, parent 100% disabled or killed in the line of duty
Ch 1606
Reserve and National Guard–not serving any Active Duty
Ch 1607
Reserve and National Guard–Active Duty Support – OEF/OIF
Parent School/Secondary
Seeking Degree at Parent school-guest at another school
MYCAA
A DOD program to assist the spouse of a deployed soldier
Benefits for veterans
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Benefits for spouses and independents of veterans
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Examples of additional benefits available to student-Veterans in the State of Utah are:
U . S . D E PA R T M E N T O F V E T E R A N S A F FA I R S –
B E N E F I T S AVA I L A B L E TO V E T E RA N S
GoArmy Ed
Unit Tuition Assistance
National Guard/Reserve
Purple Heart Tuition Waiver
DEPARTMENT OF VETERANS AFFAIRS
In addition to the MGI education benefit provided because of military service, the National Guard or Reserve
Units, or the individual state, may offer other sources of funding. Your school’s Certifying Official or State VA
VETERANS BENEFITS ADMINISTRATION
VETERANS HEALTH ADMINISTRATION
NATIONAL CEMETERY ADMINISTRATION
Office can offer information about additional benefits available in your area. (DVA handbook 2010)
H E A LT H C A R E B E N E F I T S
V O C AT I O N A L R E H A B I L I TAT I O N
A person who served on active duty and was discharged or released under conditions other than dishonorable,
Administered by Veterans Benefits Administration (VBA), the Vocational Rehabilitation program’s primary
function is to help individuals who have service-connected disabilities become suitably employed, maintain
employment or achieve independence in daily living. Vocational Rehabilitation requires at minimum a 20%
service connection disability for a military related physical or mental health condition (“service connection”
means that the VBA has determined that a disability resulted from military service; the percentage reflects
severity). Veterans use their vocational rehabilitation benefits to pay for tuition and fees and may be given an
may qualify for VA healthcare benefits through the Veterans Health Administration (VHA) and receive
healthcare at a VA Medical Center. Reservists and National Guard members may also qualify for VA
healthcare benefits if they were called to active duty (other than for training only) by a federal order, and
have completed the full period for which they were called up or ordered to active duty. For questions about
eligibility and healthcare benefits, it is suggested that Veterans call their local VA Medical Center and ask to
speak to a representative in the Enrollment Office.
allowance for course supplies (e.g., computers, calculator, paper, cognitive prosthetics, books) and a living
allowance Unlike the GI Bill, student-Veterans using their Vocational Rehabilitation benefits to return
to school are assigned a VBA Vocational Rehabilitation counselor that provides support throughout their
OTHER BENEFITS
academic career as needed. It can be useful for college/university advisors to communicate with these
counselors. This can be facilitated by the Veteran/servicemember signing a release of information (ROI).
The Veterans Benefits Administration (VBA), also called the VA Regional Office, is responsible for
administering the Department of Veterans Affairs programs that provide financial and other forms of
assistance to Veterans, their dependents, and survivors. Major benefits include service-connected disability
compensation, Veterans’ pensions, survivors’ benefits, vocational rehabilitation, educational assistance, home
GI BILL AND UBA VOCATIONAL REHAB ARE
PROGRAMS AVAILABLE TO ELIGIBLE VETERANS
THAT PROVIDE EDUCATIONAL BENEFITS.
loan guarantees, and life insurance coverage.
The National Cemetery Administration (NCA) operates 125 national cemeteries in the United States and
territories, together with oversight/management of 33 soldiers’ lots, confederate cemeteries, and monument sites.
The mission of NCA is to honor Veterans with a final resting place and commemorate their service to our Nation.
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perspective. Also, after becoming accustomed to military culture and deployment-related stressors, servicemembers may find it challenging to manage some family dilemmas. For example, the common parenting
practice of having to make a request repeatedly or coping with an inconsolable crying baby requires
readopting a civilian skill set that they may not have utilized in some time.
Under ideal conditions the readjustment process can take several months for families to reach a new
equilibrium. The emergence of deployment-related conditions like Traumatic Brain Injury (TBI) and
Posttraumatic Stress Disorder (PTSD) can further prolong this process. Collectively, these issues can
P O S T- D E P LOY M E N T I S S U E S
impact the servicemember’s and/or his or her spouse’s functioning in the academic environment. Having
reasonable expectations for this transition period as well as collaboratively negotiating new roles within the
family are important steps in readjusting after deployment. There is help available for military families.
Individual, family and child therapy is available to assist in the readjustment process and improve their
The experience of a single or sometimes multiple deployments can create unique challenges for servicemembers
and their families. Higher rates of marital discord and divorce that have been observed among servicemembers.
relationships. The appendix section of this guide includes a list of resources available to assist you in referring
student-Veterans to federal, state and community agencies that can assist them in their adjustment process.
Some of the common post-deployment concerns are discussed below; however, it is important to note that
there is no ‘typical’ readjustment pattern following a deployment. Factors such as the nature of the deployment , family functioning, and financial circumstances (among many other issues) can significantly impact
the readjustment trajectory.
FI NANC IAL ISSU E S
Veterans may return from their time serving with concerns about earning enough money to support themselves and their families. Their military pay may have changed, and veterans may need to seek alternative
M A R I T A L A N D F A M I LY I S S U E S
ways to support their families. In some cases, work positions that were intended to be held while they were
away have been filled. The process of applying for and receiving disability or academic benefits to return to
After being separated for sometimes more than a year, military families face the challenges of quickly
school can be slow, causing increased financial stress. Also, mental health issues such as PTSD, TBI, and
adapting to new parenting, spousal, and occupational responsibilities. During a deployment, servicemem-
depression or sleep problems can undermine a veteran’s ability to maintain a regular school or work schedule
bers often miss their families and may count down the days until they are able to return home and reunite
or perform at their best capacity.
with them. They may have high expectations that they will quickly pick up where they left off. However,
after a honeymoon period, the realities of readjusting and stresses of creating a new ‘normal’ can become
apparent. Servicemembers may return home to significant changes. For example, important household
VETERANS MAY RETURN FROM THEIR TIME
decisions may have been made in their absence. New family routines or traditions began, or young children
SERVING WITH CONCERNS ABOUT MAKING
may not remember them, be slow to warm up to them or cling to them.
ENOUGH MONEY TO SUPPORT THEMSELVES
AND THEIR FAMILIES.
On the other hand, the veteran’s family also may report that the veteran has changed during his or her
absence. The servicemember may have experienced combat-related events that profoundly impacted their
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SCHOOL AND WORK BALANCE
school. Sometimes there is little or no flexibility with possible appointment times. For example, in certain
clinics at VA Medical Centers, Veterans are automatically scheduled into the next available appointment
Creating balance between work and school can also be a challenge, especially if they have never attended
slot and some clinics are only available one ½ day a week. While a Veteran always has the ability to cancel
a post-secondary institution. Student-Veterans may not realize the amount of time they need to invest in
and reschedule an appointment, doing so may significantly lengthen the time before they can be seen. It
studying and may set themselves up for academic difficulties by committing to more work-hours than what
is recommended that colleges and universities be flexible in regards to Veterans needing to attend medical
is realistic. Some student-Veterans, for example, are surprised to hear that they are required to study three
appointments. If proof of a medical appointment is needed, Veterans can ask their provider for a brief state-
hours per each credit hour (i.e., one hour in class and two hours on their own), which makes the 12-credit
ment on VA letterhead.
load almost a full-time job. Further, some types of psychological distress can affect concentration, which will
further increase the time required to accomplish school work. It may be difficult for veterans to acknowledge
and ask for help when struggling.
M I L I TA R Y L E AV E A N D R E - D E P L O Y M E N T
Those still active in the National Guard/Reserves may be called up at any time for training, drill or active
DRIVING CONCERNS
duty service. At minimum they are required to attend training one weekend per month and extended
When veterans return from deployment, the significance of driving a vehicle may have changed dramati-
training for two weeks to a month at some time during the year. Some military members may also be
cally from their pre-deployment experiences. Civilian driving differs significantly from combat driving
required to attend an extended training in preparation for future deployment. National Guard and
(e.g., not stopping at stop signs, constantly scanning and watching other vehicles, avoiding potholes
Reserve members may be given activation orders for a few months down the road or receive orders
where bombs may be hidden, and driving erratically to be purposely unpredictable). For this reason, many
to report in a matter of days. They must get their affairs in order before they leave, such as their will,
returning combat veterans report that operating a vehicle or being a passenger can be highly stressful. The
power of attorney, etc.
perception of being unsafe or feeling threatened can contribute to incidents of road rage and dangerous
driving. Student-veterans may feel particularly wound up or agitated for minutes to hours after driving to
Student-Veterans care about their classes but they must leave when they are told to go. Please be
school, which may affect their concentration and participation in class.
flexible whenever possible to assist them to complete their classes or to withdraw from their classes
without penality.
Treatment is available to assist Veterans in accomplishing this transition safely and to reduce the risk of harm
and legal involvement. The appendix section of this guide includes a list of resources available to assist you
in referring Veterans and servicemembers to federal, state and community agencies that can help them in
their adjustment process.
THOSE STILL ACTIVE IN THE NATIONAL GUARD/
MISSING CLASSES FOR MEDICAL APPOINTMENTS
RESERVES MAY BE CALLED UP AT ANY TIME FOR
TRAINING, DRILL OR ACTIVE DUTY SERVICE.
It is helpful to encourage student-Veterans to schedule medical appointments at times less likely to affect
class attendance. However, they may have scheduled their appointment six months before they enrolled in
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The second cluster of symptoms is referred to as avoidant symptoms (APA, 2000). Because memories of
the traumatic event are powerful and painful, individuals with PTSD may take active steps to avoid
situations or activities that remind them of the trauma (e.g., watching war movies). It is not uncommon for
student-Veterans to avoid crowded places on campus such as the student bookstore during the first week
of class. Being surrounded by people triggers the reaction of elevated alertness and anxiety which was a
much needed response in the combat zone. Similarly, some student-Veterans struggle attending lectures in
certain classrooms where escape would be difficult. Avoidance of traumatic memories may also manifest
as numbing of emotions or memories. These individuals may appear detached or unaffected, or they may
isolate themselves from others.
M E N TA L H E A LT H A N D M E D I C A L I S S U E S
The third cluster of symptoms is referred to as hyper-arousal symptoms (APA, 2000). People with PTSD
often feel constantly alert which can cause sleeping difficulties, outbursts of anger or irritability and concentration problems. Feeling constantly “on guard,” they are compelled to survey their environment for escape
routes, possible danger points and unfriendly/dangerous looking stimuli. Engaging in such a task is quite
P T S D , D E P R E S S I O N A N D S U B S TA N C E A B U S E
cognitively taxing and can hamper their ability to attend to more salient stimuli (e.g., lecture material, or
conversation with an academic advisor). Proximity to others is also a common concern. For example, many
Veterans prefer not having people behind them, but prefer having people in their line of sight. Some class-
P O S T T R A U M AT I C S T R E S S D I S O R D E R ( P T S D )
rooms may be more anxiety-provoking than others. Auditoriums with stadium seating, rooms with bolted
PTSD is an anxiety disorder that can develop after the experience of or witnessing a traumatic event (e.g.,
military combat, natural disasters, terrorist incidents, serious accidents or physical or sexual assault as an adult
or in childhood) (APA, 2000). Most survivors of trauma will experience an initial anxiety reaction but return
to healthy equilibrium given a little time. Some people, however, will have stress reactions that do not go away
on their own or may even get worse with time. These individuals may develop PTSD. Research suggests that
approximately 15% of OEF/OIF soldiers returning from deployment have combat-related PTSD (Hoge et al,
2008). This percentage may be higher in soldiers whose military occupations were at higher risk for trauma.
chairs, or rooms with only one exit, may be particularly challenging. In such cases, you may encourage the
student to contact the school’s disability support services for accommodations.
PTSD is a serious but treatable disorder. If left untreated, however, PTSD can lead to significant problems in
day-to-day functioning, both for Veterans and their families. There are multiple treatment options available to
effectively deal with PTSD. The appendix section of this guide includes a list of resources available to assist you
in referring your student-Veterans to additional organizations and agencies that can assist Veterans with PTSD.
Three types of challenges/symptoms are present with PTSD. “Re-experiencing” symptoms (reliving of the
traumatic event) may be triggered by something that reminds the person of the trauma and takes them
M I L I TA R Y S E X U A L T R A U M A
away from being fully engaged in the here-and-now. For example, a Veteran may hear a car backfire, which
triggers the trauma of gunshots, which in turn can shift thinking to a memory of being in gunfire which is
In both civilian and military settings, servicemembers can experience a range of unwanted sexual behaviors
accompanied by a strong emotional reaction of distress, anxiety and fear.
that they may find distressing. These experiences happen to both women and men. “Military sexual trauma,”
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or MST, is the term used by the Department of Veterans Affairs to refer to experiences of sexual assault or
T R A U M AT I C B R A I N I N J U R Y ( T B I )
repeated, threatening acts of sexual harassment. Military sexual trauma can result in physical and emotional
difficulties. There is help available for servicemembers and Veterans who have experienced MST.
TBI is the result of injury to the brain brought upon by some external physical force (e.g., a fall, motor
vehicle accident, blow to the head, or a blast). TBI can result in a range of physical, cognitive, emotional and
Every VA facility has an MST Coordinator who serves as a contact person for MST-related issues, who can
behavioral symptoms. Moderate and severe traumatic brain injuries (those injuries characterized by a loss of
help Veterans find and access VA MST services and programs. In the appendix section of this guide a list of
consciousness for more than thirty minutes) can impact many different areas of functioning depending on
resources is available to assist you in referring your student-Veterans to organizations and agencies that can
the extent and location of the damage to the brain.
assist Veterans who have experienced MST.
PHYSICAL PROBLEMS
DEPRESSION
Following a TBI, individuals sometimes develop physical problems such as muscle weakness or paralysis,
Depression is different from normal human unhappiness. Depression is a deep, prolonged and painful
balance issues, dizziness and gait disturbance, problems with swallowing, headaches and changes in sensory
sadness that does not respond to attempts to help a person “cheer up.” It includes a loss of interest in
experience. Sleep difficulties and fatigue may also occur after a TBI and can intensify other symptoms.
things one was previously interested in, such as family, hobbies, friends and work. Other symptoms of
depression include diminished self-worth, irritability, problems with sleep and appetite, decreased
motivation, decreased libido, slowed thinking, and difficulties in concentration (APA, 2000).
COGNITIVE PROBLEMS
Suicidal ideation is a serious aspect of depression. If you suspect one of your student-Veterans is having
Individuals can experience cognitive deficits of varying severity after a TBI, including difficulties with
suicidal thoughts, you are encouraged to ask him/her about it, consult with your campus mental health
learning and memory, attention and concentration problems, slowed speed of thinking, changes in the
resources, and/or refer the student-Veteran to a mental health professional.
ability to understand language and express oneself and problems with organizing, planning, reasoning and
abstract thinking. Sometimes the individual may not be aware that he/she suffers from these difficulties.
S U B S TA N C E A B U S E
PTSD, pain and depression are risk factors for developing substance abuse (Bray et al., 2010). Overwhelmed
MANY MENTAL HEALTH AND MEDICAL ISSUES CAN
by insomnia and nightmares, flashbacks, and a host of family and school or work–related problems, some
IMPACT COGNITIVE FUNCTION INCLUDING TBI,
individuals may turn to alcohol or other substances, both prescribed and illegal, to manage sleep irregularities
PTSD, DEPRESSION, SLEEP PROBLEMS, CHRONIC
and cope with anxiety related to memories of trauma. Using substances can have significant social, emotional,
PAIN AND MEDICATION USE.
cognitive and academic consequences, both short term and long term. In the appendix of this guide is
information on evaluation and treatment services for alcohol and substance abuse concerns.
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EMOTIONAL PROBLEMS
Problems with emotional functioning can also occur following a TBI. Some individuals suffer from
symptoms of depression, anxiety, mood liability (unpredictable and intense mood swings), emotionality,
irritability, tearfulness or difficulty feeling and expressing emotion.
B E H AV I O R A L P R O B L E M S
Behavioral disturbances can also accompany TBI. Some may become uninhibited, impulsive or aggressive;
others may not appropriately read social cues or understand subtle non-verbal behaviors of others. They may
also experience changes in personality and temperament and may magnify personality traits and idiosyncrasies.
Any of these symptoms may result in difficulties in social, academic and occupational functioning. Most
individuals with a history of traumatic brain injury who experience ongoing difficulties will need academic
support and could benefit from the services provided by their institution’s Disability Resource Center.
MILD TBI
A mild traumatic brain injury (mTBI) is a less severe form of brain injury commonly referred to as a concussion. Recent studies have suggested that about 10-20% of deployed soldiers have sustained a probable
concussion during their deployment (Hoge et al., 2008). Civilian research studies suggest that in the majority
of cases (upwards of 97%), post-concussive symptoms resolve in 1-3 months (McCrea, 2008; Mittenberg
et al., 1996). Individuals that have suffered multiple concussions or have co-occurring mental health issues
may be at risk for more persistent symptoms (Hoge et al., 2008).
It is very important for Veterans with a history of concussions to be evaluated by a medical professional
with expertise in the area of mTBI. The VA Health Care System is equipped to evaluate and treat all
OEF/OIF/OND/OOD Veterans with possible mTBI. If you have a student-Veteran who is concerned
about possible brain injury, refer them to their local VA (see Resource Guide). In the appendix section of
this guide a list of resources is available to assist you in referring your student-Veterans to additional
organizations and agencies trained to assist Veterans with traumatic brain injury concerns.
18
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F R O M C O MB AT TO C L A SSR O O M
S E N S O R Y D I F F I C U LT I E S
reasoning and organization, problems with abstract reasoning, and changes in language abilities. These types
of difficulties have the potential to negatively impact academic functioning. Academic accommodations may be
Changes in hearing can occur in individuals who have been exposed to hazardous levels of noise, such as
beneficial to students with cognitive difficulties to facilitate academic success. Student-Veterans with concerns
weapons fire and blasts. TBI can also be a risk factor for changes in hearing. In some cases there may be
about cognitive issues should consult with their primary care physician either in the community or at the VA
increased sensitivity to everyday sounds. This can be problematic in a classroom or large group setting; it
Medical Center. They should also be encouraged to contact their institution’s Disability Resource Center for
makes it difficult to tune out extraneous noise and may affect concentration and focus.
information about possible accommodations.
Tinnitus (ringing, buzzing, humming sounds in the head) is another common problem in returning
T I P S F O R W O R K I N G W I T H V E T E R A N S W I T H C O G N I T I V E I M PA I R M E N T S
Veterans and can be distracting in the academic setting and affect concentration and attention.
Regardless of the cause of the difficulty, the following tips may be helpful when working with an individual
In many cases effective treatment or rehabilitation strategies are available. Individuals with auditory difficul-
with cognitive problems.
ties may benefit from discussing their concerns with their primary care provider, who can refer them to the
appropriate specialty provider. Evaluation and treatment of auditory concerns is available in the community
as well as through the VA Medical Center.
Individuals with memory problems may benefit from repetition to help with new learning and memory; repeat
information and instructions often.
Individuals with memory problems or processing difficulties may benefit from information that is displayed visually.
The visual system has components throughout the brain that can be affected by TBI. TBI can result in difficulty
with ocular accommodation, which involves sustaining focus on particular aspects of the environment such
as during reading. Light sensitivity may also be an issue and some student-Veterans may choose to wear
sunglasses or hats indoors as a way to compensate for this. It is important for professors and staff members
In addition to verbal instruction, visual modeling/materials can be helpful. Ask the individual to write down
important facts – names, dates, instructions and assignments, etc.
Follow-up calls or meetings may be necessary to ensure the individual understood/retained the information and was
able to follow through.
to accommodate this adaptive behavior whenever possible.
Some individuals may have difficulty following multi-step instructions due to the complexity. Break things down into
one or two simple steps at a time.
Fortunately, there are many vision therapies, environmental accommodations and task modifications that
Some individuals have slowed processing speed meaning that they need more time to comprehend what others
say and organize and formulate their own verbal or behavioral response. Be sensitive to the rate of your speech or
response time.
can be helpful in addressing visual difficulties. Student-Veterans with visual concerns should contact their
primary care physicians for a referral to the appropriate medical professional for further evaluation. They
should also consult the college Disability Resource Center for classroom accommodations.
Avoid as much as possible, noisy/distracting environments that may make it more difficult for the individual to focus.
Some individuals need hearing aids after brain injury. You do not need to speak more loudly or get closer than usual.
The hearing aids amplify sounds well. If you are uncertain as to whether you can be heard clearly, just ask.
After TBI some people have difficulty with visual organization and path-finding. Buildings and campuses can be very
confusing to those who are unfamiliar with them. Escorting students to their destination and giving clear, simple
directions are very important.
COGNITIVE PROBLEMS
Cognitive problems can occur as a result of numerous medical and mental health conditions (Iverson, 2005).
Cognitive dysfunction is common in individuals with TBI, sleep disorders, depression, anxiety, PTSD, substance
abuse, and chronic pain. Examples of common cognitive difficulties include: difficulty with concentration and
focus, problems with learning and recalling new information, slower speed of thinking, difficulty with planning,
FR OM C OM B AT TO C L AS S R OOM
Expect a delay in the person’s verbal and/or behavioral responses.
•
19
Fatigue is a common issue after TBI. Asking individuals how they are feeling and whether they want a break may be
helpful. Scheduling brief breaks (i.e., the last 5-10 minutes of every hour) will help if they are hesitant to verbalize
their fatigue.
Frustration and irritability is common after TBI. Allow breaks and align expectations accordingly.
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F R O M C O MB AT TO C L A SSR O O M
PAIN IS A COMMON PROBLEM IN RETURNING
VETERANS WHICH CAN IMPACT MOOD,
SLEEP AND COGNITION SUCH AS ATTENTION
AND MEMORY.
S L E E P P R O B L E M S A N D C H R O N I C PA I N
Veterans often report that sleep during deployment is quite disturbed. For some, problems with sleep onset
and maintenance persist when they return home (Capaldi et al., 2011).
Some individuals may feel increased anxiety and vulnerability at night. Oftentimes, missions were conducted
under the cover of darkness, which trains the soldier’s body to view darkness as dangerous. Some missions
allowed for very little or no opportunity for sleep and when it was available it may have been very different
when compared to a typical civilian sleep schedule (Wesenten and Balkin, 2010). These patterns can be
difficult to undo.
Distressing dreams of military experiences can also interfere with sleep. Often times upon awakening from a
nightmare, individuals experience significant anxiety and have difficulty with falling back asleep. Traumatic
brain injury can also affect one’s sleep cycle. Regardless of the cause, sleep deprivation enhances a person’s
vulnerability to mood disturbances, cognitive difficulties and physical issues.
Therapy and medication can be helpful in improving sleep. In the appendix section of this guide a list of
resources is available to assist you in referring student veterans to treatment if sleep is a concern.
Coping with chronic pain can be physically and emotionally exhausting and can negatively impact mood,
sleep and cognitive functioning. Medications used to treat pain, while sometimes helpful, have side effects
that can also impact mood, behavior and cognition. Sometimes non-pharmaceutical approaches to treating
pain are preferred.
FR OM C OM B AT TO C L AS S R OOM
•
21
TIPS FOR COLLEGES AND UNIVERSITIES
E F F E C T I V E C O M M U N I C AT I O N
Seemingly innocent attempts at communication around military involvement can sometimes be
W O R K I N G W I T H C O M B AT S T U D E N T-V E T E R A N S
misinterpreted. For example, some Veterans may be sensitive to opinions about war. When working with
a transitioning servicemember be conscientious and respectful.
Rapport is important when working with your student-Veterans which may take time to build and can
be facilitated with patience and a caring attitude.
Structure and routine are an essential part of military life. Some post-deployed soldiers may struggle
A very general approach is recommended.
with the lack of routine and structure in their civilian life. Assisting them in creating a schedule of
activities and goals can often be helpful.
W H AT T O S AY
W H AT N O T T O S AY
Some Veterans may have the tendency to get angry and irritable very quickly. When you notice
irritability suggest a break and do not push. Do not take the irritability personally and try not to
be defensive or argumentative.
Veterans and servicemembers have learned valuable skills while serving in the military, including team
management, a strong work ethic, attention to detail, confidence, maturity, and teaching skills. Many
student-Veterans hope to integrate the knowledge and skills they gained during their military service
Thank you for serving.
What was going to war like?
Thank you for your service to our country.
What do you think of the war?
Welcome back.
Did you see anyone die?
Thank their family for the sacrifice they made to
preserve our nation’s freedom.
Did you kill anyone?
into their civilian lives and careers. Recognizing these skills and presenting opportunities that allow
Did you lose any friends?
How did you get injured?
them to utilize these skills, can benefit the student-Veteran and those around them.
Student-Veterans may be referred to the Dean of Students office or the Behavioral Intervention Teams
Use your professional judgment and always err
Are you opposed to the war?
due to “perceived” threatening or concerning behavior. Some mental health issues can effect an indi-
on the side of caution. If you ask a question, ask
Are you okay (mentally)?
vidual’s threshold in emotional regulation. Taking into account your student-Veterans experiences may
a question that solicits direct factual answers:
Did you see a lot of dead people?
help determine an appropriate action plan.
When did you get back?
Are you traumatized?
It is recommended that you be as collaborative as possible when working with student-Veterans as some
What branch of the service are you/were you in?
Are you experiencing PTSD?
may be sensitive to authority figures and resent an authoritative approach. Respect and authority are earned
Where did you serve?
Did you see any action?
through performance in the military culture, and are not simply the result of a title or an advanced degree.
Never pry. If they don’t want to talk, don’t push it.
That must have been hard.
Avoid religious or political discussions and sharing personal views on military, political or religious is-
They will initiate a more personal conversation if they
sues (e.g., gay and lesbian servicemembers in the military, belief that the war is wrong).
trust you and wish to speak about something. Until then,
communicate/connect. For example,
remain polite and professional and open to listening.
don’t say to them “at ease” or “soldier.”
Avoid unnecessary curiosity and ask questions only if
they seem relevant to assisting the student-Veteran.
Don’t express excessive praise or thanks
to the Veteran. Simplicity is the key.
Do not ask about military service in any group environment unless the student-Veteran self-discloses
their service. These types of conversations should be conducted in one on-one settings and done so in a
very sensitive manner.
FR OM C OM B AT TO C L AS S R OOM
•
23
24
•
Don’t use military lingo as a way to
F R O M C O MB AT TO C L A SSR O O M
VETERANS AND SERVICEMEMBERS HAVE
LEARNED MANY VALUABLE SKILLS WHILE
SERVING IN THE MILITARY.
C O M M O N C H A L L E N G E S F O R S T U D E N T-V E T E R A N S
Rules for using military benefits are very rigid. The GI Bill only pays for classes that are required
towards graduation in their declared program.
Veterans have up to 36 months of benefits. When they return from serving they may test in remedial
classes or be required to retake classes that use up their benefits.
Many student-Veterans attend school, have a family and hold down a job.
Credits earned for military training often do not transfer toward their academic program of study.
Veterans receive a living stipend based on credit hours enrolled. If their required classes are not
available when they register they take a reduction in this living stipend which they count on.
Early enrollment for student-Veterans easily remedies this issue.
C LASS ROOM SU PPORT
In addition to suggestions listed throughout this manual, we encourage you to:
Enhance feelings of comfort in the classroom and in testing setting (e.g., quiet, less crowded). In such
case such as when a medical or mental health disorder is present, the student-Veteran may qualify
for academic accommodations or special arrangements, which can be made through your Disability
Resource Center.
FR OM C OM B AT TO C L AS S R OOM
•
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F R O M C O MB AT TO C L A SSR O O M
In your syllabus, include a statement about accommodations for student-Veterans, such as ways for
model has proven effective in colleges and universities where it has been established, and often pays
them to make arrangements for medical appointments, training, unexpected leaves of absence, or other
for itself in increased Veterans admissions and success. If this is initially unfeasible, find some space
needs related to adjustment issues.
or events where they can connect with other student-Veterans.
Some student-Veterans are sensitive to people being behind them or in very close physical proximity.
* If you don’t have a center for your students, determine who could serve as a point-person for your
It may make them more comfortable to let them choose where to sit in the office or classroom setting.
student-Veterans to contact and talk to if they have problems. It is important for them to know they
Recognize that some individuals will be most comfortable in the back of a classroom near an exit door.
have someone they can contact that will assist them if they need it.
Do not perceive this as disinterest. In fact, this position may enable them to better attend to and inteInvite members from the Veteran community in your area to your college to meet with your
grate new information.
Veterans often have medical appointments scheduled months in advance which may impact course
attendance. If their instructor will not work with them, they may get discouraged, possibly fail the class
and/or drop out of school. This may result in the student-Veteran being required to repay the money
paid for that class.
Student-Veterans may have special needs but are often disinclined to seek assistance due to stigma and/
or fear of appearing weak. Encourage them to contact services such as your Disability Resource Center
that can help them succeed in school.
student-Veterans. Many organizations can provide a variety of services such as enrolling students
in VA programs and services, provide tutoring support or counseling and are willing to assist
the Veterans. Contact your school Certifying official or your State Veterans Office to make
the contacts.
Consider deferment of Veterans’ tuition until later in the term. Veterans receive their pay after the
term begins, placing a considerable financial stress on the Veteran. Deferring tuition can eliminate
this pressure
Create a Veterans Committee. Gather a group of willing employees from different departments (ie:
Registration, Admissions, Disability Resource Center, Student Officer, School Certifying Official, Fi-
C R E A T I N G A V E T E R A N - F R I E N D LY C A M P U S
nancial Aid, Faculty, Administration, etc) to form a “Veterans Committee” to handle student-Veterans
concerns and offer support to your student-Veterans.
Some of the suggestions below reflect an ideal scenario, but even small changes can make a difference when
Encourage and support the creation of a Veterans Club on campus. Seek out student-Veterans with
serving your student-Veteran population.
strong leadership qualities who are interested in creating a club and support them in this endeavor. You
Track admissions of Veterans. Knowing the number of attending Veterans is crucial for assessment of
needs and goals. Having this information on file enables you to contact student-Veterans for outreach.
Send a letter from the school’s administration to all new student-Veterans welcoming them to your school.
Create a welcoming Veterans Office. It is ideal to have an office dedicated to serving the needs
of student-Veterans. Let them know they are welcome and create that connection that says they are
can contact Student Veterans of America (SVA) to assist you to set up your club (website located in the
appendix of this guide).
Build a website specifically for Veterans. In addition to your institutional requirements for the use
of the GI Bill benefits, feature links to resources and information for students success, links to easily
download relevant government documents and forms, etc.
important to the institution. If possible, provide dedicated space on campus where your
Provide workshops for your student-Veterans such as Financial Awareness, Study Skills, Stress
student-Veterans can study together, socialize, and decompress between classes. This “one-stop shop”
Management, etc.
FR OM C OM B AT TO C L AS S R OOM
•
27
28
•
F R O M C O MB AT TO C L A SSR O O M
Educate faculty, staff, and administration about student-Veterans issues. Many college and university
personnel are not aware of the challenges and opportunities presented by student-Veterans. A simple
in-service training program, like that offered by the Salt Lake City VA Medical Center and connected
with this training manual, will remedy this lack of awareness and facilitate the academic success of
student-Veterans.
Administer a Veterans’ needs survey. Ask your student-Veterans how satisfied they are with current
university/college services, what they think could be done better, and what services they would like
to see offered. They will let you know what they want and don’t want. This also sends the message to
them that the administration is listening.
Determine if your institution could participate in the VA Work-Study Program. You would have
VA-funded student-Veterans working on staff to assist other veterans. Veterans serving Veterans can be
very powerful in creating important connections.
Serve a birthday cake to the student body for the birthday of each branch of the service and hand out a
flyer with their contributions and interesting facts.
Present your student-Veterans with some special acknowledgement upon graduation. Possibilities
include a Red/White/Blue Veterans Honor cord to wear at graduation, a Veterans coin, etc.
Provide programs on Veterans Day, hold a dinner to honor your student-Veterans, plan an orientation
for Veterans only.
TRACKING ADMISSION NUMBERS OF VETERANS IS
CRUCIAL FOR ASSESSMENT OF NEEDS AND GOALS.
FR OM C OM B AT TO C L AS S R OOM
•
29
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32
•
F R O M C O MB AT TO C L A SSR O O M
REFERENCE
AUTHORS
American Council on Education (ACE). (2009). Military Servicemembers and Veterans in Higher Education:
Jennifer Romesser, PsyD
Clinical Psychologist-Polytrauma team and PTSD team
George E. Wahlen Department of Veterans Affairs Medical Center
What the New GI Bill May Mean for Postsecondary Institutions. Retrieved from www.acenet.edu
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association; 2000.
Darlene Head
Manager, SLCC Veterans Center/Certifying Official
Salt Lake Community College
Bray, R.M., Pemberton, .M.R., Lane, M.E., Hourani, L.L., Mattiko, M.J., Babeu, L.A. (2010).
Substance use and mental health trends among U.S. military active duty personnel: key findings from
the 2008 DoD Health Behavior Survey. Military Medicine: 175(6): 390-393.
Danica Richins, LCSW
Polytrauma Social Work Case Manager
Capaldi, V.F., Guerrero, M.L., Killgore, .WD. (2011) Sleep disruptions among returning combat veter-
George E. Wahlen Department of Veterans Affairs Medical Center
ans from Iraq and Afghanistan. Military medicine, 176(8): 879-88.
Jason E. Molesky
Church, T. E. (2009). Returning veterans on campus with war related injuries
and the long road back home. Journal of Postsecondary Education and
Veterans and Latino Outreach Coordinator
Americorps VISTA, Brain Injury Association of Utah
Disability, 22(1), 43-52.
DND Department of Veterans Affairs, (2009) Federal Benefits for Veterans, Dependents and Survivors,
Dallas B. Griffiths
2009 Edition, 23-41
Veterans and Latino Outreach Coordinator
Americorps VISTA, Brain Injury Association of Utah
Gironda RJ, Clark ME, Massengale J, Walker RL. Pain among veterans of Operation Enduring Freedom
and Iraqi Freedom. Pain Medicine, 2006, 7(4), 339-343.
AC KNOWLE DG M E NTS
Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A. L., Engel., C. C. & Castro, C. A. (2008) Mild traumatic brain injury in U.S. Soldiers returning from Iraq. New England Journal of Medicine, 358(5), 525-527.
We
Wewould
wouldlike
liketo
tothank
thankthose
thosewho
whocontributed
contributedto
toand
andencouraged
encouragedus
usin
inthis
thisendeavor.
endeavor.We
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wouldalso
alsolike
liketo
to
We would like to thank those who contributed to and encouraged us in this endeavor. We would also like to
acknowledge and express our appreciation to the men and women of the Armed Forces for their service and
those who support and assist them in their educational journey.
acknowledge
our
appreciation
to
the
and
of
Armed
their
acknowledge
and
express
ourOutcome
appreciation
tomild
themen
men
andwomen
women
ofthe
theCurrent
ArmedForces
Forcesfor
forPsychiatry,
theirservice
service
and
Iverson,and
G.,express
L. (2005).
from
traumatic
brain injury.
Opinion
18,and
301-317.
those
who
support
and
assist
them
in
their
educational
journey.
those who support and assist them in their educational journey.
McCrea., M. (2005), Mild traumatic brain injury and Post Concussive Syndrome: The new evidence base
for diagnosis and treatment. New York: Oxford University Press.
Mittenberg W, Tremont G, Zielinski R, Fichera S, Rayls, K. Cognitive behavioral prevention of post concussion syndrome. Archive of Clinical Neuropsychology; 1996; 11:139-145.
Wesenton, N.J. and Balkin, T.J. (2010). Cognitive Sequela of Sustained Operations. In Military Neuropsychology Eds. Kennedy, C.H., and Moore, J., L. New York Springer Publishing Company.
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35
Original document modified for use at:
Author:
G E O RG E E. WA H L E N
D E PA RT M E N T O F V E T E R A N S A F FA I R S M E D I C A L C E N T E R
500 Foothill Drive, Salt Lake City, UT 84148
(801) 582-1565