Example Lay Statement for PTSD from Wife

ON A VBA Form 20-10210 or VA Form 21-4138

I, Jane Doe, hereby declare under penalty of perjury that the following is true and correct to the best of my knowledge:

I married my husband, John Doe, on June 17, 2001. He enlisted in the U.S. Marine Corps a year after our wedding and served honorably as a combat engineer from July 2002 to July 2006. Before enlisting, he was a happy person who enjoyed spending time with family and friends. He adored his niece and loved taking her fishing. As a couple, we often took our dogs hiking on the weekends and spent our weeknights watching stand-up comedy after work or cooking dinner together. He never drank much, but he loved to eat. He worked as a chef in a local restaurant, and cooking big meals was one of our favorite things to do together. He had the biggest, warmest heart and lived for his family.

Before John deployed, he was stationed at Camp Lejune and wrote me at least once a week. His letters were lengthy, lighthearted, and reflective of the man I’d always known. However, I hardly heard from him once he deployed to Iraq in August 2003. In his six months overseas, I received about three letters that together totaled less than a page. His tone was very matter of fact. I tried not to worry and hoped things would return to normal once he returned home, but they only got worse.

When John returned, he moved all his things out of our bedroom and into the basement. He isolated himself from everyone: me, his niece, his friends, and his siblings. He lived in the basement with the shades drawn day in and day out; I had to continue working to pay bills because John would not.

When I tried to question him, he became angry and yelled louder than I’d ever heard him before. He began drinking heavily—7 or 8 beers a night before he turned to liquor. He stopped eating and the clothes that used to fit him hung loosely off his emaciated frame. He was also paranoid and reactive. He punched a man at the grocery store he accused of stalking him and had to spend the night in jail. After that, I packed a bag and moved into my parents’ house until John agreed to get help.

A year or so later, John received a DUI and was forced to attend substance abuse meetings. Since cutting back on his drinking, John slowly began to open up to me about what happened while he was deployed. He spoke of the bodies and carnage he saw, and the smell of burning oil. He refused to see a psychologist because he insisted he could care for himself and went back to work as a chef. He threw himself back into what he loved and seemed to improve.

As a result, I agreed to move back home. However, a year later, we attended a neighborhood party on the 4th of July. I was so excited John was feeling social again, and that he seemed to be returning to the man I’d married. Things were going great until some fireworks went off unexpectedly, which sent John into a frenzied rage. He began throwing things and hiding under tables. It took three of his old high school friends to retrain him and help carry him home.

Since that night, John’s mood is unpredictable. He has weeks or so where he seems like his old self before randomly turning into someone I don’t recognize. He recently agreed to attend group therapy sessions at our local VA, and it seems to help him recognize that he needs help. Things are still not the same between us, but I hope treatment will help him find the peace he needs to heal.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________ ______________________

Jane Doe Date

Example Buddy Statement for PTSD

ON A VBA Form 20-10210 or VA Form 21-4138

I, Joe Smith, hereby declare under penalty of perjury that the following is true and correct to the best of my knowledge:

John Doe and I served together as combat engineers in the U.S. Marine Corps from August 1984 to August 1992. We met during basic training and forged a strong friendship. Before we deployed, John was always cracking jokes and writing his wife. He was a happy guy, and I was glad to deploy with him.

We spent six months in Ira, surrounded by constant chaos. Dead bodies were everywhere, and everything smelt like it was on fire. On September 3, 2003, John and I were with XYZ unit monitoring a checkpoint in Anbar Province when a man and his 14-year-old daughter rapidly approached us. We quickly ordered them to stop, but they didn’t listen. They continued walking toward us until the man reached abruptly into his pocket. He pulled out a gun, and John shot him dead on the spot. The young girl then picked up her father’s weapon and aimed shot it in my direction, forcing John to shoot her too.

We attempted to resuscitate her but were unsuccessful. It was a terrible, tragic incident, and John was never the same afterwards. He didn’t speak to anyone, he showed up late to assigned duty locations, and he got into a few fist fights with other soldiers. When we returned home, John hardly kept in touch. I tried reaching out to him a few times, but my calls all went unanswered.

I recently ran into him at the VA and we caught up briefly. He told me he is in therapy and working through the events that happened in Iraq. It was good to see him, and I hope that, in time, we can restore our friendship to the way it was before we deployed.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________ ______________________

Joe Smith Date

Example Buddy Statement for PTSD

ON A VBA Form 20-10210 or VA Form 21-4138

My name is Jackson Browne and I served with Zeke Bancroft on board the U.S. Navy submarine USS Usta Fish (SSN-999). I was stationed on board the USS Usta Fish between 1980-1984.

Zeke was part of the Navigation division and we often stood watches in the same section together while underway and in port.

In early 1982, we were departing France in the early morning. The seas were rough, and my recollection was we were in state 5 seas. State 5 seas are waves between 8-13 feet in height.

While transiting on the surface we had three men in the bridge of the submarine. The bridge is the portion of the sail that men will stand watch in while on the surface and is exposed to the elements. The sail is the tower-like structure that is on the dorsal of the submarine and stands approximately 45 feet above the waterline.

During the transit, a wave washed over the bridge. At the same time, the submarine was at a down angle. This combination caused the submarine to dive under the water, completely immersing the men in the bridge. I estimate that the submarine actually dove to below 70 feet. At this time, the bridge hatch was open from the control room to the ocean. A solid column of seawater started pouring into the submarine. This lasted for about 3 minutes until the submarine’s Executive Officer LCDR Bobocheck and Zeke were able to reach up through a rushing column of water and shut the hatch.

At this time my watch station was as Radar operator in the control room which was about 10 feet from the bridge hatch. I remember that Zeke was also on watch at that time. I had an unobstructed view of the water infiltration casualty, the shutting of the hatch and the subsequent actions of the crew, including the Commanding Officer.

Actions were taken to shut down high voltage electronic systems in concern that electricity in the seawater may electrocute the crew. The captain ordered an emergency blow of the main ballast tanks. Approximately a 2-3 foot wave of water washed into the submarine, down passageways and down into the submarine. Fire was reported in the Torpedo room.

Efforts were made to ascertain if the 3 men in the sail were still alive or if they were still on board at all while crew insured that the fire and flooding was controlled. From my recollection the fate of those men was unknown for several hours while water was drained in order to open the hatch. All during this casualty the seas were still very rough and the submarine was unable to open any other hatches.

The three men in the sail were eventually found to be alive. One man, my Division Officer Ens. Newbie in the process of returning belowdecks when another wave hit prior to the depth excursion and he was injured when the ‘clamshell’ (a heavy, steel hinged cover) hit him on the head. He was trapped in the bridge trunk and had to climb back to the bridge. The others, Lt. Rockjaw and SN Nub were understandably very shaken since they had no communication, heat or contact with the submarine during the entire casualty.

If you have any questions or need to contact me, my name, address and phone number are below.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________ ______________________

Jackson Browne, ETCS(SS) USN Ret. Date

Example Buddy Statement for Sleep Apnea

ON A VBA Form 20-10210 or VA Form 21-4138

My name is Christopher Robin. I served with Ephraim Cochran aboard the submarine Flash Fish (SSN-998) from August 1993 to July 1996. Ephraim and I were Chief Petty Officers (CPO) and lived in the Flash Fish’s CPO quarters while at sea and while ashore we lived in a shared townhouse at 1313 Mockingbird Lane, Virginia Beach Virginia.

Ephraim snored; among all the residents of Flash Fish’s tiny 12-person bunk room in the CPO quarters, he was perhaps the loudest. Ephraim’s snoring was interrupted by occasional pauses and gasps but at the time I did not recognize this as a possible health issue.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________ ______________________

Christopher Robin, CSCM(SS) USN Ret. Date

Example Spouse Statement for Sleep Apnea

ON A VBA Form 20-10210 or VA Form 21-4138

My name is Sally Cochran and I am the wife of Ephraim Cochran and have been with him for the past 22 years including all his time in the Navy.

Ephraim has great difficulty sleeping. I have to check him on NUMOROUS occasions during his sleep because he stops breathing. Sometimes he just resumes breathing, sometimes he gasps for air like someone drowning. He has great difficulty staying asleep. He complains about waking up with a dry mouth on most mornings. This started while he was active duty in the Navy.

This affects me in that my concern for him when I am sleeping does not allow me to get a good night’s sleep. I feel like I have to make sure he stays breathing all night.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________ ______________________

Sally Cochran Date