The need to support injured soldiers dates back to our earliest days as a nation, starting with the pilgrims of Plymouth Colony. But it was not until 1865 that Abraham Lincoln, the 16th President of the United States, gave us this mission:
“To care for [the person] who shall have borne the battle and for his [or her] widow [or widower or partner], and his [or her] orphan.”
The United States Department of Veterans Affairs (VA) was established on March 15, 1989, replacing the previous Veterans Administration. Its charge is to continue to provide benefits and care to veterans and their families.
The mission set out by President Lincoln remains essential today. Veterans, and family or survivors of veterans, who may be eligible for VA benefits and services make up a quarter of the United States’ population. The “compensation and pension examination” is the first step in determining a person’s eligibility for this assistance.
These exams are carried out by expert and dedicated clinical professionals within the VA Healthcare System. Those who act in this role must be perceptive and embrace the concept of respect for the individual who has served and has suffered. The assessment must go beyond completing a check-off list or categorizing a person’s experiences into “yes” or “no.” Rather, the clinician must look beyond those criteria to the person who has been hurt, injured, changed, or compromised. Sometimes this damage is clear to the person’s friends and loved ones, or is obvious in the exam room. Sometimes the damage is hidden and suffered in silence. The only way to provide comprehensive and meaningful care is through respectful engagement and interaction.
Once a person’s claim has been accepted, he or she is given an appointment with the appropriate provider to address any specific injuries or other health problems. This may include another compensation and pension exam for the purpose of evaluating any mental health concerns, such as post-traumatic stress disorder, to make sure the veteran is connected with the appropriate care.
The interaction during these evaluations is designed to be non-adversarial and supportive, but for some, the examination can be stressful and upsetting. Mutual greetings and brief small talk can help engage the veteran, reduce anxiety as much as possible, and convey respect for the individual’s life story. Simple things like taking a break when emotions run high and having a box of tissues handy can help ease distress and avoid any re-traumatizing or increasing the burden on the veteran. Having a spouse, partner, or other family member participate can help support the veteran and often provides additional important information for the clinician. Each provider’s efforts to listen, clarify when needed, and consistently demonstrate care, concern, and respect should be the thread that connects the VA with the veteran.
From my participation in over a thousand compensation and pension exams, I have had the privilege of sharing in the historical reflection on events, tragedy, heroism, and unspoken emotions. I have witnessed the unearthing of hidden fears and buried feelings of guilt, blame, and anger. In these meetings, I have learned the true meaning of resilience. I have joined in the process of not only compensating people for their service, but also connecting them to the care they need. It is a good day when I am able to assist in some fashion, and I’m grateful for the opportunity to do so. That is what it means to truly express “Thank you for your service.”
From those who served in our country’s earliest wars to present-day returning veterans, there is one constant that has kept them going on in life — that of personal determination to survive, the commitment to never lose sight of one’s meaning in life, and the strength of humor. My interactions with these individuals have reminded me to enjoy the gift of smiling, laughing, and caring about others every day.