PTSD Checklist - Civilian Version (PCl-C)

Patient's Name: _

\
I Instruction to patient:
j
Below is a list of problems and complaints that veterans sometimes have in response to stressful life experiences. Please read
each one carefully, put an "X" in the box to indicate how much you have been bothered by that problem in the last month.
i

I ~o l~otat:1I11 A Iittl:~itil~od:ratel~ II ~uit::bitl~xtre=eIY

r
.•,Response: (1).1 (2). . (3).· (4) (5)

Repeated, disturbing memories, thoughts, or images of a

stressful experience from the past? COCDC
r Repeated, disturbing dreams of a stressful experience from
the past? CDDDC
r Suddenly acting or feeling as if a stressful experience were
happening again (as if you were reliving it)? CCDeC
r
..

Feeling vel}' upset when something reminded you of a

stressful experience from the past? CODen
rr Having physical reactions (e.g., heart pounding, trouble
breathing, or sweating) when something reminded you of a
stressful experience from the past?

Avoid thinking about or talking about a stressful experience

DDDn~
CODen
r
from the past or avoid having feelings related to it?

Avoid activities or situations because they remind you of a

stressful experience from the past? CCDDD
rF Trouble remembering important parts of a stressful
experience from the past?

Loss of interest in things that you used to enjoy?

DDDDn
I I I I [

F I [ I
r
Feeling distant or cut off from other people? I [

DDCr~C
Feeling emotionally numb or being unable to have loving
feelings for those close to you?

F Feeling as if your future will somehow be cut short? I I I I I

113.1 Trouble falling or staying asleep? I I I I I
14
1 .• 1Feeling irritable or having angl}' outbursts? I I I I I
15
1 .• 1Having difficulty concentrating? I I I I I
F Being "super alert" or watchful on guard? I I I [ I
117.1 Feeling jumpy or easily startled? I I I I I
Weathers, F.W., Huska, JA, Keane, T.M. PCL-C for DSM-IV. Boston: National Center for PTSD - Behavioral
Science Division, 1991.
 PTSD Checklist - Military Version (PCL-M)
NAME: _ 55# _ DA"rE: _

Instruction to patient: Below is a list of problems and complaints that veterans sometimes have in response to stressful life experiences.
Please read each one carefully, put an ·X" in the box to indicate how much you have been bothered by that problem in the last month.

Not at all A little bit Moderately Quite a bit Extremely

, No. Response
(1) (2) (3) (4) (5)
Repeated, disturbing memories, thoughts, or images of a
1.
, stressful military experience from the past?
Repeated, disturbing dreams of a stressful military
2.
experience from the past?
: Suddenly acting or feeling as if a stressful military
3. experience were happening again (as if you were reliving
: it)?
: 4. Feeling very upset when something reminded you of a
stressful military experience from the past?

i 5.
Having physical reactions (e.g., heart pounding, trouble
breathing, or sweating) when something reminded you of a
stressful military experience from the past?
Avoid thinking about or talking about a stressful military
! 6. experience from the past or avoid having feelings related to
it?
,
Avoid activities or situations because they remind you of a
7.
stressful military experience from the past?
Trouble remembering important parts of a stressful military
8.
experience from the past?
9. Loss of interest in things that you used to enjoy?
, 10. Feeling distant or cut off from other people?
Feeling emotionally numb or being unable to have loving
11.
ifeelings for those close to you?
. 12. Feeling as if your future will somehow be cut short?
I 13. Irrouble falling or staying asleep?
14. Feeling irritable or having angry outbursts?
: 15. IHaving difficulty concentrating?
16. Being "super alert" or watchful on guard?
I 17. Feeling jumpy or easily startled?

PCL-M for D5M-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD - Behavioral
Science Division
 INFORMATION PAPER

DASG-HSl
10 March 2008

SUBJECT: Deployability of Soldiers diagnosed with PTSD

1. Purpose. To provide information on deployability of Soldiers diagnosed with PTSD.

2. Talking Points

• Post Traumatic Stress Disorder and other psychiatric conditions controlled by

medication do not automatically lead to nondeployment. Soldiers with a
controlled psychiatric illness can still deploy.
• The recommendation of deployability should rest with the clinical judgment of the
treating physician or other privileged provider, in consultation with the unit
commander.
• Medications that may be used safely in theater include selective serotonin re-
uptake inhibitors and sleep medications, which are often used to treat PTSD.

3. Facts.

a. Army identifies Soldiers at risk through a pre-deployment screening process . Soldiers

get a face-to-face assessment with a provider. Providers make recommendations to
Commanders about deployability of Soldiers: Commanders use their best judgment
based on mission requirements and make the final decisions, taking into consideration
medical recommendations.

b. Soldiers who are diagnosed with PTSD or identified during the Pre-Deployment
Health Assessment as having behavioral/mental health issues that might be
exacerbated by deployment are assessed further by a provider with behavioral health
expertise . If the Soldier is determined to be non-deployable, they should be given a
profile stating their limitations. If their psychiatric situation is stable, they may be
deployed and followed-up by a behavioral health provider in theater.

c. Few medications are inherently disqualifying for deployment to all potential

operational locations and at all times during the conduct of operations. Clinical
proximity, tempo and demand of operations, and length of the deployment rotation must
be considered when determining use of psychotropic medications in the operational
environment. Soldiers with conditions determined to be at significant risk for performing
poorly in the operational environment, or whose conditions do not significantly improve
within two weeks of treatment initiation, will be clinically recommended for return to
home station, in consultation with the Commander.

Approved by: Ilb)(6)

- - - - - - - -
 INFORMATION PAPER

DASG-HSZ
6 July 2008

SUBJECT: PTSD Screening and Soldiers

1. Purpose: To provide information on policy screening updates for PTSD for

Soldiers

2. Facts:

a. This information paper is being written to inform the public on screening for
PTSD, specifically 'What are you doing to ensure that Soldier's identified with a
pre-existing personality disorder aren't wrongfully discharged when the real
problem is something else such as PTSD or TBI? "

b. A new policy was implemented in August 2007, where all recommendations

for a 5-13 personality disorder discharge need to be reviewed by the Chief of
Behavioral Health at the installation (enclosed).

c. All Soldiers discharged for selected administrative reasons are required to

receive a mental status evaluation as per Army Regulation 635-200. A new
policy was implemented in May 2008 where Soldiers who are being discharged
for any reason related to misconduct need to be specifically screened for PTSD
and TBI (enclosed).

d. Since approximately 1998, all Soldiers redeploying from the theater of

operations have been required to complete the Post Deployment Health
Assessment (DD Form 2796) either before leaving theater or shortly after
redeployment. The DD Form 2796 screens for PTSD, Major Depression,
concerns about Family issues, and concerns about drug and alcohol abuse. The
primary care provider reviews the form, interviews the Soldier as required, and
refers the Soldier to a behavioral health care provider as required. The primary
care provider may make referrals to on-site counselors or to military treatment
facilities. Approximately 5 to 6% of Soldiers are referred to behavioral health.

e. Since 2005, completing the Post-Deployment Health Reassessment

(PDHRA) screening program has been required of all redeployed Soldiers 90 to
180 after they have redeployed. Specific questions about TBI have been
recently added. If following the re-assessment there are identified healthcare
needs, Soldiers are offered care through military medical treatment facilities, VA
medical centers or VET centers, or by private healthcare providers through
TRICARE. Approximately 12 % of Soldiers are referred to behavioral health.
 f. All Soldiers (AD, USAR, and ARNG) were mandated to participate in
training on Mild Traumatic Brain Injury (mTBI) and Post Traumatic Stress
Disorder (PTSD) by 18 OCT 2007 . This chain teaching program was intended to
provide leaders and Soldiers information and resources on concussions and Post
Combat and Operational Stress. The "Chain Teach " product was designed to
provide an overview and understanding of concussion injuries such as mTBI and
Post Combat Stress Reactions that may result in PTSD. Approximately 900,000
Soldiers received this training by the end of 2007 . There are a number of other
trainings available for Soldiers and their Families, available at
www.battlemind .org or www.behavioralhealth.army.mil.

g. All Army deploying behavioral health providers now attend the Combat and
Operational Stress Control Course. Emphasizing the policies above is part of the
curriculum. This information is also reinforced at the annual Force Health
Protection conference.

3. The Way Ahead

a. Continue to ensure that Soldiers are carefully evaluated and treated for
PTSD, TBI , and other psychiatric illnesses .

E6 1
- ------;;;;;;;::==-----
Approved by L
llb_II_
61 _
 INFORMATION PAPER

DASG-HSZ
7 March, 2008

SUB..IECT: Deployability of Soldiers diagnosed with PTSD

1. Purpose. To provide information on deployability of Soldiers diagnosed with PTSD.

2. Facts.

a. We have pre-deployment screening process that identifies Soldiers at risk. They get a
face-to-face assessment with a provider. Providers make a recommendation to
Commanders about deployability of Soldiers; Commanders use their best judgment
based on mission requirements, etc. and make the final decision, taking into
consideration medical recommendations.

b. Soldiers who are diagnosed with PTSD or identified during the Pre-Deployment
Health Assessment as having behavioral/mental health issues that might be
exacerbated by deployment are assessed further by a provider with behavioral health
expertise. Guidance on Deployment Limiting Psychiatric Conditions is delineated in the
Health Affairs Policy issued in November, 2006. If the Soldier is determined to be non-
deployable, they should be given a profile stating their limitations. If their psychiatric
situation is stable, they may be deployed and followed-up by a behavioral health
provider in theater.

c. Deployment-Limiting Psychiatric Conditions Policy Memorandum, 7 November 2006,

specifies deployment considerations related to behavioral health care. The provider will
carefully assess the patient's condition, treatment regimen, and risk level. The clinical
decision to maintain or evacuate personnel diagnosed with psychiatric disorders in
Theater is based upon: the severity of symptoms and/or medication side effects; the
degree of functional impairment resulting from the disorder and/or medications; the risk
of exacerbation if the member were exposed to trauma or severe operational stress;
estimation of the member's ability and motivation to psychologically tolerate the rigors of
the deployed environment; and prognosis for recovery.

d. There are few medications that are inherently disqualifying for deployment to all
potential operational locations and at all times during the conduct of operations. Clinical
proximity, tempo and demand of operations, and time during the deployment rotation
must be considered when determining use of psychotropic medications in the
operational environment. Service branch specific standards must also be considered
(aviators for example). Medications disqualifying for deployment include antipsychotics
used to control psychotic, bipolar, and chronic insomnia symptoms; lithium and
anticonvulsants to control bipolar symptoms. Personnel diagnosed with psychotic or
bipolar spectrum disorders will be recommended for return to their home station.
Service members with other conditions that are determined to be at significant risk for
performing poorly or decompensate in the operational environment, or whose conditions
does not significantly improve within two weeks of treatment initiation, will be clinically
recommended for return to their home station, in consultation with their Commander.

e. An Army policy was issued in April 2007, which provided implementing guidance and
the waiver process. Waivers need to be submitted to and approved by the CENTCOM
Surgeon. Since April, 70 waiver requests have been received, and sixteen have been
denied.

Approved by: 11
6
_' 1
_1_1 _