Mental Health Stressor Statement

Mental Health Stressor Statement

We know that sharing traumatic events from your service can be difficult, and your well-being is our priority—please take your time and care for yourself as you complete this form. The detailed information you provide is essential to building a strong VA disability claim, and we’re here to support you every step of the way.
Name

First NameLast Name
Email
example@example.com
Who are you working with at OSDRI?

Military Service
What branch of service were you in?
Please enter your dates of service:*
Do you have a formal mental health diagnosis from a medical professional?*
What is your formal mental health diagnosis? List ALL mental health diagnoses.
Depression, Anxiety, PTSD, etc.
WHO diagnosed you with each mental health condition listed above? Provide the name of the doctor or psychologist and their address.
WHEN were you diagnosed with each mental health condition?
Do you have symptoms of PTSD?
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event—especially one involving death, serious injury, or a threat to yourself or others. In the military, common causes include combat exposure, IED blasts, sexual assault or harassment, and witnessing the death or suffering of others.

Not all trauma leads to PTSD, but if the effects of a traumatic experience are disrupting your life long after the event, you may be dealing with PTSD.

🧠 Is It PTSD or Something Else?
PTSD often overlaps with other mental health conditions like depression, anxiety, or substance use disorders. If you’ve experienced trauma and have ongoing emotional struggles, it’s worth getting evaluated. A professional diagnosis isn't just helpful for treatment—it can also support your VA claim.
🔍 Key Symptoms of PTSD
PTSD symptoms are grouped into four main categories. You don’t need to have all of them to qualify for a diagnosis or for VA benefits:

1. Re-Experiencing the Trauma
- Flashbacks, nightmares, or intrusive memories
- Feeling like you're back in the traumatic moment
  Physical reactions (sweating, heart pounding) when reminded of the event
2. Avoidance
- Avoiding people, places, or situations that remind you of the trauma
- Trying not to think or talk about what happened
- Withdrawing from family, friends, or activities
3. Negative Thoughts and Mood Changes
- Feeling numb, hopeless, or emotionally distant
- Guilt or shame (especially survivor's guilt)
- Trouble remembering parts of the trauma
- Losing interest in things you used to enjoy
4. Hyperarousal and Reactivity
- Constantly on edge or easily startled
- Angry outbursts or irritability
- Trouble sleeping or concentrating
- Reckless or self-destructive behavior

PTSD Stressor Info
Select the type of traumatic event you experienced in service.

Event While in CombatPersonal Assault NOT involving Military Sexual TraumaPersonal Assault involving Military Sexual TraumaEvent that Involved Actual or Threatened Death or Serious Injury to MyselfEvent that Involved Actual or Threatened Death or Serious Injury to Another (to include duties as a drone aircraft crew member)Other Traumatic Event

Another Stressful Event
What happened during service that caused your mental health condition?

involvement in car accident or natural disasterworked on burn ward or graves registration, witnessed the death, injury, or threat to the physical integrity of another person not caused by the enemy, or an experience that involved friendly fire that occurred on a gunnery range during a training missionOther

Stressor #1 Details
Dates the Traumatic Event Occurred
ie. month(s) or year(s), if known, or approximate dates are acceptable
Location of the Traumatic Event
ie. unit assignment, residence, off-base, duty station or state, if known)
For Army requests, provide the full unit designation to the company level, such as: HHC, 1st Brigade, 2d Armored Division (instead of 2d Armored Division only), and Company C, 1st Battalion, 14th Infantry, 1st Brigade Combat Team, 4th Infantry Division.

For Navy requests, provide the full unit designation and hull numbers for ships, such as: USS Franklin D. Roosevelt (CVA-42) instead of USS Roosevelt only.

For Air Force requests, at a minimum, provide squadron and group designations, such as: 366th Field Maintenance Squadron, 366th Combat Support Group instead of 366th Tactical Fighter Wing only.
Briefly summarize the traumatic event you experienced.
ie. injury in warfare, physical assault, sexual harassment, witnessed the death or injury of a person, etc.
Was there a person(s) wounded or killed during this incident?
Select one
Name of person or persons injured (if you know)
Did you experience ANOTHER traumatic event or stressor in service?

Stressor #2 Details
Dates the Traumatic Event Occurred
ie. month(s) or year(s), if known, or approximate dates are acceptable
Location of the Traumatic Event
ie. unit assignment, residence, off-base, duty station or state, if known)
For Army requests, provide the full unit designation to the company level, such as: HHC, 1st Brigade, 2d Armored Division (instead of 2d Armored Division only), and Company C, 1st Battalion, 14th Infantry, 1st Brigade Combat Team, 4th Infantry Division.

For Navy requests, provide the full unit designation and hull numbers for ships, such as: USS Franklin D. Roosevelt (CVA-42) instead of USS Roosevelt only.

For Air Force requests, at a minimum, provide squadron and group designations, such as: 366th Field Maintenance Squadron, 366th Combat Support Group instead of 366th Tactical Fighter Wing only.
Briefly summarize the traumatic event you experienced.
ie. injury in warfare, physical assault, sexual harassment, witnessed the death or injury of a person, etc.
Was there a person(s) wounded or killed during this incident?
Select one
Name of person or persons injured (if you know)
Did you experience ANOTHER traumatic event or stressor in service?

Stressor #3 Details
Dates the Traumatic Event Occurred
ie. month(s) or year(s), if known, or approximate dates are acceptable
Location of the Traumatic Event
ie. unit assignment, residence, off-base, duty station or state, if known)
For Army requests, provide the full unit designation to the company level, such as: HHC, 1st Brigade, 2d Armored Division (instead of 2d Armored Division only), and Company C, 1st Battalion, 14th Infantry, 1st Brigade Combat Team, 4th Infantry Division.

For Navy requests, provide the full unit designation and hull numbers for ships, such as: USS Franklin D. Roosevelt (CVA-42) instead of USS Roosevelt only.

For Air Force requests, at a minimum, provide squadron and group designations, such as: 366th Field Maintenance Squadron, 366th Combat Support Group instead of 366th Tactical Fighter Wing only.
Briefly summarize the traumatic event you experienced.
ie. injury in warfare, physical assault, sexual harassment, witnessed the death or injury of a person, etc.
Was there a person(s) wounded or killed during this incident?
Select one
Name of person or persons injured (if you know)

Additional Information
Would you like to include any additional information?
Would you like to include any documents or images with your statement?

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Should be Empty:

Mental Health Stressor Statement

Military Service

PTSD Stressor Info

Combat

Personal Assault (including Military Sexual Trauma)

Event that Involved Actual or Threatened Death or Serious Injury to Myself or Another

Another Stressful Event

Stressor #1 Details

Stressor #2 Details

Stressor #3 Details

Behavioral Changes or "Markers"

Reporting

Treatment & Symptoms

Additional Information