Memo

VA Form 10-21087

OMB Number 2900-XXXX

Estimated Burden: 50 MIN.

DEPLOYMENT EXPERIENCES

PART I

This survey contains questions regarding your experiences before, during, and after military deployment. No one has had exactly the same experiences that you have had, so your input is very important. There are no right or wrong answers.

Be sure to answer every statement, and press firmly on the page when circling your responses. If you want to change your response, please place an “X” over your original answer, and then circle the more appropriate response.

The survey was prepared with support from the Veterans Affairs Health Services Research & Development Service, Dr. Dawne S. Vogt, Principal Investigator, the Department of Defense, Drs. Daniel W. King and Lynda A. King, Co-Principal Investigators, and the National Center for PTSD. For inquiries or further information, please contact Dr. Dawne Vogt at NCPTSD, 116B-3, VA Boston, 150 S. Huntington Ave., Boston, MA 02130; Phone: 617-232-9500, ext. 45976;

Email: Dawne.Vogt@va.gov.

The Paperwork Reduction Act of 1995 requires us to notify you that this information collected is in accordance with the clearance requirements of section 3507 of this Act. The public reporting burden for this collection of information is estimated to average 50 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. No person will be penalized for failing to furnish this information if it does not display a currently valid OMB control number. This collection of information is intended to fulfill the need identified by the Department of Veterans Affairs in their call for the development, improvement, and/or validation of measures for screening, detection, and diagnosis. Response to this survey is voluntary and failure to furnish this information will have no effect on any of your benefits.

VA Form 10-21087

OMB Number 2900-XXXX

Estimated Burden: 50 MIN.

SECTION A: PRE-DEPLOYMENT LIFE EVENTS

The statements below refer to events you may have experienced AT ANY TIME BEFORE YOUR MOST RECENT DEPLOYMENT. Please circle “Yes” or “No” for each question below.

Before I was deployed, I experienced…
...a natural disaster (for example, a flood or hurricane), a fire, or an accident in which I was hurt or my property was damaged.	Yes	No
2. ...exposure to a toxic substance (such as dangerous chemicals, radiation).	Yes	No
3. ...combat or exposure to a war zone (in the military or as a civilian).	Yes	No
4. ...the mental illness (for example, clinical depression, anxiety disorder), or life-threatening physical illness (for example, cancer or heart disease) of someone close to me.	Yes	No
5. ...a parent who had a problem with drugs or alcohol.	Yes	No
6. ...the death of someone close to me.	Yes	No
Before I was deployed, I had...
...been through a divorce or been left by a partner or significant other.	Yes	No
8. ...witnessed someone being assaulted or violently killed.	Yes	No
9. ...been robbed or had my home broken into.	Yes	No
110. ...lost my job.	Yes	No
11. ...been emotionally mistreated (for example, shamed, embarrassed, ignored, or repeatedly told I was no good).	Yes	No
12. ...seen or heard physical fighting between my parents or caregivers.	Yes	No
13. ...been physically punished by a parent or primary caregiver.	Yes	No
14. ...been physically injured by another person (for example, hit, kicked, beaten up).	Yes	No
14a. [IF YES] did this occur (circle all that apply):	in childhood	in adulthood
15. ...experienced unwanted sexual activity as a result of force, threat of harm, or manipulation.	Yes	No
15a. [IF YES] did this occur (circle all that apply):	in childhood	in adulthood
Before I was deployed:
16. ...I experienced a natural disaster (for example, a hurricane), a fire, or an accident in which I or someone close to me was hurt or had serious property damage.	Yes	No
17. ...someone close to me experienced serious physical or mental health problems.	Yes	No
18. ...a close family member or friend experienced a serious drug or alcohol problem.	Yes	No
19. ...I witnessed someone being seriously assaulted or killed.	Yes	No
20. ...I lost my job or was demoted.	Yes	No
21. ...I was emotionally mistreated by a family member or other loved one (for example, ignored or repeatedly told I was no good).	Yes	No
22. ...I experienced serious financial problems.	Yes	No
23. ...I experienced serious physical or mental health problems.	Yes	No
24. ...I experienced combat or exposure to a war zone in the military or as a civilian (e.g., prior deployment).	Yes	No
25. ...I was seriously physically injured by another person (for example, hit or beaten up).	Yes	No
25a. [IF YES] did this occur (circle all that apply):	In childhood	In adulthood

SECTION B: CHILDHOOD EXPERIENCES

The sentences below refer to YOUR FAMILY WHEN YOU WERE GROWING UP. Please read each statement and describe how often it was true for your family by circling the number that best fits your choice. If you spent time in more than one family setting, please answer these questions about the family in which you spent the greatest part of your childhood.

	Almost none of the time	A few times	Some of the time	Most of the time	Almost all of the time
1. People in my family did things together.	1	2	3	4	5
2. Family members got on each other’s nerves (annoyed each other).	1	2	3	4	5
Family members felt uncomfortable with each other.	1	2	3	4	5
4. Family members were there for each other during difficult times.	1	2	3	4	5
5. Family members felt very close to each other.	1	2	3	4	5
6. Family members avoided each other.	1	2	3	4	5
7. When problems arose, family members compromised.	1	2	3	4	5
Family members were afraid to say what was on their minds.	1	2	3	4	5
9. There was fighting among family members.	1	2	3	4	5
10. Family members yelled when they were angry with each other.	1	2	3	4	5
11. Family members discussed their personal problems with each other.	1	2	3	4	5
12. Family members shared household responsibilities.	1	2	3	4	5
13. Family members were affectionate with each other.	1	2	3	4	5
14. Family members got on each other’s nerves.	1	2	3	4	5
15. Family members insulted or swore at each other.	1	2	3	4	5
16. Family members were critical of each other.	1	2	3	4	5

SECTION C: FAMILY’S PREPAREDNESS FOR DEPLOYMENT

Below are several statements about different preparations military personnel who have spouses or significant others and/or children may make prior to deployment, if time allows. Please circle “Yes,” “No,” or “NA” (Not Applicable) for each statement below. PLEASE SKIP TO SECTION D IF YOU DID NOT HAVE A SPOUSE OR SIGNIFICANT OTHER AND/OR CHILDREN WHEN YOU DEPLOYED.

Before I deployed:
1. ...a tentative plan was made for how my family would stay in touch (for example, phone, mail, video, etc.).	Yes	No	NA
2. ...family members were told who to contact to get information about my unit’s safety.	Yes	No	NA
3. ...my family discussed what was and was not OK to talk about during the deployment (for example, exposure to dangerous situations in the war-zone, problems at home).	Yes	No	NA
4. ...a plan was made for how household maintenance tasks would be managed.	Yes	No	NA
5. ...arrangements were made to ensure that there would be enough money to cover expenses at home.	Yes	No	NA
6. ...a plan was made for how to handle any financial problems that might come up.	Yes	No	NA
7. ...my family agreed on how money would be spent.	Yes	No	NA
8. ...my family discussed where to get help for different problems that might come up (for example, if home or car repairs were needed).	Yes	No	NA
9. ...my family talked about how we would manage any conflicts that came up.	Yes	No	NA
10. ...my family discussed where they should go for help (for example, another family member or friend) in case there was an emergency.	Yes	No	NA
11. ...a backup childcare or other care plan was made for family dependents (for example, who would care for child(ren) if family members were unable to).	Yes	No	NA
12. ...my spouse or significant other and I explained what was going to happen during the deployment to our child(ren).	Yes	No	NA
13. ...my spouse or significant other and I talked to our child(ren) about how their activities or responsibilities would change during the deployment.	Yes	No	NA

SECTION D: DEPLOYMENT ENVIRONMENT

The next set of statements is about the conditions of day-to-day life DURING DEPLOYMENT. Please read each statement and describe what amount of time you were exposed to each condition over the course of the entire time you were deployed. Circle the number that best fits your choice.

	Almost none of the time	A few times	Some of the time	Most of the time	Almost all of the time
1. The climate was extremely uncomfortable.	1	2	3	4	5
2. I had to deal with annoying animals, insects, or plants during my deployment.	1	2	3	4	5
3. I had access to clean clothing when I needed it.	1	2	3	4	5
4. I could get a cold drink (for example, water, juice, etc.) when I wanted one.	1	2	3	4	5
5. The food I had to eat was of very poor quality (for example, bad or old MREs).	1	2	3	4	5
6. The conditions I lived in were extremely unsanitary.	1	2	3	4	5
I had access to bathrooms or showers when I needed them.	1	2	3	4	5
8. I got as much sleep as I needed.	1	2	3	4	5
9. The living space was too crowded.	1	2	3	4	5
10. I was able to get enough privacy.	1	2	3	4	5
11. The workdays were too long.	1	2	3	4	5
12. I got the R&R (rest and relaxation) that I needed.	1	2	3	4	5
13. I got my mail in a timely manner.	1	2	3	4	5
14. I was exposed to awful smells.	1	2	3	4	5
15. I was subjected to loud noises.	1	2	3	4	5
16. I had to hassle with putting on and taking off NBC equipment.	1	2	3	4	5
17. I had the equipment or supplies to do what I needed to do.	1	2	3	4	5
18. My daily activities were restricted because of local religious or ethnic customs.	1	2	3	4	5
19. I felt comfortable living in the culture or cultures where I was deployed.	1	2	3	4	5
20. Pressure to conform to the local culture made it difficult for me to do my job.	1	2	3	4	5
21. I was able to get some rest when I needed it.	1	2	3	4	5
22. I could email home when I needed to.	1	2	3	4	5
23. I could call home when I needed to.	1	2	3	4	5
24. I had to hassle with putting on and taking off heavy or annoying gear.	1	2	3	4	5
25. I was exposed to insects, parasites, or other creatures that could harm me.	1	2	3	4	5
26. The local culture made it difficult for me to do my job.	1	2	3	4	5
27. I had enough time to myself.	1	2	3	4	5
28. I was not allowed to do the things I needed to do to get my job done.	1	2	3	4	5
29. The nature of my work or routine was often very boring.	1	2	3	4	5
30. My activities during deployment were meaningful to me.	1	2	3	4	5
31. I had adequate shelter from uncomfortable living conditions (for example, heat, cold, wet, etc.).	1	2	3	4	5
30. My work felt very repetitive.	1	2	3	4	5

SECTION E: MISSION CHALLENGES

Please rate the extent to which you agree with the following statements about your deployment experience. Indicate your agreement with each statement by circling the response that best fits your experience.

	Not applicable	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
1. I was concerned that the locals could not be trusted.	0	1	2	3	4	5
2. The rules of engagement were confusing.	0	1	2	3	4	5
3. I felt as if our humanitarian efforts didn’t make a difference.	0	1	2	3	4	5
I was frustrated by limits placed on when I could use my weapon.	0	1	2	3	4	5
5. I felt as if our efforts to rebuild war-torn areas were a waste of time.	0	1	2	3	4	5
6. I felt as if efforts to help the locals (for example, providing food and supplies) didn’t make a difference.	0	1	2	3	4	5
7. I was concerned that civilians might actually be combatants in disguise.	0	1	2	3	4	5
8. I worried that enemy combatants would target civilians as punishment for their contact with American personnel.	0	1	2	3	4	5
9. I felt as if the locals did not want the help of American forces.	0	1	2	3	4	5
10. I felt as if our mission was a waste of time, money, or lives.	0	1	2	3	4	5
11. I worried that I would be criticized by my superiors for not following the rules of engagement.	0	1	2	3	4	5
12. I was concerned that I would be punished by the military for trying to do my job.	0	1	2	3	4	5
13. I was concerned that locals who were supposed to be helping us were actually working against us.	0	1	2	3	4	5
14. I was frustrated by repeated changes to the rules of engagement.	0	1	2	3	4	5
15. I felt as if we made little or no positive impact on civilians’ lives.	0	1	2	3	4	5
16. I was concerned about being trapped in the crossfire of local nationals.	0	1	2	3	4	5
17. I felt that our humanitarian efforts were not appreciated.	0	1	2	3	4	5
18. The rules of engagement made it hard for me to do my job.	0	1	2	3	4	5

SECTION F: COMBAT EXPERIENCES

The statements below are about your combat experiences during deployment. As used in these statements, the term “unit” refers to those you lived and worked with on a daily basis during deployment. Please describe how often you experienced each circumstance by circling the number that best fits your choice.

.

While deployed:	Never	A few times over entire deployment	A few times each month	A few times each week	Daily or almost daily
1. I went on combat patrols or missions.	1	2	3	4	5
2. I or members of my unit encountered land or water mines and/or booby traps.	1	2	3	4	5
3. I or members of my unit received hostile incoming fire from small arms, artillery, rockets, mortars, or bombs.	1	2	3	4	5
4. I or members of my unit received "friendly" incoming fire from small arms, artillery, rockets, mortars, or bombs.	1	2	3	4	5
5. I was in a vehicle (for example, a truck, tank, APC, helicopter, plane, or boat) that was under fire.	1	2	3	4	5
6. I or members of my unit were attacked by terrorists or civilians.	1	2	3	4	5
7. I was part of a land or naval artillery unit that fired on the enemy.	1	2	3	4	5
8. I was part of an assault on entrenched or fortified positions.	1	2	3	4	5
9. I took part in an invasion that involved naval and/or land forces.	1	2	3	4	5
10. My unit engaged in battle in which it suffered casualties.	1	2	3	4	5
11. I personally witnessed someone from my unit or an ally unit being seriously wounded or killed.	1	2	3	4	5
12. I personally witnessed soldiers from enemy troops being seriously wounded or killed.	1	2	3	4	5
13. I was wounded or injured in combat.	1	2	3	4	5
14. I fired my weapon at the enemy.	1	2	3	4	5
15. I killed or think I killed someone in combat.	1	2	3	4	5
16. I encountered land or water mines, booby traps, or roadside bombs (for example, IEDs).	1	2	3	4	5
17. My unit received hostile incoming fire.	1	2	3	4	5
18. My unit received "friendly" incoming fire.	1	2	3	4	5
19. I was in a vehicle (for example, a “humvee,” helicopter, or boat) or part of a convoy that was attacked.	1	2	3	4	5
20. I was part of a land or naval artillery unit that fired on enemy combatants.	1	2	3	4	5
21. My unit suffered casualties.	1	2	3	4	5
22. I personally witnessed enemy combatants being seriously wounded or killed.	1	2	3	4	5
23. I personally witnessed civilians (for example, women and children) being seriously wounded or killed.	1	2	3	4	5
24. I was wounded in combat.	1	2	3	4	5
25. I fired my weapon at enemy combatants.	1	2	3	4	5
26. I wounded or think I wounded someone during combat operations.	1	2	3	4	5
27. I killed or think I killed someone during combat operations.	1	2	3	4	5
While deployed:	Never	A few times over entire deployment	A few times each month	A few times each week	Daily or almost daily
28. I was involved in locating or disarming explosive devices.	1	2	3	4	5
29. I was involved in searching or clearing homes, buildings, or other locations.	1	2	3	4	5
30. A unit member I knew went missing in action or was taken prisoner/hostage.	1	2	3	4	5
31. I participated in hand-to-hand combat.	1	2	3	4	5
32. I experienced a “close call” or attack by an enemy combatant (for example, an insurgent).	1	2	3	4	5
33. I was involved in searching and/or disarming civilians.	1	2	3	4	5

SECTION G: POST-BATTLE EXPERIENCES

Next are statements about your exposure to the consequences of warfare. As used in these statements, the term “unit” refers to those you lived and worked with on a daily basis during deployment. Please describe how often you experienced each circumstance by circling the number that best fits your choice.

	Never	A few times over entire deployment	A few times each month	A few times each week	Daily or almost daily
1. I observed homes or villages that had been destroyed.	1	2	3	4	5
2. I saw refugees who had lost their homes and belongings as a result of battle.	1	2	3	4	5
3. I saw people begging for food.	1	2	3	4	5
4. I or my unit took prisoners of war.	1	2	3	4	5
5. I interacted with enemy soldiers who were taken as prisoners of war.	1	2	3	4	5
6. I was exposed to the sight, sound, or smell of animals that had been wounded or killed from war-related causes.	1	2	3	4	5
7. I took care of injured or dying people.	1	2	3	4	5
8. I was involved in removing dead bodies after battle.	1	2	3	4	5
9. I was exposed to the sight, sound, or smell of dying men and women.	1	2	3	4	5
10. I saw enemy soldiers after they had been severely wounded or disfigured in combat.	1	2	3	4	5
11. I saw the bodies of dead enemy soldiers.	1	2	3	4	5
12. I saw civilians after they had been severely wounded or disfigured.	1	2	3	4	5
13. I saw the bodies of dead civilians.	1	2	3	4	5
14. I saw Americans or allies after they had been severely wounded or disfigured in combat.	1	2	3	4	5
15. I saw the bodies of dead Americans or allies.	1	2	3	4	5
16. I observed homes or communities that had been destroyed.	1	2	3	4	5
17. I saw refugees who had lost their homes and belongings.	1	2	3	4	5
18. My unit took detainees or prisoners of war.	1	2	3	4	5
19. I interacted with detainees or prisoners of war.	1	2	3	4	5
20. I was exposed to the sight, sound, or smell of dead or dying animals.	1	2	3	4	5
21. I was involved in handling human remains.	1	2	3	4	5
22. I saw enemy combatants after they had been severely wounded or disfigured.	1	2	3	4	5
23. I saw the bodies of dead enemy combatants.	1	2	3	4	5
24. I saw Americans or allies after they had been severely wounded or disfigured.	1	2	3	4	5
25. Someone I cared about was killed.	1	2	3	4	5

SECTION H: EXPOSURE TO NUCLEAR, BIOLOGICAL, CHEMICAL AGENTS

Next are some statements about nuclear, biological, and chemical agents (NBCs) that you may have been exposed to during the time you were preparing for deployment or during your deployment. Please circle “Yes,” “No,” or “Don’t know” for each question below.

Either in preparation for or during my deployment…
1. ...I took pyridostigmine or little white pills in foil packets, sometimes called NAPPs, which are used to protect against nerve gas.	Yes	No	Don’t know
2. ...I received preventative vaccinations by injection (for example, to prevent anthrax or botulism). [Note: for women, preventative vaccinations may include deprovera (birth control).]	Yes	No	Don’t know
3. ...I took preventative pills (for example, to protect against nerve gas).	Yes	No	Don’t know
4. ...I received preventative vaccinations by injection (for example, to prevent anthrax or botulism).	Yes	No	Don’t know
While I was deployed, I was exposed to…
5. ...nerve gas agents (for example, sarin).	Yes	No	Don’t know
6. ...mustard gas or other blistering agents.	Yes	No	Don’t know
7. ...environmental pesticides (for example, from "fogger" trucks).	Yes	No	Don’t know
8. ...pesticides in uniforms.	Yes	No	Don’t know
9. ...pesticides in flea collars.	Yes	No	Don’t know
10. ...government-issued DEET-containing insect repellents.	Yes	No	Don’t know
11. ...non-government issued insect repellents (for example, Avon Skin-So-Soft, Off).	Yes	No	Don’t know
12. ...smoke or other air pollution.	Yes	No	Don’t know
13. ...diesel or other petrochemical fuel on my skin.	Yes	No	Don’t know
14. ...fumes or exhaust from heaters or generators, including heaters in tents.	Yes	No	Don’t know
15. ...depleted uranium in munitions.	Yes	No	Don’t know
16. ...burning trash or burning feces.	Yes	No	Don’t know
17. ...chlorine gas.	Yes	No	Don’t know
18. ...pesticides (for example, in flea collars, uniforms, or the environment).	Yes	No	Don’t know
19. ...local food other than that provided by the Armed Forces.	Yes	No	Don’t know
20. ...poisoned food.	Yes	No	Don’t know
While I was deployed…
21. ...I was within 1 km of an exploding artillery shell.	Yes	No	Don’t know
22. ...I was within 5 km of an exploding missile.	Yes	No	Don’t know
23. ...I entered an enemy bunker or military facility.	Yes	No	Don’t know
24. ...I climbed inside an enemy tank that had been abandoned or burned out.	Yes	No	Don’t know
25. ...I was exposed to chemical or biological weapons.	Yes	No	Don’t know
26. ...I was within 5 km of an exploding missile or mortar, or attack by a rocket-propelled grenade (RPG).	Yes	No	Don’t know

SECTION I: DEPLOYMENT CONCERNS

The statements below are about the amount of danger you felt you were exposed to while you were deployed. As used in these statements, the term “unit” refers to those you lived and worked with on a daily basis during deployment. Please describe how much you agree or disagree with each statement by circling the number that best fits your choice.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
1. I thought I would never survive.	1	2	3	4	5
2. I felt safe.	1	2	3	4	5
3. I was extremely concerned that the enemy would use nuclear, biological, chemical agents (NBCs) against me.	1	2	3	4	5
4. I felt that I was in great danger of being killed or wounded.	1	2	3	4	5
5. I was concerned that my unit would be attacked by the enemy.	1	2	3	4	5
6. I worried about the possibility of accidents (for example, friendly fire or training injuries in my unit).	1	2	3	4	5
7. I was afraid I would encounter a mine or booby trap.	1	2	3	4	5
8. I felt secure that I would be coming home after the war.	1	2	3	4	5
9. I thought that vaccinations I received would actually cause me to be sick.	1	2	3	4	5
10. I was concerned that the tablets I took to protect me would make me sick.	1	2	3	4	5
11. I felt that I would become sick from the pesticides or other routinely used chemicals.	1	2	3	4	5
12. I was concerned about the health effects of breathing bad air.	1	2	3	4	5
13. I thought that exposure to depleted uranium would negatively affect my health.	1	2	3	4	5
14. I was afraid that the equipment I was given to protect me from nuclear, biological, chemical agents (NBCs) would not work.	1	2	3	4	5
15. I worried about getting an infectious disease.	1	2	3	4	5
16. I was extremely concerned that I would be exposed to nuclear, biological, or chemical agents (NBC) agents.	1	2	3	4	5
17. I felt I was in great danger of being wounded (for example, losing a limb).	1	2	3	4	5
18. I was concerned that my unit would be attacked.	1	2	3	4	5
19. I was concerned that I would encounter an explosive device (for example, a roadside bomb, mine, or booby trap).	1	2	3	4	5
20. I was concerned that the medicine I was given to protect me from illness would make me sick.	1	2	3	4	5
21. I felt that I would become sick from pesticides (for example, bug spray) or other routinely used chemicals.	1	2	3	4	5
22. I was concerned about the effects of breathing bad air.	1	2	3	4	5
23. I worried about exposure to depleted uranium in munitions.	1	2	3	4	5
24. I feared that the protective gear I was given would not work.	1	2	3	4	5
25. I worried that I would be intentionally hurt by one of my own.	1	2	3	4	5
26. I was concerned that I would be attacked while on convoy or patrol.	1	2	3	4	5
27. I was concerned that a rocket or mortar would hit our living quarters.	1	2	3	4	5
28. I worried that others in my unit could not keep me safe.	1	2	3	4	5
29. I spent a lot of time worrying about the bad things that could happen to me.	1	2	3	4	5
30. I worried that someone I thought I could trust would turn against me.	1	2	3	4	5
31. I worried that I might be taken hostage.	1	2	3	4	5

SECTION J: TRAINING AND DEPLOYMENT PREPARATION

Below are several statements about how well prepared you were by the military for your deployment. As used in these statements, the term “unit” refers to those you lived and worked with on a daily basis during deployment. Please describe how much you agree or disagree with each statement by circling the number that best fits your choice.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
1. I had the supplies and equipment needed to get my job done.	1	2	3	4	5
2. The equipment I was given functioned the way it was supposed to.	1	2	3	4	5
3. I received adequate training on how to use my equipment.	1	2	3	4	5
4. I knew how to treat animal bites, insect stings, or allergic reactions to plants in the region.	1	2	3	4	5
5. I received adequate training on what to do in case of a nuclear, biological, or chemical (NBC) attack.	1	2	3	4	5
6. I had enough gear to protect myself in case of a nuclear, biological, or chemical (NBC) attack.	1	2	3	4	5
7. I received adequate training on how to perform daily life activities while wearing nuclear, biological, or chemical (NBC) protective gear.	1	2	3	4	5
8. I was adequately prepared to deal with the region’s climate.	1	2	3	4	5
9. I was accurately informed about what to expect from the enemy.	1	2	3	4	5
10. I saw as much combat as I expected.	1	2	3	4	5
11. I was informed about the role my unit was expected to play in the deployment.	1	2	3	4	5
12. When I was deployed I had a pretty good idea of how long the mission would take to complete.	1	2	3	4	5
13. I was accurately informed of what daily life would be like during my deployment.	1	2	3	4	5
14. I was adequately trained to work the shifts required of me during my deployment.	1	2	3	4	5
15. I had enough gear to protect myself in case of an attack.	1	2	3	4	5
16. I received adequate training for the nature of the deployment I experienced.	1	2	3	4	5
17. I was accurately informed about what to expect from enemy combatants.	1	2	3	4	5
18. I was trained by people who were knowledgeable and well-informed about the topics they were covering.	1	2	3	4	5
19. I had a pretty good idea of how long my deployment would last.	1	2	3	4	5
20. I was accurately informed of what daily life would be like.	1	2	3	4	5
21. My military duties and assignments were what I expected.	1	2	3	4	5
22. My unit was prepared to operate as a team during deployment.	1	2	3	4	5

SECTION K: UNIT SUPPORT

The statements below are about your relationships with other military personnel while you were deployed. As used in these statements, the term “unit” refers to those you lived and worked with on a daily basis during deployment. Please describe how much you agree or disagree with each statement by circling the number that best fits your choice.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
1. My unit was like family to me.	1	2	3	4	5
2. I felt a sense of camaraderie between myself and other soldiers in my unit.	1	2	3	4	5
3. Members of my unit understood me.	1	2	3	4	5
4. Most people in my unit were trustworthy.	1	2	3	4	5
5. I could go to most people in my unit for help when I had a personal problem.	1	2	3	4	5
6. My commanding officer(s) were interested in what I thought and how I felt about things.	1	2	3	4	5
7. I was impressed by the quality of leadership in my unit.	1	2	3	4	5
8. My superiors made a real attempt to treat me as a person.	1	2	3	4	5
9. The commanding officer(s) in my unit were supportive of my efforts.	1	2	3	4	5
10. I felt like my efforts really counted to the military.	1	2	3	4	5
11. The military appreciated my service.	1	2	3	4	5
12. I was supported by the military.	1	2	3	4	5
13. I felt a sense of camaraderie with other members of my unit.	1	2	3	4	5
	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
14. Others in my unit understood me.	1	2	3	4	5
15. Other unit members appreciated my efforts.	1	2	3	4	5
16. Other unit members were there to “back me up” if things went wrong.	1	2	3	4	5
17. Unit leaders were interested in what I thought and how I felt about things.	1	2	3	4	5
18. Unit leaders made a real attempt to treat me as a person.	1	2	3	4	5
19. Unit leaders supported the decisions I made during deployment.	1	2	3	4	5
20. I felt like my efforts really counted to the military leadership.	1	2	3	4	5
21. My service was appreciated by the military leadership.	1	2	3	4	5
22. I was supported by the military leadership.	1	2	3	4	5

SECTION L: RELATIONSHIPS WITHIN UNIT

The next set of questions is again about your relationships with other military personnel while deployed. Please describe how often you experienced each circumstance by circling the number that best fits your choice.

While I was deployed, military leaders or other service members:	Never	Once or twice	Several times	Many times
1. …treated me in an overly critical way.	1	2	3	4
2. …behaved in a way that was uncooperative when working with me.	1	2	3	4
3. ... treated me as if I had to work harder than others to prove myself.	1	2	3	4
4. ... questioned my abilities or commitment to perform my job effectively.	1	2	3	4
5. ... acted as though my mistakes were worse than others.	1	2	3	4
6. …tried to make my job more difficult to do.	1	2	3	4
7. ..."put me down" or treated me in a condescending way.	1	2	3	4
8. ... gossiped about my sex life or spread rumors about my sexual activities.	1	2	3	4
9. ... made crude and offensive sexual remarks directed at me, either publicly or privately.	1	2	3	4
10. ... offered me some sort of reward or special treatment to take part in sexual behavior.	1	2	3	4
11. ... threatened me with some sort of retaliation for not being sexually cooperative (for example, the threat of a negative review, physical violence, or to ruin my reputation).	1	2	3	4
12. ... made unwanted attempts to stroke or fondle me (for example, stroking my leg or neck).	1	2	3	4
13. ...made unwanted attempts to have sex with me.	1	2	3	4
14. ...forced me to have sex.	1	2	3	4
15. ...threatened my physical safety.	1	2	3	4
16. ...spread negative rumors about my sexual activities.	1	2	3	4
17. ...pressured me into unwanted sexual activity.	1	2	3	4
18. ...threatened me with some sort of retaliation for not being sexually cooperative (for example, the threat of a negative review or physical violence).	1	2	3	4

SECTION M: LIFE & FAMILY CONCERNS

The following set of statements refers to concerns you may have had related to your life and family back home while you were deployed. These questions do not ask if these events actually occurred, but only how concerned you were that they might happen while you were deployed. Please describe how concerned you were by circling the number that best fits your choice.

While I was deployed, I was concerned about:	Not applicable	Not at all	A little	Moderately	A great deal
…missing out on a promotion at my job back home.	0	1	2	3	4
…missing out on opportunities to start a career while I was away.	0	1	2	3	4
3. …damaging my career because I was overseas for a long time.	0	1	2	3	4
4. …losing touch with my co-workers or supervisors back home.	0	1	2	3	4
5…being unable to financially support my family while I was away.	0	1	2	3	4
6. …harming my relationship with my spouse/significant other.	0	1	2	3	4
7. …being left by my spouse/significant other.	0	1	2	3	4
…missing out on my children’s growth and development while I was away.	0	1	2	3	4
9. …losing touch with my friends.	0	1	2	3	4
10. …missing important events at home such as birthdays, weddings, funerals, graduations, etc.	0	1	2	3	4
11. …the well-being of my family or friends while I was away.	0	1	2	3	4
12. …my inability to help my family or friends if they had some type of problem.	0	1	2	3	4
13. …my inability to directly manage or control family affairs.	0	1	2	3	4
14. …the care that my children were receiving while I was away.	0	1	2	3	4
15. …damaging my career because I was deployed for a long time.	0	1	2	3	4
16. …the care that my child(ren) or other dependents were receiving.	0	1	2	3	4
17. …the care that my pet(s) were receiving.	0	1	2	3	4
18. …being cheated on by my spouse or significant other.	0	1	2	3	4
19. …the safety and well-being of a loved one who was also deployed.	0	1	2	3	4
20. …my family’s ability to manage their stress and worries about my safety.	0	1	2	3	4
21. …my spouse or significant other’s ability to manage the household (for example, chores, bills, home repairs, etc.).	0	1	2	3	4
22. …how my finances were being managed.	0	1	2	3	4

SECTION N: FAMILY EVENTS

The next set of statements refers to stressful family events that you may have experienced during your deployment. Please circle “Yes” or “No” for each question below.

While I was deployed:
1. …I had serious problems getting in touch with a family member or other loved one.	Yes	No
2. …a family member or other loved one suffered a serious physical illness or mental health crisis.	Yes	No
3. …a family member or other loved one had serious legal problems.	Yes	No
4. …a family member or other loved one was injured.	Yes	No
5. …a family member or other loved one was severely mistreated.	Yes	No
6. …a family member or other loved one passed away.	Yes	No
7. …my family had serious money problems.	Yes	No
8. …a spouse or significant other cheated on me.	Yes	No
9. …a spouse or significant other heard that I had cheated on him/her.	Yes	No
10. …my relationship with a spouse or significant other ended.	Yes	No
11. …I had a major conflict with a family member or other loved one.	Yes	No
12. …I stopped hearing from a family member or other loved one.	Yes	No
13. …my family or other loved ones had serious difficulty adjusting to my absence.	Yes	No
14. …my home was robbed or broken into.	Yes	No
15. …my money or belongings were stolen.	Yes	No
16. …a family member or other person I trusted stole or wasted my money.	Yes	No
17. …I learned that a loved one was doing things I disapproved of.	Yes	No
18. …a family member or other loved one was also deployed.	Yes	No
19. …a family member got into serious trouble at home, at school, or in the community.	Yes	No

SECTION O: SUPPORT FROM FAMILY/FRIENDS

The next set of statements refers to social support from family or friends during your deployment. Please describe how much you agree or disagree with each statement by circling the number that best fits your choice.

During my deployment:	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
1. ...I was carefully listened to by family members or friends.	1	2	3	4	5
2. ...I had family members or friends back home who were proud of my service to my country.	1	2	3	4	5
3. ...Among my friends or relatives, there was someone who made me feel better when I was feeling down.	1	2	3	4	5
4. ...I had problems that I could not discuss with family or friends.	1	2	3	4	5
5. ...Among my friends or relatives, there was someone I could talk to when I needed good advice.	1	2	3	4	5
6. ...People at home just did not understand what I was going through.	1	2	3	4	5
7. ...My friends and family respected my role in the Armed Forces.	1	2	3	4	5
8. ...I had friends or relatives to look out for my family or other dependents (including pets), or take care of my finances, property, or belongings if needed.	1	2	3	4	5
9. ...I was disappointed by how little communication I got from home.	1	2	3	4	5
10. ...I was disappointed by how little support I got from home.	1	2	3	4	5
11. ...There were people at home who cared about me.	1	2	3	4	5
12. ...I had friends or family members I could talk to about my deployment experiences.	1	2	3	4	5

SECTION P: POSTDEPLOYMENT REINTEGRATION

You have completed the questions about your deployment. The next set of statements relates to experiences that you may have had in the process of readjusting/reintegrating into life at home after deployment. Please describe how much you agree or disagree with each statement as it reflects your experiences IN THE FIRST THREE MONTHS AFTER YOU RETURNED FROM DEPLOYMENT by circling the number that best fits your choice.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
1. The transition back from deployment went smoothly.	1	2	3	4	5
2. I was frustrated by people asking me questions about my deployment.	1	2	3	4	5
3. Finding a job or returning to work or school was difficult for me.	1	2	3	4	5
4. I was happy at work or school.	1	2	3	4	5
5. I had trouble getting along with others at work or school.	1	2	3	4	5
6. Other people’s complaints about their daily lives irritated me.	1	2	3	4	5
7. I felt more comfortable talking to my military buddies than my friends or family.	1	2	3	4	5
8. I had trouble dealing with people who reminded me of the enemy.	1	2	3	4	5
9. I didn’t feel needed by friends, family, or coworkers anymore.	1	2	3	4	5
10. I felt like I was in the way around my friends and family.	1	2	3	4	5
11. I no longer fit in with my friends and family.	1	2	3	4	5
12. I had trouble relaxing around friends and family.	1	2	3	4	5
13. I enjoyed doing the things I used to do.	1	2	3	4	5
14. I spent a lot of time watching TV shows, listening to radio programs, or reading articles about the war.	1	2	3	4	5
15. It was hard for me to stop thinking about things that happened during the deployment.	1	2	3	4	5
16. People bothered or annoyed me more than they used to.	1	2	3	4	5
17. People voiced opinions about the deployment that made me angry.	1	2	3	4	5
18. I found it hard to be around old friends.	1	2	3	4	5
19. I had an easy time making new friends.	1	2	3	4	5
20. Someone I once relied on for support was no longer around.	1	2	3	4	5

SECTION Q: POSTDEPLOYMENT SUPPORT

You have completed the questions about your deployment. The next set of statements refers to social support after deployment. Please decide how much you agree or disagree with each statement and circle the number that best fits your choice.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
The reception I received when I returned from my deployment made me feel appreciated for my efforts.	1	2	3	4	5
2. The American people made me feel at home when I returned.	1	2	3	4	5
3. When I returned, people made me feel proud to have served my country in the Armed Forces.	1	2	3	4	5
4. I am carefully listened to and understood by family members or friends.	1	2	3	4	5
5. Among my friends or relatives, there is someone who makes me feel better when I am feeling down.	1	2	3	4	5
6. I have problems that I can't discuss with family or friends.	1	2	3	4	5
7. Among my friends or relatives, there is someone I go to when I need good advice.	1	2	3	4	5
8. People at home just don't understand what I have been through while in the Armed Forces.	1	2	3	4	5
9. There are people to whom I can talk about my deployment experiences.	1	2	3	4	5
10. The people I work with respect the fact that I am a veteran.	1	2	3	4	5
11. My supervisor understands when I need time off to take care of personal matters.	1	2	3	4	5
12. My friends or relatives would lend me money if I needed it.	1	2	3	4	5
13. My friends or relatives would help me move my belongings if I needed to.	1	2	3	4	5
14. When I am unable to attend to daily chores, there is someone who will help me with these tasks.	1	2	3	4	5
15. When I am ill, friends or family members will help out until I am well.	1	2	3	4	5
16. The reception I received from my family made me feel appreciated for my efforts.	1	2	3	4	5
17. The reception I received from members of my community made me feel appreciated for my efforts.	1	2	3	4	5
18. The people I work with respect the fact that I served my country.	1	2	3	4	5
19. I am carefully listened to by family members or friends.	1	2	3	4	5

SECTION R: POSTDEPLOYMENT FAMILY EXPERIENCES

The sentences below refer to family experiences for military personnel who are CURRENTLY married or living with other family members. Please describe how much you agree or disagree with each statement by circling the number that best fits your choice. If you spend time in more than one family setting, please answer these questions about the family in which you spend the greatest amount of time.

PLEASE SKIP TO SECTION S IF YOU ARE NOT MARRIED OR LIVING WITH OTHER FAMILY MEMBERS.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
1. People in my family do things together.	1	2	3	4	5
2. Family members get on each other’s nerves.	1	2	3	4	5
3. Family members feel uncomfortable with each other.	1	2	3	4	5
4. Family members are there for each other during difficult times.	1	2	3	4	5
5. Family members feel very close to each other.	1	2	3	4	5
6. Family members avoid each other.	1	2	3	4	5
7. When problems arise, family members compromise.	1	2	3	4	5
8. Family members are afraid to say what is on their minds.	1	2	3	4	5
9. There is fighting among family members.	1	2	3	4	5
10. Family members yell when they are angry with each other.	1	2	3	4	5
11. Family members discuss their personal problems with each other.	1	2	3	4	5
12. Family members share household responsibilities.	1	2	3	4	5
13. Family members are affectionate with each other.	1	2	3	4	5
14. Family members insult or swear at each other.	1	2	3	4	5
15. Family members are critical of each other.	1	2	3	4	5

SECTION S: POST-DEPLOYMENT LIFE EVENTS

The next statements refer to events you may have experienced SINCE RETURNING FROM YOUR DEPLOYMENT. These questions are similar to the items you’ve answered previously about events

before your deployment. For this page, please circle “Yes” or “No” for each question below.

Since returning home, I have experienced…
1. ...a natural disaster (for example, a flood or hurricane), a fire, or an accident in which I was hurt or my property was damaged.	Yes	No
2. ...exposure to a toxic substance (such as dangerous chemicals or radiation).	Yes	No
3. ...combat or exposure to a war-zone (in the military or as a civilian).	Yes	No
4. ...a serious operation.	Yes	No
5. ...a mental illness (for example, clinical depression or anxiety disorder), or life-threatening physical illness (for example, cancer or heart disease) of someone close to me.	Yes	No
6. ...the death of someone close to me.	Yes	No
Since returning home, I have...
7. ...experienced stressful legal problems (for example, being sued or suing someone else).	Yes	No
8. ...witnessed someone being assaulted or violently killed.	Yes	No
9. ...been robbed or had my home broken into.	Yes	No
10. ...had a family member with a serious drug or alcohol problem.	Yes	No
11. ...been unemployed and seeking employment for at least 3 months.	Yes	No
12. ...been emotionally mistreated (for example, shamed, embarrassed, ignored, or repeatedly told I was no good).	Yes	No
13. ...experienced unwanted sexual activity as a result of force, threat of harm, or manipulation.	Yes	No
14. ...been physically injured by another person (for example, hit, kicked, or beaten up).	Yes	No
15. ...lost my job.	Yes	No
16. ...gone through a divorce or been left by a partner or significant other.	Yes	No
17. ...had problems getting access to adequate healthcare.	Yes	No
Since returning home:
18. ...I have experienced a natural disaster (for example, a hurricane), a fire, or an accident in which I or someone close to me was hurt or had serious property damage.	Yes	No
19. ...someone close to me has experienced serious physical or mental health problems.	Yes	No
20. ...a close family member or friend has experienced a serious drug or alcohol problem.	Yes	No
21. ...I have witnessed someone being seriously assaulted or killed.	Yes	No
22. ...I have lost my job or been demoted.	Yes	No
23. ...I have been emotionally mistreated by a family member or other loved one (for example, ignored or repeatedly told I was no good).	Yes	No
24. ...I have experienced serious financial problems.	Yes	No
25. ...I have experienced serious physical or mental health problems.	Yes	No
26. ...I have experienced stressful legal problems (for example, being sued, suing someone else, or being in a custody battle).	Yes	No
27. ...I have been seriously physically injured by another person (for example, hit or beaten up).	Yes	No

SECTION T: POST-DEPLOYMENT DISTRESS

The following statements refer to feelings you may have had since returning from your deployment. Please think about the event or events that were most disturbing to you while you were deployed and respond to the statements about experiences or feelings you have had in the last three months. Circle the number that best fits your choice.

In the last three months I have been bothered by...	Not at all	A little bit	Moderately	Quite a bit	Extremely
...repeated, disturbing memories of my military experiences.	1	2	3	4	5
...repeated, disturbing dreams of my military experiences.	1	2	3	4	5
...suddenly acting or feeling as if my military experiences were happening again.	1	2	3	4	5
...feeling very upset when something happened that reminded me of my military experiences.	1	2	3	4	5
...trouble remembering important parts of my military experiences.	1	2	3	4	5
...loss of interest in activities that I used to enjoy.	1	2	3	4	5
...feeling distant or cut off from other people.	1	2	3	4	5
...feeling emotionally numb, or being unable to have loving feelings for those close to me.	1	2	3	4	5
...feeling as if my future will somehow be cut short.	1	2	3	4	5
...trouble falling or staying asleep.	1	2	3	4	5
...feeling irritable or having angry outbursts.	1	2	3	4	5
...having difficulty concentrating.	1	2	3	4	5
...being “super alert,” or watchful or on guard.	1	2	3	4	5
...feeling jumpy or easily startled.	1	2	3	4	5
...having physical reactions when something reminds me of my military experiences.	1	2	3	4	5
In the past three months, I have tried to:
...avoid thinking about my military experiences, or avoid having feelings about them.	1	2	3	4	5
...avoid activities or situations because they reminded me of my military experiences.	1	2	3	4	5

SECTION U: ADDITIONAL SURVEY INFORMATION

Please check the appropriate response or fill in the required information.

1. What is your gender?

___ Male

___ Female

2. What is your age? ____

3 Are you of Hispanic or Latino origin or descent?

___ Yes, Hispanic

___ No, not Hispanic or Latino

4. In which of the following categories do you feel that you belong? (Please check all that apply)

___ Pacific Islander or Native Hawaiian ___ Black or African/American

___ American Indian or Alaskan Native ___ White

___ Asian ___ Other (Please specify) ____________________

5. What is the highest level of education you have attained?

___ 8^th grade or less ___ Some college

___ Some high school ___ Four-year college graduate

___ High school graduate ___ Some graduate or professional school

___ Vocational or technical training ___ Graduate or professional degree

6. What is your current marital status?

___ Married ___ Divorced

___ Living as a couple ___ Widowed

___ Separated ___ Single/Never married

7. Which of the following categories best describes your 2006 household income before taxes?

___ $15,000 or less ___ $50,001 to $75,000

___ $15,001 to $25,000 ___ $75,001 to $100,000

___ $25,001 to $35,000 ___ Over $100,000

___ $35,001 to $50,000

8. Are you currently serving in the military either on active duty or with the National Guard or Reserves?

___ Yes

___ No

8a. (If Yes) Are you currently:

___ Regular active duty

___ National Guard

___ Reserves

9. Have you ever applied or are you currently applying for service-connected disability status?

___ Yes

___ No

9a. (If yes in past) Did you receive service-connected disability status?

___ Yes

___ No

9b. If yes, What is the total % disability rating you received? ___

9c. What % disability rating did you receive for disability related to your mental health? ___

9d. What % disability rating did you receive for disability related to your physical health?

10. Do you receive disability benefits? (Check all that apply.)

___ Yes, Disability payments from the VA

___ Yes, SSI

___ Yes, SSDI

___ Yes, Worker’s compensation

___ Yes, Disability Insurance from employer

___ Yes, Self-purchased disability insurance

___ Yes, I get disability payments, but not sure where they come from

___ No, I don’t receive any disability payments

11. During what time period was your most recent deployment to Iraq or Afghanistan?

From ____/____/____ (month/day/year)

To ____/____/____ (month/day/year)

12. Was this most recent deployment in support of:

___ OEF (Operation Enduring Freedom)

___ OIF (Operation Iraqi Freedom)

13. When you were deployed, were you:

___ Regular active duty

___ National Guard

___ Reserves

14. What was your branch of the military when you were deployed?

Marines____ Army____ Navy____ Air Force____ Coast Guard ____

15. What was your military rank when you were deployed (e.g., E-5, O-6)? _____________

16. What was your primary military occupation during your most recent deployment?
___ Combat arms

___ Combat support

___ Service support

17. Please briefly describe what duties your unit performed (e.g. transportation, moving equipment from ports to front lines).

___________________________________________________________________________

_______________________________________________________________________________________

18. Where were you stationed?

_______________________________________________________________________________________

19. What was your marital status when you deployed?

___ Married ___ Divorced

___ Living as a couple ___ Widowed

___ Separated ___ Single/Never married

20. Did you have any children when you deployed?

___ Yes

___ No

21. Have you had children since you deployed?
___ Yes

___ No

22. IF YES TO EITHER 18 OR 19: How many children do you have and what are their ages? ____________________________________________

23. Do you think that you have in the past or are currently suffering from deployment-related illnesses?

___ No, never

___ Yes, in the past

___ Yes, currently

24. Did you have an experience during deployment that was so frightening, horrible, or upsetting that, in the past month, you:

a. Have had nightmares about it or thought about it when you did not want to? ___Yes ___No

b. Tried hard not to think about it or went out of your way to avoid situations that reminded you of

it? ___ Yes ___ No

c. Were constantly on guard, watchful, or easily startled? ___ Yes ___No

d. Felt numb or detached from others, activities, or your surroundings? ___ Yes ___ No

25. Did you have any injury(ies) during your most recent deployment from any of the following?

___ Fragment

___ Bullet

___ Vehicular (any type of vehicle, including airplane)

___ Blast (for example, Improvised Explosive Device, RPG, Land mine, Grenade, etc.)

___ Fall

26. Did any injury you received while you were deployed result in any of the following? Check all that apply.

___ Being dazed, confused or “seeing stars”

___ Not remembering the injury

___ Losing consciousness (knocked out) for less than a minute

___ Losing consciousness for 1-30 minutes

___ Losing consciousness for longer than 30 minutes

___ Symptoms of concussion afterward (such as headache, dizziness, irritability, etc.)

___ Head Injury

___ None of the above

Please take a minute to go back through the survey and make sure you haven’t skipped any pages. Thank you for your participation!