As a veteran, you know military service has a lasting impact on your life in many ways. If you had to witness or do something in the military that transgressed your own moral beliefs, values, or ethics, you could be suffering from moral injury.
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In this article about moral injury and PTSD
What is moral injury?
According to the VA, “in traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations. Moral injury is the distressing psychological, behavioral, social, and sometimes spiritual aftermath of exposure to such events.” Some refer to moral injury as a “soul wound” because it deeply affects someone’s morals and values–the core identity of a person.
Moral injury should be taken seriously as it can have adverse effects on your mental health. Studies have shown that morally injurious events can lead to a higher risk of suicide among veterans beyond PTSD and depressive symptoms.
In the context of war, many morally injurious events can take place. Some examples include:
- Failing to report an event that violates rules or ethics
- Killing or harming others
- When medics cannot care for all that was harmed
- Freezing/failing to perform a task during a dangerous or traumatic event
- Witnessing or engaging in acts of disproportionate violence and feeling nothing or exhilaration while causing harm to or killing others
- Officers who have to make decisions that affect the survival of others
It is important to keep in mind that every service member experiences events differently. An event that causes moral injury for one person will not necessarily cause moral injury for another. Because of this, there is no definitive list of morally injurious events.
Symptoms of moral injury
Veterans who experience moral injury often experience many symptoms. They are usually overwhelmed with negative emotions. Feelings of remorse, guilt, and shame from past events that violated their beliefs can be persistent. It is also common to lose trust in people in general after being betrayed by a trusted commander in service, for example. Depression often goes hand in hand with MI. You can also lose interest in once enjoyable activities and find it difficult to feel happy.
Veterans can also frequently relive the events that caused their moral injury. Any trigger can cause painful memories to surface and make it feel as if you are experiencing the events again. This can happen in dreams or when you are fully awake.
If moral injury is not treated properly, many veterans will cope with drugs and alcohol. Drugs and alcohol are an easy but detrimental escape from painful memories.
Veterans will also avoid situations and environments that remind them of the traumatizing event. Whether it be large crowds, a specific place, or a specific time of day, they will try their best to avoid anything that triggers memories of the events.
Guilt and Shame
Guilt and shame are the most common symptoms you can experience with moral injury. It is important to know the difference between the two since they are similar.
Guilt is having a sense of remorse caused by feeling responsible for some offense. Guilt usually occurs when someone feels as if they should have acted, thought, or felt differently in a particular situation.
Someone can feel guilty after going through a traumatic situation for many reasons. They might feel guilty for surviving a traumatic event when someone else didn’t. This is called survivor’s guilt. They may also feel guilty if they were unable to rescue others, or for actions they committed during that time. These actions may include harming or killing people, or engaging in unreasonable violence. Sometimes the guilt service members feel can be inadvertently reinforced by others.
Guilt is a sense of “I did something bad,” while shame is a sense of “I am bad because of what I did.”
Shame is when someone thinks there is something wrong with them (i.e. they think they are a bad person). Some service members experience shame due to their actions or lack of actions they took during their time in service. Some veterans will think of themselves as “damaged” or “tainted” by their actions and think they deserve to suffer from PTSD and other negative experiences. No veteran ever deserves to go through the pain of PTSD or other negative experiences, so it is important veterans get the help they need.
How do I know if I have moral injury?
Unfortunately, moral injury cannot be medically diagnosed like post-traumatic stress disorder (PTSD). The military, the VA, nor the American Psychiatric Association have not sanctioned moral injury as a diagnosis, but the idea is still starting to gain traction. The VA considers PTSD a “mental disorder that requires a diagnosis” and moral injury a “dimensional problem.” However, the symptoms listed above can be accurate detectors of moral injury.
Many self-report questionnaires assess moral injury. The most common is the Moral Injury Questionnaire (MIQ). It consists of 20 questions, and it assesses the frequency and exposure of events that service members may experience in war.
The Moral Injury Events Scale (MIES) asks nine questions about war-related events including perpetration by others or yourself, and betrayal. Three dimensions are assessed: perceived transgressions by self, perceived betrayal by others, and perceived transgressions by others. The MIES measures both the occurrence of transgressive events and the symptoms from those events.
The Moral Injury Symptoms Scale is a lengthier questionnaire that measures ten different dimensions of moral injury: guilt, shame, betrayal, moral concerns, loss of meaning and purpose, difficulty forgiving, loss of trust, self-condemnation, religious struggles, and loss of religious faith and hope.
The Expression of Moral Injury Scale (EMIS) is 17 questions and asks about the experience of moral emotions related to events that took place during your time in the military.
These are not the only tests to determine moral injury. You can also take assessments that look at moral injury’s core features. The Trauma-Related Guilt Inventory measures beliefs and feelings based on guilt surrounding a traumatic event. The Trauma-Related Shame Inventory measures shame surrounding a traumatic event.
Every case of moral injury is a little different because every person is different. It is important to discuss your symptoms with a doctor experienced with PTSD, moral injury, and the VA. Physicians who are not experienced with veterans may mistake moral injury for burnout.
Moral injury vs. PTSD
Moral injury and PTSD have similar symptoms but are different. According to the VA, fear is the underlying component of PTSD, whereas moral injury is feeling alienated from your personal beliefs and ethics. Both start when someone experiences a life-threatening or harmful event to themselves or others. Criteria for diagnosing PTSD can be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is how the American Psychiatric Association (APA) diagnoses and identifies PTSD.
It is likely that someone who suffers from PTSD also has moral injury, but it is not always the case. However, someone could have moral injury and not meet the standards for PTSD. In that situation, the veteran would be denied VA disability for PTSD but still have trouble keeping a job and living their life because of their service-connected moral injury.
MI appears to be a barrier to recovery from PTSD. A study found that out of 427 veterans, 90% had at least one symptom of MI that was rated a nine or ten on a scale from one to ten. Fifty percent had five or more symptoms at the same level.
Another difference between the two conditions is that moral injury begins with an act of transgression. That is not the case with PTSD. Anyone who witnesses or experiences an event they deem traumatic can develop PTSD.
Moral injury VA disability benefits
Since moral injury is not considered a diagnosis and therefore is not eligible for VA disability benefits. Since MI and PTSD have overlapping symptoms and treatments, there is a good chance you would be able to receive PTSD VA disability benefits for moral injury.
To be eligible for PTSD VA disability benefits, a doctor must have diagnosed you with PTSD, you can’t function as well as you once could because of your symptoms, and the stressor happened during your time in service. The VA considers any of the following a traumatic event: you suffered a serious injury, sexual or personal trauma, or sexual violation or you were threatened with injury, death, or other assault.
What Does It Take to Get a 70% PTSD Rating?
Advice from experienced VA disability lawyers on what it takes to get an increased PTSD rating.
How can a VA attorney help?
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Call us today to discuss your VA disability appeal or your first application. The call is free and we won’t charge you a single fee until we win your case. We even pay for the postage for all of the documentation you send to our office. You can look for a VA disability attorney near you or call us and join the thousands of veterans living off of VA disability thanks to Woods and Woods.
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Yes and no. We can help you appeal your PTSD claim to show that your moral injury symptoms are service-connected. The VA won’t give you a rating for moral injury, but Anxiety, PTSD, Depression, and other symptoms of MI qualify for VA disability. We just need to prove the nexus.
The VA is required to give you a rating based on your symptoms, not always the complete diagnosis. If the symptoms of an injury, physical or spiritual, prevent you from living a normal life and were caused by your time in the service, you should get VA disability for that injury. Call us and we’ll see if we can win your claim. The call is free, so you have nothing to lose.