Have you or has someone close to you ever served in the military?

• When did you serve?
• Which branch?
• Were you Active Duty, Reserve, or National Guard?
• What was your primary role while you were in the military?
• Were you assigned to a hostile or combative area?
• Did you experience enemy fire or see combat?
• Did you witness casualties? 
• Were you wounded, injured, or hospitalized?
• Did you participate in any experimental projects or tests?
• Were you exposed to chemicals, gases, demolition of munitions, pesticides, hurn pits, or other hazardous substances?
  • Have you ever received a toxic exposure screening?
  • When was your last screening?
• Would you like more information about toxic exposure screenings?

Where do you receive your medical care now?

• Have you ever used the VA for health care?
  • When was your last visit to the VA?
  • Is there a waiver or permission needed to access these records?
• Do you have a service-connected disability or presumptive condition?
  • Do you have a claim pending?
  • If so, what is the nature of the claim?
• Would you like more information about establishing care at the VA?

Do you have a place to go when you leave today?

•  Is your living situation stable?
• Do you feel safe where you live?
• Do you have a stable source of food?
• Do you need assistance in caring for yourself or members of your household?
• Would you like help with this?

Do you have any health concerns related to military service, or do you think that military service is having an effect on your current health?

Post Traumatic Stress

Have you ever experienced or witnessed event(s) which caused you to believe your life or the lives of those around you were in danger? If so, in the past month have you - 

• Had nightmares or unwanted thoughts about the event(s)?
• Tried hard not to think about the event(s) or avoided situations that reminded you of the event(s)?
• Been constantly on guard, watchful, or easily startled? Felt numb or detached from people, activities, or your surroundings?
• Felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused?
• Felt guilty for surviving events in combat?
• Would you like help with this?

Military Sexual Trauma

During military service, did you:

• Receive uninvited or unwanted sexual attention that you found threatening, such as touching, cornering, pressure for sexual favors, sexual harassment, or sexual remarks?
• Have sexual contact against your will or when you were unable to say no?
• Is this an ongoing problem?
• Would you like help with this?

Blast Concussions/Traumatic Brain Injury

• During your service, did you experience:
  • heavy artillery fire, vehicular or aircraft accidents, explosions (improved explosive devices, rocket-propelled grenades, land mines, grenades), or fragments or bullet wounds above the shoulders?
  • Low-Level Blasts - activities like firing heavy weapons, participating in breaching exercises, and working with explosive ordnance?
• Did you have any of these symptoms immediately afterwards:
  • loss of consciousness or being knocked out, being dazed and seeing stars, not remembering the event, or diagnosis of concussion or head injury?
• Would you like help with this?

Recently, have you:

• Wished you were dead?
• Felt that you or your family would be better off if you were dead?
• Had thoughts about killing/hurting yourself?
• Have you ever tried to kill yourself?
• Are you having thoughts of killing yourself right now?

Would you like help with this?

• Do you drink or do drugs?

Recently, have you:

• Had an increased urge to drink or use drugs?
• Had an inability to stop drinking or using drugs?

Would you like help with this?

Veterans and military-connected families may have been exposed to toxic substances during deployment and/or on military bases. Common exposures include:

• Air pollution, such as burn pit smoke
• Chemicals, such as Agent Orange
• Radiation from nuclear weapons, x-rays, or depleted uranium
• Contaminated Water
• Warfare agents such as nerve agents, biological toxins, infectious agents, and gases
• Infectious diseases such as Hepatitis C, Malaria, and rabies etc.

These exposures can place veterans and their families at risk for numerous conditions. The PACT Act expands VA care to cover more than 20 service-related, presumptive conditions related to military-toxic exposures.

National Association of State Directors of Veterans Affairs (NASDVA): Each state or territory has a local “boots on the ground” agency tasked with assisting veterans. Learn more: https://nasdva.us/resources

Veterans Experience Office: 1-855-948-2311 - Calls are answered 24/7, 365 days a year by an agent who has extensive training on VA programs and services.

Women Veterans Call Center: 1-855-VA-WOMEN (1-855-829-6636) - Mon-Fri 8 a.m. - 10 p.m. ET; Sat 8
a.m. - 6:30 p.m. ET. Information regarding services the VA provides for women Veterans, including in crisis situations such as suicidal behavior, homelessness, sexual trauma, and domestic violence.

Military Environmental Exposures: Information on the most current environmental hazards. www.va.gov/health-care/health-needs-conditions/chemical-hazardous-materials-exposure

Types of Exposures and Presumptive Conditions: www.va.gov/disability/eligibility/hazardous-materials-exposure/

PACT Act Eligibility: The PACT Act expands eligibility to VA benefits and services for Veterans exposed to burn pits, Agent Orange, and other toxic substances. www.va.gov/PACT

Veterans Crisis Line: Dial 988 then press 1

VA Benefits Specialist: 1-800-MYVA411 (1-800-698-2411)