PTSD Questionnaire (Non-War)
  1. Your Name(*)
    Please let us know your name.
  2. Your Email(*)
    Please let us know your email address.
  3. Phone (###-###-####)
    Invalid Input

  4. Previous Submitted Mental Health Claim

    Invalid Input
  5. Service Details

  6. Branch(es) of Service(*)











    Invalid Input
  7. Please specify your dates of service. If your service dates are too complicated to define here (multiple branches, full time followed by active reserve duty, etc. please explain in "additional notes" field below.
  8. Date Entered(*)
    / / Invalid Input
    Date you entered the military

  9. Date Discharged(*)
    / / Invalid Input
    Date you discharged from the military

  10. Discharge Type(*)



    Invalid Input

  11. Stressor Details

  12. Stressor Experience






    Invalid Input
  13. Is stressor documented by records?

    Invalid Input
    Your stressor (above) must be something you can document with 1) military medical or personnel records; OR 2) news clippings; OR 3) lay statements (letter(s) from family member or friend that corroborates your account of events)

  14. Incident Occurred Between(*)
    Invalid Input
  15. and This Date(*)
    Invalid Input
  16. Base/Location During Incident(*)
    Invalid Input
  17. Unit Assignment(*)
    Invalid Input
    With what unit did you serve?
  18. MOS(*)
    Invalid Input
    Specify your MOS (your job and its associated MOS code)
  19. Briefly Describe Incident
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      • CTRL + P
        Go line up
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        CTRL +
        + END
        +
        Go to end

      • CTRL + B
        Go to left
      • CTRL + L + L Goto line
      • ALT +
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        +
        END
        CTRL + E
        Goto to line end
      • ALT +
        HOME
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        CTRL + A
        Goto to line start
      • PAGEDOWN OPT + PAGEDOWN
        CTRL + V
        Goto to page down
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      • CTRL + F
        Go to right
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        +
        Go to start
      • CTRL + OPT + Go to word left
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      • SHIFT + TAB SHIFT + TAB Outdent
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        CTRL + Y
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        + Y
        Redo
      • CTRL + D + D Remove line
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        Remove word left
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      • SHIFT + SHIFT + Select right
      • CTRL + SHIFT + END
        ALT + SHIFT +
        + SHIFT + Select to end
      • ALT + SHIFT + + SHIFT + Select to line end
      • ALT + SHIFT + + SHIFT + Select to line start
      • CTRL + SHIFT + HOME
        ALT + SHIFT +
        + SHIFT + Select to start
      • SHIFT + SHIFT + Select up
      • CTRL + SHIFT + OPT + SHIFT + Select word left
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      • CTRL + O Split line
      • CTRL + 7 + 7 Toggle comment
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