Veterans who were exposed to highly traumatic events during deployment to Iraq or Afghanistan and discharged because of post-traumatic stress disorder recently won a class-action law suit entitling them to lifetime disability benefits, including military health insurance. The ruling affects more than 1,000 veterans with PTSD who were denied these benefits upon discharge. The National Veterans Legal Service Program argued that the military services violated the law by failing to assign a 50 percent disability rating to those discharged for PTSD. A 50 percent disability rating entitles the veteran to disability retirement benefits.

This week one of my patients shared his emotional scars. “On April 1, 2004, I was on a convoy in Amarah, Iraq,” he said. “We started taking sniper fire and then got ambushed. My M-249 gunner was shot in the head and fell onto my lap. In the middle of the firefight, we ran over a mine which flipped our Humvee on its side. I was covered by the blood of my dead gunner and took shrapnel in my arms and legs. I couldn’t believe it was happening. This was supposed to be a normal convoy. It was the worst day in my life. I feel so guilty for my lost gunner. The worst part was having to explain to his son that his daddy wasn’t coming home. I have nightmares every day of my life. It just eats me up inside. It affects my marriage the most because my wife just doesn’t understand my pain.”

PTSD is triggered by terrifying experiences and is accompanied by symptoms that can include nightmares, anxiety, uncontrollable thoughts and flashbacks. Those with PTSD often feel a tremendous sense of separation from their families and friends. I recall another patient, an Asian woman who had just returned from Iraq. Although she suffered no bodily harm, she too described invasive thoughts, irritability, dreams in which she relives horrifying scenes, and difficulty relating to her boyfriend.

It is so much easier to appreciate the stark reality of physical disfigurement, such as an amputated limb, but PTSD is a common problem affecting as many as 35 percent of veterans returning from war. Last year alone more than 400,000 veterans who received mental health services had a diagnosis of PTSD.

Treatment can be challenging. Veterans Affairs Department researchers recently found that the second most commonly prescribed drug is no more effective than a placebo. The Food and Drug Administration has approved only two drugs, Zoloft and Paxil, for treatment.

On another front the Department of Defense and Veteran’s Affairs have jointly developed a free smartphone application, PTSD Coach.

Designed for veterans to help themselves outside of the doctor’s office, it includes a self-assessment mode to gauge distress levels and the ability to bring up meaningful, reassuring and inspiring photos and music. It also provides educational material and teaches users important coping mechanisms and self-management techniques.

From 2001 to 2011 military medical costs rose twice as fast as national health care costs and went from 6 percent to 9 percent of overall defense spending.

Treatment of PTSD and assignment of disability benefits and health insurance come at a tremendous cost, but they are the right thing to do.