Since the Vietnam War, hundreds of thousands of veterans have received other-than-honorable (OTH) discharges, many for misconduct related to post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Many veterans don’t realize that they may be eligible for a discharge upgrade, if the evidence shows they experienced service-related trauma.

On leaving the military, service members receive one of six discharge designations that determines their eligibility for healthcare and disability benefits provided by the U.S. Department of Veteran Affairs (V.A.). However, an OTH discharge can render soon-to-be veterans potentially ineligible for V.A. benefits, leaving those with mental and physical injuries without access to life-saving treatments.

In 2017, the U.S. Government Accountability Office found that 62 percent of the over 90,000 service members discharged for misconduct between 2011 and 2015 had been diagnosed with PTSD or a TBI at least two years before release. These results added to growing concerns that trauma may be contributing to veterans’ misconduct, leading to these less-than-honorable discharges.

The loss of benefits is not the only setback, however. When vets leave the military with an OTH discharge and try to integrate back into civilian life, it can cause debilitating shame, create barriers to employment, and increase a veteran’s risk of becoming homeless or of committing suicide.

Coco Culhane is the founder and executive director of the Veteran Advocacy Project, a non-profit that provides free, legal services to low-income veterans seeking discharge upgrades and more. “I find this shocking,” she said at Bronx Community Board 7 (CB7) Veterans’ Affairs Committee meeting on Apr. 28. “To me, it’s the clearest indication that we are punishing mental injury and mental illness.” she added.

Culhane said when clients of her nonprofit who have experienced trauma learn about the discharge upgrades, they realize they’re not alone. “[They] were just up against this unjust system,” she said. “It can be healing to realize that their misconduct was out of their control.”

According to data collated by the V.A.’s National Center for PTSD, roughly 22 percent of all veterans who fought in Afghanistan and Iraq sustained brain injuries, compared to 12 percent of Vietnam veterans. TBIs can be caused by improvised explosive device (IED) blasts, motor vehicle accidents, and gunshot wounds. The severity of symptoms can range from mild, causing temporary headache and dizziness, to more severe, including angry outbursts, anxiety, depression, and marked changes in personality.

Unlike brain injuries, which are caused by a sudden blow or jolt to the head, PTSD, generally, can occur when a person is exposed to life-threatening situations related to, or during, combat.

The VA estimates between 11 to 20 percent of veterans who served in Afghanistan and Iraq live with PTSD compared to 30 percent of veterans who served in Vietnam.

Veterans seeking an OTH discharge upgrade should know the process can be long and arduous, and includes a review by one of two military boards, each governed by its own set of rules and regulations. In total, the entire process can take up to 24 months or longer.

However, without an OTH discharge upgrade, veterans can still apply for V.A. benefits and health care through a process called Character of Discharge or COD. Unlike the process for applying for a discharge upgrade, where a bulk of the work falls on the shoulders of the veteran, a COD review is carried out by the V.A., and the process is triggered when a veteran first applies for benefits.

Upon review of the veteran’s record of service, the V.A. will decide whether to grant him, her or them an honorable COD. If obtained, the veteran will then be given the equivalent of a waiver into the V.A. However, it is not considered a discharge upgrade.

Most veterans and their spouses aren’t aware of this health care option, a point raised by committee member, Jean Hill, at the Apr. 28 Veteran Affairs Committee meeting. “I’ve been the wife of a veteran for years and I’ve never heard of this before,” she said at the time.