Example Lay Statement for PTSD from Wife

ON A VBA Form 20-10210 or VA Form 21-4138

I, Jane Doe, hereby declare under penalty of perjury that the following is true and correct to the best of my knowledge:

I married my husband, John Doe, on June 17, 2001. He enlisted in the U.S. Marine Corps a year after our wedding and served honorably as a combat engineer from July 2002 to July 2006. Before enlisting, he was a happy person who enjoyed spending time with family and friends. He adored his niece and loved taking her fishing. As a couple, we often took our dogs hiking on the weekends and spent our weeknights watching stand-up comedy after work or cooking dinner together. He never drank much, but he loved to eat. He worked as a chef in a local restaurant, and cooking big meals was one of our favorite things to do together. He had the biggest, warmest heart and lived for his family.

Before John deployed, he was stationed at Camp Lejune and wrote me at least once a week. His letters were lengthy, lighthearted, and reflective of the man I’d always known. However, I hardly heard from him once he deployed to Iraq in August 2003. In his six months overseas, I received about three letters that together totaled less than a page. His tone was very matter of fact. I tried not to worry and hoped things would return to normal once he returned home, but they only got worse.

When John returned, he moved all his things out of our bedroom and into the basement. He isolated himself from everyone: me, his niece, his friends, and his siblings. He lived in the basement with the shades drawn day in and day out; I had to continue working to pay bills because John would not.

When I tried to question him, he became angry and yelled louder than I’d ever heard him before. He began drinking heavily—7 or 8 beers a night before he turned to liquor. He stopped eating and the clothes that used to fit him hung loosely off his emaciated frame. He was also paranoid and reactive. He punched a man at the grocery store he accused of stalking him and had to spend the night in jail. After that, I packed a bag and moved into my parents’ house until John agreed to get help.

A year or so later, John received a DUI and was forced to attend substance abuse meetings. Since cutting back on his drinking, John slowly began to open up to me about what happened while he was deployed. He spoke of the bodies and carnage he saw, and the smell of burning oil. He refused to see a psychologist because he insisted he could care for himself and went back to work as a chef. He threw himself back into what he loved and seemed to improve.

As a result, I agreed to move back home. However, a year later, we attended a neighborhood party on the 4th of July. I was so excited John was feeling social again, and that he seemed to be returning to the man I’d married. Things were going great until some fireworks went off unexpectedly, which sent John into a frenzied rage. He began throwing things and hiding under tables. It took three of his old high school friends to retrain him and help carry him home.

Since that night, John’s mood is unpredictable. He has weeks or so where he seems like his old self before randomly turning into someone I don’t recognize. He recently agreed to attend group therapy sessions at our local VA, and it seems to help him recognize that he needs help. Things are still not the same between us, but I hope treatment will help him find the peace he needs to heal.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________                            ______________________

Jane Doe                                                                               Date

Example Buddy Statement for PTSD

ON A VBA Form 20-10210 or VA Form 21-4138

I, Joe Smith, hereby declare under penalty of perjury that the following is true and correct to the best of my knowledge:

I served with John Doe in the U.S. Marine Corps as a combat engineer from August 1984 to August 1992. We met in basic training and became close friends. Before deployment, John was upbeat, social, and always joking around. He wrote his wife regularly and was well‑liked by everyone in our unit. He had no issues with anger, isolation, or disciplinary problems. He was a dependable Marine and a good friend.

During our deployment to Iraq, the environment was extremely stressful. We were exposed to constant danger, destruction, and traumatic scenes. On September 3, 2003, John and I were assigned to XYZ unit at a checkpoint in Anbar Province. A man and a young girl approached our position rapidly and ignored repeated commands to stop. The man reached into his pocket and produced a weapon. John reacted immediately and fired to protect us. The girl then picked up the weapon and pointed it toward us, forcing John to fire again. We attempted to render aid, but were unsuccessful. This incident deeply affected John, and I witnessed the change in him immediately afterward.

Following that event, John became withdrawn and quiet. He stopped joking around, avoided conversation, and seemed constantly on edge. He began arriving late to assigned duty locations and got into several confrontations with other Marines—behavior that was completely out of character for him. His overall demeanor shifted from confident and social to tense, distant, and irritable.

After we returned home, John rarely kept in touch. I attempted to reach out several times, but he did not respond. This was unusual because we had been close friends throughout our service.

I recently saw John at the VA, and he told me he is in therapy working through what happened during deployment. Although our conversation was brief, it was clear that he is still dealing with the emotional impact of the events we experienced.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________               ______________________

Joe Smith                                                                 Date

Example Buddy Statement for PTSD

ON A VBA Form 20-10210 or VA Form 21-4138

I, Jackson Browne, hereby declare under penalty of perjury that the following is true and correct to the best of my knowledge:

I served with Zeke Bancroft on board the U.S. Navy submarine USS Usta Fish (SSN‑999). I was stationed on the Usta Fish from 1980 to 1984. Zeke worked in the Navigation Division, and we frequently stood watch together both in port and while underway. I knew him well and observed his behavior regularly during daily operations.

In early 1982, while departing France, we encountered extremely rough seas. My recollection is that conditions were around Sea State 5, with waves approximately 8–13 feet high. During surface transit, three men were standing watch in the submarine’s bridge, which is located in the sail and fully exposed to the elements.

During this transit, a large wave washed over the bridge at the same time the submarine was at a down angle. This caused the submarine to dip below the surface unexpectedly, completely immersing the men in the bridge. At that moment, the bridge hatch was open, allowing a solid column of seawater to pour directly into the submarine.

I was on watch as the radar operator in the control room, approximately ten feet from the open hatch. I had a clear view of the flooding and the crew’s response. Water rushed into the boat for several minutes until the Executive Officer, LCDR Bobocheck, and Zeke were able to reach up through the incoming water and close the hatch. Their actions prevented further flooding and likely saved the submarine.

During the casualty, high‑voltage systems were shut down due to the risk of electrical hazards in the seawater. The Commanding Officer ordered an emergency blow of the main ballast tanks. Water continued to wash through passageways, and a fire was reported in the Torpedo Room. There was also uncertainty for several hours about whether the three men in the sail had survived, as communication was impossible until the water level dropped enough to safely open the hatch.

Eventually, all three men were found alive. One officer, Ensign Newbie, had been struck in the head by the clamshell cover during the initial wave and was injured. The other two, Lt. Rockjaw and SN Nub, were extremely shaken after being trapped in the sail without communication, heat, or contact with the crew during the entire emergency.

I witnessed the flooding, the emergency actions taken, and Zeke’s involvement in securing the hatch. This was a severe and traumatic event for everyone involved, and I observed firsthand the stress and danger faced by the crew during the casualty.

If you need any additional information, my name, address, and phone number are listed below.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________               ______________________

Jackson Browne, ETCS(SS) USN Ret.                    Date

Example Buddy Statement for Sleep Apnea

ON A VBA Form 20-10210 or VA Form 21-4138

I, Christopher Robin, hereby declare under penalty of perjury that the following is true and correct to the best of my knowledge:

I served with Ephraim Cochran aboard the submarine USS Flash Fish (SSN‑998) from August 1993 to July 1996. Ephraim and I were both Chief Petty Officers (CPOs). While underway, we lived in the Flash Fish’s CPO quarters, which consisted of a small 12‑person bunk room. When ashore, we shared a townhouse at 1313 Mockingbird Lane, Virginia Beach, Virginia. Because of this, I observed Ephraim’s sleep habits daily for several years.

Throughout our time serving together, Ephraim snored loudly and consistently. His snoring was disruptive enough that other CPOs frequently commented on it. In addition to the loud snoring, I regularly observed pauses in his breathing, followed by gasping or choking sounds before he resumed snoring. At the time, I did not recognize these symptoms as a potential medical condition, but I now understand they are consistent with sleep apnea.

These breathing interruptions occurred both at sea and ashore, regardless of whether he was sleeping in the submarine’s CPO quarters or in our shared townhouse. Ephraim often appeared tired during the day, and I recall him mentioning that he did not feel rested even after a full night’s sleep.

Based on my direct observations over several years, Ephraim exhibited loud snoring, repeated breathing pauses, and gasping episodes during sleep while on active duty.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________               ______________________

Christopher Robin, CSCM(SS) USN Ret.                    Date 

Example Spouse Statement for Sleep Apnea

ON A VBA Form 20-10210 or VA Form 21-4138

I, Sally Cochran, hereby declare under penalty of perjury that the following is true and correct to the best of my knowledge:

I am the wife of Ephraim Cochran, and we have been together for 22 years, including all of his time on active duty in the U.S. Navy. Because of this, I have observed his sleep patterns consistently both during his military service and after discharge.

Throughout our relationship, Ephraim has had significant difficulty sleeping. I frequently observe him stop breathing during sleep, often for several seconds at a time. These pauses are followed either by him resuming breathing on his own or by gasping for air, similar to someone who is choking or struggling to breathe. These episodes occur multiple times throughout the night.

Ephraim also has trouble staying asleep. He wakes up repeatedly and often complains of having a dry mouth in the mornings. These symptoms began while he was still on active duty and have continued ever since.

His sleep issues affect me as well. Because I am worried about his breathing stopping during the night, I often wake up to check on him. This constant concern prevents me from getting a full night’s sleep, and I feel like I have to monitor him to make sure he continues breathing.

Based on my direct observations over many years, Ephraim has had loud snoring, repeated breathing pauses, gasping episodes, and difficulty staying asleep since his time in the Navy.

I hereby certify that the information I have given is true to the best of my knowledge and belief.

_________________________________               ______________________

Sally Cochran                                                           Date