Academic Reasonable Accommodations for Post-9/11 Veterans With Psychiatric Diagnoses, Part 1

Age differences, multiple roles, and lack of shared life experiences with traditional college students contribute to student veterans’ perceptions of a paucity of campus social support and often lead to a sense of distinct isolation.^18,19 These added stressors deplete a veteran’s ability to concentrate on academic studies and may exacerbate the effects of underlying mental health diagnoses, transition issues, and medication use.

Symptomatic psychiatric diagnoses can amplify the difficulties normally experienced when changing from a veteran role to a student veteran role.¹ The student veteran’s apprehension about returning to school often is elevated because of the time gap since the veteran was last in a formal, nonmilitary classroom. Acclimated to the structured style of military coursework for many years, student veterans may find adjusting to new teaching styles or different academic expectations awkward.^20,21 They may experience heightened anxiety, because expectations of classroom performance may not be as clearcut as it was in the military. Such heightened anxiety can compound learning difficulties caused by underlying emotional states, transition issues, medication AEs, and life stressors.

Related: The VA/DoD Chronic Effects of Neurotrauma Consortium: An Overview at Year 1

Many student veterans with impaired learning ability related to psychiatric symptoms also have secondary physical diagnoses that can impede learning. For example, tinnitus and hearing loss are common in combat veterans.^22,23 These issues make it hard to participate in a classroom setting because of difficulty in recognizing speech or filtering out background noise. For some, chronic pain may impede concentration, depress mood, worsen irritability, and make prolonged sitting difficult.^24,25 Physical disabilities related to amputation or major joint injury may present challenges to participating in certain types of college settings and/or navigating between classes in a timely fashion.²⁶

Although mild-to-moderate TBI sustained in combat often will spontaneously resolve within 3 months, in some individuals, TBI symptoms may persist after months or years.^27,28 During this time, learning styles may be altered for veterans exposed to TBI. Similar to the effects caused by other factors impeding learning in post-9/11 veterans, common post-TBI symptoms that reduce academic performance include fatigue, decreased memory, slowed abstract thinking, difficulty articulating thoughts, poor tolerance to frustration, sleep difficulties, chronic pain, and increased irritability.^27-29 Veterans with a history of mild TBI often are found to have clinically significant rates of depression, anxiety, or posttraumatic stress disorder (PTSD).^27,28,30,31 These findings mirror those found in the general population.³² Mild TBI and PTSD may further complicate the learning process by exacerbating underlying mental health symptoms that already impair academic performance. The degree to which these individuals with TBI and mental health issues will return to premorbid academic functioning is not predictable based on current literature.³³

Recognizing the stressors that some combat veterans face in an academic setting is vital to anticipating the added support that is needed by student veterans with concurrent moderate-to-severe psychiatric issues.³⁴ Symptoms usually noted in the transition period may be much more pronounced. Automatic behaviors developed as survival responses during deployment can complicate participation in the educational arena.^4,35 Seemingly mundane tasks, such as the daily school commute, can cause significant anxiety and hypervigilance especially when the veterans must navigate crowds and traffic formerly associated with risk of attack in combat-related circumstances.⁴ Minor roadway debris or roadside construction also can abnormally heighten anxiety because of reflex training to avoid potentially hidden explosive devices during convoy movements.⁴ Random assignment of a classroom seat can be stress-provoking, because combat veterans’ training compels them to position themselves with the greatest vantage point, usually nearest to exits and with minimal activity behind them.^4,35 A need to constantly survey the surroundings for potential cover from hostile events can cause hyper alertness that distracts the student veteran’s full concentration on academic tasks.^3,4

Although veterans should be able to adjust learning styles for minor issues or transitory problems, significant psychiatric symptoms have a negative effect on learning and pose a direct threat to academic performance.^33,36-38 Moderate-to-severe psychiatric concerns may further heighten transition symptoms, compound psychosocial adjustment, and complicate TBI recovery. In addition, periods of high stress may further provoke symptoms of the underlying psychiatric diagnosis.

Reasonable Accommodations

In postsecondary education, reasonable accommodations are formal modifications or adjustments in the school environment that enable individuals with physical or psychological issues to successfully learn and function within the academic institution. In general, these academic accommodations for student veterans with mental health diagnoses involve modifying the learning environment to compensate for delays in executive functioning, such as memorization, recall, and complex analysis. Coursework is not altered; rather specific actions are used to assist the student to process and recall the material more easily. The reasonable accommodations also may be structured in a way that avoids exacerbating an underlying mental health diagnosis, such as PTSD or anxiety. The purpose of reasonable accommodations is to effectively remove barriers to a student veteran’s ability to learn and succeed academically.