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Combat Veterans Survey
1.
Branch Served
Army
Navy
Marine Corps
Air Force
Coast Guard
2.
How long did you serve in the military?
1-4 years
4-8 years
8-12 years
12-20 years
20 + years
3.
Did you serve in Afghanistan or Iraq after 9/11?
Yes
No
4.
Were you assigned to a Combat MOS?
Yes
No
5.
Were you a Special Operator?
If so, please check all that apply.
N/A
Army Ranger
Army Special Forces
Delta
160th SOAR
Navy SEALs
MARSOC
USMC Force Recon
Marine Raider Regiment
AF Special Tactics
AF Combat Control Team
6.
How many tours did you serve in Combat?
7.
Were you injured during Combat?
Yes
No
8.
Do you suffer from Combat PTSD?
Yes
No
9.
Did you sustain any of the listed physical injuries?
Open wounds
Type 1 TBI/ facial injuries
Disseminated Injuries
Type 2 TBI
Lower extremity injuries
Burns
Chest/ abdominal
None
10.
Were you medically discharged?
Yes
No
11.
Do you receive VA benefits?
Yes
No
12.
Are you 100% disabled per the VA?
Yes
No
13.
Do you take any form of pharmaceuticals prescribed for injuries related to Combat?
Yes (If so, please check all that apply)
Pain Management
Anxiety/Depression
Sleep Disorder
No
14.
Do you drink alcohol?
Yes
No
15.
If so, how often?
Social
Daily
High-Level Daily
Binge
N/A
16.
Do you use tobacco products?
Yes
No
17.
Do you use cannabis or any form (Delta 8 or 9)?
Yes
No
If Yes, do you prefer Indica
If Yes, do you prefer Sativa
18.
Do you use or have used recreational drugs since Combat exposure?
Yes (if yes, check all that apply)
Cocaine
Methamphetamine
Heroin
Mushrooms
MDMA (Ecstasy/Molly)
NO
19.
Do you use anabolic Steroids?
Yes
No
20.
Have you been diagnosed with an autoimmune disorder?
Yes
No
21.
Have you been diagnosed with any mental health disorders?
Yes
No
22.
Have you received medical care for any conditions related to your service?
Yes
No
23.
Do you feel the VA has been helpful in navigating benefits, healthcare, or other services? (Please explain)
24.
Gender
Male
Female
25.
Race
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Another race
26.
Relationship status
Married
Seperated
Divorced
Dating
Single
27.
Did your relationship change after military service ended?
Yes
No
28.
Have you been arrested since your military service ended?
Yes
No
29.
Have you ever been arrested for the following:
Domestic Violence
Battery
DUI
Reckless Driving
N/A
30.
Did the state/county where you were arrested, offer Veteran Court?
Yes
No
N/A
31.
Do you believe your charges were related to combat trauma and NOT criminal activity?
Yes
No
N/A
32.
Do you have a support group/person?
Yes
No
33.
Do you have a pet?
Dog
Cat
Other
34.
Do you have a support animal?
Yes
No
35.
Please add any additional comments related to this survey