CRC survey1

Veterans of the Afghanistan and Gulf Theaters of Operation Survey

Please indicate your branch of military service:

I. Army Navy Air Force Marines Coast Guard

a. Were you deployed as a member of the U.S. Reserves or National Guard? Yes No

1. Please select "yes" or "no" for the following questions:

b.Were you employed at the time of deployment? Yes No

c.Were you away from home for more than 15 days? Yes No

d. Do you currently have an injury, disability or chronic illness? Yes No

GENERAL INFORMATION

Please note: The term employer refers to your employer at the time of your most recent deployment.

2. How many times have you been deployed overseas in the last five years?

3. Please indicate the month and year you began your most recent deployment (mm/yy)

3a.

4. How long was your most recent deployment in months (total time away from home)? months

5. Based on the scale below what was your rank, or equivalent, at the end of your most recent deployment?

E1-E4 E5-E9

CW1-CW2 CW3-CW5 O1-O3 O4-O6

Other

6. At the time of your deployment, how long had you been employed with your employer? years

months

7. How many hours did you work on average?

Less than 15 hours per week

15-30 hours per week (part-time)

more than 30 hours per week (full-time)

8. Please describe the industry that best describes your employer:

9. Please select the size of your employer:

15 or less employees 16-100 employees 101-500 employees 501-1000 employees 1001-5000 employees more than 5000 employees

10. What was your annual household gross income before the deployment?

below $15,000 $15,000-24,999 $25,000-$49,999 $50,000-99,999 $100,000-200,000 $200,000+

EXPERIENCES OF DEPLOYMENT

Please reflect back on your most recent deployment experience and indicate how often you experienced the following circumstances/events.

EXPERIENCE OF ORGANIZATIONAL SUPPORT

Listed below are some common ways employers have shown support to military personnel who were called to active duty. Please indicate whether or not you received/experienced the type of support from your employer as described below.

11.Were you working for wages before your last deployment? Yes No

11a. If yes, what was your monthly take home pay from this job only. $ per month

12. When you returned from your deployment did you return to your same pre-deployment job? Yes No

12a. If no, what was your primary reason for not returning to your pre-deployment job?

Job was no longer available (company eliminated position, downsized etc).

Returned to school. Decided to change career/profession.

Received a better job offer from another company. Did not feel supported by employer and decided not to go back.

Family circumstances (death in family, etc). Relocated. Unable to work due to disability sustained during deployment

Other

13. If you are currently looking for work, what has been the reaction from employers concerning your disability and war experience?

14. Have you worked with a Certified Rehabilitation Counselor to help you transition back to work? yes no

14a.If yes, how has the experience of working with a rehabilitation counselor been for you?

14b. Is there any information you think would be helpful for rehabilitation counselors to have in working with veterans returning from deployment?

15. What is your current monthly take home pay from this job only? $per month

16. How much time did you take off before going back to work?

No time off Less than 2 weeks 2-4 weeks 5-7 weeks

8-10 weeks 10-12 weeks more than 12 weeks

17. Please take a moment and describe your work experiences since returning from deployment and working with a disability.

18. Are you still employed with the same company today?

Yes

No, I left the company after being there for Please indicate weeks, months, years.

21. Are you a member of U.S.A.R. or similar reserve? (Meaning, are you currently drilling as a member of a reserve component?)

Yes No

.22.What is your age? 23. Are you Female Male

23a. What is your injury (disability) or chronic illness?

(30.) How old were you when you were diagnosed or started experiencing this condition?

years

24. How would you best describe your race (ethnic group)?

25. What is your marital status ?

	Married or living as married		Divorced
	Separated		Never married
	Widowed		Other

26. Which of the following best describes your highest level of education ?

	Less than high school		College graduate
	High school grad. or equivalent		Master’s degree or higher
	Some college or technical school

27. Which of the following best describes your position about paid work?

	Employed full-time		Employed Part-Time
	Unemployed- Seeking work		Homemaker
	Student		Permanent Disability
	Retired		Number of hours per week:

31. At the present time how disabled are you by your condition?

32. Do you have any other medical conditions or illnesses?

Yes No

32a. If ‘Yes’ please describe:

LADDER OF ADJUSTMENT

37. Suppose that a person's overall adjustment to a disability could be shown on a ladder having 10 steps with the 10th step representing the best possible adjustment and the 1st representing the worst possible. On what step of the ladder would you place yourself to indicate your current overall adjustment (1-10) (check one)?

10 – Best Possible Adjustment

_____ 9

_____ 8

_____ 7

_____ 6

_____ 5

_____ 4

_____ 3

_____ 2

_____ 1 – Worst Possible Adjustment

38. Where on the ladder do you expect yourself to be in five years (1-10) (check one)?

10-Best Possible Adjustment

_____ 9

_____ 8

_____ 7

_____ 6

_____ 5

_____ 4

_____ 3

_____ 2

_____ 1 – Worst Possible Adjustment

55. Has you condition been diagnosed by a medical doctor or similar health professional? Yes No

56. Have you filed a disability claim with the VA? Yes No; If yes, what was the result?

Please provide an address (or alternative contact information) where a research assistant send you your gift card for completing this survey

15. Which type of gift card would you like to receive? Target Walgreens Home Depot Please donate my gift card to Wounded Warriors Foundation

Are there any other comments you would like to tell us?

Hit Counter

		Never	Rarely	Sometimes	Most of the time	All of the time
1.	I felt confident that I could do my job well.
2.	My work schedule was consistent.
3.	I felt I received too little information about what was going on.
4.	I was able to exercise and get in shape.
5.	I could not do my job because of an injury/wound.
6.	I was given a time for rest and recuperation (R&R).
7.	I practiced my faith on a regular basis.
8.	I received troublesome news from my family (death of a family member or friend, significant financial hardship, home burglary, etc.)
9.	I was upset with the way the news media portrayed the war.
10.	I was fatigued.
11.	I was bored.
12.	I felt my leaders took good care of me.
13.	I was put in a position where I had to make hard choices between right and wrong.
14.	I felt frustrated with cultural differences of language barriers of the host nation.
15.	I felt pressured from my peers to break the rules (leaving the base, fraternizing, using illegal drugs, drinking alcohol, disobeying orders, etc).

16.	I felt a sense of pride for serving my country.
17.	I felt close to the members of my unit.
18.	I was subjected to extreme weather conditions.
19.	I encountered alarms of NBC attack.
20.	I was required to travel in difficult or arduous terrain.
21.	I came in direct contact with enemy forces, terrorists, or insurgents.
22.	I was in position where it was difficult to distinguish enemy from friendly foes.
23.	I feared for my personal safety.
24.	I felt a sense of hopelessness.
25.	I witnessed or experienced a catastrophic event (s) (e.g. bombings, death and dying of peers/children/enemies, mortar or grenade attacks, vehicular accidents, etc.)
26.	I felt a sense of loss for the fallen soldiers and/or civilians
	Please indicate the degree to which you agree with the following statement:
		Strongly Disagree	Moderately Disagree	Neither Agree Nor Disagree	Moderately Agree	Strongly Agree
1.	Overall, my deployment experience was positive.

As you read the statements below, please reflect on how you felt about your job before you left for deployment versus how you felt approximately 6 months after you returned to your pre-deployment job (if it has not been 6 months, please respond how you feel today)		Much worse than before	Worse than before	No change/same as before	Better than before	Much better than before
1.	My ability to concentrate at work was:
2.	My productivity/performance level was:
3.	My relationship with my boss was:
4.	My relationship with my co-workers was:
5.	My motivation to continue doing my job was:
6.	My overall attitude toward my company was:

If you are still employed with the same company, please indicate the degree to which you agree with the statements below:		Strongly Disagree	Moderately Disagree	Neither Agree Nor Disagree	Moderately Agree	Strongly Agree
1.	Overall I am satisfied with my job.
2.	I am likely to stay with this company for another year.

There are many ways that people manage their disability, and many ways to learn more about how to manage your disability effectively. This section asks about ways that you take care of yourself, manage your disability and its treatment, and how you feel about these things. For each item just mark the circle of the item that shows how much you agree with the statement. When considering your disability or condition, please answer the following:		Strongly Disagree	Moderately Disagree	Neither Agree Nor Disagree	Moderately Agree	Strongly Agree
1.	I feel like I understand what disability condition is.
2.	I have insurance that pays for my medication.
3.	I I I have many unanswered questions about my disability and its treatment
4.	There are aspects of my life that make it difficult to make it to my doctors appointments (e.g. need for a babysitter).
5.	On most days, I like the person I am.
6.	Most decisions in my life I make on my own (or with my partner).
7.	There are few outside (e.g. financial) limits to the decisions I make in life.
8.	My immediate family is very supportive of me in handling my condition.
9.	Mood changes are sometimes a symptom of my condition
10.	It may be dangerous to stop taking my medications without asking my doctor
11.	I check with my doctor before taking other medicines.
12.	Taking my medication helps me get the things I value in my life.
13.	If I get sad, anxious, or worried, I tell my doctor
14.	I have friends who are supportive of me in handling my condition
15.	Taking my medication is a routine part of my regular activities (like brushing my teeth)
		Strongly Disagree	Moderately Disagree	Neither Agree Nor Disagree	Moderately Agree	Strongly Agree
16.	I have never had a mental illness diagnosis. O
17.	I am confident in my ability to properly take my medication.
18.	I am confident I need to take my medication to be healthy. O
19.	I understand why I take my medication and what they are suppose to do O
20.	I take my medication exactly the way my doctor prescribes.
21.	The schedule of when and how I take my medications is difficult to understand.
22.	Purchasing my medication puts significant strain on my financial situation.
23.	Side effects make it very difficult for me to take my medications as I should
24.	I have confidence in the treatment approach of my medical provider.
25.	I am comfortable discussing my questions with my health care provider
26.	My medical provider is very willing to answer all of my questions.
27.	My doctor and I have very good communication about my condition.
28.	I talk to my doctor about the side effects from my medication
29.	I feel like I am involved in decisions about my treatment
30.	I feel like taking my medication is a trial-run, I might decide to stop
31.	I seek out information about my medical condition.
32	I don’t even think about it- taking my medication is just a habit now
33.	Since I was diagnosed with my condition I have learned very much about it
34.	I feel like taking care of my health helps me control my symptoms
35.	Transportation issues often make it difficult to make my doctor appointments
36.	Sometimes I still forget to take my medication
37.	I am able to plan things so I am always able to take my medication when I should

Read each statement below and mark the circle that indicates to what extent you agree or disagree with the statement.
	Strongly Disagree	Disagree	Agree	Strongly Agree
1.With my disability, all areas of my life are affected in some major way.
2.Having my disability, I am unable to do things like people without disabilities do.
3. Disability or not, I am going to make good in life.
4. Because of my disability, I have little to offer other people.
5. Good physical appearance and physical ability are the most important things in life.
6. A person with a disability is restricted in certain ways, but there is still much s/he is able to do.
7. No matter how hard I try or what I accomplish, I could never be as good as the person who does not have my disability.
8. It makes me feel very bad to see all the things that people without disabilities can do that I cannot.
9. The most important thing in this world is to be physically capable.
10. Because of my disability, other people’s lives have more meaning than my own.
11. Because of my disability, I feel miserable much of the time.
12. Though I have a disability, my life is full.
13. The kind of person I am and my accomplishments in life are less important than those of persons without disabilities.
14. A physical disability affects a person’s mental ability.
15. Since my disability interferes with just about everything I try to do, it is foremost in my mind practically all of the time.
16. There are many things a person with my disability is able to do.
17. My disability in itself affects me more than any other characteristic about me.
18. There are many more important things in life than physical ability and appearance.
19. Almost every area of life is closed to me.
20. My disability prevents me from doing just about everything I really want to do and from becoming the kind of person I want to be.
21. I feel like an adequate person regardless of the limitation of my disability.

	Strongly Disagree	Disagree	Agree	Strongly Agree
22. My disability affects those aspects of life that I care most about.
23. A disability such as mine is the worst possible thing that can happen to a person.
24.You need a good and whole body to have a good mind.
25. There are times that I completely forget that I have a disability.
26. If I didn't have my disability, I think I would be a much better person.
27. When I think of my disability, it makes me so sad and upset that I am unable to do anything else.
28. People with disabilities are able to do well in many ways.
29. I feel satisfied with my abilities and my disability does not bother me too much.
30. In just about everything, my disability is annoying to me so that I can’t enjoy anything.
31. Physical wholeness and appearance make a person who s/he is.
32. I know what I can’t do because of my disability, and I feel that I can live a full life.

		Yes	No
1.	My employer reassured me that I would have a job to come back to when I returned from deployment
2.	My employer provided me with differential pay while I was deployed.
3.	My employer provided medical benefits for my family members while I was deployed.
4.	My employer showed concern for my well-being while I was deployed (sent letters, cards, e-mails, care packages).
5.	My employer allowed me to take off as much time as I needed-within the limits of company's HR policy- before returning to work.
6.	My employer provided me with orientation training upon returning to work.
7.	My employer gave me recognition for my service (a letter from the CEO, a homecoming party, etc) upon returning to work.
8.	My employer gave me updates about work while I was deployed.

As you read the statements below, please reflect on how you felt about your job before you left for deployment versus how you felt approximately 6 months after you returned to your pre-deployment job (if it has not been 6 months, please respond how you feel today)

If you are still employed with the same company, please indicate the degree to which you agree with the statements below:

When considering your disability or condition, please answer the following: