II. Definitions
- Veteran
- Person who has served in the military, especially during war
- In the U.S., military services include Army, Navy, Air Force, Marine Corp, Coast Guard and National Guard
- Also includes commissioned officers in public health service, environmental science services, NOAA
- A sub-segment of Veterans are eligible for service related medical care (e.g. VA)
III. Epidemiology
- Prevalence: 18.2 Million in U.S. (1.6 Million women)
IV. History: Musculoskeletal Injuries
- Common cause of medical discharge from military
- Mechanisms
- Repetitive joint loading activities (e.g. Running, marching, wearing heavy body armor)
- Non-combat injuries are far more common than non-combat injuries
- Chronic Pain is common
- Exacerbated by superimposed Mood Disorders, PTSD, Substance Abuse, Traumatic Brain Injury, Obesity
- Conditions
- Lower extremity injuries
- Chronic Neck or Back pain
- Osteoarthritis
V. History: Mental Health Conditions
- Post-tramatic Stress Disorder
- Affects 10-13% of Veterans from recent U.S. wars (Vietnam, Gulf, Alghanistan, Iraq)
- Features
- See Post-Traumatic Stress Disorder
- Avoids potentially triggering events, including thoughs, memories
- Insomnia and Nightmares are common
- Associated with significant functional Impairment (unemployed, family dysfunction, aggressive behavior)
- Screening Tools
- See Post-Traumatic Stress Disorder Screening Tool
- Postraumatic Stress Disorder Screening Checklist (PCL-5)
- Management
- See Post-Traumatic Stress Disorder
- PTSD Treatment Essentials (VA)
- Moral Injury
- Guilt, shame, anger, sadness after witnessing or being a part of acts against held moral beliefs
- May be associated with PTSD
- Responds to Acceptance and Committment Therapy as well as Mindfulness Therapy
- Military Sexual Trauma
- Unwanted sexual experience in military is common (occurs in nearly 40% of women, 4% of men)
- VA Coordinators are assigned to each VA facility to coordinate care of sexual Trauma patients
- Screening Questions:
- Did you have any unwanted sexual experiences in the military,
- For example, threatening or repeated sexual attention, comments or touching?
- Did you have any sexual contact against your will, or when unable to say no,
- Such as being forced or when asleep or intoxicated?
- Did you have any unwanted sexual experiences in the military,
-
Major Depression and Suicidality
- See Veterans Crisis Line as below
- Suicide Relative Risk in Male Veterans: 1.4 (esp. ages 18 to 34)
- Suicide Relative Risk in Female Veterans: 1.8
- Major Depression screening (e.g. PHQ-9) and Suicidality screening
- Screen yearly for first 5 years after military separation, then
- Screen every 5 years
VI. History: Traumatic Brain Injury
- See Traumatic Brain Injury
- Associated with Cognitive Impairment
- Associated with Chronic Pain (esp. Headache, neck and back pain)
- Associated with Post-Traumatic Stress Disorder
VII. History: Exposures
- Noise Induced Hearing Loss
- Infectious Disease
- Wound related skin and soft issue infections (including Osteomyelitis)
- Urinary Tract Infections are more common in wounded Veterans
- Endemic infection exposures are specific to regions served
- Infectious Disease Outbreaks (CDC)
- Traveler's Health (CDC)
- Environmental Exposures
- Toxin exposures are specific to regions and conflicts served
- See Veterans Exposures link below
VIII. Resources
- Military Health History Card
- Veterans Crisis Line
- https://www.mentalhealth.va.gov/suicide_prevention/veterans-crisis-line.asp
- Phone: 1-800-273-8255 (press 1)
- Veterans Exposures
IX. References
- Yedlinsky (2019) Am Fam Physician 100(9): 544-51