Military Veteran Medical Care

Aka: Military Veteran Medical Care, Healthcare of the Military Veteran, Veteran, Veterans Health, Veterans Affairs, United States Department of Veterans Affairs

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II. Definitions

  1. Veteran
    1. Person who has served in the military, especially during war
    2. In the U.S., military services include Army, Navy, Air Force, Marine Corp, Coast Guard and National Guard
    3. Also includes commissioned officers in public health service, environmental science services, NOAA
    4. A sub-segment of Veterans are eligible for service related medical care (e.g. VA)

III. Epidemiology

  1. Prevalence: 18.2 Million in U.S. (1.6 Million women)

IV. History: Musculoskeletal Injuries

  1. Common cause of medical discharge from military
  2. Mechanisms
    1. Repetitive joint loading activities (e.g. Running, marching, wearing heavy body armor)
    2. Non-combat injuries are far more common than non-combat injuries
    3. Chronic Pain is common
      1. Exacerbated by superimposed Mood Disorders, PTSD, Substance Abuse, Traumatic Brain Injury, Obesity
  3. Conditions
    1. Lower extremity injuries
    2. Chronic Neck or Back pain
    3. Osteoarthritis

V. History: Mental Health Conditions

  1. Post-tramatic Stress Disorder
    1. Affects 10-13% of Veterans from recent U.S. wars (Vietnam, Gulf, Alghanistan, Iraq)
    2. Features
      1. See Post-Traumatic Stress Disorder
      2. Avoids potentially triggering events, including thoughs, memories
      3. Insomnia and Nightmares are common
      4. Associated with significant functional Impairment (unemployed, family dysfunction, aggressive behavior)
    3. Screening Tools
      1. See Post-Traumatic Stress Disorder Screening Tool
      2. Postraumatic Stress Disorder Screening Checklist (PCL-5)
    4. Management
      1. See Post-Traumatic Stress Disorder
      2. PTSD Treatment Essentials (VA)
        1. https://www.ptsd.va.gov/professional/treat/txessentials/index.asp
  2. Moral Injury
    1. Guilt, shame, anger, sadness after witnessing or being a part of acts against held moral beliefs
    2. May be associated with PTSD
    3. Responds to Acceptance and Committment Therapy as well as Mindfulness Therapy
  3. Military Sexual Trauma
    1. Unwanted sexual experience in military is common (occurs in nearly 40% of women, 4% of men)
    2. VA Coordinators are assigned to each VA facility to coordinate care of sexual Trauma patients
    3. Screening Questions:
      1. Did you have any unwanted sexual experiences in the military,
        1. For example, threatening or repeated sexual attention, comments or touching?
      2. Did you have any sexual contact against your will, or when unable to say no,
        1. Such as being forced or when asleep or intoxicated?
  4. Major Depression and Suicidality
    1. See Veterans Crisis Line as below
    2. Suicide Relative Risk in Male Veterans: 1.4 (esp. ages 18 to 34)
    3. Suicide Relative Risk in Female Veterans: 1.8
    4. Major Depression screening (e.g. PHQ-9) and Suicidality screening
      1. Screen yearly for first 5 years after military separation, then
      2. Screen every 5 years

VI. History: Traumatic Brain Injury

  1. See Traumatic Brain Injury
  2. Associated with Cognitive Impairment
  3. Associated with Chronic Pain (esp. Headache, neck and back pain)
  4. Associated with Post-Traumatic Stress Disorder

VII. History: Exposures

  1. Noise Induced Hearing Loss
  2. Infectious Disease
    1. Wound related skin and soft issue infections (including Osteomyelitis)
    2. Urinary Tract Infections are more common in wounded Veterans
    3. Endemic infection exposures are specific to regions served
      1. Infectious Disease Outbreaks (CDC)
        1. https://www.cdc.gov/outbreaks/index.html
      2. Traveler's Health (CDC)
        1. https://wwwnc.cdc.gov/travel/destinations/list
  3. Environmental Exposures
    1. Toxin exposures are specific to regions and conflicts served
    2. See Veterans Exposures link below

VIII. Resources

  1. Military Health History Card
    1. https://www.va.gov/oaa/archive/Military-Health-History-Card-for-print.pdf
  2. Veterans Crisis Line
    1. https://www.mentalhealth.va.gov/suicide_prevention/veterans-crisis-line.asp
    2. Phone: 1-800-273-8255 (press 1)
  3. Veterans Exposures
    1. https://www.publichealth.va.gov/exposures/

IX. References

  1. Yedlinsky (2019) Am Fam Physician 100(9): 544-51

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Related Studies

Ontology: United States Department of Veterans Affairs (C0041735)

Definition (NCI) A division of the Executive Branch of the United States government concerned with overall planning, promoting, and administering programs pertaining to veterans. The Department of Veterans Affairs (VA) was established March 15, 1989 as a Cabinet-level position.
Definition (MSH) A cabinet department in the Executive Branch of the United States Government concerned with overall planning, promoting, and administering programs pertaining to VETERANS. It was established March 15, 1989 as a Cabinet-level position.
Concepts Organization (T092)
MSH D014493
English United States Veterans Administration, United States Veterans' Administration, Veterans Administration, Veterans Administration (U.S.), Veterans Affairs (U.S.), VETERANS ADMIN, UNITED STATES VETERANS ADMIN, United States Department of Veterans Affairs, United States. Dept. of Veterans Affairs, VA, veterans administration, administration veterans
Czech Úřad veteránů USA
Finnish United States Department of Veterans Affairs
French Administration américaine des Vétérans, Département aux affaires des vétérans des USA, Département des anciens combattants des USA, Département des vétérans des États-Unis, Département des anciens combattants des États-Unis d'Amérique, Département américain des vétérans, Département des vétérans des États-Unis d'Amérique, Département chargé des vétérans des USA, Département des anciens combattants des États-Unis, Département des vétérans des USA, Department of Veterans Affairs (USA), Département américain des anciens combattants, Veterans Administration (USA)
Russian SSHA, UPRAVLENIE PO DELAM VETERANOV VOINY, США, УПРАВЛЕНИЕ ПО ДЕЛАМ ВЕТЕРАНОВ ВОЙНЫ
Italian United States. Dept. of Veterans Affairs, Veterans Administration (U.S.), Veterans Affairs (U.S.), United States Veterans Administration, United States Veterans' Administration, United States Department of Veterans Affairs
Swedish United States Department of Veterans Affairs
Polish United States Departament of Veterans Affairs
Norwegian United States Department of Veterans Affairs
Spanish Agencia de los Veteranos (Estados Unidos), Agencia de los Veteranos de los Estados Unidos, Asuntos de los Veteranos (E.E.U.U.), Asuntos de los Veteranos de los Estados Unidos, Agencia de los Veteranos (E.E.U.U.), Departamento de Asuntos de los Veteranos de los Estados Unidos, United States Department of Veterans Affairs, United States Veterans Administration, Veterans Administration (U.S.), Veterans Affairs (U.S.)
Portuguese Departamento de Assuntos de Veteranos dos Estados Unidos, Agência dos Veteranos (Estados Unidos), Agência dos Veteranos (E.U.A.), Agência dos Veteranos dos Estados Unidos, Assuntos dos Veteranos (E.U.A.), Assuntos dos Veteranos dos Estados Unidos, United States Department of Veterans Affairs, United States Veterans Administration, Veterans Administration (U.S.), Veterans Affairs (U.S.)
German United States Department of Veterans Affairs, United States Veterans Administration, Veterans Administration (USA), Veterans Affairs (USA)
Dutch United States Department of Veterans Affairs, United States Veterans Administration, Veterans Administration (VS), Veterans Affairs (VS)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Veterans (C0042610)

Definition (CSP) person who has served in a military force, especially during a war.
Definition (MSH) Former members of the armed services.
Concepts Population Group (T098)
MSH D014728
English Veteran, veteran, veterans, Veterans
Swedish Veteraner
Czech veteráni váleční
Finnish Veteraanit
Russian VETERANY, ВЕТЕРАНЫ
Croatian VETERANI
French Anciens combattants, Vétérans
Polish Weterani
Norwegian Krigsveteraner, Veteraner
German Kriegsveteranen, Veteranen, Ausgediente Soldaten
Italian Veterani
Dutch Oorlogsveteranen, Veteraan, Veteranen
Portuguese Veteranos
Spanish Veteranos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Veterans Affairs (C1549054)

Concepts Organization (T092)
HL7 VA
LNC LA18827-8
English VA, Veterans Affairs
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Veterans Health (C2936316)

Definition (MSH) The concept covering the physical and mental conditions of VETERANS.
Definition (MEDLINEPLUS)

Military service members and veterans face some different health issues than civilians. During combat, the main health concerns are life-threatening injuries. These include

  • Shrapnel and gunshot wounds
  • Lost limbs
  • Head and brain injuries

There may also be a risk of health problems from exposure to environmental hazards, such as contaminated water, chemicals, and infections.

Being in combat and being separated from your family can be stressful. The stress can put service members and veterans at risk for mental health problems. These include anxiety, post-traumatic stress disorder, depression and substance abuse. Suicide can also be a concern.
Concepts Group Attribute (T102)
MSH D058014
English Health, Veterans, Veterans Health, Veterans and Military Health, Military Health
French Santé des anciens combattants, Santé des vétérans
German Veteranen-Gesundheit
Czech váleční veteráni - zdraví, zdraví válečných veteránů
Italian Salute degli ex-combattenti
Spanish Salud de los Veteranos
Russian ВЕТЕРАНОВ ЗДОРОВЬЕ, VETERANOV ZDOROV'E
Portuguese Saúde dos Veteranos
Polish Zdrowie weteranów
Norwegian Veteraners helse
Derived from the NIH UMLS (Unified Medical Language System)

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