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

IX. References

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

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