Have you received medical care for this condition from any other provider,  including military or VA?

By asking this question, you may find out that the individual is under VA care, for example. It would might lead you to ask if he is receiving medications from the VA he has not yet revealed; that he has already seen a VA doctor who has ordered tests of use to you also, saving both of you both time and money while also helping to ensure patient safety.

Do you think your service has affected your health?

This inquiry gives the veteran an opportunity to raise any concerns he/she has regarding his health.  The Military Health Risks by Military Service Era section implies why this is important.   You It may uncover other related issues.  Since military service can affect many aspects of a person’s health – physically , mentally and socially, it is important to let them know you are not only interested in their physical health.

What did you do?

While military jargon about jobs and titles may be confusing and intimidating, siimply asking what a veteran did while he or she was serving could provide important insights.  If he/she does not want to talk about it, the person will tell you that and the question can be left lying.  However, the advantage of asking the question can be enormous and most will appreciate that you are showing both professional diligence and concern.

For example, if as implied in the previous question, you find the veteran was never stationed outside of the United States, you might not think they had a high risk of  war related mental trauma.  Instead, you might find his state side job was to receive returning bodies from a war or worked with the extremely seriously injured.  Although this veteran may have never have seen battle, he may be experiencing the effects of secondary trauma.

Where did you/he/she serve?

Different decades and eras of service have different risk associations.  Knowing the decade or era, however is not enough, knowing where is equally important to determining unique exposures, especially if it involved being in a combat theater.

An example would be the use of Agent Orange as an herbicide in Vietnam and elsewhere in Asia during the Vietnam Conflict era.   And then there are the environmental diseases related to specific geographic areas such as in deserts and the tropics – uncommon to here and not generally considered.

When did you/he/she serve?

It is suggested to give them different options to choose – for example, decades or eras of military service.  This will give clinicians a quick idea of what exposures the veteran may have been experienced  (See The Military Health Risks by Military Service Era section).

Separating the years into decades or periods is a good tip, for it allows the veteran to give a quick reference if they can’t remember exact dates.  Be prepared for veterans, especially those who made a career of being in the armed forces, having served in more than one era.

Have you or someone close to you ever served in the military or armed forces on active duty?  Who?

Note that the question does not ask if the person is a veteran.  Some veterans will not identify themselves as veterans, even though they are.  This may be due to still having an active military status and only seeing veteran status as denoting being separated from the military.  It may also come from never having served in a “war zone” and feeling one does not deserve to be called a veteran.  Data suggests that many women who have served in the armed forces fail to think of themselves as veterans.

Whatever the case may be, some veterans will answer no when asked if they are a veteran, but they will more likely answer yes when asked if they have served in the military or armed forces on active duty.  The term, “armed forces”, is the better of the two terms to use because includes the military services, defined  as the Army, Marines, Navy, and the Air Force – and also the Coast Guard.  Coast Guardsmen often called up to perform as a military service during periods of armed conflict or war and, in so doing, qualify as veterans. That raises another key point – active duty service is entailed in the definition of a being a veteran.

It is suggested the patient be asked not only if he/she has served, but also if anyone close to him/her has served. Health issues may arise in loved ones of deployed personnel and veterans – generally those revolving around mental health and reproduction. If the family deployed with the spouse, they may be subject to some of the same environmental contaminators (e.g. the Camp Lejeune water contamination situation).

• When reviewing a patient’s health history it is important to ask about their veteran status.

• Answers to the six questions will provide you with information helpful in understanding the patient’s’ medical problems and concerns; and in establishing the needed rapport and therapeutic partnership.

• For the more recently returned veteran, developing social relationships in the community is a key social need for his/her well-being.  The asking implies concern for his welfare and leads to a more helpful patient. If you are a veteran yourself, it might help to relate that fact

• The resulting answers may also provide a basis for timely referral to specialized medical resources.

• Not asking these questions may lead  to a misdiagnosis; and an inability to track  down useful veteran-related information and data.

• The Military Health Risks by Military Service Era section provides specific illnesses of which to be aware.

Note:

The VA’s commonly recognized major “periods of war” (declared war and conflicts) plus the “Cold War”, Bosnia and Herzegovina Humanitarian Operation and Camp LeJeune water contamination incident – the periods with the greatest number of health issues associated – are listed in reverse chronological order. Therefore, not all military operations (conflicts and expeditions) are listed. For example, the Lebanon (1982-1983), Grenada (1983), and Panama (1989-1990) Conflicts and the Somalia (1992-1995) Humanitarian Operations are not listed. However, some of the military health risks still apply.

• Occupational Hazards  to include

       −    Asbestos
       −    Burn Pit Smoke
       −    Contaminated Water (benzene, trichloroethylene, vinyl chloride)
       −    Endemic Diseases
       −    Hexavalent Chromium
       −   Ionizing & Non-Ionizing Radiation
       −    Jet Fuel
       −    Lead
       −    Mustard Gas
       −    Nerve Agents
       −    Particulate Matter
       −    Pesticides
       −    TCDD & other dioxins

World War II (1941-1946):

• Cold Injury

• Chemical Warfare Agent Experiments

• Exposure to Nuclear Weapons (including testing or cleanup)

• Former Prisoners of War

Korean Conflict (1950-1955):

• Cold Injury

• Chemical Warfare Agent Experiments

• Exposure to Nuclear Weapons (including testing or cleanup)

• Former Prisoners of War

Vietnam Conflict (1961-1975):

• Agent Orange Exposure

            – Commonly Associated Agent Orange Diseases

           – Spina Bifida in Veterans’ Children

• Birth Defects in Women Veterans’ Children

• Former Prisoners of War

• Hepatitis B

• Hepatitis B – Resource #2

• Hepatitis C

• Hepatitis C – Resource #2

• HIV/AIDS

• Military Sexual Trauma

• PTSD Resource #1

• PTSD Resource  #2 (VA/DoD Clinical Practice Guidelines)

• Substance Abuse

Camp Lejeune Water Contamination (1957-1987):

• Esophageal cancer
• Breast cancer
• Kidney cancer
• Multiple myeloma
• Renal toxicity
• Female infertility
• Scleroderma
• Non-Hodgkin’s lymphoma
• Lung cancer
• Bladder cancer
• Leukemia
• Myelodysplastic syndromes
• Hepatic steatosis
• Miscarriage
• Neurobehavioral effects

Cold War (1945-1990):

• Agent Orange Exposure

              – Commonly Associated Agent Orange Diseases

• Camp Lejeune Water Contamination

• Chemical Warfare Agents Experiments at Aberdeen/Edgewood Arsenal

• Chemical Warfare Agent Experiments

• Exposure to Nuclear Weapons (including testing or cleanup)

Persian Gulf Conflict / Gulf War / Desert Shield/Storm (1990-1991):

• Amyotrophic lateral sclerosis (ALS)

• Chemical or Biological Agents

• Depleted Uranium Resource #1

• Depleted Uranium Resource #2

• Dermatological Issues

• Chronic Fatigue Syndrome

• Chronic Multisymptom Illness (Gulf War Syndrome)

• Chronic Multisymptom Illness (Gulf War Syndrome) – Resource #2 (MUS)

• Infectious Disease Diseases of the Gulf War (e.g. Leishmaniasis and Malaria)

• Military Sexual Trauma

• Oil Well Fires

• PTSD Resource #1

• PTSD Resource #2 (VA/DoD Clinical Practice Guidelines)

• Reproductive Health Issues

• Substance Abuse

• Vaccinations and Medications

Bosnia and Herzegovina Humanitarian Operation (1992-1996):

• Depleted Uranium Resource #1

• Depleted Uranium Resource #2

OEF (Operation Enduring Freedom – Afganistain / OIF (Operation Iraqi Freedom – Iraq) / OND (Operation New Dawn – Iraq) Conflicts/Global War on Terrorism (2001 – Present):

• Acinetobacter  (multi-drug resistant)

• Animal Bites/Rabies

• Combined Penetrating, Blunt Trauma, Burn Injuries (Blast Injuries)

• Burn Pits

• Chronic Fatigue Syndrome

• Cold Injury (Afghanistan)

• Dermatologic Issues

• Depleted Uranium Resource #1

• Depleted Uranium Resource #2

• Hearing Impairment/Loss

• Infectious Diseases of SW Asia

• Mental Health Issues

• Military Sexual Trauma

• PTSD Resource #1

• PTSD Resource #2 (VA/DoD Clinical Practice Guidelines)

• Reproductive Health Issues

• Substance Abuse

• Spinal Cord Injury

• Toxic Embedded Fragments (shrapnel)

• Traumatic Amputation Resource #1

• Traumatic Amputation Resource #2( VA/DoD Clinical Practice Guidelines)

• Traumatic Brain Injury Resource #1

• Traumatic Brain Injury Resource #2 (VA/DoD Clinical Practice Guidelines)

• Vaccinations and Medications

• Vision Impairment/Loss

The Lehigh Valley Military Affairs Council wishes to acknowledge the Department of Veterans Affairs for its Military Health History Pocketcard for Clinicians, which was the start point for this product.  The Clinicians’ Guide  takes advantage of the capabilities of the internet in providing a quick and reference tool to assist clinicians in relating to and diagnosing their military veteran patients – if information is properly collected and organized.

The Lehigh Valley Military Affairs Council also wishes to recognize Cohort 9, Team One, “Class of 2014″ The Wescoe School, Muhlenberg College, Allentown PA for all their hard work assessing, planning, and the initial development of this project.

• VA Portal

• Exposures for Providers

• Four Ways to Look Up Exposures

• Hazardous Exposures

 

 

• Acinetobacter (multi-drug resistant)

• Agent Orange Exposure

• - Commonly Associated Agent Orange Diseases

• - Spina Bifida in Veterans’ Children

• - Korea and various stateside and overseas locations

• Amyotrophic lateral sclerosis (ALS)

• Animal Bites/Rabies

• Birth Defects in Women Veterans’ Children

• Burn Pits

• Camp Lejeune Water Contamination

• Chemical or Biological Agents

• Chemical or Biological Agents - Resource #2

• Chemical Warfare Agents Experiments at Aberdeen/Edgewood Arsenal

• Chemical Warfare Agent Experiments

• Chronic Multisymptom Illness (Gulf War Syndrome);  Resource #2 (MUS)
• Cold Injury

• Cold War Health Risks

• Combined Penetrating, Blunt Trauma, Burn Injuries (Blast Injuries)

• Depleted Uranium Resource #1;

• Depleted Uranium Resource #2

• Dermatologic Issues

• Disability Benefits Questionnaires (DBQ)

• Exposure to Nuclear Weapons (including testing or cleanup)

• Gulf War Health Risks

• Gulf War Illness

• Gulf War Veterans’ Illnesses;  Diagnosis and Treatment of Gulf War Illnesses

• Gulf War Syndrome

• Heat Injuries

• Hepatitis B

• Hepatitis B – Resource #2

• Hepatitis C

• Hepatitis C – Resource #2

• HIV/AIDS

• Vaccinations and Medications

• Infectious Diseases of SW Asia (i.e. Leishmaniasis)

• Infectious Diseases of the Gulf War (i.e. Leishmaniasis and Malaria)

• Korean War Health Risks

• Mental Health Issues

• Military Exposures

• Military Sexual Trauma

• Mustard Gas

• Noise Exposures

• Nuclear Weapons Testing (Atomic Veterans); other Provider Resources

• Oil Well Fires

• OIF/OEF/OND (Global War on Terrorism) Era Health Risks

• Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hazardous

• Exposures

• Other Potential Environmental Exposures

• Project 112/Project SHAD

• PTSD Resource #1

• PTSD Resource #2 (VA/DoD Clinical Practice Guidelines)

• Rabies

• Radiation Exposure; Radiation

• Reproductive Health Issues

• Spina Bifida in Veterans’ Children

• Spinal Cord Injury

• Substance Abuse

• Toxic Embedded Fragments (shrapnel)

• Traumatic Amputation Resource #1; Resource #2( VA/DoD Clinical Practice Guidelines)

• Traumatic Brain Injury Resource #1;

• Traumatic Brain Injury Resource #2 (VA/DoD Clinical Practice Guidelines)

• VA/DoD Evidence Based Clinical Practices

• VA Portal

• Vietnam War Health Risks

• Vision Impairment/Loss

• World War II Health Risks

You may encounter veterans who wish you to use a Disability Benefits Questionnaire .  They may be seeking a private evaluation for what they believe is a service-connected injury, which is allowed by the VA, in an effort to receive VA service-connected compensation or, at least, permanent VA health care for the condition.  Even if they do not request you use the form for this sort of examination, you should do so.

Originally developed for  compensation examinations by either VA or private health care providers in an effort to improve the quality of examinations needed for “Fully Developed Claims”, these forms have an additional use in that they allow for a thorough examination of a suspected condition.  The forms are downloadable and found by form name or by symptom.

 

Forms

Disability Benefits Questionnaire

Private Evaluation Forms

Forms By: Form Name

Forms By: Symptom

The VA/DoD Evidence-Based Practice Guideline Work Group (EBPWG) was established to advise the VA/DoD Health Executive Council (HEC) on the use of clinical and epidemiological evidence to improve the health of the population across the Veterans Health Administration (VHA) and Military Health System. The work group was first chartered in 2004.

 

As clinical practices are developed, they are published on the VA/DoD Clinical Practice Guidelines website.