Veterans that served in the U.S. military, in active duty, face unique health challenges, both while on duty and when they arrive back home and re-enter civilian life. As compared to civilians, veterans are more vulnerable to traumatic brain injuries, post-traumatic stress disorder, suicide, and other mental health issues. They also may face the repercussions of traumatic physical injuries, which may be mental and physical. Substance abuse and addiction, homelessness, and sexual assault are also struggles that many veterans face and must learn to cope with after returning home from active duty or transitioning to civilian life. The Veterans Administration (VA) as well as community, government, and non-profit groups, are all available to provide assistance and health care.

Physical Trauma and Lost Limbs

Men and women serving in the Iraq and Afghanistan wars have been at particular risk for traumatic physical injuries because of the extensive use of improvised explosive devices and roadside bombs. Veterans who suffered these injuries face lifelong challenges. Some may be paralyzed to some extent, many live with chronic and debilitating pain, and others have lost a limb, or multiple limbs as a result of the physical trauma to the body.

These veterans not only face the physical challenges of being injured so badly; they also may suffer from psychological consequences. Aside from the trauma of the actual incident, they also face living with a body that is different and that does not function as it once did. They must face a future looking different and requiring assistance, when previously they had been independent. These veterans may require lifelong physical and emotional support.

Traumatic Brain Injuries

Explosive devices have not only caused these physical injuries, but also traumatic brain injuries (TBI). The Department of Defense has estimated that 22 percent of active duty casualties from Iraq and Afghanistan are brain injuries. This is as compared to 12 percent in Vietnam injuries. These injuries may be caused by vehicle accidents, being struck in the head, or gunshot wounds, but in the military, most are the result of being near an explosion.

The shock wave from the explosion can cause a concussive TBI with unique symptoms, and these are likely to last up to two years after the incident. Some veterans will develop residual, chronic symptoms that last indefinitely. Symptoms may include headaches, insomnia, tinnitus, difficulty concentrating or remembering things, depression, anxiety, irritability, and behavioral issues.

TBI is a disease or injury that is still not well understood, but it is thought that what used to be termed shell shock is actually traumatic brain injury. Research into exactly what happens to the brain during a concussive TBI is ongoing, as is research into how to treat it. Currently these veterans are given treatments based on their symptoms, and there is no known treatment for the actual brain injury.

Post-Traumatic Stress Disorder

Another type of illness that spiked in veterans returning home from Afghanistan and Iraq is post-traumatic stress disorder, or PTSD. This is a mental health condition that is caused by experiencing some kind of trauma. For veterans this is often some kind of violent trauma that they witnessed or experienced first-hand while on active duty, such as being a victim of an IED or watching a friend die or get severely injured. Sexual abuse or assault, which is of primary concern to women in the military, may also trigger PTSD.

Symptoms of PTSD include vivid memories and flashbacks of the traumatizing incident, nightmares, survivor guilt, hypervigilance, and avoiding anything that reminds the person of the incident. These symptoms can be debilitating in some veterans and can make holding down a job, maintaining relationships, and living a normal life challenging. Treatment helps control PTSD and may include therapy of various kinds, including exposure therapy, and medications.

Active Duty Exposure

Active duty military members may be put at risk of being exposed to a number of harmful substances, from dust that causes respiratory illness to chemical weapons to infectious agents. These can cause a number of health problems, some of which may cause symptoms and complications indefinitely. During the most recent operations in Iraq and Afghanistan, as well as during the Persian Gulf War, men and women in the military were breathing in dust and sand particles, as well as finer particulates that may have included chemicals, metals, or acid. This inhalation can lead to lasting respiratory health problems, or may exacerbate conditions like asthma.

Chemical agents also put military members at risk for dangerous exposure. Those that worked with explosive ordinances could have been exposed to mustard gas and other harmful chemicals. Many Vietnam veterans were exposed to Agent Orange, a mix of herbicides used to kill crops in North Vietnam. It was spread liberally in some areas and many veterans were exposed and a number of diseases have been associated with it: Parkinson’s disease, peripheral neuropathy, type 2 diabetes, and a number of different types of cancer.

Veterans who served in the Gulf War may experience what the VA calls “medically unexplained illnesses.” Some call it Gulf War Syndrome, but what caused it is unknown and may be related to exposure. Symptoms include fatigue, joint pain, respiratory difficulties, memory problems, insomnia, headaches, and indigestion.

Sexual Harassment and Abuse

Military sexual trauma, or MST, is a term used by the VA to indicate sexual assault or harassment experienced during military service. While itself not an actual condition, sexual assault may cause physical injuries, and also psychological trauma that has lasting consequences. After surveying veterans the VA found that one in four women in the military has experienced MST. One in 100 men in the military experienced MST. The numbers are actually thought to be higher, because the survey only came from those veterans who sought out VA health care.

Each victim of MST may experience different symptoms, consequences, and degrees of trauma. Some may experience PTSD, while others will have emotional struggles that do not qualify for a diagnosis: difficulties with relationships or intimacy, numbed feelings, trouble concentrating, and feelings of depression, anxiety, and irritability or anger. These veterans may also suffer from physical health problems, like pain, sexual dysfunction, or gastrointestinal problems, and they are vulnerable to substance abuse and addiction.

Depression and Anxiety

Mental health conditions are not uncommon for veterans. There are many factors of serving in the military that can trigger stress, depression, or an anxiety disorder. Simply being away from home and family may be enough, but coupled with the dangers of active duty, the experience of trauma, and other factors, veterans may develop a serious mental health condition. Treatment, including therapy and medications, can be effective in controlling these problems.

Family members of veterans may also be at risk of mental health challenges. Spouses, in particular, face the stress of handling the responsibilities of parenting and of the household while a husband or wife is deployed. Once that spouse returns, if he or she is struggling with physical or mental health challenges, this can also have consequences for the mental health of his or her partner. A spouse may also be vulnerable to physical and domestic abuse.

Suicide and Prevention

Suicide rates are higher among veterans than the general population. This was not always the case, but the number of suicides rose beginning in the early 2000s. About 20 percent of all suicide victims are veterans. Approximately 22 veterans a day die from suicide. Most of these were diagnosed with a mental health condition. Depression, PTSD, MST, and TBI and other mental health issues may contribute to a suicide. There may also be other factors that make suicide rates among veterans so high.

A recent government study found that most of the veterans who committed suicide had behavioral or emotional challenges and were more likely to have already attempted suicide even before enlisting in the military. The study also identified previously unreported risk factors for suicide, which included being white and male, not having a high school diploma or GED, and being demoted.

The VA and other organizations have tried to lower suicide numbers through identifying risk factors, prevention, treatment, and veterans support. A Veterans Crisis Line, for instance is staffed by trained workers through the VA who can help veterans find the support and help they need if they are feeling suicidal. Education is also important, particularly for the loved ones of veterans so that they can learn to recognize signs of suicidal thoughts and take appropriate steps to help them.

Substance Abuse and Addiction

Veterans returning home from active duty are vulnerable to substance abuse, which can lead to addiction. They may abuse alcohol, prescription drugs, or illegal drugs and this substance abuse is most often a way to self-medicate. Veterans may turn to drugs or alcohol to avoid confronting negative feelings, to cope with PTSD, or to avoid asking for help or support. Chronic pain from injuries can also lead to abuse of prescription painkillers, which may eventually lead to addiction.

Veterans and those who care about them need to be aware of the signs of substance abuse, because left untreated this is a disease that can have devastating consequences. When use of alcohol or other substances becomes excessive, is out of control, causes problems in other areas of life such as relationships or work, or when it is tied to negative emotions, it has already become a substance abuse problem.

Homelessness

Approximately ten percent of homeless people in the U.S. are veterans. Among these, around 75 percent struggle with some kind of mental illness or substance abuse disorder, or both. Being homeless further puts these vulnerable members of the population at risk for health problems. They are less likely to be treated for mental illness or substance abuse than non-homeless people. Additionally, they are at risk for not getting enough to eat, being exposed to the elements and suffering health problems as a result, contracting infectious diseases, and suffering from inadequate health care of all types, including dental care.

Veterans’ Health and Compensation Benefits

Most veterans are eligible for some degree of health care through the VA, but some may receive special care or compensation. For instance, veterans who came home with a disability, or who served in the Gulf War or Vietnam War, may qualify for enhanced benefits to help provide for the extended care and support they need as a direct result of their service. Mental health care benefits are especially important for many returning military members and the VA offers this care.

For veterans that served in specific wars and locations, there may be specialized compensation. For example, those who served in Vietnam, and for a certain period in Korea, the VA offers compensation related to Agent Orange exposure. The VA requires proof of an illness and service in the right locations during the right years for a veteran to receive the compensation, which is a monthly payment that depends on the extent of disease and disability. Gulf War veterans struggling with unexplained illnesses can also receive benefits.

Homeless veterans may be able to receive special support through the VA. The VA can also provide resources and assistance to homeless veterans by finding those that need help through outreach, by connecting them with affordable housing, employment services, and community assistance groups.

Serving in the military requires sacrifice and dedication, but unfortunately our veterans are also facing serious health issues and at greater rates than the general population. From mental health issues to physical and sexual trauma to traumatic brain injuries and substance abuse, this is a vulnerable population that needs assistance to heal from these illnesses.