Clinicians’ Guide

Clinicians’ Guide

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Military Health History

How to take one

Health Risks

by Service Era

VA/DoD Clinical Practices

DBQ’s

(Disability Benefits Questionnaires)

Lookup Alternatives

Index and Alternative Methods

Afterword

Bibliography

LVMAC Health Care Portal

Question Six

 

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.

 

Question Five

 

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.

 

Question Four

 

What did you do?

While the 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.

 

Question Three

 

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.

 

Question Two

 

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.

 

Question One

 

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).

 

Introduction

 

  • 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.

 

Notes

 

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 Operation are not listed.  However, some of the military health risks still apply.

 

Other Exposures

 

−   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

 

World War II (1941-1946):

 

Korea

 

Korean Conflict (1950-1955):

 

Vietnam

 

Vietnam Conflict (1961-1975):

            – Commonly Associated Agent Orange Diseases

           – Spina Bifida in Veterans’ Children

 

Camp Lejeune

 

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

 

Cold War (1945-1990):

              – Commonly Associated Agent Orange Diseases

 

Gulf War

 

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

  • Dermatological Issues
  • Reproductive Health Issues

 

Bosnia

 

Bosnia and Herzegovina Humanitarian Operation (1992-1996):

 

OEF OIF OND

 

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

  • Combined Penetrating, Blunt Trauma, Burn Injuries (Blast Injuries)
  • Dermatologic Issues
  • Reproductive Health Issues
  • Substance Abuse

 

LVMAC

 

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 developing this project.

 

 

Bibliography

Caring for War Wounded (OEF/OIF) – Veterans Health Initiatives.  Dept. of Veterans Affairs, n.d. Web. 18 June 2014. <http://www.publichealth.va.gov/vethealthinitiative/oefoif.asp>.

Disability Benefit Questionnaires – VA Claims Transformation Plan. Dept. of Veterans Affairs, n.d. Web. 18 June 2014. <http://benefits.va.gov/disabilityexams/>.

“Hazardous Exposures and Birth Defects.” Lehigh Valley Military Affairs Councils Blog. N.p., n.d. Web. 18 June 2014. <http://lvmac.wordpress.com/resources/hazardous_exposures/>.

Military Exposures – Public Health. Dept. of Veterans Affairs, n.d. Web. 18 June 2014. <http://www.publichealth.va.gov/exposures/index.asp>.

Military Health History Pocket Card for Clinicians – Office of Academic Affiliations. Dept. of Veterans Affairs, n.d. Web. 18 June 2014.  <http://www.va.gov/oaa/pocketcard/>.

Patient Treatment – Public Health. Dept. of Veterans Affairs, n.d. Web. 18 June 2014. <http://www.publichealth.va.gov/patient-treatment.asp>.

VA/DoD Clinical Practice Guidelines Home.  Dept. of Veterans Affairs, n.d. Web. 18 June 2014. < http://www.healthqua

lity.va.gov/index.asp>.

Veterans Health Council. Vietnam Veterans of America, n.d. Web. 18 June 2014. <http://www.veteranshealth.org/>.

Veterans Health Initiative – Public Health. Dept of Veterans Affairs, n.d. Web. 18 June 2014. <http://www.publichealth.va.gov/vethealthinitiative/index.asp>.

 

Alternative Lookup

 

 

 

 

Lookup Methods

Index

Alternative Methods

Index

 

  • Combined Penetrating, Blunt Trauma, Burn Injuries (Blast Injuries)
  • Dermatologic Issues
  • Reproductive Health Issues

 

Disability Benefits

 

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

 

Clinical Practices

 

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. 

 

Military Service

OEF OIF OND 2001-Present

Bosnia 1992-1996

Gulf War 1990-1991

Cold War 1945-1990

Camp Lejeune 1957-1987

Vietnam 1961-1975

Korea 1950-1955

World War II 1945-1946

Other Exposures

Notes

Six Questions

0

Taking a Military Health History: Six Critical Questions (Introduction)

1

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

2

When did you/he/she serve?

3

Where did you/he/she serve?

4

What did you do?

5

Do you think your service has affected any part of your health?

6

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