By Dr. Sudip Bose, MD, FACEP, FAAEM
Veterans wrote a blank check on their lives when they volunteered to join the military, went to war in many cases, and risked not coming home to their families. Some never got to see their children be born because they were overseas protecting our freedom. They truly did serve our country by giving up their normal lives for a life spent on guard, on watch, ready to fight and die, if necessary to protect Americans and keep our enemies at bay.
But what many people who haven’t served in the military don’t really understand, is that after veterans stop fighting the enemy, they continue the struggle fighting against injuries or illness sustained while on active duty – either physical or mental, or both. In many instances, their battle continues.
I know, because I’ve been there. I walked that walk. I was an officer in the Army and attained the rank of major; I served as a front-line physician in the Second Battle of Fallujah and served one of the longest combat tours by a physician since World War II, for which I earned the Bronze Star. I became an emergency physician while I was in the Army, and I now serve as an emergency room physician and also have become one of America’s most experienced doctors on mass casualties, disaster care and PTSD (Post-Traumatic Stress Disorder). I also created TheBattleContinues.org, which is a 501c(3) nonprofit entity aimed to raise awareness of veterans’ issues and help veterans who have returned from war. Every penny of the money donated to TheBattleContinues.org goes directly to the benefit of veterans.
The health challenges veterans face are unique, almost entirely unlike those faced by any other demographic in America. A Washington Post / Kaiser Family Foundation poll taken in 2013 showed that more than half of the service members polled who served in Iraq and/or Afghanistan admitted to suffering a physical or mental health problem as a result of their service. More service members than ever before have survived combat wounds that would have been fatal in previous wars. It’s now our responsibility as a nation to tend to our veterans when they return from overseas and are discharged from military service. Some of the things our veterans have to deal with include:
1) Mental health challenges. Not all wounds are physical. The Institute of Medicine estimates that 20 percent of returning veterans suffer from PTSD, a condition that develops after experiencing extreme fear, helplessness, or horror — all common emotions in battle. PTSD causes victims to continually relive their trauma, producing great anxiety in their daily lives. Furthermore, studies have shown that having PTSD exacerbates other medical conditions. PTSD also can bring on behavioral disorders such as substance abuse, binge drinking, depression, and suicide. Many of these both stem from and worsen other war-related medical problems. Ultimately, veterans with mental health problems feel alienated from society and suffer significant strains on their relationships with loved ones. Research suggests that these mental health disorders are highly treatable, but not enough veterans currently are able to get the mental health care they need.
2) Traumatic brain injury (TBI). Deemed the “signature wound” of Operations Iraqi Freedom and Enduring Freedom, wartime TBI is usually caused by being near intense explosions, a common occurrence due to our enemy’s use of hidden explosive devices, or IEDs. The powerful shock wave from these explosions can cause injury to the brain. Veterans with severe TBI require rehabilitation to recover their ability to function in everyday life. For many who do not get the support they need, life will never be the same. Over time, doctors realized that even mild and repetitive TBIs – often in the form of concussions – were causing unseen damage to our veterans, such as PTSD, depression, and chronic headaches.
3) Loss of limbs and paralysis. Violent and explosive weapons employed against our military men and women by the enemy have not only caused TBIs but have also produced devastating wounds to extremities that often require amputations. More than 1,500 service members in Operations Iraqi Freedom, Enduring Freedom, and New Dawn suffered a major limb amputation. Additionally, bullets and shrapnel from bombs can tear through nerves and the spinal cord, causing paralysis. Both loss of limb and paralysis result in our veterans losing a significant part of themselves and their everyday function. America’s advanced medical knowledge in rehabilitation can get veterans back in action to be able to live their normal lives despite their injuries, but only if we can get our veterans access to the medical care they need and deserve.
4) Chronic pain and musculoskeletal problems. People often fail to recognize pain as a serious medical problem for veterans, even though it can be severe, persist throughout life, and erode the willpower and quality of life of our service members.
5) Chemical, biological, and physical exposure. Our service members frequently are in contact with such hazards like depleted uranium, asbestos, lead, radiation, and contaminated water. Many of these substances can result in cancer or infertility over the long-term. On foreign soils, dangerous and unfamiliar diseases can hit our soldiers, such as malaria, tuberculosis, and West Nile Virus, diseases that are aggressive, difficult to treat, and sometimes require treatment for life. Dust and soot inhalation can produce serious lung damage, and constant exposure to loud noises regularly also causes hearing loss.
6) Genitourinary injury. It is often a problem we don’t often talk about, but it brings major implications into the lives of our veterans. Nearly 1,300 service members in the recent wars fell victim to injury to their genitals or urinary system, often as a result of improvised explosive devices (IEDs). Although limbs can be replaced by prostheses, medical technology has little to offer as a way to deal with loss of function of sexual organs. Veterans with genitourinary injury may be unable to have children, have difficulty in intimate relationships, and suffer from other mental health problems.
7) Barriers to access healthcare. Perhaps the overarching problem for veterans facing health challenges is the difficulty in actually getting access to adequate healthcare. Unfortunately, the Veterans Affairs Health Administration has been swamped with the overwhelming number of veterans who need care, creating a large backlog of people waiting for treatment. Many ideas to deal with the backlog have been proposed and enacted, however, the problem is far from fixed. The bureaucracy of getting things through the VA pipeline – such as treatment approvals and decisions on disability ratings – are stunningly slow. “Whatever the process is, whoever had to review the documentation [related to my disability rating] – it took six months for them to say, ‘OK, your disability rating is 100 percent,’ “ said one veteran at a VA facility in North Las Vegas. “It seems like that might have been an easier [decision],” he said. “And I’m lucky. Six months is not a long time compared to a lot of my friends … who went through the process. That was my biggest challenge [with the VA].
Our commitment to our brave military members should not end when they come home, because we know that the fight does not end there. Imagine a soldier with one, two, three or more of these health challenges, and you’ll get just a glimmer of an idea of how daunting their situations can be. All the seven points above can lead to homelessness, joblessness, opioid dependence and addiction, and suicide. Veterans commit suicide on an average of 20 times every day. The VA just released a report that details the struggle with suicide and shows a state-by-state breakdown of veteran suicide and provides other statistics.
These returning service members defended our country and our very lives, putting themselves in harm’s way to keep us safe. Shouldn’t their sacrifices receive our complete attention and devotion of resources, personnel and financing? Medical technology in our country can help to measurably improve the health struggles of our veterans, but we need to make addressing the challenges they face and the resources they need one of our top priorities as a nation. We benefited from their heroism in combat and we will all continue to benefit from what these veterans can contribute to society.
And if you are a veteran seeking care, please see our Veteran Resources page at TheBattleContinues.org for trusted and reliable resources that can help you. And if you would like to support our veterans, please consider making a donation to TheBattleContinues.org. Our veterans certainly would appreciate it. Every dollar helps, no matter how small the amount.