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Military Deployment and Coming Home - VA R&D

By: Veterans Health Administration, Research & Development Department

More than 250,000 U.S. troops have been deployed to the Gulf region. Some will return wounded, and some will return sick. As Secretary of Veterans Affairs, Anthony Principi stated, "We have to make sure that our system is capable of providing care for them. We have learned that every battlefield poses unique dangers. There are bullet wounds and shrapnel wounds, but there are those things that may not manifest themselves for years." Secretary Principi also recently spoke about VA working with the Department of Defense to create baseline medical records for the men and women serving in the Gulf. VA is one of the largest national health care systems and supports a natural collaborative relationship with the military. Improved record keeping in the battlefield can be used to help VA clinicians and researchers identify any chemical agents or other diseases to which troops may have been exposed.1

As part of its commitment to providing the best care for our returning troops, VA has solicited applications, through itsOffice of Research and Development (ORD) and the Health Services Research and Development Service (HSR&D) for "Deployment Health Services Research" and "Amputations and Prosthetics Outcomes Research."

Deployment Research

A deployment health care need is defined as a person’s health concern about an event or activity related to duty in our nation’s armed forces that involves a military operation, location, command, or exposure to combat and other hazardous environments. HSR&D is designating research funds that will target three major areas related to deployment health:

Health delivery systems organization resources, structures and processes of utilization of a continuum of health services;
Population characteristics; and
Health and satisfaction outcomes.
Questions that need answering in relation to Population Characteristics, for example, might include – "How do female and male deployment health concerns differ?" "Do family separation, social support, and coping issues vary across National Guard, Reserve, and Active Duty forces?

Amputations and Prosthetics Outcomes Research

Due to advances in body armor and battlefield first aid, many soldiers who would otherwise have been killed in action are surviving, albeit with severe injury to their extremities. Some 130 troops have returned from Iraq and Afghanistan as major-limb amputees, with one in five having lost more than one limb. Thus, there has been an influx of traumatic-injury amputees from Iraq and Afghanistan into Walter Reed Army Medical Center, and it is anticipated that many of these amputees may enter the VA healthcare system. This ORD solicitation will provide funding for research that will optimize amputee functioning, independence and quality of life. Target priority areas for this solicitation include:

Comparing the cost-effectiveness of different prostheses;
Identifying barriers for amputees reintegrating into military or civilian life; and
Developing and evaluating rehabilitation methods.
In addition, VA’s Office of Research and Development recently held a "Traumatic Amputation QUERI (Quality Enhancement Research Initiative) Workshop" in Washington, DC, to teach VA rehabilitation investigators the QUERI process—a method for systematically integrating research findings and evidence-based recommendations into routine clinical practice. The meeting was also aimed at encouraging established QUERI investigators in VA to pursue studies on amputation and prosthetics.

HSR&D Deployment-Related Research

In addition to physical injury, some of the more common war-related conditions include: post-traumatic stress disorder (PTSD), unexplained illness, and Gulf War Syndrome. See below to learn more about a few HSR&D studies and articles related to these conditions.

PTSD Adversely Affects Physical Health in Women Veterans

Post-traumatic stress disorder (PTSD) commonly occurs with depression. Women are more likely than men to develop severe and persistent PTSD symptoms following exposure to trauma; however, the link between PTSD, depression, and physical illness in women is poorly understood. Investigators in this study, funded by HSR&D and VA’s Office of Women’s Health, used data from a large, nationally representative survey of women veterans receiving VA care to examine how the presence of diagnosed depression and/or PTSD relates to physical health and functional status. PTSD is a high frequency event among women veterans, for whom common exposures include combat-related trauma, military sexual trauma, domestic violence, and childhood abuse. Data collection took place between July 1999 and January 2000, and nearly 31,000 women responded to the mailed survey. Both physical health and mental health were assessed, and results showed that 14% of the respondents reporting having PTSD, and 25% had depression without PTSD. Women with a reported history of PTSD, versus those with depression or neither, had more medical conditions and worse physical health status – across every age group. Despite their relatively young age, 90% with a history of PTSD had at least one serious medical condition (.e.g., arthritis, chronic low back pain, obesity, hypertension).2

Determining the Functional Status in Veterans at Risk for Unexplained Illness

Soldiers experience numerous stressful events and environmental exposure during hazardous deployments that may increase the risk of experiencing medically-unexplained symptoms (MUS). Excessive MUS are a costly problem for both civilian and VA heath care due to the number of visits to physicians and the high costs associated with expensive medical testing. Service personnel are at particular risk for MUS, with 15-20% of Gulf War veterans having excessive numbers of MUS, and nearly 10% of individuals who served in the first Gulf War meeting criteria for Gulf War Illness (a chronic multi-symptom illness defined by excessive MUS). This ongoing HSR&D study will examine both pre- and immediately post-deployment factors that are probable risk factors for increased MUS in military personnel post-deployment. Investigators will assess 700 Army reserve personnel who receive their pre-mobilization soldier readiness processing at Fort Dix, New Jersey. Variables measured include: personality, neuroendocrine reactivity to stress, coping style, social support, perceived distress, as well as assessing baseline measures for symptoms and functional status. Understanding the prospective risks for MUS will increase our ability to develop appropriate inoculation and treatment strategies, and facilitate treatment earlier in the course of illness when it is more likely to be successful.3

Understanding Gulf War Illness

Many soldiers who served during the Gulf War developed a variety of unexplained medical symptoms and neurocognitive difficulties (e.g., poor memory, reduced concentration, slower psychomotor speed) that have been termed Gulf War Illness (GWI). While these difficulties have been commonly reported, the extent to which they affect deployed GW veterans is unclear. The main goal of this ongoing HSR&D study is to better understand the neurocognitive health of Gulf War veterans by comparing neurocognitive differences and self-reported quality of life between veterans who meet the criteria for GWI and those GW veterans who do not. Researchers will also compare traditional neuropsychological testing results, and will determine whether cognitive impairment is correlated with psychiatric distress in patients with GWI.4