Morbidities Experienced by Geriatric Combat Veterans

One disease of the circulatory system that is associated with geriatric combat veterans is ischemic heart disease. Ischemic heart disease (also known as coronary artery disease) has been linked to exposure to Agent Orange during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Coronary artery disease is common even among non-combat veterans. It is the number one cause of death in the United States (Coronary artery disease, 2017). While this morbidity is comparable to civilian counterparts, for geriatric combat veterans of the Vietnam War exposure to Agent Orange has become an uncontrollable risk factor.

            When compared to non-veteran populations, some respiratory morbidities are higher among veterans. One study revealed adjusted ratios of mesothelioma to be higher among veteran populations than among New York state or Los Angeles County totals (Spirtas, et al., 1994). While asbestos was once common in the United States in carpentry related taskings, it was also common in Naval shipyards. This translates to an increased risk of mesothelioma for Navy Veterans especially during and before the 1980s.

            Because of one of the more recent conflicts, veterans of the Gulf War have experienced chronic digestive symptoms (Weng, Guo, & Yang, 2015). These morbidities range from heartburn to irritable bowel syndrome. Many gastrointestinal symptoms experienced by these Gulf War veterans began while they were in country. Many veterans did not report this especially if there was minimal interference with day-to-day life.

            Another by-product of Agent Orange is early onset peripheral neuropathy. Some combat veterans of the Vietnam War began suffering from peripheral neuropathy within only one year after their time in country ended (Veterans' Diseases Associated with Agent Orange, 2015). Thus, many veterans have been suffering weakness, numbness, and pain in their extremities for a very long time (Peripheral neuropathy, n.d.). Most people do not develop peripheral neuropathy until they are over the age of 55 (Understanding peripheral neuropathy, n.d.).

            A morbidity of the endocrine system that is experienced by geriatric combat veterans is Hodgkin’s lymphoma. Hodgkin’s lymphoma is another morbidity that is secondary to Agent Orange exposure during the Vietnam War (Veterans' Diseases Associated with Agent Orange, 2015). Also known as Hodgkin’s disease, this is a cancer of the lymphatic system (Hodgkin's lymphoma (Hodgkin's disease), n.d.). Research has shown a positive association between Agent Orange and the development of Hodgkin’s lymphoma (Hodgkin's disease and Agent Orange, 2016).

            Immune system disorders are dangerous because they reduce a person’s natural ability to fight diseases. While some studies have suggested a statistical difference in the immune systems of Vietnam veterans exposed to Agent Orange, follow-up studies do not support these findings (Veterans and Agent Orange, 2010). While Immune disorders in combat veterans may not be related to combat exposure, there is a link between autoimmune disease and prevalence in their descendants. Adult children of Vietnam veterans who were exposed to Agent Orange seem to have a higher prevalence of autoimmune disorders (Ornstein, Fresques, & Hixenbaugh, 2016).

            One disease of the skin that occurs more often in Vietnam War veterans is chloracne. Chloracne, for many Veterans, began soon after exposure to Agent Orange during their time in country (Veterans' Diseases Associated with Agent Orange, 2015). Chloracne is a rare skin condition that includes blackheads, cysts, and nodules (Chloracne or Acneform Disease and Agent Orange, 2017). Studies have shown a direct link with this skin condition and chemicals used in Agent Orange (Institute of Medicine, 1994).

            Amputation has been a historically unavoidable byproduct of combat. While amputations accounted for 5% of combat wounded during World War II, they rose to 19% during the Vietnam War (Burkhalter, 1994, p. 131).  Most of these service members had more than one limb amputated due to use of field-expedient tourniquets. Advancement in prosthetics has improved the day-to-day lives of many of these veterans.

            One of the greatest problems experienced by geriatric combat veterans is mental health ailments such as post-traumatic stress disorder (PTSD). There is a demonstrated long-term pattern of healthcare utilization by geriatric veterans with serious and chronic mental illnesses (Sajatovic, Popli, & Semple, 1996). Chronic mental health issues have led to an increase in suicides in Veterans. The rate of suicide among veterans reached 22 per day in 2010 (Lazar, 2014, p. 459).

Conclusions and Final Thoughts

While there are several morbidities that seem to be consistent among civilian populations, there are several that are exacerbated by conditions experienced during combat. There seems to be a lack of foresight with use of chemicals such as Agent Orange. The military is learning from the mistakes of the past. All soldiers heading to combat are now assigned gas masks and chemical suites called JSLIST (Joint service lightweight integrated suit technology) and MOPP gear (mission oriented protective posture) for short.

Tricare and the VA have both made grand strides in delivery of mental healthcare as of late. Last year, the new Secretary of the VA, Dr. David Shulkin, opened access for mental healthcare to those with other than honorable discharges. This was important because many of these discharges came about because in the past, services didn’t recognize the need for mental healthcare and it was seen as a weakness by not only seniors but peers and subordinates. This is a stigma that we are still getting past, but we are heading in the right direction.

About the Author

Josh Johnson is a former combat medic in the U.S. Army with three combat tours, Joshua Johnson currently works as an Administrative Officer at the Robert J. Dole VA Medical Center in Wichita, Kansas. In addition, he is completing his M.H.A. degree at Saint Joseph’s College of Maine.

References

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Chloracne or Acneform Disease and Agent Orange. (2017). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/chloracne.asp

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Hodgkin's disease and Agent Orange. (2016). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/hodgkins.asp

Hodgkin's lymphoma (Hodgkin's disease). (n.d.). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/hodgkins-lymphoma/symptoms-causes/syc-20352646

Institute of Medicine. (1994). Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. Washington, D.C.: The National Academies Press.

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Ornstein, C., Fresques, H., & Hixenbaugh, M. (2016). The children of Agent Orange. Retrieved from Pro Publica: https://www.propublica.org/article/the-children-of-agent-orange

Peripheral neuropathy. (n.d.). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061

Sajatovic, M., Popli, A., & Semple, W. (1996). Ten-year use of hospital-based services by geriatric veterans with schizophrenia and bipolar disorder. Pschiatric Services, 961-965.

Spirtas, R., Heineman, E. F., Bernstein, L., Beebe, G. W., Keehn, R. J., Stark, A., . . . Benichou, J. (1994). Malignant mesothelioma: attributable risk of asbestos exposure. Occupational and Environmental Medicine, 804-811.

Understanding peripheral neuropathy. (n.d.). Retrieved from American Academy of Neurology: http://patients.aan.com/globals/axon/assets/9585.pdf

Veterans and Agent Orange. (2010). Washington D.C.: National Academies Press. Retrieved from https://www.nap.edu/read/13166/chapter/1

Veterans' Diseases Associated with Agent Orange. (2015). Retrieved from U.S. Department of Veterans Affairs: https://www.publichealth.va.gov/exposures/agentorange/conditions/

Weng, W., Guo, X., & Yang, Y. (2015). Gastrointestinal problems in modern wars: clinical features and possible mechanisms. Military Medical Research, 1-8.