Spring 2025

Spring 2025 Issue

Veterans and Chronic Disabilities
By Susan Chapman, MA, MFA
Today’s Geriatric Medicine
Vol. 18 No. 2 P. 14

Understanding the Issues and Options

Military veterans often face unique challenges due to the toll their service takes on them, including a higher prevalence of chronic disabilities compared with civilians.

Naomi Mathis, assistant national legislative director of Disabled American Veterans (DAV), emphasizes the importance of recognizing these service-connected disabilities. “Our veterans have sacrificed so much for our country. It’s crucial that we acknowledge their physical challenges and provide them with the necessary support and care,” she says. This article explores common health challenges veterans face as well as treatment eligibility and the types of care they might expect to receive.

Health Challenges
Veterans face a range of physical issues, from hypertension and hearing loss to more severe conditions like limb loss, traumatic brain injury, and other neurological disorders. Conditions such as amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS), both degenerative neurological disorders, are particularly prevalent among veterans. ALS is automatically considered service-connected upon diagnosis. An MS diagnosis is somewhat different, only considered presumptive upon diagnosis for seven years following a veteran’s discharge from service.

Mathis points out the unique challenges faced by veterans with neurological disorders. “Neurological conditions like ALS and MS can be particularly debilitating,” she says. “ALS, for instance, typically progresses very quickly, so health care providers absolutely have to help the veteran get everything that they need, not only in terms of health care but also assistance for their survivors. They have to ensure they’re able to take care of the veteran and themselves. The caregiver may have to quit working or hire in-home help. It’s essential to provide specialized care and support to help these veterans maintain their quality of life.”

By applying through the VA website (VA.gov), primary and secondary caregivers can determine if they are eligible for support services such as the following:

• counseling;
• training and education;
• financial assistance to offset the cost of traveling with a veteran for care;
• a monthly stipend; and
• health care if they are not covered by another plan.

In addition, physical disabilities in veterans are frequently accompanied by mental health issues. Veterans may struggle with PTSD or chronic injuries or pain, which can impact them psychologically. “Chronic pain can lead to mental health challenges, affecting a veteran’s ability to earn and maintain housing security,” Mathis says. “When a veteran is dealing with chronic pain, it often takes a toll on their mental well-being. It’s not just about treating the physical symptoms but also addressing the emotional and psychological impact.” To address such issues, the VA offers the Whole Healthy Library, which provides education on self-care, available modalities, and other resources.

The VA acknowledges that veterans can also suffer from substance use disorder (SUD), such as binge drinking or drug use, as a way to cope with PTSD, anxiety, or depression, among other contributing factors, with approximately 11% of first-time VHA patients presenting with this challenge.1 The use of substances creates serious issues for veterans and their families and has been connected to “trauma, homelessness, mental health disorders, physical health issues, increased risk of suicide, and problems in relationships and at work.”1

Treatment Eligibility
While the VHA is the largest integrated health care system in the United States, serving more than 9 million veterans every year and “providing care at 1,380 health care facilities, including 170 medical centers and 1,193 outpatient sites,”2 not every veteran is necessarily eligible for care. A 2023 Rand Health Quarterly report states that “eligibility is based on length of military service, having a health condition related to military service, and income. Eligible veterans are sorted into VHA enrollment priority groups, which determine whether and how much veterans must contribute financially to their care.”3

Through its website, the VA provides a checklist and self-service application to determine if a veteran is eligible for care. Even if a veteran does not meet the VA’s published criteria, they may still qualify for care based on their income, and that information is available on the site.

Types of Care
For those veterans who qualify for care, the VHA offers a range of traditional therapies to address the issues they face.

Medication and Management
Veterans suffering from chronic conditions such as diabetes, hypertension, arthritis, or neurological disorders, for example, can receive medications to help manage their symptoms and improve their quality of life. Proper medication management is essential in preventing complications and reducing any discomfort associated with those conditions. Veterans may receive prescriptions directly through the VA, which provides access to specialized care and medication monitoring.

In addition, health care providers should be working closely with patients to adjust dosages, address side effects, and ensure medications are effectively supporting their overall health and well-being.

Surgical Options
Veterans facing more severe or debilitating conditions may require surgical procedures to restore function and alleviate pain. Surgical interventions are available for a range of medical needs, including limb loss, spinal cord injuries, and other critical conditions that significantly impact daily life. Advances in medical technology have allowed for improved prosthetic limb surgeries, spinal repair procedures, and other life-enhancing operations that help veterans regain mobility and independence. Postoperative care and rehabilitation services are also integral in ensuring a smooth recovery and successful reintegration into daily activities.

Physical Therapy
Physical therapy plays a critical role in the rehabilitation and recovery process for veterans with physical disabilities or injuries or who are in the postoperative phase. By focusing on improving mobility, strength, and overall function, physical therapy helps veterans regain independence and enhance their quality of life. Individualized treatment plans may include exercises to increase flexibility, balance training, and strength-building activities tailored to each veteran’s specific needs. Additionally, physical therapists often incorporate assistive devices, pain management strategies, and ongoing assessments to track progress. As a result, physical therapy serves as a cornerstone of long term care, promoting better health outcomes.

Mathis underscores the importance of the traditional therapies the VHA provides, noting, “Medications, surgeries, and physical therapy are vital components of a veteran’s treatment plan. These therapies are vital to helping veterans manage their symptoms and improve their overall well-being.”

Whole Health Model
Providing medications and offering surgery and physical therapy are components of the VHA’s comprehensive approach to health care known as the Whole Health model, which emphasizes treating the veteran as a whole person rather than just addressing specific symptoms or conditions. A significant aspect of this model is personalized health plans, which enable veterans to work closely with their health care providers to create roadmaps to address their unique needs and goals.

The model incorporates a range of complementary and integrative health therapies. According to a VA report, complementary and alternative medicine (CAM) is defined “as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. ‘Complementary medicine’ refers to the use of CAM together with conventional medicine. ‘Alternative medicine’ refers to the use of CAM in place of conventional medicine. ‘Integrative medicine’ (also called integrated medicine) refers to a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness.”4

Within the Whole Health model, veterans are able to receive such CAM modalities as acupuncture, chiropractic care, and mindfulness practices, among others, and such services can offer benefits. In a 2015 randomized controlled study, researchers found that “[a]mong veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity.” 5 Additionally, veterans who practiced mindfulness, reported reduced feelings of anxiety and depression.2

Other alternative therapies are also available to support veterans’ overall wellbeing. For instance, depending on the care facility, veterans can receive massage therapy to help alleviate muscle spasms, yoga therapy to assist with pain management and improve mental health, and practices such as tai chi to help with balance, flexibility, and physical health.

Pain Management
One of the more prevalent issues that veterans face is the lingering pain they can face throughout their lives. In fact, veterans experience more chronic pain compared with the general population, a condition that can frequently be accompanied by mental health problems. A 2016 study found that “65.5% of US military [v]eterans reported pain in the previous three months, with 9.1% classified as having severe pain. In comparison to [v]eterans, fewer nonveterans reported any pain (56.4%) or severe pain (6.4%). While [v]eterans aged 18 to 39 had significantly higher prevalence rates for severe pain (7.8%) than did similar-aged nonveterans.”6 Musculoskeletal conditions, including joint and back pain, are among the most frequently diagnosed health issues in veterans who served in Iraq and Afghanistan.

The VA reports that veterans who struggle with chronic pain can also suffer from sleep issues, reduced quality of life, depression, anxiety, and SUD. Furthermore, some veterans with this condition may also face disabilities, higher costs for health care, decreased productivity, and increased suicide risk.

Mathis stresses the importance of managing discomfort for veterans with long-term disabilities. “Effective pain management is about finding the right balance of treatments to help veterans manage their pain and live fulfilling lives,” she says. “And pain management isn’t always about medication. There are many ways health care providers are helping veterans manage pain successfully.” To Mathis’s point, the VHA offers various strategies to reduce this chronic condition, including nondrug modalities like massages and yoga. These alternatives provide veterans with effective ways to control their symptoms without relying solely on medication.

SUD Treatment Options
The VA also offers a wide range of treatment options for SUD, including evidence-based medications and therapies. Medications are meant to help with withdrawal symptoms, craving reduction, and cessation of tobacco use. Among the therapies offered are cognitive behavioral therapy, motivational interviewing, marriage and family counseling, and live-in care. The VA website provides location services to enable veterans to find available treatment options in their respective areas.

However, researchers are studying the efficacy of some of the VA’s approaches to SUD. For instance, acupuncture and relaxation techniques are components of the whole-health model. A 2023 study on their efficacy in treating SUD demonstrated that acupuncture and relaxation response reduced both cravings and anxiety associated with SUD recovery after only one session. Rates of both continued to decline with additional interventions.7

Challenges in Rural Areas
It should be noted that veterans in rural areas, who comprise nearly half of all VHA patients, often face difficulties accessing care, as they tend to live in places that lack providers or have experienced hospital closures.3 “Access to care is a significant issue for veterans in these regions. We need to ensure that they have the same opportunities for specialized treatment as those in urban areas,” Mathis adds.

In response to this problem and complaints about wait times at VHA facilities in 2014, “President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act), calling for the VA to implement the Veterans Choice Program. The Veterans Choice Program … allows eligible [v]eterans to receive care from non-VA facilities, connecting them to timely and convenient access to health care, instead of waiting for a VA appointment or traveling long distances to a VA facility. Veterans who live more than 40 miles away from a VA medical facility or have an excessive travel burden are eligible.”8 With this change, it is hoped that accessible care within a veteran’s own community will make it easier for those who live far from VA facilities to obtain the care they need.

Support Systems for Caregivers
Often, veterans with chronic disabilities may require a caregiver to assist them. However, caregiving for veterans can be an emotionally demanding role, often leading to high levels of stress, anxiety, and burnout. Recognizing the crucial role caregivers play, the VHA has established a caregiver support program. This program provides resources and assistance to caregivers, helping them manage their mental health and navigate the challenges of caring for a veteran. These resources may include access to counseling, stress management techniques, mindfulness training, and therapy sessions tailored to caregivers’ individual needs. Additionally, mental health professionals can offer guidance on navigating the emotional complexities of caregiving, ensuring that caregivers receive the necessary support to maintain their quality of life while providing compassionate care for their loved ones.

To ensure caregivers are well-prepared to support veterans with specific medical and psychological needs, various educational resources are made available. Those resources include training sessions, instructional materials, and online courses that cover essential topics such as managing chronic conditions, providing mobility assistance, and understanding mental health disorders, like PTSD and traumatic brain injuries.

Given the physically and emotionally taxing nature of caregiving, respite care services offer caregivers much-needed opportunities to take breaks and recharge. These services provide temporary relief by offering professional care for veterans, allowing caregivers to step away for a few hours, days, or even longer when necessary. Whether it’s for self-care, attending to personal obligations, or simply resting, respite care plays a vital role in preventing burnout and ensuring caregivers can continue providing effective support over the long term.

Furthermore, caregivers can often feel isolated in their responsibilities, making peer support an invaluable component of their overall well-being. Programs that facilitate connections between caregivers create a strong sense of community, allowing individuals to share their experiences, exchange advice, and offer emotional support to one another. “Support groups, online forums, and in-person meetings can provide a space where caregivers can find encouragement, reassurance, and understanding from others facing similar challenges. This sense of camaraderie not only reduces feelings of loneliness but also fosters resilience and strength among caregivers. Caregivers are the unsung heroes. They provide invaluable support to veterans, and it’s essential that we offer them the resources and assistance they need,” Mathis explains.

Final Thoughts
Veterans with chronic disabilities face numerous challenges. Through the VA, the VHA provides a comprehensive support system to address their needs. From specialized treatments to caregiver support, its holistic approach aims to ensure that veterans receive the care they deserve.

In addition, nonprofit organizations, such as the DAV, can also provide much-needed veteran support. For instance, among DAV’s offerings are job fairs, emergency grants, and free transportation. The organization is also a vocal advocate for veterans’ rights, working to influence local, state, and federal legislation to better serve veterans’ needs. “Our veterans have given so much for our country.” Mathis states. “It’s our duty to ensure they receive the best possible care and support. By addressing their physical, mental, and emotional needs, we can help them lead healthier, more fulfilling lives.”

— Susan Chapman, MA, MFA, is a Los Angeles–based freelance writer and editor.

References
1. Miller L. Statistics on veterans and substance abuse. America Addiction Centers website. https://veteranaddiction.org/resources/veteran-statistics. Published November 13, 2024.

2. Veterans Health Administration. US Department of Veterans Affairs website. https://www.va.gov/health/aboutvha.asp#:~:text=The%20Veterans%20Health%20
Administration%20(VHA,Veterans%20enrolled%20in%20the%20VA. Updated January 20, 2025.

3. Rasmussen P, Farmer CM. The promise and challenges of VA community care: veterans' issues in focus. Rand Health Q. 2023;10(3):9.

4. US Department of Veterans Affairs. Complementary and alternative medicine. https://www.research.va.gov/research_topics/2011cam_finalreport.pdf. Published September 2011.

5. Polusny MA, Erbes CR, Thuras P, et al. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA. 2015;314(5):456-465.

6. Nahin RL. Severe pain in veterans: the effect of age and sex, and comparisons with the general population. J Pain Res. 2017;18(3):247-254.

7. Chang BH, Sommers E. Acupuncture and relaxation response for craving and anxiety reduction among military veterans in recovery from substance use disorder. Am J Addict. 2014;23(2):129-136.

8. Using the Veterans Choice Program. US Department of Veterans Affairs website. https://www.publichealth.va.gov/exposures/publications/oef-oif-ond/post-9-11-vet-fall-2015/veterans-choice-program.asp. Updated August 25, 2023.