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BACKGROUND

The rehabilitation of veterans and active-duty service members (ADSMs) is one of the most demanding of all rehabilitation populations. The rehabilitation of this population is a complex task requiring the coordination of an interdisciplinary team. The severity of the disorder dictates the resources that are required and the personnel involved in the care of the patient.

Clinicians in the U.S. Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA) need to understand the impact of combat and noncombat operations on the body's function. It is common for ADSMs to return from deployment with a diverse range of difficulties. In addition, more than 50% of returning ADSMs enroll in the VA's health care system for treatment of their difficulties, including service-related conditions. Therefore, it is imperative that the clinicians providing their care become familiar with the strain that military life may put on an individual. This chapter describes the specific exposures, injuries, and illnesses that rehabilitation professionals commonly treat in the DoD and VA. In recent years, concern about combat-associated traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) has been at the forefront of clinical care and research pathways. This chapter will focus on those issues, adding a brief description of other conditions related to military service.

VA specifically documents exposure-related health concerns (Box 100–1) to increase clinician and veteran knowledge about a variety of illness and injuries and to facilitate a systematic approach to care, including (1) Agent Orange, (2) Gulf War syndrome (GWS), (3) infectious diseases of Southwest Asia, (4) toxic embedded fragments, (5) TBI, (6) radiation exposure, (7) chemical, biological, and radiological weapons, (8) cold injuries, and (9) heat injuries. In addition, the VA created the Veterans Health Initiative (VHI) to knowledge-translate and disseminate these topics in greater detail for the purpose of providing enhanced understanding of these conditions that primarily affect ADSMs and veterans. In parallel, a better appreciation of these issues facilitates the DoD's ability to prepare and protect American service members in future operations (i.e., force readiness).

Box 100–1 Military Exposures

  • Agent Orange

  • GWS

  • Infectious diseases of Southwest Asia

  • Toxic-embedded fragments

  • TBI

  • Radiation exposure

  • Chemical, biological, and radiological weapons

  • Cold injuries

  • Heat injuries

During the Vietnam War, Agent Orange, a broad-spectrum herbicide, was used to clear foliage and improve battlefield visibility for troops. It was only after its use that its potential negative health impacts were understood. VA relates many illnesses in veterans and their children to the use of this toxicant (Box 100–2). Rehabilitation professionals should be familiar with these illnesses and disorders as many of them affect function and will respond to therapy and other interventions.

Box 100–2 Diseases Associated with Agent Orange Exposure

Veterans

  • AL amyloidosis

  • Chronic B-cell leukemia

  • Chloracne

  • Diabetes mellitus type 2

  • Hodgkin's disease

  • Ischemic heart disease

  • Multiple myeloma

  • Non-Hodgkin's lymphoma

  • Parkinson's disease

  • Peripheral neuropathy (early onset)

  • Porphyria cutanea ...

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