CCMS Medicine Summer 2017 - 24

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The Ever-growing Spectrum
of Military/Veterans' Health
Hazards and Illnesses
BY JOHN P. MAHER, MD, MPH

T

wo years ago, we were advised by a number of veterans and
Veterans Service Organizations (VSOs) that all too many
health care providers were unaware of, and unprepared to
handle, the unique health care hazards and issues of returning GIs
and other military veterans. Consequently, this journal published
an article about what primary care physicians need to know, ask,
and evaluate: "When Johnny Comes Marching Home Again"
(Chester County Medicine, Summer 2015, pp. 8-9) in order to
make physicians more aware and help in their treatment of those
who have borne the heat of battle to make and keep this nation
"the home of the free because of the brave."
In his farewell address to the Congress (4/19/51), General of
the Armies Douglas MacArthur closed his message with the words
of an old Army barracks ballad: "...old soldiers never die, they just
fade away." But, while that is poetic and emotional, and may have
described the soldier's situation in the early 20th century, it is no
longer true. We still have wars, interventions and police actions,
and no doubt will continue to do so for a long time to come.
Our military, the best of our youth, as well as the more
experienced and career active military, are spread out pretty much
all over the world - in many nations, on nearly every continent.
Whether they are there as active combatants, military advisors,
peace-keepers, or protectors of our civilian workers and embassies,
they are always in proximity to any of a myriad of unique and
potential hazards which can affect them acutely, sub-acutely, or
chronically, and which may result in unique health care issues
affecting them even after they return home. Those health care
issues are multiple, complex, not uncommon, and sometimes
difficult to zero in on and accurately diagnose. Consequently, these
veterans are often labeled as alcoholics, addicts, neurotics, even
psychotics; they are prescribed tranquilizers and their signs and
symptoms dismissed out of hand.
We sometimes forget that not all military are sent into actual
combat. Nevertheless, they may face other kinds of dangers,
such as those related to the geographical areas or bases where
they are assigned, even those right here in the USA as well as
other places where they can be sent by Uncle Sam. For example,
training accidents occur fairly often; the same herbicides used in
southeast Asia were also used as standard herbicides around many
military bases. Personnel stationed in some Air Force bases around
the nation were exposed to contaminated ground waters (e.g.,
perfluorinated organic firefighting foam); those at dozens of sites
24 CHESTER COUNT Y Medicine | SUMMER 2017

around the nation may have been exposed to depleted Uranium
(DU) where DU munitions were produced, stored or tested. Agent
Orange (Fig. #1a) was used and/or stored in diverse spots such as
Korea, Okinawa, and Guam, as well as Southeast Asia. Anyone
stationed in the Caribbean, or Central or South America, could
be exposed to Yellow Fever, Zika, Dengue, Cholera, etc. Plague,
Hanta virus and Valley Fever are endemic to the southwest US
states. More recently, it was shown that Marine Corps personnel
and their families may have been affected by severely contaminated
groundwater at Camp Lejeune, NC, and the VA has listed the
illnesses and conditions related to that exposure. (Fig #1b)
Figure # 1
VA LIST OF ILLNESSES/CONDITIONS PRESUMED DUE
TO SPECIFIC EXPOSURES
(Fig. #1a) Diseases & Conditions Listed by the VA as "presumptive diseases associated with exposure to Agent Orange or
other herbicides during military service:"
* AL Amyloidosis
* Chronic B-Cell Leukemias
* 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 Tarda
* Prostate Cancer
* Respiratory Cancers,
including lung cancer
* Soft Tissue Sarcomas
(other than osteo-, chondro,
or Kaposi's sarcomas, or
mesothelioma)

(Fig. #1b) List of diseases/conditions for which the VA has
established a presumptive service-connection for Veterans,
Reservists, or National Guard members exposed to the contaminated water supply at Camp Lejeune, NC, between 8/1/53 and
12/31/87 and who later developed any of these::
* Adult Leukemia
* Aplastic Anemia & other
myelodysplastic syndromes
* Bladder Cancer
* Kidney Cancer

* Liver Cancer
* Multiple Myeloma
* Multiple Myeloma
Non-Hodgkin's Lymphoma
* Multiple Myeloma
Parkinson's Disease

[ Source: www.publichealth.va.gov]
http://chestercms.org/index.html http://www.publichealth.va.gov
Table of Contents for the Digital Edition of CCMS Medicine Summer 2017
