Executive Summary
Military veterans who recently served in Afghanistan, Iraq, and other countries often return home with "invisible" healthcare needs that might be overlooked in community healthcare settings.
The VA offers new veterans case management that includes screening for common problems such as post-traumatic stress disorder, traumatic brain injury, sexual trauma, and depression.
VA case managers help veterans navigate the system and receive medical and psychosocial care.
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Community case managers should first identify veterans and then make referrals to a VA program, where they can be screened for mental health and brain injury problems.
U.S. veterans who have served in Afghanistan and Iraq often return to their homes ready to re-engage in their civilian lives. But there’s a post-deployment price to pay, and it can include "invisible injuries" such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), or even suicidal thoughts and depression.
They might not be aware of their own neurological and mental health symptoms, but someone should know. When the veteran visits a community hospital or local providers for care, then case managers might assist by addressing their hidden psychosocial needs.
"I’d like case managers in civilian settings to know that every VA hospital has a program for new veterans," says Carolyn G. Dunbar, RN, MSN, OEF/OIF/OND RN case manager at the Southeast Louisiana Veterans Health Care System in New Orleans.
"A lot of veterans are ready to get home, and they don’t pay attention to their own needs because sometimes they just want to get back into civilian life," Dunbar notes. "They aren’t interested in what resources are available for them."
For instance, combat veterans can receive five years of free healthcare related to their service injuries if they served in Afghanistan and some other regions in Operation Enduring Freedom (OEF), or in Iraq in Operation Iraqi Freedom (OIF), or in Iraq after 2010 in Operation New Dawn (OND).
Dunbar would like case managers and health systems to make certain patients who are new veterans do not fall through the cracks. One of the first ways to prevent this is to screen for veterans by routinely asking patients if they are veterans and when they last served, she says.
"I ask veterans if they went somewhere else for healthcare," Dunbar says. "If they say, yes,’ I ask them if they told the hospital that they were a veteran, and they always say, no.’"
From a case management perspective, a "yes" answer to the new veteran question opens up many resource possibilities: A case manager can call the VA hospital nearest to them and help the veteran make an appointment. The VA has screening exam services for depression, substance abuse, PTSD, military sexual trauma, and TBI. Case managers also can refer service members to the VA’s website for new veterans at www.oefoif.va.gov.
"We would like to see every OEF/OIF/OND veteran," Dunbar says. "Everybody should know about the Veterans Health Administration and their services for veterans."
For instance, the VA’s services include case management and assistance with finding jobs, returning to school, housing, life insurance, and prosthetics and sensory aids.
There also are specialized services for women veterans, who comprise the fastest growing group within the veteran population. Each VA site has a Women Veterans Program Manager who advocates for women veterans. For this population, the top diagnoses are PTSD, hypertension, and depression, and 20% of the women screen positively for military sexual trauma.
Women veterans also can receive disease prevention services including Pap smears and mammograms, birth control, menopausal support, nutrition counseling, weight control, smoking cessation, and substance abuse treatment. Those who have been sexually traumatized are offered counseling and treatment.
When veterans are referred to the VA from military treatment facilities, they first are assessed by a military assistance case manager who determines their needs and makes referrals to a VA facility.
"The case manager lets us know what their needs are so we can provide seamless transition," Dunbar says.
The VA case manager’s role is to assist veterans with both medical and non-medical needs. The veteran might have difficulty financially once leaving the service, so the case manager might help them address this issue, she says.
"We also help with the claims process," she adds.
"New veterans face a change of life situation," Dunbar explains. "Some were not on active duty and then were called up for deployment, and once you return home it’s different for you — there are a lot of different changes in your life."
Case managers are there to help with those changes and to help veterans deal with their losses, which could include an actual loss of limb or marital issues. "We also have services for families of veterans so they can understand what the veteran is going through, and we encourage them to use these services," Dunbar says. "Our goal is to provide seamless transition into the Veterans Health Administration."
