Chapter 80: Primary Care of Veterans

With over 20 million veterans in the United States and more than half receiving care from non-Veterans Health Administration providers, community-based healthcare professionals play a critical role in recognizing and managing service-related health conditions. The chapter establishes the importance of conducting sensitive military history assessments that incorporate questions about service period, occupational specialty, and environmental exposures while creating safe space for discussion of trauma-related experiences. Veterans face elevated risks across multiple health domains linked directly to their service era: those exposed to Agent Orange during Vietnam experience increased cancer and metabolic disease incidence, while Gulf War and recent Iraq and Afghanistan veterans commonly suffer from respiratory complications and Gulf War Illness associated with burn pit exposure. Infectious disease burden, particularly hepatitis C infection, remains disproportionately high in this population. Hearing loss and traumatic brain injury emerge as signature injuries from modern conflicts, frequently occurring alongside chronic pain and posttraumatic stress responses. The chapter emphasizes that mental health conditions, including post-traumatic stress disorder affecting 10 to 13 percent of veterans and military sexual trauma impacting substantial portions of both male and female service members, significantly increase risks for physical comorbidities, substance use disorders, and suicide. Musculoskeletal conditions occur at two to three times the population baseline, with particular gender-specific variations in osteoarthritis presentation and injury patterns. Special attention addresses disparities experienced by female veterans, whose population is projected to grow substantially, and by lesbian, gay, bisexual, transgender, and queer-identified veterans, who face compounded health inequities. The chapter concludes that veteran-centered primary care requires integration of military service history into electronic health records, evidence-based screening protocols for psychological conditions, and understanding of how military service fundamentally shapes long-term health trajectories across physical, mental, and social dimensions.