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Because Saddam Hussein did not withdraw his troops from Kuwait as demanded by the United Nations Security Council, the Gulf War began in 1990/1991 (Khan Academy, 2019). A tremendous airstrike coalition led by the United States of America forced Hussein to call a ceasefire and give up Kuwait in February 1991 (History, 2019). The Gulf War is also known as the Persian Gulf War and/or Operation Desert Storm (History, 2019). The U.S. Department of Veterans Affairs (2014) webpage explains that more than 650.000 U.S. service members served in the Gulf War. However, due to definition differences concerning the ending of the Gulf War, the Gulf War Era Veterans Report conducted by the U.S. Department of Veterans Affairs (2011) speaks of 6,516,030 military personnel on active duty in the Pre-911 period which describes the period from 08/02/1990 to 09/10/2001.
Gulf War veterans are former active duty service personnel or activated Reserve and National Guard personnel who take part in Operation Desert Shield, Operation Desert Storm, or post-Desert Storm (U.S. Department of Veterans Affairs, 2011). 85 % are male while 15 % are female (U.S. Department of Veterans Affairs, 2011). 41 % is between 35 and 44 years of age and 17 % truly deploys to the Gulf region (U.S. Department of Veterans Affairs, 2011). Because not all deployed service members participated in the 1990-1992 Gulf War, the Department of Defense explains that 68 % or 763,337 service members were actual participants in the Gulf War (U.S. Department of Veterans Affairs, 2011). In Fiscal Year 09 (FY09), 17 % of all Pre-911 veteran disability compensations are service-connected for a minimum of one condition which shockingly describes a massive increase in comparison to the previous fiscal year (U.S. Department of Veterans Affairs, 2011).
While in FY00 147,225 service-connected pre-911 Veterans receive healthcare, in FY09 the number jumps to 571,656 (U.S. Department of Veterans Affairs, 2011). One registers an 87 % increase in healthcare encounters for illnesses that affect the metabolic-endocrine system and an 85 % increase in encounters for mental health (U.S. Department of Veterans Affairs, 2011). For all body systems, the overall number records a 79 % increase in encounters (U.S. Department of Veterans Affairs, 2011).
Of note is the so-called Gulf War Syndrome. Military.com (2019) explains the term Gulf War Syndrome describes as a cluster of medically unexplained chronic symptoms that can include fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems . The VA acknowledges that diseases such as the Gulf War Syndrome, some infectious diseases as well as Amyotrophic lateral sclerosis (ALS) are presumably due to military service in the Southwest Asia region (U.S. Department of Veterans Affairs, 2014). Interestingly, the VA prefers the term Medically Unexplained Illnesses over the term Gulf War Syndrome because symptoms vary (U.S. Department of Veterans Affairs, 2018). The VA categorizes symptoms such as abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headache, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders, and sleep disturbances as Medically Unexplained Illnesses (U.S. Department of Veterans Affairs, 2018).
Gwini et al. (2016), on the other hand, speak of Multi Symptom Illnesses (MSI). Healthcare needs of Gulf War Veterans increased as proven by an increase in healthcare usage and disability claims that are significantly higher in the MSI group than the group without MSI or chronic illness (Gwini et al., 2016). The U.S. Department of Veterans Affairs (2019) further illustrates that exposure to vaccinations, chemicals, and other environmental hazards (noise, heat, sand, dust, uranium, oil well fires, pesticides, chemical agent resistant coating (CARC) paint) play a role in Medically Unexplained Illnesses. In addition, infectious diseases such as malaria are connected to Southwest Asia and Afghanistan military service (U.S. Department of Veterans Affairs, 2019). Finally, a peer-reviewed systematic review and meta-analysis reveal Depression occurs twice-fold among Gulf War Veterans in comparison to service members who are not deployed (Blore et al., 2015).
Veterans who serve in the Gulf War and are discharged honorably are covered to receive disability benefits such as healthcare and compensation (U.S. Department of Veterans Affairs, n.d.). To be eligible for benefits one must show that a diagnosed condition evolved during military deployment before 12/31/2016 (U.S. Department of Veterans Affairs, n.d.). A condition that causes illness for at least six months with a disability rating of ten percent and is solely due to military deployment (U.S. Department of Veterans Affairs, n.d.). In addition, so-called presumed disabilities like infectious diseases, are eligible for disability benefits if a disability occurs within twelve months of separation and the presumed disability has a disability rating of at least ten percent (U.S. Department of Veterans Affairs, n.d.). It is vital to note, the restrictions, e.g. the restriction date of 12/31/2016 published on the above-mentioned Veterans Affairs webpage is not correct: Because symptoms can have a delayed onset and/or can get worse over time, the Department of Veterans Affairs extends the Presumptive Period for Compensation for Gulf War Veterans in a ruling on 10/24/2017 (Federal Register, 2017). VA removed the date, December 31, 2016, from 38 CFR 3.317(a)(1)(i) and added, in its place, December 31, 2021 (Federal Register, 2017).
Disability truly is a life-changing occurrence. Disability affects the mental, physical, and spiritual health of the person and might negatively affect relationships with family and friends. The socio-economic situation changes. Depending on the severity, the disabled veteran might have to look for different occupational avenues. Thankfully, the VA Vocational Rehabilitation and Employment Program (VR&E or Chapter 31) provides benefits and assistance in evaluating new employment and training possibilities (U.S. Department of Veterans Affairs, n.d.). Finally, VR&E/Chapter 31 benefits might extend to family members of a disabled veteran (U.S. Department of Veterans Affairs, n.d.).
Resources such as the internet (online the veteran can find information about eligibility criteria, e-file for benefits, and communicate with fellow veterans), VA phone numbers, VA hotlines, VA hospitals, and VA Service Centers are available in many communities throughout the United States. One important local resource in Tampa, Florida is called Tampa Vet Center. Tampa Vet Center offers quality readjustment counseling and timely referral assistance with employment (Evans, personal communication, May 27, 2019). The centers goal is to assist veterans to readjust into civilian life (Evans, personal communication, May 27, 2019). Tampa Vet Center offers counseling services when it comes to readjustment needs for combat veterans and active duty service members, group counseling/workshops, family and couples counseling for issues related to readjustment, bereavement counseling for families who experience an active duty or reserve death, and military sexual trauma (MST) counseling related to assault or repeated harassment (Evans, personal communication, May 27, 2019). All services are free of charge (Evans, personal communication, May 27, 2019). The center also offers assessment and referral services about substance abuse, employment resources, VBA benefits, and claims assistance referrals (Evans, personal communication, May 27, 2019). Evans stresses out eligible for services are active duty members and veterans and their families; there is no referral needed to qualify for Vet Center Services (Evans, personal communication, May 27, 2019).
While approximately seven thousand veterans visit the Tampa Vet Center per year (Evans, personal communication, May 27, 2019), barriers to utilizing resources exist.
First, one hurdle is navigation of the internet and/or navigating resources. Not everyone knows how to use the internet and confusion exists with regards to VA benefit eligibility criteria.
Second, veterans might find it difficult to access care as resources are located too far from home. Pride and shame are additional traits that impede care. Furthermore, Cheney et al. (2018) list barriers of financial nature, personal nature, and mistrust towards the VA. Cheney et al. (2018) conclude that military culture plays a significant role in why hurdles exist. A veteran culture of being strong and selfless can be the culprit of why care-seeking is delayed. The veteran culture consists of core values that characterize behavior and thinking. For example, the Seven Core Army Values are Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, and Personal Courage (Army.mil, n.d.). Yet another group of veterans that forms its public health vulnerability group is veterans who are mentally and/or behaviorally ill. Some wont be able to tolerate help, find help, or even know that they need help. Stigmatization of mental illness serves as an obstacle to care.
Nurses can promote health by stressing that Veterans very much deserve care and that nurses want to help especially in the context of their status as military Veterans. Veteran clients can be part of a family that takes care of the veteran at home. Clinicians must have a thorough understanding to better support caregivers (Saban et al., 2015). A better understanding should translate into increased clinician empathy. To overcome the hurdle of physical healthcare inaccessibility, a recommendation is for Congress to increase VA budgets to establish rural VA Centers. Increased awareness and education of the public about veteran healthcare issues can change military culture, destigmatize mental illness, and clear up misconceptions. Both, veterans with mental illness and civilians with mental illness could benefit from higher public acceptance of mental disease. Nurses must speak with family and friends about veteran culture, veteran health problems, barriers to care, etc. Nurses can spread the word on social media, and they can demonstrate for congressional budget increases. Nurses can build coalitions with veterans, speak on TV, publish articles in newspapers, advertise banners, and call and write government representatives. Additionally, nursing students and nursing educators can propose colleges include the topic Care of Veterans in a programs curriculum. Nurses can teach students as preceptors in practice, attend or hold seminars, and create online assignments/tests. State Boards of Nursing could make it mandatory for nurses to increase knowledge about Care of Veterans in connection with continuing education requirements for nurses.
Education and going public incidentally increase awareness of issues surrounding veterans and incidentally lead to destigmatization which hopefully results in more veterans seeking healthcare services without delay. To increase healthcare compliance among veterans, follow-up communication (phone calls, letters) could be effective. Another – yet controversial – idea to increase treatment compliance is to reduce individual veteran government benefits if one does not adhere to treatment plans. The costs saved could then be used to fill up the budget needed to care for veterans who appreciate treatment.
One easily concludes veteran needs are truly complex. Needs go beyond the constraints of the Nurses Scope of Practice. Therefore, a comprehensive, effective plan of care must include additional professional input from social services, case management, physicians, and community resources such as Vet Centers and other VA resources.
References
- Blore, J., Sim, M., Forbes, A., Creamer, M., & Kelsall, H. (2015). Depression in Gulf War veterans: a systematic review and meta-analysis, 45(8), 15651580. https://doi.org/10.1017/S0033291714001913
- Cheney, A., Koenig, C., Miller, C., Zamora, K., Wright, P., Stanley, R., & Pyne, J. (2018). Veteran-centered barriers to VA mental healthcare services use. BMC Health Services Research, 18(1), 114. https://doi.org/10.1186/s12913-018-3346-9
- Federal Register. (2017). Extension of the Presumptive Period for Compensation for Gulf War Veterans. Retrieved from https://www.federalregister.gov/documents/2017/10/24/2017-22970/extension-of-the-presumptive-period-for-compensation-for-gulf-war-veterans
- Gwini, S., Forbes, A., Kelsall, H., Sim, M., & Gwini, S. (2016). S04-4Health service use and disability claims among Gulf War veterans and other military personnel with multisymptom illness 20 years after the Gulf War. Occupational and Environmental Medicine, 73(Suppl 1), A100A100. https://doi.org/10.1136/oemed-2016-103951.270
- History.com. (2019). Persian Gulf War. Retrieved from https://www.history.com/topics/middle-east/persian-gulf-war
- Khan Academy. (2019). The Gulf War. Retrieved from https://www.khanacademy.org/humanities/us-history/modern-us/1990s-america/a/the-gulf-war
- Military.com (2019), Gulf War Syndrome. Retrieved from https://www.military.com/benefits/veterans-health-care/gulf-war-syndrome.html
- Saban, K. L., Hogan, N. S., Hogan, T. P. and Pape, T. L. (2015), He Looks Normal But & Challenges of Family Caregivers of Veterans Diagnosed with a Traumatic Brain Injury. Rehabil Nurs, 40: 277-285. doi:10.1002/rnj.182
- U.S. Department of Veterans Affairs. (2011). Gulf War Era Veterans Report: Pre-9/11. Retrieved from https://www.va.gov/vetdata/docs/SpecialReports/GW_Pre911_report.pdf
- U.S. Department of Veterans Affairs. (n.d.). Gulf War Illness linked to service in Southwest Asia. Retrieved from https://www.va.gov/disability/eligibility/hazardous-materials-exposure/gulf-war-illness-southwest-asia/
- U.S. Department of Veterans Affairs. (2019). Gulf War Veterans health issues. Retrieved from https://www.va.gov/health-care/health-needs-conditions/health-issues-related-to-service-era/gulf-war/
- U.S. Department of Veterans Affairs. (n.d.). VA Vocational Rehabilitation and Employment (Chapter 31). Retrieved from https://www.va.gov/careers-employment/vocational-rehabilitation/
- U.S. Department of Veterans Affairs. (2014). Veterans. Retrieved from https://www.benefits.va.gov/persona/veteran-gulfwar.asp
- U.S. Department of Veterans Affairs. (2018). Public Health. Retrieved from https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp
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