By Stacey Butterfield
If you have a mental image of what a veteran looks like, it's probably outdated and it definitely can't be relied on to guide your care. That's the biggest lesson experts in military medicine wanted attendees to take away from a Friday morning clinical workshop during Internal Medicine Meeting 2026.
The speakers urged their colleagues practicing outside the Veterans Affairs (VA) system to increase their awareness of how many of their patients have served in the military and how it may have affected them.
About 7% of the adult population of the U.S. are veterans, reported Thomas E. Reznik, MD, MPH, FACP. Thus, many internal medicine physicians will find significant military experience within their patient panels.
“It really takes a village; it takes a nation to care for these men and women who have served,” said Dr. Reznik, a primary care physician with the VA Providence Healthcare System in Providence, R.I. “The things that you can learn and understand about those patients really change the course of how you discuss and evaluate symptoms and really get to the heart of what's going on.”
Speaker Andrea Kossoudji, MS, MBA, RN, COHN-S, offered herself an example, describing a visit she had with her primary care clinician, who was unaware of the details of her military service. “I was complaining of some musculoskeletal issues that I was having and had been having, and she said, ‘Oh, you're too young to have that,’” said Ms. Kossoudji.
Given that Ms. Kossoudji had spent years deployed to combat zones wearing ill-fitting body armor and running long distances wearing a pack weighing as much as half her body, she was not, in fact, too young to have the medical problems she was reporting.
Ms. Kossoudji, who is now an implementation lead and nurse educator with the War Related Illness and Injury Study Center at the VA in San Diego, and the other experts urged internal medicine physicians to specifically ask their patients for a military history. She also had advice on how to do so effectively: Rather than asking “Are you a veteran?” say, "Have you served?”
“Many women don't actually consider themselves veterans for a variety of reasons, and someone who's not serving in combat may feel like they are not a veteran, so changing the question can significantly change the response,” she said.
A growing number of the veterans presenting for care will be women, she pointed out. “We are the fastest-growing population within the VA. The number of women serving in the military has doubled in the past 20 years,” said Ms. Kossoudji, adding that 17% of active-duty forces are women and the percentage is even higher among reserves.
After establishing that a patient is a veteran, a second question is recommended: What experiences did you have during military service that could impact your care? The most common answers for female patients may include musculoskeletal conditions (reported by two-thirds, Ms. Kossoudji noted), history of dehydration and urinary tract infections during deployment, mental health conditions, and traumatic experiences.
“Forty percent have suffered military sexual trauma. That is significant,” said Ms. Kossoudji.
All types of trauma can manifest effects long after a veteran returns home, she noted. “When I first got back, it was like, ‘OK, back to the unit, back to the floor, OK, everything's fine.’ It wasn't until a decade later, once I was having kids, that I was like, ‘Oh, this is now coming back to hit me in a way that I never expected,’” Ms. Kossoudji said. “These are experiences that stay with us forever.”
For a patient of any gender, military service should be considered a social determinant of health, leading clinicians to consider how it affects a patient's financial and health care status, the experts said. Also consider how the specifics of service may highlight particular risks, for example, Agent Orange exposure in Vietnam or traumatic brain injury from wars in Iraq or Afghanistan.
It's yet to be seen what the next item on that list will be. The latest war in the Middle East has already led to 350 injuries among the troops, and the events in the news could have spillover effects on veterans, Ms. Kossoudji noted. “Consider how this current conflict is affecting the veterans that you're seeing now, and of course, the people that are overseas once they come back,” she said. “We don't think that this is going to be ending any time soon.” ■