Have you or has someone close to you ever served in the military?
When did you serve?
What did you do while you were in the military?
Were you assigned to a hostile or combative area?
Did you experience enemy fire, see combat, or witness casualties?
Were you wounded, injured, or hospitalized?
Did you participate in any experimental projects or tests?
Were you exposed to noise, chemicals, gases, demolition of munitions, pesticides, or other hazardous substances?
Have you ever used the VA for health care?
When was your last visit to the VA?
Do you have a service-connected disability or condition? Do you have a claim pending? If so, what is the nature of the claim?
Do you have a VA primary care provider?
Do you have a safe place to go when you leave today?
Do you need assistance in caring for yourself or members of your household?
General Areas of Concern for All Veterans
Post-Traumatic Stress Have you ever experienced:
A traumatic or stressful event which caused you to believe your life or the lives of those around you were in danger?
Trauma-related thoughts or feelings?
Nightmares, vivid memories, or flashbacks of the event?
Feeling anxious, jittery, watchful, or easily startled?
A sense of panic that something bad is about to happen?
Feeling numb or detached from others?
Difficulty sleeping or concentrating?
Military Sexual Trauma
During military service did you receive uninvited or unwanted sexual attention, such as touching, pressure for sexual favors or sexual remarks?
Did anyone ever use force or threat of force to have sexual contact with you against your will?
Did you report the incidents to your command and/or military or civilian authorities? Is this an on-going problem?
Would you like some help with this?
Blast Concussions/Traumatic Brain Injury
During your service, did you experience:
heavy artillery fire, vehicular or aircraft accidents;
explosions (improvised explosive devices, rocket-propelled grenades, land mines, grenades); or
fragment or bullet wounds above the shoulders?
Did you have any of these symptoms immediately afterwards:
loss of consciousness or being knocked out;
being dazed or seeing stars, not remembering the event, or diagnosis of concussion or head injury?
Common Military Health Risks:
Radiation Exposure/Nuclear Weapons (WWII: Amchitka, Alaska, Hiroshima, Nagasaki, POW in Japan; Korea; sub-mariners exposed to nasopharyngeal radium treatment; Gulf Wars; Bosnia; Afghanistan): High risk for cancer.
Agent Orange Exposure (Korea & Vietnam): High risk for cancers (including respiratory and prostate cancer), chloracne, type 2 diabetes, ischemic heart disease, soft tissue sarcoma, peripheral neuropathy, spina bifida in veterans’ biological children.
Camp Lejeune Water Contamination (January 1, 1957–December 31, 1987): Veterans and families stationed at Camp Lejeune exposed to chemical contaminants in the groundwater and wells are at risk for the following cancers (bladder, blood dyscrasia, breast, esophageal, kidney, leukemia, lung, multiple myeloma, myelodysplatic syndromes, non-Hodgkin’s lymphoma) and conditions (female infertility, hepatic steatosis, miscarriage, renal toxicity, scleroderma).
Hepatitis C (Vietnam): Transfusions prior to 1992, battlefield exposures to blood and human fluids, group use of needles, razors, toothbrushes, and other personal items.
Exposure to Open Air Burn Pits (Vietnam, Iraq, Afghanistan): High risk for respiratory illnesses and wide variety of cancers, including leukemia.
Gulf War Syndrome (Gulf Wars): Characterized by fibromyalgia, chronic fatigue syndrome, headaches, gastrointestinal problems, cognitive impairment and pain, high rates of brain and testicular cancers, and neurodegenerative diseases (ALS,MS).
Depleted Uranium (Gulf Wars, Bosnia, Afghanistan): Inhaled or ingested microfine particles (heavy metal toxicity). Risk for respiratory and kidney diseases.