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VHA Facilities Report Severe Staffing Shortages
VHA Facilities Report Severe Staffing Shortages
For > 10 years, the US Department of Veterans Affairs (VA) Office of Inspector General (OIG) has annually surveyed Veterans Health Administration (VHA) facilities about staffing. Its recently released report is the 8th to find severe shortages—in this case, across the board. There were 4434 severe staffing shortages reported across all 139 VHA facilities in fiscal year (FY) 2025, a 50% increase from FY 2024.
In the OIG report lexicon, a severe shortage refers to "particular occupations that are difficult to fill," and is not necessarily an indication of vacancies. Vacancy refers to a "specific unoccupied position and is distinct from the designation of a severe shortage." For example, a facility could identify an occupation as a severe occupational shortage, which could have no vacant positions or 100 vacant positions.
Nearly all facilities (94%) had severe shortages for medical officers, and 79% had severe shortages for nurses even with VHA's ability to make noncompetitive appointments for those occupations. Psychology was the most frequently reported severe clinical occupational staffing shortage, reported by 79 facilities (57%), down slightly from FY 2024 (61%). One facility reported 116 clinical occupational shortages.
The report notes that the OIG does not verify or otherwise confirm the questionnaire responses, but it appears to support other data. In the first 9 months of FY 2024, the VA added 223 physicians and 3196 nurses compared with a deficit of 781 physicians and 2129 nurses over the same period in FY 2025.
VHA facilities are finding it hard to reverse the trend. According to internal documents examined by ProPublica, nearly 4 in 10 of the roughly 2000 doctors offered jobs from January through March 2025 turned them down, 4 times the rate in the same time period in 2024. VHA also lost twice as many nurses as it hired between January and June. Many potential candidates reportedly were worried about the stability of VA employment.
VA spokesperson Peter Kasperowicz did not dispute the ProPublica findings but accused the news outlet of bias and "cherry-picking issues that are mostly routine." A nationwide shortage of health care workers has made hiring and retention difficult, he said.
Kasperowicz said the VA is "working to address" the number of doctors declining job offers by speeding up the hiring process and that the agency "has several strategies to navigate shortages." Those include referring veterans to telehealth and private clinicians.
In a statement released Aug. 12, Sen Richard Blumenthal (D-CT), ranking member of the Senate Committee on Veterans' Affairs, said, "This report confirms what we've warned for months—this Administration is driving dedicated VA employees to the private sector at untenable rates."
The OIG survey did not ask about facilities' rationales for identifying shortages. Moreover, the OIG says the responses don't reflect the possible impacts of "workforce reshaping efforts," such as the Deferred Resignation Program announced on January 28, 2025.
In response to the OIG report, Kasperowicz said it is "not based on actual VA health care facility vacancies and therefore is not a reliable indicator of staffing shortages." In a statement to CBS News, he added, "The report simply lists occupations facilities feel are difficult for which to recruit and retain, so the results are completely subjective, not standardized, and unreliable." According to Kasperowicz, the system-wide vacancy rates for doctors and nurses are 14% and 10%, respectively, which are in line with historical averages.
The OIG made no recommendations but "encourages VA leaders to use these review results to inform staffing initiatives and organizational change."
For > 10 years, the US Department of Veterans Affairs (VA) Office of Inspector General (OIG) has annually surveyed Veterans Health Administration (VHA) facilities about staffing. Its recently released report is the 8th to find severe shortages—in this case, across the board. There were 4434 severe staffing shortages reported across all 139 VHA facilities in fiscal year (FY) 2025, a 50% increase from FY 2024.
In the OIG report lexicon, a severe shortage refers to "particular occupations that are difficult to fill," and is not necessarily an indication of vacancies. Vacancy refers to a "specific unoccupied position and is distinct from the designation of a severe shortage." For example, a facility could identify an occupation as a severe occupational shortage, which could have no vacant positions or 100 vacant positions.
Nearly all facilities (94%) had severe shortages for medical officers, and 79% had severe shortages for nurses even with VHA's ability to make noncompetitive appointments for those occupations. Psychology was the most frequently reported severe clinical occupational staffing shortage, reported by 79 facilities (57%), down slightly from FY 2024 (61%). One facility reported 116 clinical occupational shortages.
The report notes that the OIG does not verify or otherwise confirm the questionnaire responses, but it appears to support other data. In the first 9 months of FY 2024, the VA added 223 physicians and 3196 nurses compared with a deficit of 781 physicians and 2129 nurses over the same period in FY 2025.
VHA facilities are finding it hard to reverse the trend. According to internal documents examined by ProPublica, nearly 4 in 10 of the roughly 2000 doctors offered jobs from January through March 2025 turned them down, 4 times the rate in the same time period in 2024. VHA also lost twice as many nurses as it hired between January and June. Many potential candidates reportedly were worried about the stability of VA employment.
VA spokesperson Peter Kasperowicz did not dispute the ProPublica findings but accused the news outlet of bias and "cherry-picking issues that are mostly routine." A nationwide shortage of health care workers has made hiring and retention difficult, he said.
Kasperowicz said the VA is "working to address" the number of doctors declining job offers by speeding up the hiring process and that the agency "has several strategies to navigate shortages." Those include referring veterans to telehealth and private clinicians.
In a statement released Aug. 12, Sen Richard Blumenthal (D-CT), ranking member of the Senate Committee on Veterans' Affairs, said, "This report confirms what we've warned for months—this Administration is driving dedicated VA employees to the private sector at untenable rates."
The OIG survey did not ask about facilities' rationales for identifying shortages. Moreover, the OIG says the responses don't reflect the possible impacts of "workforce reshaping efforts," such as the Deferred Resignation Program announced on January 28, 2025.
In response to the OIG report, Kasperowicz said it is "not based on actual VA health care facility vacancies and therefore is not a reliable indicator of staffing shortages." In a statement to CBS News, he added, "The report simply lists occupations facilities feel are difficult for which to recruit and retain, so the results are completely subjective, not standardized, and unreliable." According to Kasperowicz, the system-wide vacancy rates for doctors and nurses are 14% and 10%, respectively, which are in line with historical averages.
The OIG made no recommendations but "encourages VA leaders to use these review results to inform staffing initiatives and organizational change."
For > 10 years, the US Department of Veterans Affairs (VA) Office of Inspector General (OIG) has annually surveyed Veterans Health Administration (VHA) facilities about staffing. Its recently released report is the 8th to find severe shortages—in this case, across the board. There were 4434 severe staffing shortages reported across all 139 VHA facilities in fiscal year (FY) 2025, a 50% increase from FY 2024.
In the OIG report lexicon, a severe shortage refers to "particular occupations that are difficult to fill," and is not necessarily an indication of vacancies. Vacancy refers to a "specific unoccupied position and is distinct from the designation of a severe shortage." For example, a facility could identify an occupation as a severe occupational shortage, which could have no vacant positions or 100 vacant positions.
Nearly all facilities (94%) had severe shortages for medical officers, and 79% had severe shortages for nurses even with VHA's ability to make noncompetitive appointments for those occupations. Psychology was the most frequently reported severe clinical occupational staffing shortage, reported by 79 facilities (57%), down slightly from FY 2024 (61%). One facility reported 116 clinical occupational shortages.
The report notes that the OIG does not verify or otherwise confirm the questionnaire responses, but it appears to support other data. In the first 9 months of FY 2024, the VA added 223 physicians and 3196 nurses compared with a deficit of 781 physicians and 2129 nurses over the same period in FY 2025.
VHA facilities are finding it hard to reverse the trend. According to internal documents examined by ProPublica, nearly 4 in 10 of the roughly 2000 doctors offered jobs from January through March 2025 turned them down, 4 times the rate in the same time period in 2024. VHA also lost twice as many nurses as it hired between January and June. Many potential candidates reportedly were worried about the stability of VA employment.
VA spokesperson Peter Kasperowicz did not dispute the ProPublica findings but accused the news outlet of bias and "cherry-picking issues that are mostly routine." A nationwide shortage of health care workers has made hiring and retention difficult, he said.
Kasperowicz said the VA is "working to address" the number of doctors declining job offers by speeding up the hiring process and that the agency "has several strategies to navigate shortages." Those include referring veterans to telehealth and private clinicians.
In a statement released Aug. 12, Sen Richard Blumenthal (D-CT), ranking member of the Senate Committee on Veterans' Affairs, said, "This report confirms what we've warned for months—this Administration is driving dedicated VA employees to the private sector at untenable rates."
The OIG survey did not ask about facilities' rationales for identifying shortages. Moreover, the OIG says the responses don't reflect the possible impacts of "workforce reshaping efforts," such as the Deferred Resignation Program announced on January 28, 2025.
In response to the OIG report, Kasperowicz said it is "not based on actual VA health care facility vacancies and therefore is not a reliable indicator of staffing shortages." In a statement to CBS News, he added, "The report simply lists occupations facilities feel are difficult for which to recruit and retain, so the results are completely subjective, not standardized, and unreliable." According to Kasperowicz, the system-wide vacancy rates for doctors and nurses are 14% and 10%, respectively, which are in line with historical averages.
The OIG made no recommendations but "encourages VA leaders to use these review results to inform staffing initiatives and organizational change."
VHA Facilities Report Severe Staffing Shortages
VHA Facilities Report Severe Staffing Shortages
VA Workforce Shrinking as it Loses Collective Bargaining Rights
VA Workforce Shrinking as it Loses Collective Bargaining Rights
The US Department of Veterans Affairs (VA) is on pace to cut nearly 30,000 positions by the end of fiscal year 2025, an initiative driven by a federal hiring freeze, deferred resignations, retirements, and normal attrition. According to the VA Workforce Dashboard, health care experienced the most significant net change through the first 9 months of fiscal year 2025. That included 2129 fewer registered nurses, 751 fewer physicians, and drops of 565 licensed practical nurses, 564 nurse assistants, and 1294 medical support assistants. In total, nearly 17,000 VA employees have left their jobs and 12,000 more are expected to leave by the end of September 2025.
According to VA Secretary Doug Collins, the departures have eliminated the need for the "large-scale" reduction-in-force that he proposed earlier in 2025.
The VA also announced that in accordance with an Executive Order issued by President Donald Trump, it is terminating collective bargaining rights for most of its employees, including most clinical staff not in leadership positions. The order includes the National Nurses Organizing Committee/National Nurses United, which represents 16,000 VA nurses, and the American Federation of Government Employees, which represents 320,000 VA employees. The order exempted police officers, firefighters, and security guards. The Unions have indicated they will continue to fight the changes.
VA staffing has undergone significant reversals over the past year. The VA added 223 physicians and 3196 nurses in the first 9 months of fiscal year 2024 before reversing course this year. According to the Workforce Dashboard, the VA and Veterans Health Administration combined to hire 26,984 employees in fiscal year 2025. Cumulative losses, however, totaled 54,308.
During exit interviews, VA employees noted a variety of reasons for their departure. "Personal/family matters" and "geographic relocation" were cited by many job categories. In addition, medical and dental workers also noted "poor working relationship with supervisor or coworker(s)," "desired work schedule not offered," and "job stress/pressure" among the causes. The VA has lost 148 psychologists in fiscal year 2025 who cited "lack of trust/confidence in senior leaders," as well as "policy or technology barriers to getting the work done," and "job stress/pressure" among their reasons for departure.
The US Department of Veterans Affairs (VA) is on pace to cut nearly 30,000 positions by the end of fiscal year 2025, an initiative driven by a federal hiring freeze, deferred resignations, retirements, and normal attrition. According to the VA Workforce Dashboard, health care experienced the most significant net change through the first 9 months of fiscal year 2025. That included 2129 fewer registered nurses, 751 fewer physicians, and drops of 565 licensed practical nurses, 564 nurse assistants, and 1294 medical support assistants. In total, nearly 17,000 VA employees have left their jobs and 12,000 more are expected to leave by the end of September 2025.
According to VA Secretary Doug Collins, the departures have eliminated the need for the "large-scale" reduction-in-force that he proposed earlier in 2025.
The VA also announced that in accordance with an Executive Order issued by President Donald Trump, it is terminating collective bargaining rights for most of its employees, including most clinical staff not in leadership positions. The order includes the National Nurses Organizing Committee/National Nurses United, which represents 16,000 VA nurses, and the American Federation of Government Employees, which represents 320,000 VA employees. The order exempted police officers, firefighters, and security guards. The Unions have indicated they will continue to fight the changes.
VA staffing has undergone significant reversals over the past year. The VA added 223 physicians and 3196 nurses in the first 9 months of fiscal year 2024 before reversing course this year. According to the Workforce Dashboard, the VA and Veterans Health Administration combined to hire 26,984 employees in fiscal year 2025. Cumulative losses, however, totaled 54,308.
During exit interviews, VA employees noted a variety of reasons for their departure. "Personal/family matters" and "geographic relocation" were cited by many job categories. In addition, medical and dental workers also noted "poor working relationship with supervisor or coworker(s)," "desired work schedule not offered," and "job stress/pressure" among the causes. The VA has lost 148 psychologists in fiscal year 2025 who cited "lack of trust/confidence in senior leaders," as well as "policy or technology barriers to getting the work done," and "job stress/pressure" among their reasons for departure.
The US Department of Veterans Affairs (VA) is on pace to cut nearly 30,000 positions by the end of fiscal year 2025, an initiative driven by a federal hiring freeze, deferred resignations, retirements, and normal attrition. According to the VA Workforce Dashboard, health care experienced the most significant net change through the first 9 months of fiscal year 2025. That included 2129 fewer registered nurses, 751 fewer physicians, and drops of 565 licensed practical nurses, 564 nurse assistants, and 1294 medical support assistants. In total, nearly 17,000 VA employees have left their jobs and 12,000 more are expected to leave by the end of September 2025.
According to VA Secretary Doug Collins, the departures have eliminated the need for the "large-scale" reduction-in-force that he proposed earlier in 2025.
The VA also announced that in accordance with an Executive Order issued by President Donald Trump, it is terminating collective bargaining rights for most of its employees, including most clinical staff not in leadership positions. The order includes the National Nurses Organizing Committee/National Nurses United, which represents 16,000 VA nurses, and the American Federation of Government Employees, which represents 320,000 VA employees. The order exempted police officers, firefighters, and security guards. The Unions have indicated they will continue to fight the changes.
VA staffing has undergone significant reversals over the past year. The VA added 223 physicians and 3196 nurses in the first 9 months of fiscal year 2024 before reversing course this year. According to the Workforce Dashboard, the VA and Veterans Health Administration combined to hire 26,984 employees in fiscal year 2025. Cumulative losses, however, totaled 54,308.
During exit interviews, VA employees noted a variety of reasons for their departure. "Personal/family matters" and "geographic relocation" were cited by many job categories. In addition, medical and dental workers also noted "poor working relationship with supervisor or coworker(s)," "desired work schedule not offered," and "job stress/pressure" among the causes. The VA has lost 148 psychologists in fiscal year 2025 who cited "lack of trust/confidence in senior leaders," as well as "policy or technology barriers to getting the work done," and "job stress/pressure" among their reasons for departure.
VA Workforce Shrinking as it Loses Collective Bargaining Rights
VA Workforce Shrinking as it Loses Collective Bargaining Rights
Million Veteran Program Drives Prostate Cancer Research
About 15,000 veterans are annually diagnosed with prostate cancer. Fortunately, those veterans enrolled in the US Department of Veterans Affairs (VA) Million Veteran Program (MVP) provide researchers with a deep pool of genetic data that can help identify causes, aid diagnosis, and guide targeted treatments.
More than 1,000,000 veterans have enrolled in MVP and donated their anonymized DNA to foster research. It is also one of the most genetically diverse health-related databases: 20% of participants identify as Black, 8% as Hispanic, 2% as Asian American, and 1% as Native American.
Ethnically and racially diverse data are particularly important for advancing the treatment of underserved groups. In a 2020 review, researchers found a number of areas where Black veterans differed from White veterans, including prostate-specific antigen (PSA) levels, incidence (almost 60% higher), clinical course, and mortality rate (2 to 3 times greater). To facilitate research, the MVP developed the “DNA chip,” a custom-designed tool that tests for > 750,000 genetic variants, including > 300,000 that are more common in minority populations.
“The whole thing about understanding genetics and diversity is like a circular feedback loop,” Director of MVP Dr. Sumitra Muralidhar said in a VA news article. “The more people you have represented from different racial and ethnic backgrounds, the more we’ll be able to discover genetic variants that contribute to their health. The more we discover, the more we can help that group. It’s a complete circular feedback loop.”
In addition to veterans’ blood samples and 600,000-plus baseline surveys on lifestyle, military service, and health, the MVP has collected upwards of 825,000 germline DNA samples, which have helped inform research into prostate cancer, the most commonly diagnosed solid tumor among veterans. By mining these data, researchers have built more evidence of how genes add to risk and disease progression.
In one study preprint that has not been peer reviewed, VA researchers investigated the significance of high polygenic hazard scores. The scores are strongly associated with age at diagnosis of any prostate cancer, as well as lifetime risk of metastatic and fatal prostate cancer. However, because they’re associated with any prostate cancer, the researchers say, there is concern that screening men with high polygenic risk could increase overdiagnosis of indolent cancers.
The researchers analyzed genetic and phenotypic data from 69,901 men in the MVP who have been diagnosed with prostate cancer (6413 metastatic). They found their hypothesis to be correct: Among men eventually diagnosed with prostate cancer, those with higher polygenic risk were more likely to develop metastatic disease.
Genetic risk scores like PHS601, a 601-variant polygenic score, can be performed on a saliva sample at any time during a person’s life, the researchers note. Thus, the scores provide the earliest information about age-specific risk of developing aggressive prostate cancer. These scores might be useful, they suggest, to support clinical decisions not only about whom to screen but also at what age.
Another study led by Stanford University researchers and published in Nature Genetics aimed to make screening more targeted, in this case prostate specific antigen screening. Estimates about PSA heritability vary from 40% to 45%, with genome-wide evaluations putting it at 25% to 30%, suggesting that incorporating genetic factors could improve screening.
This study involved 296,754 men (211,342 with European ancestry, 58,236 with African ancestry, 23,546 with Hispanic/Latino ancestry, and 3630 with Asian ancestry; 96.5% of participants were from MVP)—a sample size more than triple that in previous work.
The researchers detected 448 genome-wide significant variants, including 295 that were novel (to the best of their knowledge). The variance explained by genome-wide polygenic risk scores ranged from 11.6% to 16.6% for European ancestry, 5.5% to 9.5% for African ancestry, 13.5% to 18.2% for Hispanic/Latino ancestry, and 8.6% to 15.3% for Asian ancestry, and decreased with increasing age. Midlife genetically adjusted PSA levels were more strongly associated with overall and aggressive prostate cancer than unadjusted PSA levels.
The researchers say their study highlights how including higher proportions of participants from underrepresented populations can improve genetic prediction of PSA levels, offering the potential to personalize prostate cancer screening. Adjusting PSA for individuals’ predispositions in the absence of prostate cancer could improve the specificity (to reduce overdiagnosis) and sensitivity (to prevent more deaths) of screening.
Their findings, the researchers suggest, also explain additional variation in PSA, especially among men of African heritage, who experience the highest prostate cancer morbidity and mortality. They note that this work “moved us closer to leveraging genetic information to personalize PSA and substantially improved our understanding of PSA across diverse ancestries.”
A third study from a team at the VA Tennessee Valley Healthcare System also investigated the risk of inheriting a predisposition to prostate cancer. These researchers explored pathogenic variants using both genome-wide single-allele and identity-by-descent analytic approaches. They then tested their candidate variants for replication across independent biobanks, including MVP.
The researchers discovered the gene WNT9B E152K more than doubled the risk of familial prostate cancer. Meta-analysis, collectively encompassing 500,000 patients, confirmed the genome-wide significance. The researchers say WNT9B shares an “unexpected commonality” with the previously established prostate cancer risk genes HOXB13 and HNF1B: Each are required for embryonic prostate development. Based on that finding, the researchers also evaluated 2 additional genes, KMT2D and DHCR7, which are known to cause Mendelian genitourinary developmental defects. They, too, were nominally associated with prostate cancer under meta-analyses.
Tens of thousands of participants in MVP have had prostate cancer. The genetic research they participate in advances detection, prediction, and treatment for themselves and others, and science in general. The research is not only about finding causes, but what to do if the cancer develops. An “acting on MVP prostate cancer findings” study at VA Puget Sound Health Care System is testing how communicating with veterans about MVP prostate cancer results will affect their care. Those with prostate cancer will be screened to determine genetic contributions to their cancers. Those found to have a gene-based cancer diagnosis will be offered genetic counseling. Their immediate family will also be offered screening to test for inherited prostate cancer risk.
In 2016, the VA partnered with the Prostate Cancer Foundation to establish the Precision Oncology Program for Cancer of the Prostate (POPCaP). In collaboration with MVP and the Genomic Medicine Service, the program uses genetic information to individualize treatments for veterans with advanced prostate cancer.
US Army Veteran James Perry is one of the beneficiaries of the program. First diagnosed with prostate cancer in 2001, he was initially treated with radiation therapy, but the cancer recurred and spread to his lung. The John J. Cochran Veterans Hospital in St. Louis sent a sample of Perry's lung tumor to the laboratory for genetic testing, where they discovered he had a BRCA1 gene mutation.
His oncologist, Dr. Martin Schoen, recommended Perry enroll in AMPLITUDE, a clinical trial testing the effectiveness of poly-ADP ribose polymerase inhibitors, a new class of drugs to treat hormone-sensitive prostate cancer. One year later, Perry’s lung tumor could barely be seen on computed tomography, and his PSA levels were undetectable.
"I would highly recommend enrolling in a trial," Perry told VA Research Currents. “If a veteran has that opportunity, I would encourage it—anything that is going to give you a few more days is worth it.” In the interview, Perry said he enjoyed being part of the trial because he knows he is getting the most advanced care possible and is proud to help others like himself.
"We are honored to support VA's work to improve the lives of veterans who are living with advanced prostate cancer," Vice President and National Director of the PCF Veterans Health Initiative Rebecca Levine said. "Clinical trials play a vital role in bringing new treatments to patients who need them most. Mr. Perry's experience illustrates VA's commitment to provide state-of-the-art cancer care to all veterans who need it."
About 15,000 veterans are annually diagnosed with prostate cancer. Fortunately, those veterans enrolled in the US Department of Veterans Affairs (VA) Million Veteran Program (MVP) provide researchers with a deep pool of genetic data that can help identify causes, aid diagnosis, and guide targeted treatments.
More than 1,000,000 veterans have enrolled in MVP and donated their anonymized DNA to foster research. It is also one of the most genetically diverse health-related databases: 20% of participants identify as Black, 8% as Hispanic, 2% as Asian American, and 1% as Native American.
Ethnically and racially diverse data are particularly important for advancing the treatment of underserved groups. In a 2020 review, researchers found a number of areas where Black veterans differed from White veterans, including prostate-specific antigen (PSA) levels, incidence (almost 60% higher), clinical course, and mortality rate (2 to 3 times greater). To facilitate research, the MVP developed the “DNA chip,” a custom-designed tool that tests for > 750,000 genetic variants, including > 300,000 that are more common in minority populations.
“The whole thing about understanding genetics and diversity is like a circular feedback loop,” Director of MVP Dr. Sumitra Muralidhar said in a VA news article. “The more people you have represented from different racial and ethnic backgrounds, the more we’ll be able to discover genetic variants that contribute to their health. The more we discover, the more we can help that group. It’s a complete circular feedback loop.”
In addition to veterans’ blood samples and 600,000-plus baseline surveys on lifestyle, military service, and health, the MVP has collected upwards of 825,000 germline DNA samples, which have helped inform research into prostate cancer, the most commonly diagnosed solid tumor among veterans. By mining these data, researchers have built more evidence of how genes add to risk and disease progression.
In one study preprint that has not been peer reviewed, VA researchers investigated the significance of high polygenic hazard scores. The scores are strongly associated with age at diagnosis of any prostate cancer, as well as lifetime risk of metastatic and fatal prostate cancer. However, because they’re associated with any prostate cancer, the researchers say, there is concern that screening men with high polygenic risk could increase overdiagnosis of indolent cancers.
The researchers analyzed genetic and phenotypic data from 69,901 men in the MVP who have been diagnosed with prostate cancer (6413 metastatic). They found their hypothesis to be correct: Among men eventually diagnosed with prostate cancer, those with higher polygenic risk were more likely to develop metastatic disease.
Genetic risk scores like PHS601, a 601-variant polygenic score, can be performed on a saliva sample at any time during a person’s life, the researchers note. Thus, the scores provide the earliest information about age-specific risk of developing aggressive prostate cancer. These scores might be useful, they suggest, to support clinical decisions not only about whom to screen but also at what age.
Another study led by Stanford University researchers and published in Nature Genetics aimed to make screening more targeted, in this case prostate specific antigen screening. Estimates about PSA heritability vary from 40% to 45%, with genome-wide evaluations putting it at 25% to 30%, suggesting that incorporating genetic factors could improve screening.
This study involved 296,754 men (211,342 with European ancestry, 58,236 with African ancestry, 23,546 with Hispanic/Latino ancestry, and 3630 with Asian ancestry; 96.5% of participants were from MVP)—a sample size more than triple that in previous work.
The researchers detected 448 genome-wide significant variants, including 295 that were novel (to the best of their knowledge). The variance explained by genome-wide polygenic risk scores ranged from 11.6% to 16.6% for European ancestry, 5.5% to 9.5% for African ancestry, 13.5% to 18.2% for Hispanic/Latino ancestry, and 8.6% to 15.3% for Asian ancestry, and decreased with increasing age. Midlife genetically adjusted PSA levels were more strongly associated with overall and aggressive prostate cancer than unadjusted PSA levels.
The researchers say their study highlights how including higher proportions of participants from underrepresented populations can improve genetic prediction of PSA levels, offering the potential to personalize prostate cancer screening. Adjusting PSA for individuals’ predispositions in the absence of prostate cancer could improve the specificity (to reduce overdiagnosis) and sensitivity (to prevent more deaths) of screening.
Their findings, the researchers suggest, also explain additional variation in PSA, especially among men of African heritage, who experience the highest prostate cancer morbidity and mortality. They note that this work “moved us closer to leveraging genetic information to personalize PSA and substantially improved our understanding of PSA across diverse ancestries.”
A third study from a team at the VA Tennessee Valley Healthcare System also investigated the risk of inheriting a predisposition to prostate cancer. These researchers explored pathogenic variants using both genome-wide single-allele and identity-by-descent analytic approaches. They then tested their candidate variants for replication across independent biobanks, including MVP.
The researchers discovered the gene WNT9B E152K more than doubled the risk of familial prostate cancer. Meta-analysis, collectively encompassing 500,000 patients, confirmed the genome-wide significance. The researchers say WNT9B shares an “unexpected commonality” with the previously established prostate cancer risk genes HOXB13 and HNF1B: Each are required for embryonic prostate development. Based on that finding, the researchers also evaluated 2 additional genes, KMT2D and DHCR7, which are known to cause Mendelian genitourinary developmental defects. They, too, were nominally associated with prostate cancer under meta-analyses.
Tens of thousands of participants in MVP have had prostate cancer. The genetic research they participate in advances detection, prediction, and treatment for themselves and others, and science in general. The research is not only about finding causes, but what to do if the cancer develops. An “acting on MVP prostate cancer findings” study at VA Puget Sound Health Care System is testing how communicating with veterans about MVP prostate cancer results will affect their care. Those with prostate cancer will be screened to determine genetic contributions to their cancers. Those found to have a gene-based cancer diagnosis will be offered genetic counseling. Their immediate family will also be offered screening to test for inherited prostate cancer risk.
In 2016, the VA partnered with the Prostate Cancer Foundation to establish the Precision Oncology Program for Cancer of the Prostate (POPCaP). In collaboration with MVP and the Genomic Medicine Service, the program uses genetic information to individualize treatments for veterans with advanced prostate cancer.
US Army Veteran James Perry is one of the beneficiaries of the program. First diagnosed with prostate cancer in 2001, he was initially treated with radiation therapy, but the cancer recurred and spread to his lung. The John J. Cochran Veterans Hospital in St. Louis sent a sample of Perry's lung tumor to the laboratory for genetic testing, where they discovered he had a BRCA1 gene mutation.
His oncologist, Dr. Martin Schoen, recommended Perry enroll in AMPLITUDE, a clinical trial testing the effectiveness of poly-ADP ribose polymerase inhibitors, a new class of drugs to treat hormone-sensitive prostate cancer. One year later, Perry’s lung tumor could barely be seen on computed tomography, and his PSA levels were undetectable.
"I would highly recommend enrolling in a trial," Perry told VA Research Currents. “If a veteran has that opportunity, I would encourage it—anything that is going to give you a few more days is worth it.” In the interview, Perry said he enjoyed being part of the trial because he knows he is getting the most advanced care possible and is proud to help others like himself.
"We are honored to support VA's work to improve the lives of veterans who are living with advanced prostate cancer," Vice President and National Director of the PCF Veterans Health Initiative Rebecca Levine said. "Clinical trials play a vital role in bringing new treatments to patients who need them most. Mr. Perry's experience illustrates VA's commitment to provide state-of-the-art cancer care to all veterans who need it."
About 15,000 veterans are annually diagnosed with prostate cancer. Fortunately, those veterans enrolled in the US Department of Veterans Affairs (VA) Million Veteran Program (MVP) provide researchers with a deep pool of genetic data that can help identify causes, aid diagnosis, and guide targeted treatments.
More than 1,000,000 veterans have enrolled in MVP and donated their anonymized DNA to foster research. It is also one of the most genetically diverse health-related databases: 20% of participants identify as Black, 8% as Hispanic, 2% as Asian American, and 1% as Native American.
Ethnically and racially diverse data are particularly important for advancing the treatment of underserved groups. In a 2020 review, researchers found a number of areas where Black veterans differed from White veterans, including prostate-specific antigen (PSA) levels, incidence (almost 60% higher), clinical course, and mortality rate (2 to 3 times greater). To facilitate research, the MVP developed the “DNA chip,” a custom-designed tool that tests for > 750,000 genetic variants, including > 300,000 that are more common in minority populations.
“The whole thing about understanding genetics and diversity is like a circular feedback loop,” Director of MVP Dr. Sumitra Muralidhar said in a VA news article. “The more people you have represented from different racial and ethnic backgrounds, the more we’ll be able to discover genetic variants that contribute to their health. The more we discover, the more we can help that group. It’s a complete circular feedback loop.”
In addition to veterans’ blood samples and 600,000-plus baseline surveys on lifestyle, military service, and health, the MVP has collected upwards of 825,000 germline DNA samples, which have helped inform research into prostate cancer, the most commonly diagnosed solid tumor among veterans. By mining these data, researchers have built more evidence of how genes add to risk and disease progression.
In one study preprint that has not been peer reviewed, VA researchers investigated the significance of high polygenic hazard scores. The scores are strongly associated with age at diagnosis of any prostate cancer, as well as lifetime risk of metastatic and fatal prostate cancer. However, because they’re associated with any prostate cancer, the researchers say, there is concern that screening men with high polygenic risk could increase overdiagnosis of indolent cancers.
The researchers analyzed genetic and phenotypic data from 69,901 men in the MVP who have been diagnosed with prostate cancer (6413 metastatic). They found their hypothesis to be correct: Among men eventually diagnosed with prostate cancer, those with higher polygenic risk were more likely to develop metastatic disease.
Genetic risk scores like PHS601, a 601-variant polygenic score, can be performed on a saliva sample at any time during a person’s life, the researchers note. Thus, the scores provide the earliest information about age-specific risk of developing aggressive prostate cancer. These scores might be useful, they suggest, to support clinical decisions not only about whom to screen but also at what age.
Another study led by Stanford University researchers and published in Nature Genetics aimed to make screening more targeted, in this case prostate specific antigen screening. Estimates about PSA heritability vary from 40% to 45%, with genome-wide evaluations putting it at 25% to 30%, suggesting that incorporating genetic factors could improve screening.
This study involved 296,754 men (211,342 with European ancestry, 58,236 with African ancestry, 23,546 with Hispanic/Latino ancestry, and 3630 with Asian ancestry; 96.5% of participants were from MVP)—a sample size more than triple that in previous work.
The researchers detected 448 genome-wide significant variants, including 295 that were novel (to the best of their knowledge). The variance explained by genome-wide polygenic risk scores ranged from 11.6% to 16.6% for European ancestry, 5.5% to 9.5% for African ancestry, 13.5% to 18.2% for Hispanic/Latino ancestry, and 8.6% to 15.3% for Asian ancestry, and decreased with increasing age. Midlife genetically adjusted PSA levels were more strongly associated with overall and aggressive prostate cancer than unadjusted PSA levels.
The researchers say their study highlights how including higher proportions of participants from underrepresented populations can improve genetic prediction of PSA levels, offering the potential to personalize prostate cancer screening. Adjusting PSA for individuals’ predispositions in the absence of prostate cancer could improve the specificity (to reduce overdiagnosis) and sensitivity (to prevent more deaths) of screening.
Their findings, the researchers suggest, also explain additional variation in PSA, especially among men of African heritage, who experience the highest prostate cancer morbidity and mortality. They note that this work “moved us closer to leveraging genetic information to personalize PSA and substantially improved our understanding of PSA across diverse ancestries.”
A third study from a team at the VA Tennessee Valley Healthcare System also investigated the risk of inheriting a predisposition to prostate cancer. These researchers explored pathogenic variants using both genome-wide single-allele and identity-by-descent analytic approaches. They then tested their candidate variants for replication across independent biobanks, including MVP.
The researchers discovered the gene WNT9B E152K more than doubled the risk of familial prostate cancer. Meta-analysis, collectively encompassing 500,000 patients, confirmed the genome-wide significance. The researchers say WNT9B shares an “unexpected commonality” with the previously established prostate cancer risk genes HOXB13 and HNF1B: Each are required for embryonic prostate development. Based on that finding, the researchers also evaluated 2 additional genes, KMT2D and DHCR7, which are known to cause Mendelian genitourinary developmental defects. They, too, were nominally associated with prostate cancer under meta-analyses.
Tens of thousands of participants in MVP have had prostate cancer. The genetic research they participate in advances detection, prediction, and treatment for themselves and others, and science in general. The research is not only about finding causes, but what to do if the cancer develops. An “acting on MVP prostate cancer findings” study at VA Puget Sound Health Care System is testing how communicating with veterans about MVP prostate cancer results will affect their care. Those with prostate cancer will be screened to determine genetic contributions to their cancers. Those found to have a gene-based cancer diagnosis will be offered genetic counseling. Their immediate family will also be offered screening to test for inherited prostate cancer risk.
In 2016, the VA partnered with the Prostate Cancer Foundation to establish the Precision Oncology Program for Cancer of the Prostate (POPCaP). In collaboration with MVP and the Genomic Medicine Service, the program uses genetic information to individualize treatments for veterans with advanced prostate cancer.
US Army Veteran James Perry is one of the beneficiaries of the program. First diagnosed with prostate cancer in 2001, he was initially treated with radiation therapy, but the cancer recurred and spread to his lung. The John J. Cochran Veterans Hospital in St. Louis sent a sample of Perry's lung tumor to the laboratory for genetic testing, where they discovered he had a BRCA1 gene mutation.
His oncologist, Dr. Martin Schoen, recommended Perry enroll in AMPLITUDE, a clinical trial testing the effectiveness of poly-ADP ribose polymerase inhibitors, a new class of drugs to treat hormone-sensitive prostate cancer. One year later, Perry’s lung tumor could barely be seen on computed tomography, and his PSA levels were undetectable.
"I would highly recommend enrolling in a trial," Perry told VA Research Currents. “If a veteran has that opportunity, I would encourage it—anything that is going to give you a few more days is worth it.” In the interview, Perry said he enjoyed being part of the trial because he knows he is getting the most advanced care possible and is proud to help others like himself.
"We are honored to support VA's work to improve the lives of veterans who are living with advanced prostate cancer," Vice President and National Director of the PCF Veterans Health Initiative Rebecca Levine said. "Clinical trials play a vital role in bringing new treatments to patients who need them most. Mr. Perry's experience illustrates VA's commitment to provide state-of-the-art cancer care to all veterans who need it."
Service Connection Expanded to Additional Cancers
The US Department of Veterans Affairs (VA) is "lowering the burden of proof" for thousands, making acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, myelofibrosis, urinary bladder, ureter, and related genitourinary cancers presumptive for service connection.
The Jan. 8 decision included Gulf War veterans, those who served in Somalia or the Southwest Asia theater of operations during the Persian Gulf War on or after Aug. 2, 1990; and post-9/11 veterans, those who served in Afghanistan, Iraq, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, or Uzbekistan and the airspace above these locations during the Gulf War on or after Sept. 11, 2001. It also includes veterans who served at the Karshi-Khanabad (K2) base in Uzbekistan after Sept. 11, 2001.
Veterans no longer must prove their service caused their condition to receive benefits. This landmark decision allows them access to free health care for that condition.
According to the VA, these steps are also part of a comprehensive effort to ensure that K2 veterans—and their survivors—receive the care and benefits they deserve. K2 veterans have higher claim and approval rates than any other cohort of veterans: 13,002 are enrolled in VA health care, and the average K2 veteran is service connected for 14.6 conditions.
The 2022 PACT Act was the largest expansion of veteran benefits in generations. The VA then made millions of veterans eligible for health care and benefits years earlier than called for by the law. It also launched the largest outreach campaign in the history of the VA to encourage veterans to apply.
Nearly 890,000 veterans have signed up for VA health care since the bill was signed into law, a nearly 40% increase over the previous equivalent period, and veterans have submitted > 4.8 million applications for VA benefits (a 42% increase over the previous equivalent period and an all-time record). The VA has delivered > $600 billion in earned benefits directly to veterans, their families, and survivors during that time.
The VA encourages all eligible veterans—including those with previously denied claims—to apply for benefits. To apply for benefits, veterans and survivors may visit VA.gov or call 1-800-MYVA411.
The US Department of Veterans Affairs (VA) is "lowering the burden of proof" for thousands, making acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, myelofibrosis, urinary bladder, ureter, and related genitourinary cancers presumptive for service connection.
The Jan. 8 decision included Gulf War veterans, those who served in Somalia or the Southwest Asia theater of operations during the Persian Gulf War on or after Aug. 2, 1990; and post-9/11 veterans, those who served in Afghanistan, Iraq, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, or Uzbekistan and the airspace above these locations during the Gulf War on or after Sept. 11, 2001. It also includes veterans who served at the Karshi-Khanabad (K2) base in Uzbekistan after Sept. 11, 2001.
Veterans no longer must prove their service caused their condition to receive benefits. This landmark decision allows them access to free health care for that condition.
According to the VA, these steps are also part of a comprehensive effort to ensure that K2 veterans—and their survivors—receive the care and benefits they deserve. K2 veterans have higher claim and approval rates than any other cohort of veterans: 13,002 are enrolled in VA health care, and the average K2 veteran is service connected for 14.6 conditions.
The 2022 PACT Act was the largest expansion of veteran benefits in generations. The VA then made millions of veterans eligible for health care and benefits years earlier than called for by the law. It also launched the largest outreach campaign in the history of the VA to encourage veterans to apply.
Nearly 890,000 veterans have signed up for VA health care since the bill was signed into law, a nearly 40% increase over the previous equivalent period, and veterans have submitted > 4.8 million applications for VA benefits (a 42% increase over the previous equivalent period and an all-time record). The VA has delivered > $600 billion in earned benefits directly to veterans, their families, and survivors during that time.
The VA encourages all eligible veterans—including those with previously denied claims—to apply for benefits. To apply for benefits, veterans and survivors may visit VA.gov or call 1-800-MYVA411.
The US Department of Veterans Affairs (VA) is "lowering the burden of proof" for thousands, making acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, myelofibrosis, urinary bladder, ureter, and related genitourinary cancers presumptive for service connection.
The Jan. 8 decision included Gulf War veterans, those who served in Somalia or the Southwest Asia theater of operations during the Persian Gulf War on or after Aug. 2, 1990; and post-9/11 veterans, those who served in Afghanistan, Iraq, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, or Uzbekistan and the airspace above these locations during the Gulf War on or after Sept. 11, 2001. It also includes veterans who served at the Karshi-Khanabad (K2) base in Uzbekistan after Sept. 11, 2001.
Veterans no longer must prove their service caused their condition to receive benefits. This landmark decision allows them access to free health care for that condition.
According to the VA, these steps are also part of a comprehensive effort to ensure that K2 veterans—and their survivors—receive the care and benefits they deserve. K2 veterans have higher claim and approval rates than any other cohort of veterans: 13,002 are enrolled in VA health care, and the average K2 veteran is service connected for 14.6 conditions.
The 2022 PACT Act was the largest expansion of veteran benefits in generations. The VA then made millions of veterans eligible for health care and benefits years earlier than called for by the law. It also launched the largest outreach campaign in the history of the VA to encourage veterans to apply.
Nearly 890,000 veterans have signed up for VA health care since the bill was signed into law, a nearly 40% increase over the previous equivalent period, and veterans have submitted > 4.8 million applications for VA benefits (a 42% increase over the previous equivalent period and an all-time record). The VA has delivered > $600 billion in earned benefits directly to veterans, their families, and survivors during that time.
The VA encourages all eligible veterans—including those with previously denied claims—to apply for benefits. To apply for benefits, veterans and survivors may visit VA.gov or call 1-800-MYVA411.
DoD Surveillance: Low to Moderate Effectiveness for Flu Vaccine
A mid-season analysis of the influenza vaccine by the US Department of Defensive (DoD) Global Respiratory Pathogen Surveillance Program (DoDGRPSP) has reported low to moderate vaccine effectiveness (VE).
The study included 295 Military Health System (MHS) beneficiaries (adults and children) who tested positive for influenza and 965 controls who tested negative. Vaccinated patients had received the 2024-2025 influenza vaccine at least 14 days prior to symptom onset. The study conducted VE analyses for influenza A (any subtype), influenza A(H1N1)pdm09, and influenza A(H3N2).
Overall, moderate effectiveness against influenza A(H1N1)pdm09 was reported in all beneficiaries and children aged 6 months to 17 years. In adults aged 18 to 64 years—and all beneficiaries—there was moderate effectiveness against influenza A(H3N2). VE estimates against influenza A (any subtype) for all beneficiaries, children, and adults were not significant; VE estimates were also not effective among children for influenza A(H3N2) and in adults for influenza A(H1N1)pdm09.
Adjusted VE estimates among all participants for influenza A (any subtypes), influenza A(H1N1)pdm09, and influenza A(H3N2) were 25%, 58%, and 42%, respectively. VE for influenza B was not calculated due to a low number of cases.
Flu vaccination rates for adults are usually in the 30% to 60% range despite the recommended target of 70%. Flu vaccination rates were rising by around 1% to 2% annually before 2020, but began dropping after the COVID-19 pandemic, especially in higher-risk groups. In adults aged ≥ 65 years, flu vaccination rates dropped from 52% in 2019-2020 to 43% in 2024-2025.
According to the Centers for Disease Control and Prevention (CDC), at the end of the 2023-2024 flu season, 9.2 million fewer doses were administered in pharmacies and doctors offices compared with the baseline before the COVID-19 pandemic. Since 2022, private manufacturers have distributed significantly fewer influenza vaccine doses.
Each March, the US Food and Drug Association (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets to analyze the current influenza season and forecast the next. The committee reviews and discusses data on influenza strain circulation and VE, which come from DoDGRPSP analyses. In February, US Department of Health and Human Services officials indefinitely postponed a public meeting of the CDC Advisory Committee on Immunization Practice (ACIP), at which members were also expected to discuss, among other things, VE and vaccine recommendations. The FDA canceled a March 13 VRBPAC meeting and provided no reason for the cancelation to members. That day, however, the FDA issued new recommendations for the influenza vaccine for the 2025-2026 season without the input of VRBPAC. Instead, experts from the FDA, CDC, and DoD made recommendations after reviewing surveillance data from the US and globally.
For the 2025-2026 influenza season, the FDA recommends the vaccines be trivalent and target 2 strains of influenza A and 1 strain of influenza B. The FDA anticipates there will be an “adequate and diverse supply” of approved trivalent seasonal influenza vaccines. Trivalent flu vaccines are formulated to protect against 3 influenza viruses: an A(H1N1) virus, an A(H3N2) virus, and a B/Victoria virus. All influenza vaccines for the 2025-2026 season are anticipated to be trivalent in the US.
A mid-season analysis of the influenza vaccine by the US Department of Defensive (DoD) Global Respiratory Pathogen Surveillance Program (DoDGRPSP) has reported low to moderate vaccine effectiveness (VE).
The study included 295 Military Health System (MHS) beneficiaries (adults and children) who tested positive for influenza and 965 controls who tested negative. Vaccinated patients had received the 2024-2025 influenza vaccine at least 14 days prior to symptom onset. The study conducted VE analyses for influenza A (any subtype), influenza A(H1N1)pdm09, and influenza A(H3N2).
Overall, moderate effectiveness against influenza A(H1N1)pdm09 was reported in all beneficiaries and children aged 6 months to 17 years. In adults aged 18 to 64 years—and all beneficiaries—there was moderate effectiveness against influenza A(H3N2). VE estimates against influenza A (any subtype) for all beneficiaries, children, and adults were not significant; VE estimates were also not effective among children for influenza A(H3N2) and in adults for influenza A(H1N1)pdm09.
Adjusted VE estimates among all participants for influenza A (any subtypes), influenza A(H1N1)pdm09, and influenza A(H3N2) were 25%, 58%, and 42%, respectively. VE for influenza B was not calculated due to a low number of cases.
Flu vaccination rates for adults are usually in the 30% to 60% range despite the recommended target of 70%. Flu vaccination rates were rising by around 1% to 2% annually before 2020, but began dropping after the COVID-19 pandemic, especially in higher-risk groups. In adults aged ≥ 65 years, flu vaccination rates dropped from 52% in 2019-2020 to 43% in 2024-2025.
According to the Centers for Disease Control and Prevention (CDC), at the end of the 2023-2024 flu season, 9.2 million fewer doses were administered in pharmacies and doctors offices compared with the baseline before the COVID-19 pandemic. Since 2022, private manufacturers have distributed significantly fewer influenza vaccine doses.
Each March, the US Food and Drug Association (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets to analyze the current influenza season and forecast the next. The committee reviews and discusses data on influenza strain circulation and VE, which come from DoDGRPSP analyses. In February, US Department of Health and Human Services officials indefinitely postponed a public meeting of the CDC Advisory Committee on Immunization Practice (ACIP), at which members were also expected to discuss, among other things, VE and vaccine recommendations. The FDA canceled a March 13 VRBPAC meeting and provided no reason for the cancelation to members. That day, however, the FDA issued new recommendations for the influenza vaccine for the 2025-2026 season without the input of VRBPAC. Instead, experts from the FDA, CDC, and DoD made recommendations after reviewing surveillance data from the US and globally.
For the 2025-2026 influenza season, the FDA recommends the vaccines be trivalent and target 2 strains of influenza A and 1 strain of influenza B. The FDA anticipates there will be an “adequate and diverse supply” of approved trivalent seasonal influenza vaccines. Trivalent flu vaccines are formulated to protect against 3 influenza viruses: an A(H1N1) virus, an A(H3N2) virus, and a B/Victoria virus. All influenza vaccines for the 2025-2026 season are anticipated to be trivalent in the US.
A mid-season analysis of the influenza vaccine by the US Department of Defensive (DoD) Global Respiratory Pathogen Surveillance Program (DoDGRPSP) has reported low to moderate vaccine effectiveness (VE).
The study included 295 Military Health System (MHS) beneficiaries (adults and children) who tested positive for influenza and 965 controls who tested negative. Vaccinated patients had received the 2024-2025 influenza vaccine at least 14 days prior to symptom onset. The study conducted VE analyses for influenza A (any subtype), influenza A(H1N1)pdm09, and influenza A(H3N2).
Overall, moderate effectiveness against influenza A(H1N1)pdm09 was reported in all beneficiaries and children aged 6 months to 17 years. In adults aged 18 to 64 years—and all beneficiaries—there was moderate effectiveness against influenza A(H3N2). VE estimates against influenza A (any subtype) for all beneficiaries, children, and adults were not significant; VE estimates were also not effective among children for influenza A(H3N2) and in adults for influenza A(H1N1)pdm09.
Adjusted VE estimates among all participants for influenza A (any subtypes), influenza A(H1N1)pdm09, and influenza A(H3N2) were 25%, 58%, and 42%, respectively. VE for influenza B was not calculated due to a low number of cases.
Flu vaccination rates for adults are usually in the 30% to 60% range despite the recommended target of 70%. Flu vaccination rates were rising by around 1% to 2% annually before 2020, but began dropping after the COVID-19 pandemic, especially in higher-risk groups. In adults aged ≥ 65 years, flu vaccination rates dropped from 52% in 2019-2020 to 43% in 2024-2025.
According to the Centers for Disease Control and Prevention (CDC), at the end of the 2023-2024 flu season, 9.2 million fewer doses were administered in pharmacies and doctors offices compared with the baseline before the COVID-19 pandemic. Since 2022, private manufacturers have distributed significantly fewer influenza vaccine doses.
Each March, the US Food and Drug Association (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets to analyze the current influenza season and forecast the next. The committee reviews and discusses data on influenza strain circulation and VE, which come from DoDGRPSP analyses. In February, US Department of Health and Human Services officials indefinitely postponed a public meeting of the CDC Advisory Committee on Immunization Practice (ACIP), at which members were also expected to discuss, among other things, VE and vaccine recommendations. The FDA canceled a March 13 VRBPAC meeting and provided no reason for the cancelation to members. That day, however, the FDA issued new recommendations for the influenza vaccine for the 2025-2026 season without the input of VRBPAC. Instead, experts from the FDA, CDC, and DoD made recommendations after reviewing surveillance data from the US and globally.
For the 2025-2026 influenza season, the FDA recommends the vaccines be trivalent and target 2 strains of influenza A and 1 strain of influenza B. The FDA anticipates there will be an “adequate and diverse supply” of approved trivalent seasonal influenza vaccines. Trivalent flu vaccines are formulated to protect against 3 influenza viruses: an A(H1N1) virus, an A(H3N2) virus, and a B/Victoria virus. All influenza vaccines for the 2025-2026 season are anticipated to be trivalent in the US.
ACES Act to Study Cancer in Aviators Is Now Law
A bipartisan bill establishing research directives aimed at revealing cancer risks among military aviators and aircrews recently became law.
Spearheaded by Sen. Mark Kelly (D-AZ) and Sen. Tom Cotton (R-AR), as well as Rep. August Pfluger (R-TX-11) and Rep. Jimmy Panetta (D-CA-19), all of whom are veterans, the Aviator Cancer Examination Study (ACES) Act was signed into law on August 14. The ACES Act will address cancer rates among Army, Navy, Air Force, and Marine Corps aircrew members by directing the Secretary of the US Department of Veterans Affairs to study cancer incidence and mortality rates among these populations.
Military aviators and aircrews face a 15% to 24% higher rate of cancer compared with the general US population, including a 75% higher rate of melanoma, 31% higher rate of thyroid cancer, 20% higher rate of prostate cancer, and 11% higher rate of female breast cancer, with potential links to non-Hodgkin lymphoma and testicular cancer. These individuals are also diagnosed earlier in life, at the median age of 55 years compared with 67 years. However, further investigation is still needed to understand why.
“By better understanding the correlation between aviator service and cancer, we can better assist our military and provide more adequate care for our veterans,” Kelly said.
Some reasons for the higher rates of cancer in aviators seem clear, such as the association between dioxin exposure and cancer. In a study of cancer incidence and mortality in Air Force veterans of the Vietnam War, incidence of melanoma and prostate cancer was increased among White veterans who sprayed herbicides during Operation Ranch Hand. The risk of cancer at any site, prostate cancer, and melanoma was increased in the highest dioxin exposure category among veterans who spent ≤ 2 years in Southeast Asia.
However, some links between these veterans and increased cancer rates are less clear. In a review of 28 studies (including 18 studies in military settings), slight evidence was found for associations between jet fuel exposure and various outcomes including cancer. Cosmic ionizing radiation (CIR) exposure is another possible cause. Several epidemiological studies have documented elevated incidence and mortality for several cancers in flight crews, but a link between them and CIR exposure has not been established.
Certain occupations have been associated with increased risk of testicular germ cell tumors, including aircraft maintenance, military pilots, fighter pilots, and aircrews. Those associations led to hypotheses that job-related chemical exposures (eg, per- and polyfluoroalkyl substances, solvents, paints, hydrocarbons in degreasing/lubricating agents, lubricating oils) may increase risk. A study of young active-duty Air Force servicemen found that pilots and men with aircraft maintenance jobs had elevated tenosynovial giant cell tumor risk, but indicates that further research is needed to “elucidate specific occupational exposures underlying these associations.”
“As a former Navy pilot, there are certain risks that we know and accept come with our service, but we know far less about the health risks that are affecting many aviators and aircrews years later,” Kelly said in a statement. “Veteran aviators and aircrews deserve answers about the correlation between their job and cancer risks so we can reduce those risks for future pilots. Getting this across the finish line has been a bipartisan effort from the start, and I’m proud to see this bill become law so we can deliver real answers and accountability for those who served.”
“The ACES Act is now the law of the land,” Cotton added. “We owe it to past, present, and future aviators in the armed forces to study the prevalence of cancer among this group of veterans.”
The ACES Act complements Kelly’s bipartisan Counting Veterans’ Cancer Act, which requires Veterans Health Administration facilities to share cancer data with state cancer registries, thereby guaranteeing their inclusion in the national registries. Key provisions of the Counting Veterans’ Cancer Act were included in the first government funding package of fiscal year 2024.
A bipartisan bill establishing research directives aimed at revealing cancer risks among military aviators and aircrews recently became law.
Spearheaded by Sen. Mark Kelly (D-AZ) and Sen. Tom Cotton (R-AR), as well as Rep. August Pfluger (R-TX-11) and Rep. Jimmy Panetta (D-CA-19), all of whom are veterans, the Aviator Cancer Examination Study (ACES) Act was signed into law on August 14. The ACES Act will address cancer rates among Army, Navy, Air Force, and Marine Corps aircrew members by directing the Secretary of the US Department of Veterans Affairs to study cancer incidence and mortality rates among these populations.
Military aviators and aircrews face a 15% to 24% higher rate of cancer compared with the general US population, including a 75% higher rate of melanoma, 31% higher rate of thyroid cancer, 20% higher rate of prostate cancer, and 11% higher rate of female breast cancer, with potential links to non-Hodgkin lymphoma and testicular cancer. These individuals are also diagnosed earlier in life, at the median age of 55 years compared with 67 years. However, further investigation is still needed to understand why.
“By better understanding the correlation between aviator service and cancer, we can better assist our military and provide more adequate care for our veterans,” Kelly said.
Some reasons for the higher rates of cancer in aviators seem clear, such as the association between dioxin exposure and cancer. In a study of cancer incidence and mortality in Air Force veterans of the Vietnam War, incidence of melanoma and prostate cancer was increased among White veterans who sprayed herbicides during Operation Ranch Hand. The risk of cancer at any site, prostate cancer, and melanoma was increased in the highest dioxin exposure category among veterans who spent ≤ 2 years in Southeast Asia.
However, some links between these veterans and increased cancer rates are less clear. In a review of 28 studies (including 18 studies in military settings), slight evidence was found for associations between jet fuel exposure and various outcomes including cancer. Cosmic ionizing radiation (CIR) exposure is another possible cause. Several epidemiological studies have documented elevated incidence and mortality for several cancers in flight crews, but a link between them and CIR exposure has not been established.
Certain occupations have been associated with increased risk of testicular germ cell tumors, including aircraft maintenance, military pilots, fighter pilots, and aircrews. Those associations led to hypotheses that job-related chemical exposures (eg, per- and polyfluoroalkyl substances, solvents, paints, hydrocarbons in degreasing/lubricating agents, lubricating oils) may increase risk. A study of young active-duty Air Force servicemen found that pilots and men with aircraft maintenance jobs had elevated tenosynovial giant cell tumor risk, but indicates that further research is needed to “elucidate specific occupational exposures underlying these associations.”
“As a former Navy pilot, there are certain risks that we know and accept come with our service, but we know far less about the health risks that are affecting many aviators and aircrews years later,” Kelly said in a statement. “Veteran aviators and aircrews deserve answers about the correlation between their job and cancer risks so we can reduce those risks for future pilots. Getting this across the finish line has been a bipartisan effort from the start, and I’m proud to see this bill become law so we can deliver real answers and accountability for those who served.”
“The ACES Act is now the law of the land,” Cotton added. “We owe it to past, present, and future aviators in the armed forces to study the prevalence of cancer among this group of veterans.”
The ACES Act complements Kelly’s bipartisan Counting Veterans’ Cancer Act, which requires Veterans Health Administration facilities to share cancer data with state cancer registries, thereby guaranteeing their inclusion in the national registries. Key provisions of the Counting Veterans’ Cancer Act were included in the first government funding package of fiscal year 2024.
A bipartisan bill establishing research directives aimed at revealing cancer risks among military aviators and aircrews recently became law.
Spearheaded by Sen. Mark Kelly (D-AZ) and Sen. Tom Cotton (R-AR), as well as Rep. August Pfluger (R-TX-11) and Rep. Jimmy Panetta (D-CA-19), all of whom are veterans, the Aviator Cancer Examination Study (ACES) Act was signed into law on August 14. The ACES Act will address cancer rates among Army, Navy, Air Force, and Marine Corps aircrew members by directing the Secretary of the US Department of Veterans Affairs to study cancer incidence and mortality rates among these populations.
Military aviators and aircrews face a 15% to 24% higher rate of cancer compared with the general US population, including a 75% higher rate of melanoma, 31% higher rate of thyroid cancer, 20% higher rate of prostate cancer, and 11% higher rate of female breast cancer, with potential links to non-Hodgkin lymphoma and testicular cancer. These individuals are also diagnosed earlier in life, at the median age of 55 years compared with 67 years. However, further investigation is still needed to understand why.
“By better understanding the correlation between aviator service and cancer, we can better assist our military and provide more adequate care for our veterans,” Kelly said.
Some reasons for the higher rates of cancer in aviators seem clear, such as the association between dioxin exposure and cancer. In a study of cancer incidence and mortality in Air Force veterans of the Vietnam War, incidence of melanoma and prostate cancer was increased among White veterans who sprayed herbicides during Operation Ranch Hand. The risk of cancer at any site, prostate cancer, and melanoma was increased in the highest dioxin exposure category among veterans who spent ≤ 2 years in Southeast Asia.
However, some links between these veterans and increased cancer rates are less clear. In a review of 28 studies (including 18 studies in military settings), slight evidence was found for associations between jet fuel exposure and various outcomes including cancer. Cosmic ionizing radiation (CIR) exposure is another possible cause. Several epidemiological studies have documented elevated incidence and mortality for several cancers in flight crews, but a link between them and CIR exposure has not been established.
Certain occupations have been associated with increased risk of testicular germ cell tumors, including aircraft maintenance, military pilots, fighter pilots, and aircrews. Those associations led to hypotheses that job-related chemical exposures (eg, per- and polyfluoroalkyl substances, solvents, paints, hydrocarbons in degreasing/lubricating agents, lubricating oils) may increase risk. A study of young active-duty Air Force servicemen found that pilots and men with aircraft maintenance jobs had elevated tenosynovial giant cell tumor risk, but indicates that further research is needed to “elucidate specific occupational exposures underlying these associations.”
“As a former Navy pilot, there are certain risks that we know and accept come with our service, but we know far less about the health risks that are affecting many aviators and aircrews years later,” Kelly said in a statement. “Veteran aviators and aircrews deserve answers about the correlation between their job and cancer risks so we can reduce those risks for future pilots. Getting this across the finish line has been a bipartisan effort from the start, and I’m proud to see this bill become law so we can deliver real answers and accountability for those who served.”
“The ACES Act is now the law of the land,” Cotton added. “We owe it to past, present, and future aviators in the armed forces to study the prevalence of cancer among this group of veterans.”
The ACES Act complements Kelly’s bipartisan Counting Veterans’ Cancer Act, which requires Veterans Health Administration facilities to share cancer data with state cancer registries, thereby guaranteeing their inclusion in the national registries. Key provisions of the Counting Veterans’ Cancer Act were included in the first government funding package of fiscal year 2024.
Earlier Vaccinations Helped Limit Marine Adenovirus Outbreak
Earlier Vaccinations Helped Limit Marine Adenovirus Outbreak
During an adenovirus (AdV) outbreak among recruits and staff at the Marine Corps Recruit Depot (MCRD) in San Diego, an investigation revealed that the earlier individuals working at the site received vaccination, the better. The clinical team found that accelerating the vaccination schedule could help prevent further outbreaks, medical separations, and training disruption.
From July 1, 2024, through September 23, 2024, a total of 212 trainees and staff developed AdV and 28 were hospitalized. Nine patients were hospitalized with AdV pneumonia within a 2-week period; 3 were admitted to the intensive care unit. Outpatient acute respiratory disease (ARD) cases also increased, with recruits accounting for nearly 97% of the AdV outbreak cases.
AdV is a frequent cause of illness among military recruits. Research has found that up to 80% of cases of febrile ARD in recruits are due to AdV, and 20% result in hospitalization.
The military developed and implemented a live, oral vaccine against AdV serotypes 4 and 7 (most common in recruits) starting in the 1970s, reducing febrile respiratory illness in recruit training sites by 50% and AdV infection by > 90%. However, the manufacturer halted production of the vaccine in 1995. By 1999, vaccine supply was depleted, and ARD cases rose. A replacement vaccine introduced in 2011 proved 99% effective, leading to a dramatic 100-fold decline in AdV disease among military trainees.
While the vaccine is effective, outbreaks are still possible among closely congregating groups like military trainees. AdV pneumonia cases spiked as the virus spread through the training companies and into new companies when they arrived at the MCRD in early July 2024. Most new infections were in recruits who had missed the AdV vaccination day.
Early symptoms of AdV may be very mild, and some recruits were likely already symptomatic when vaccinated. Aggressive environmental cleaning, separation of sick and well recruits, masking, and other nonpharmaceutical interventions did not slow the spread.
The preventive medicine and public health teams noted that AdV vaccination was being administered 11 days postarrival, to allow for pregnancy testing, and for assessing vaccine titers. US Department of Defense regulations do not dictate precise vaccination schedules. Implementation of the regulation varies among military training sites.
After reviewing other training sites’ vaccine timing schedules (most required vaccination by day 6 postarrival) and determining the time required for immunity, the medical teams at MCRD recommended shifting AdV vaccine administration, along with other standard vaccines, from day 11 to day 1 postarrival. Two weeks after the schedule change, overall incidence began declining rapidly.
Nearly 75% of patients had coinfections with other respiratory pathogens, most notably seasonal coronaviruses, COVID-19, and rhinovirus/enterovirus, suggesting that infection with AdV may increase susceptibility to other viruses, a finding that has not been identified in previous AdV outbreaks. Newly increased testing sensitivity associated with multiplex respiratory pathogen PCR availability may have been a factor in coinfection identification during this outbreak.
AdV is a significant medical threat to military recruits. Early vaccination, the investigators advise, should remain “a central tenet for prevention and control of communicable diseases in these high-risk, congregate settings.”
During an adenovirus (AdV) outbreak among recruits and staff at the Marine Corps Recruit Depot (MCRD) in San Diego, an investigation revealed that the earlier individuals working at the site received vaccination, the better. The clinical team found that accelerating the vaccination schedule could help prevent further outbreaks, medical separations, and training disruption.
From July 1, 2024, through September 23, 2024, a total of 212 trainees and staff developed AdV and 28 were hospitalized. Nine patients were hospitalized with AdV pneumonia within a 2-week period; 3 were admitted to the intensive care unit. Outpatient acute respiratory disease (ARD) cases also increased, with recruits accounting for nearly 97% of the AdV outbreak cases.
AdV is a frequent cause of illness among military recruits. Research has found that up to 80% of cases of febrile ARD in recruits are due to AdV, and 20% result in hospitalization.
The military developed and implemented a live, oral vaccine against AdV serotypes 4 and 7 (most common in recruits) starting in the 1970s, reducing febrile respiratory illness in recruit training sites by 50% and AdV infection by > 90%. However, the manufacturer halted production of the vaccine in 1995. By 1999, vaccine supply was depleted, and ARD cases rose. A replacement vaccine introduced in 2011 proved 99% effective, leading to a dramatic 100-fold decline in AdV disease among military trainees.
While the vaccine is effective, outbreaks are still possible among closely congregating groups like military trainees. AdV pneumonia cases spiked as the virus spread through the training companies and into new companies when they arrived at the MCRD in early July 2024. Most new infections were in recruits who had missed the AdV vaccination day.
Early symptoms of AdV may be very mild, and some recruits were likely already symptomatic when vaccinated. Aggressive environmental cleaning, separation of sick and well recruits, masking, and other nonpharmaceutical interventions did not slow the spread.
The preventive medicine and public health teams noted that AdV vaccination was being administered 11 days postarrival, to allow for pregnancy testing, and for assessing vaccine titers. US Department of Defense regulations do not dictate precise vaccination schedules. Implementation of the regulation varies among military training sites.
After reviewing other training sites’ vaccine timing schedules (most required vaccination by day 6 postarrival) and determining the time required for immunity, the medical teams at MCRD recommended shifting AdV vaccine administration, along with other standard vaccines, from day 11 to day 1 postarrival. Two weeks after the schedule change, overall incidence began declining rapidly.
Nearly 75% of patients had coinfections with other respiratory pathogens, most notably seasonal coronaviruses, COVID-19, and rhinovirus/enterovirus, suggesting that infection with AdV may increase susceptibility to other viruses, a finding that has not been identified in previous AdV outbreaks. Newly increased testing sensitivity associated with multiplex respiratory pathogen PCR availability may have been a factor in coinfection identification during this outbreak.
AdV is a significant medical threat to military recruits. Early vaccination, the investigators advise, should remain “a central tenet for prevention and control of communicable diseases in these high-risk, congregate settings.”
During an adenovirus (AdV) outbreak among recruits and staff at the Marine Corps Recruit Depot (MCRD) in San Diego, an investigation revealed that the earlier individuals working at the site received vaccination, the better. The clinical team found that accelerating the vaccination schedule could help prevent further outbreaks, medical separations, and training disruption.
From July 1, 2024, through September 23, 2024, a total of 212 trainees and staff developed AdV and 28 were hospitalized. Nine patients were hospitalized with AdV pneumonia within a 2-week period; 3 were admitted to the intensive care unit. Outpatient acute respiratory disease (ARD) cases also increased, with recruits accounting for nearly 97% of the AdV outbreak cases.
AdV is a frequent cause of illness among military recruits. Research has found that up to 80% of cases of febrile ARD in recruits are due to AdV, and 20% result in hospitalization.
The military developed and implemented a live, oral vaccine against AdV serotypes 4 and 7 (most common in recruits) starting in the 1970s, reducing febrile respiratory illness in recruit training sites by 50% and AdV infection by > 90%. However, the manufacturer halted production of the vaccine in 1995. By 1999, vaccine supply was depleted, and ARD cases rose. A replacement vaccine introduced in 2011 proved 99% effective, leading to a dramatic 100-fold decline in AdV disease among military trainees.
While the vaccine is effective, outbreaks are still possible among closely congregating groups like military trainees. AdV pneumonia cases spiked as the virus spread through the training companies and into new companies when they arrived at the MCRD in early July 2024. Most new infections were in recruits who had missed the AdV vaccination day.
Early symptoms of AdV may be very mild, and some recruits were likely already symptomatic when vaccinated. Aggressive environmental cleaning, separation of sick and well recruits, masking, and other nonpharmaceutical interventions did not slow the spread.
The preventive medicine and public health teams noted that AdV vaccination was being administered 11 days postarrival, to allow for pregnancy testing, and for assessing vaccine titers. US Department of Defense regulations do not dictate precise vaccination schedules. Implementation of the regulation varies among military training sites.
After reviewing other training sites’ vaccine timing schedules (most required vaccination by day 6 postarrival) and determining the time required for immunity, the medical teams at MCRD recommended shifting AdV vaccine administration, along with other standard vaccines, from day 11 to day 1 postarrival. Two weeks after the schedule change, overall incidence began declining rapidly.
Nearly 75% of patients had coinfections with other respiratory pathogens, most notably seasonal coronaviruses, COVID-19, and rhinovirus/enterovirus, suggesting that infection with AdV may increase susceptibility to other viruses, a finding that has not been identified in previous AdV outbreaks. Newly increased testing sensitivity associated with multiplex respiratory pathogen PCR availability may have been a factor in coinfection identification during this outbreak.
AdV is a significant medical threat to military recruits. Early vaccination, the investigators advise, should remain “a central tenet for prevention and control of communicable diseases in these high-risk, congregate settings.”
Earlier Vaccinations Helped Limit Marine Adenovirus Outbreak
Earlier Vaccinations Helped Limit Marine Adenovirus Outbreak
What Effect Can a ‘Caring Message’ Intervention Have?
What Effect Can a ‘Caring Message’ Intervention Have?
Caring messages to veterans at risk for suicide come in many forms: cards, letters, phone calls, email, and text messages. Each message can have a major impact on the veteran’s mental health and their decision to use health care provided by the US Department of Veterans Affairs (VA). A recent study outlined ways to centralize that impact, ensuring the caring message reaches those who need it most.
The study examined the impact of the VA Veterans Crisis Line (VCL) caring letters intervention among veterans at increased psychiatric risk. It focused on veterans with ≥ 2 Veterans Health Administration (VHA) health service encounters within 24 months prior to VCL contact. The primary outcome was suicide-related events (SRE), including suicide attempts, intentional self-harm, and suicidal self-directed violence. Secondary outcomes included VHA health care use (all-cause inpatient and outpatient, mental health outpatient, mental health inpatient, and emergency department).
Of 186,514 VCL callers, 8.3% had a psychiatric hospitalization, 4.8% were flagged as high-risk by the REACH VET program, 6.2% had an SRE, and 12.9% met any of these criteria in the year prior to initial VCL contact. There was no association between caring letters and all-cause mortality or SRE, even though caring letters is one of the only interventions to demonstrate a reduction in suicide mortality as a randomized controlled trial.
While reducing suicide has not been the expected result, caring letters have consistently been associated with increased use of outpatient mental health services. The analysis found that veterans with and without indicators of elevated psychiatric risk were using services more. That, the researchers suggest, is more evidence that caring letters might prompt engagement with VHA care, even among veterans not identified as high risk.
Psychiatrist Jerome A. Motto, MD believed long-term supportive but nondemanding contact could reduce a suicidal person’s sense of isolation and enhance feelings of connectedness. His 1976 intervention established a plan to “exert a suicide prevention influence on high-risk persons who decline to enter the health care system.” In Motto’s 5-year follow-up study of 3,006 psychiatric inpatients, half of those who were not following their postdischarge treatment plan received calls or letters expressing interest in their well-being. Suicidal deaths were found to “diverge progressively,” leading Motto to claim the study showed “tentative evidence” that a high-risk population for suicide can be identified and that risk might be reduced through a systematic approach.
Despite those findings, the results of studies on repeated follow-up contact have been mixed. One review outlined how 5 studies showed a statistically significant reduction in suicidal behavior, 4 showed mixed results with trends toward a preventive effect, and 2 studies did not show a preventive effect.
In 2020, the VA launched an intervention for veterans who contacted the VCL. In the first 12 months, CLs were sent to > 100,000 veterans. In feedback interviews, participants described feeling appreciated, cared for, encouraged, and connected. They also said that the CLs helped them engage with community resources and made them more likely to seek VA care. Even veterans who were skeptical of the utility of the caring letters sometimes admitted keeping them.
Finding effective ways to prevent suicide among veterans has been a top priority for the VA. In 2021, then-US Surgeon General Jerome Adams issued a Call to Action that recommended using caring letters when gaps in care may exist, including following crisis line calls.
Caring messages to veterans at risk for suicide come in many forms: cards, letters, phone calls, email, and text messages. Each message can have a major impact on the veteran’s mental health and their decision to use health care provided by the US Department of Veterans Affairs (VA). A recent study outlined ways to centralize that impact, ensuring the caring message reaches those who need it most.
The study examined the impact of the VA Veterans Crisis Line (VCL) caring letters intervention among veterans at increased psychiatric risk. It focused on veterans with ≥ 2 Veterans Health Administration (VHA) health service encounters within 24 months prior to VCL contact. The primary outcome was suicide-related events (SRE), including suicide attempts, intentional self-harm, and suicidal self-directed violence. Secondary outcomes included VHA health care use (all-cause inpatient and outpatient, mental health outpatient, mental health inpatient, and emergency department).
Of 186,514 VCL callers, 8.3% had a psychiatric hospitalization, 4.8% were flagged as high-risk by the REACH VET program, 6.2% had an SRE, and 12.9% met any of these criteria in the year prior to initial VCL contact. There was no association between caring letters and all-cause mortality or SRE, even though caring letters is one of the only interventions to demonstrate a reduction in suicide mortality as a randomized controlled trial.
While reducing suicide has not been the expected result, caring letters have consistently been associated with increased use of outpatient mental health services. The analysis found that veterans with and without indicators of elevated psychiatric risk were using services more. That, the researchers suggest, is more evidence that caring letters might prompt engagement with VHA care, even among veterans not identified as high risk.
Psychiatrist Jerome A. Motto, MD believed long-term supportive but nondemanding contact could reduce a suicidal person’s sense of isolation and enhance feelings of connectedness. His 1976 intervention established a plan to “exert a suicide prevention influence on high-risk persons who decline to enter the health care system.” In Motto’s 5-year follow-up study of 3,006 psychiatric inpatients, half of those who were not following their postdischarge treatment plan received calls or letters expressing interest in their well-being. Suicidal deaths were found to “diverge progressively,” leading Motto to claim the study showed “tentative evidence” that a high-risk population for suicide can be identified and that risk might be reduced through a systematic approach.
Despite those findings, the results of studies on repeated follow-up contact have been mixed. One review outlined how 5 studies showed a statistically significant reduction in suicidal behavior, 4 showed mixed results with trends toward a preventive effect, and 2 studies did not show a preventive effect.
In 2020, the VA launched an intervention for veterans who contacted the VCL. In the first 12 months, CLs were sent to > 100,000 veterans. In feedback interviews, participants described feeling appreciated, cared for, encouraged, and connected. They also said that the CLs helped them engage with community resources and made them more likely to seek VA care. Even veterans who were skeptical of the utility of the caring letters sometimes admitted keeping them.
Finding effective ways to prevent suicide among veterans has been a top priority for the VA. In 2021, then-US Surgeon General Jerome Adams issued a Call to Action that recommended using caring letters when gaps in care may exist, including following crisis line calls.
Caring messages to veterans at risk for suicide come in many forms: cards, letters, phone calls, email, and text messages. Each message can have a major impact on the veteran’s mental health and their decision to use health care provided by the US Department of Veterans Affairs (VA). A recent study outlined ways to centralize that impact, ensuring the caring message reaches those who need it most.
The study examined the impact of the VA Veterans Crisis Line (VCL) caring letters intervention among veterans at increased psychiatric risk. It focused on veterans with ≥ 2 Veterans Health Administration (VHA) health service encounters within 24 months prior to VCL contact. The primary outcome was suicide-related events (SRE), including suicide attempts, intentional self-harm, and suicidal self-directed violence. Secondary outcomes included VHA health care use (all-cause inpatient and outpatient, mental health outpatient, mental health inpatient, and emergency department).
Of 186,514 VCL callers, 8.3% had a psychiatric hospitalization, 4.8% were flagged as high-risk by the REACH VET program, 6.2% had an SRE, and 12.9% met any of these criteria in the year prior to initial VCL contact. There was no association between caring letters and all-cause mortality or SRE, even though caring letters is one of the only interventions to demonstrate a reduction in suicide mortality as a randomized controlled trial.
While reducing suicide has not been the expected result, caring letters have consistently been associated with increased use of outpatient mental health services. The analysis found that veterans with and without indicators of elevated psychiatric risk were using services more. That, the researchers suggest, is more evidence that caring letters might prompt engagement with VHA care, even among veterans not identified as high risk.
Psychiatrist Jerome A. Motto, MD believed long-term supportive but nondemanding contact could reduce a suicidal person’s sense of isolation and enhance feelings of connectedness. His 1976 intervention established a plan to “exert a suicide prevention influence on high-risk persons who decline to enter the health care system.” In Motto’s 5-year follow-up study of 3,006 psychiatric inpatients, half of those who were not following their postdischarge treatment plan received calls or letters expressing interest in their well-being. Suicidal deaths were found to “diverge progressively,” leading Motto to claim the study showed “tentative evidence” that a high-risk population for suicide can be identified and that risk might be reduced through a systematic approach.
Despite those findings, the results of studies on repeated follow-up contact have been mixed. One review outlined how 5 studies showed a statistically significant reduction in suicidal behavior, 4 showed mixed results with trends toward a preventive effect, and 2 studies did not show a preventive effect.
In 2020, the VA launched an intervention for veterans who contacted the VCL. In the first 12 months, CLs were sent to > 100,000 veterans. In feedback interviews, participants described feeling appreciated, cared for, encouraged, and connected. They also said that the CLs helped them engage with community resources and made them more likely to seek VA care. Even veterans who were skeptical of the utility of the caring letters sometimes admitted keeping them.
Finding effective ways to prevent suicide among veterans has been a top priority for the VA. In 2021, then-US Surgeon General Jerome Adams issued a Call to Action that recommended using caring letters when gaps in care may exist, including following crisis line calls.
What Effect Can a ‘Caring Message’ Intervention Have?
What Effect Can a ‘Caring Message’ Intervention Have?
Military Service May Increase Risk for Early Menopause
Military Service May Increase Risk for Early Menopause
Traumatic and environmental exposures during military service may put women veterans at risk for early menopause, a recent longitudinal analysis of data from 668 women in the Gulf War Era Cohort Study found.
The study examined associations between possible early menopause (aged < 45 years) and participants’ Gulf War deployment, military environmental exposures (MEEs), Gulf War Illness, military sexual trauma (MST) and posttraumatic stress disorder (PTSD).
Of 384 Gulf War–deployed veterans, 63% reported MEEs and 26% reported MST during deployment. More than half (57%) of study participants (both Gulf War veterans and nondeployed veterans) met criteria for Gulf War Illness, and 23% met criteria for probable PTSD.
At follow-up, 15% of the women had possible early menopause—higher than population estimates for early menopause in the US, which range from 5% to 10%.
Gulf War deployment, Gulf War–related environmental exposures, and MST during deployment were not significantly associated with early menopause. However, both Gulf War Illness (odds ratio [OR], 1.83; 95% CI, 1.14 to 2.95) and probable PTSD (OR, 2.45; 95% CI, 1.54 to 3.90) were strongly associated with early menopause. Women with probable PTSD at baseline had more than double the odds of possible early menopause.
Previous research suggests that deployment, MEEs, and Gulf War Illness are broadly associated with adverse reproductive health conditions in women veterans. Exposure to persistent organic pollutants and combustion byproducts (eg, from industrial processes and burn pits) have been linked to ovarian dysfunction and oocyte destruction presumed to contribute to accelerated ovarian aging.
The average age for menopause in the US is 52 years. About 5% of women go through early menopause naturally. Early and premature (< 40 years) menopause may also result from a medical or surgical cause, such as a hysterectomy. Regardless the cause, early menopause can have a profound impact on a woman’s physical, emotional, and mental health. It is associated with premature mortality, poor bone health, sexual dysfunction, a 50% increased risk of cardiovascular disease, and 2-fold increased odds of depression.
“Sometimes we talk about menopause symptoms thinking that they're just sort of 1 brief point in time, but we're also talking about things that may affect women's health and functioning for a third or half of a lifespan,” Carolyn Gibson, PhD, MPH, said at the 2024 Spotlight on Women's Health Cyberseminar Series.
Gibson, a staff psychologist at the San Francisco Veterans Affairs (VA) Women’s Mental Health Program and lead author on the recent early-menopause study, pointed to some of the chronic physical health issues that might develop, such as cardiovascular disease, but also the psychological effects.
“It's just important,” she said during the Cyberseminar Series. “To think about the number of things that women in midlife tend to be juggling and managing, all of which may turn up the volume on symptom experience, effect of vulnerability to health and mental health challenges during this period.”
The findings of the study have clinical implications. Midlife women veterans (aged 45 to 64 years) are the largest group of women veterans enrolled in VA health care. Early menopause brings additional age-related care considerations. The authors advise prioritizing support for routine screening for menopause status and symptoms as well as gender-sensitive training, resources, and staffing to provide comprehensive, trauma-informed, evidence-based menopause care for women at any age.
Traumatic and environmental exposures during military service may put women veterans at risk for early menopause, a recent longitudinal analysis of data from 668 women in the Gulf War Era Cohort Study found.
The study examined associations between possible early menopause (aged < 45 years) and participants’ Gulf War deployment, military environmental exposures (MEEs), Gulf War Illness, military sexual trauma (MST) and posttraumatic stress disorder (PTSD).
Of 384 Gulf War–deployed veterans, 63% reported MEEs and 26% reported MST during deployment. More than half (57%) of study participants (both Gulf War veterans and nondeployed veterans) met criteria for Gulf War Illness, and 23% met criteria for probable PTSD.
At follow-up, 15% of the women had possible early menopause—higher than population estimates for early menopause in the US, which range from 5% to 10%.
Gulf War deployment, Gulf War–related environmental exposures, and MST during deployment were not significantly associated with early menopause. However, both Gulf War Illness (odds ratio [OR], 1.83; 95% CI, 1.14 to 2.95) and probable PTSD (OR, 2.45; 95% CI, 1.54 to 3.90) were strongly associated with early menopause. Women with probable PTSD at baseline had more than double the odds of possible early menopause.
Previous research suggests that deployment, MEEs, and Gulf War Illness are broadly associated with adverse reproductive health conditions in women veterans. Exposure to persistent organic pollutants and combustion byproducts (eg, from industrial processes and burn pits) have been linked to ovarian dysfunction and oocyte destruction presumed to contribute to accelerated ovarian aging.
The average age for menopause in the US is 52 years. About 5% of women go through early menopause naturally. Early and premature (< 40 years) menopause may also result from a medical or surgical cause, such as a hysterectomy. Regardless the cause, early menopause can have a profound impact on a woman’s physical, emotional, and mental health. It is associated with premature mortality, poor bone health, sexual dysfunction, a 50% increased risk of cardiovascular disease, and 2-fold increased odds of depression.
“Sometimes we talk about menopause symptoms thinking that they're just sort of 1 brief point in time, but we're also talking about things that may affect women's health and functioning for a third or half of a lifespan,” Carolyn Gibson, PhD, MPH, said at the 2024 Spotlight on Women's Health Cyberseminar Series.
Gibson, a staff psychologist at the San Francisco Veterans Affairs (VA) Women’s Mental Health Program and lead author on the recent early-menopause study, pointed to some of the chronic physical health issues that might develop, such as cardiovascular disease, but also the psychological effects.
“It's just important,” she said during the Cyberseminar Series. “To think about the number of things that women in midlife tend to be juggling and managing, all of which may turn up the volume on symptom experience, effect of vulnerability to health and mental health challenges during this period.”
The findings of the study have clinical implications. Midlife women veterans (aged 45 to 64 years) are the largest group of women veterans enrolled in VA health care. Early menopause brings additional age-related care considerations. The authors advise prioritizing support for routine screening for menopause status and symptoms as well as gender-sensitive training, resources, and staffing to provide comprehensive, trauma-informed, evidence-based menopause care for women at any age.
Traumatic and environmental exposures during military service may put women veterans at risk for early menopause, a recent longitudinal analysis of data from 668 women in the Gulf War Era Cohort Study found.
The study examined associations between possible early menopause (aged < 45 years) and participants’ Gulf War deployment, military environmental exposures (MEEs), Gulf War Illness, military sexual trauma (MST) and posttraumatic stress disorder (PTSD).
Of 384 Gulf War–deployed veterans, 63% reported MEEs and 26% reported MST during deployment. More than half (57%) of study participants (both Gulf War veterans and nondeployed veterans) met criteria for Gulf War Illness, and 23% met criteria for probable PTSD.
At follow-up, 15% of the women had possible early menopause—higher than population estimates for early menopause in the US, which range from 5% to 10%.
Gulf War deployment, Gulf War–related environmental exposures, and MST during deployment were not significantly associated with early menopause. However, both Gulf War Illness (odds ratio [OR], 1.83; 95% CI, 1.14 to 2.95) and probable PTSD (OR, 2.45; 95% CI, 1.54 to 3.90) were strongly associated with early menopause. Women with probable PTSD at baseline had more than double the odds of possible early menopause.
Previous research suggests that deployment, MEEs, and Gulf War Illness are broadly associated with adverse reproductive health conditions in women veterans. Exposure to persistent organic pollutants and combustion byproducts (eg, from industrial processes and burn pits) have been linked to ovarian dysfunction and oocyte destruction presumed to contribute to accelerated ovarian aging.
The average age for menopause in the US is 52 years. About 5% of women go through early menopause naturally. Early and premature (< 40 years) menopause may also result from a medical or surgical cause, such as a hysterectomy. Regardless the cause, early menopause can have a profound impact on a woman’s physical, emotional, and mental health. It is associated with premature mortality, poor bone health, sexual dysfunction, a 50% increased risk of cardiovascular disease, and 2-fold increased odds of depression.
“Sometimes we talk about menopause symptoms thinking that they're just sort of 1 brief point in time, but we're also talking about things that may affect women's health and functioning for a third or half of a lifespan,” Carolyn Gibson, PhD, MPH, said at the 2024 Spotlight on Women's Health Cyberseminar Series.
Gibson, a staff psychologist at the San Francisco Veterans Affairs (VA) Women’s Mental Health Program and lead author on the recent early-menopause study, pointed to some of the chronic physical health issues that might develop, such as cardiovascular disease, but also the psychological effects.
“It's just important,” she said during the Cyberseminar Series. “To think about the number of things that women in midlife tend to be juggling and managing, all of which may turn up the volume on symptom experience, effect of vulnerability to health and mental health challenges during this period.”
The findings of the study have clinical implications. Midlife women veterans (aged 45 to 64 years) are the largest group of women veterans enrolled in VA health care. Early menopause brings additional age-related care considerations. The authors advise prioritizing support for routine screening for menopause status and symptoms as well as gender-sensitive training, resources, and staffing to provide comprehensive, trauma-informed, evidence-based menopause care for women at any age.
Military Service May Increase Risk for Early Menopause
Military Service May Increase Risk for Early Menopause
End of Medical Exemptions for Grooming Impacts Black Soldiers
End of Medical Exemptions for Grooming Impacts Black Soldiers
The US military has revised its grooming standards to remove medical exemptions for male facial hair, a policy change that may put careers at risk for thousands of service members. According to the updated guidelines, all soldiers must be clean-shaven on duty when in uniform or civilian clothes, with temporary exemptions for medical reasons and permanent exemptions for religious accommodations.
The Army is the latest service branch to update its guidelines about beards: Soldiers with skin conditions will no longer be granted permanent medical waivers that allow them to avoid shaving. The Air Force and Space Force updated their guidance on grooming waivers in January, as did the Marine Corps in March.
Defense Secretary Pete Hegseth, who ordered the guideline review, focused on grooming and appearance. In a Feb. 7 townhall with troops and department employees, he said, “It starts with the basic stuff, right? It’s grooming standards and uniform standards and training standards, fitness standards, all of that matters.”
Hegseth compared not enforcing grooming standards to the “broken windows” theory of policing: “I’m not saying if you violate grooming standards, you’re a criminal. The analogy is incomplete. But if you violate the small stuff and you allow it to happen, it creates a culture where the big stuff, you’re not held accountable for.”
The policy changes are particularly significant for soldiers who grow beards because they suffer from pseudofolliculitis barbae (PFB), an often-painful genetic condition that causes ingrown hairs. PFB produces flesh-colored or red follicular papules, which can be itchy, tender, and may bleed when shaved. Even if they heal, the lesions may lead to postinflammatory hyperpigmentation, scarring (including keloid scarring), and abscess.
Although the updated standards affect all service members with beards, they draw ire from those who claim the rules disproportionately affect men of African descent. Up to 60% of Black men have PFB, according to the American Osteopathic College of Dermatology. According to the US Department of Defense (DoD) 2023 Demographics: Profile of the Military Community, service members who self-identify as Black or African American make up 17% of the total DoD military force (N = 2,034,426). Of 1,273,382 active-duty members, 18% are Black. Of 1,038,909 active-duty enlisted members, 20% are Black, and 9% of 234,473 active-duty officers are Black.
“Almost 65% of the US Air Force shaving waivers are held by Black men. And PFB is one of the most common reasons,” DanTasia Welch, MS, told Federal Practitioner. She, along with Richard P. Usatine, MD, and Candrice R. Heath, MD, wrote a recent review of the impact of PFB that was published in Federal Practitioner.
“It is almost exclusively found in men of African descent,” Usatine said. “That just means if you have a policy that affects people with this condition, you are basically aiming that policy directly at Black men.”
“Pseudofolliculitis barbae, a lot of that just has to do with your shaving technique is what we’ve determined,” Steve Warren, an Army spokesman, told reporters in early July. “A vast majority of minority soldiers, African American soldiers, are within the standards all the time.”
Usatine disagreed: “[PFB] is genetic, and whether you shave with or against the direction of the hairs, the problem is still there, and you can't just shave it away by ‘shaving correctly.’ They're going after one racial/ethnic group who has this problem, because almost everyone that has the problem is of African descent.”
The most effective management for PFB is to discontinue shaving. Grooming techniques and topical medications can be effective in treating mild-to-moderate cases of PFB, but more severe cases respond best to laser therapy. The Army, Navy, and Marine Corps advise laser therapy as a treatment option, but it has drawbacks. It is expensive and coded as a cosmetic procedure, and patients also may not have access to specialists experienced in performing the procedure in people with darker skin tones. Some patients may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons.
A survey of Air Force members with 10,383 responses suggested that the men who had medical shaving waivers experienced longer times to promotion than those with no waiver. Most in the waiver group were Black or African American.
The branches have handled the rule change in different ways. The Air Force, for example, which began tightening its standards on uniform and shaving waivers in January 2025, grants long-term shaving waivers only to airmen or guardians who have severe cases of PFB following consultation with medical practitioners. Air Force Surgeon General Lt. Gen. John DeGoes said in a video that the department’s 2020 (now expired) policy allowing 5-year shaving waivers did not give clinicians enough clarity on diagnosis by not differentiating between PFB and shaving irritation.
“They are 2 different things,” DeGoes said. “Ensuring a standardized approach to managing PFB is essential. And it is crucial that we provide consistent and effective care to our service members, enabling them to meet grooming standards while managing their condition.”
The new grooming policies leave many service members in an uncomfortable quandary: Keep the beard, run the risk of getting kicked out; keep shaving and put your skin and health at risk for complications; or receive laser treatment and have to deal with lack of beard hair after leaving the military.
Simply changing the rules isn’t enough. Candrice Heath, MD, told Federal Practitioner, “You need to always strike a balance. One of those points that’s always raised is about the facial equipment that's needed to protect during times of war.”
Heath called for more research funding to develop equipment, so people can have some facial hair if needed. “There is an opportunity to not just say, hey, this is an issue, but there's an opportunity for innovation here, to really think about it this problem in a different way, so that we are solution-focused.”
The US military has revised its grooming standards to remove medical exemptions for male facial hair, a policy change that may put careers at risk for thousands of service members. According to the updated guidelines, all soldiers must be clean-shaven on duty when in uniform or civilian clothes, with temporary exemptions for medical reasons and permanent exemptions for religious accommodations.
The Army is the latest service branch to update its guidelines about beards: Soldiers with skin conditions will no longer be granted permanent medical waivers that allow them to avoid shaving. The Air Force and Space Force updated their guidance on grooming waivers in January, as did the Marine Corps in March.
Defense Secretary Pete Hegseth, who ordered the guideline review, focused on grooming and appearance. In a Feb. 7 townhall with troops and department employees, he said, “It starts with the basic stuff, right? It’s grooming standards and uniform standards and training standards, fitness standards, all of that matters.”
Hegseth compared not enforcing grooming standards to the “broken windows” theory of policing: “I’m not saying if you violate grooming standards, you’re a criminal. The analogy is incomplete. But if you violate the small stuff and you allow it to happen, it creates a culture where the big stuff, you’re not held accountable for.”
The policy changes are particularly significant for soldiers who grow beards because they suffer from pseudofolliculitis barbae (PFB), an often-painful genetic condition that causes ingrown hairs. PFB produces flesh-colored or red follicular papules, which can be itchy, tender, and may bleed when shaved. Even if they heal, the lesions may lead to postinflammatory hyperpigmentation, scarring (including keloid scarring), and abscess.
Although the updated standards affect all service members with beards, they draw ire from those who claim the rules disproportionately affect men of African descent. Up to 60% of Black men have PFB, according to the American Osteopathic College of Dermatology. According to the US Department of Defense (DoD) 2023 Demographics: Profile of the Military Community, service members who self-identify as Black or African American make up 17% of the total DoD military force (N = 2,034,426). Of 1,273,382 active-duty members, 18% are Black. Of 1,038,909 active-duty enlisted members, 20% are Black, and 9% of 234,473 active-duty officers are Black.
“Almost 65% of the US Air Force shaving waivers are held by Black men. And PFB is one of the most common reasons,” DanTasia Welch, MS, told Federal Practitioner. She, along with Richard P. Usatine, MD, and Candrice R. Heath, MD, wrote a recent review of the impact of PFB that was published in Federal Practitioner.
“It is almost exclusively found in men of African descent,” Usatine said. “That just means if you have a policy that affects people with this condition, you are basically aiming that policy directly at Black men.”
“Pseudofolliculitis barbae, a lot of that just has to do with your shaving technique is what we’ve determined,” Steve Warren, an Army spokesman, told reporters in early July. “A vast majority of minority soldiers, African American soldiers, are within the standards all the time.”
Usatine disagreed: “[PFB] is genetic, and whether you shave with or against the direction of the hairs, the problem is still there, and you can't just shave it away by ‘shaving correctly.’ They're going after one racial/ethnic group who has this problem, because almost everyone that has the problem is of African descent.”
The most effective management for PFB is to discontinue shaving. Grooming techniques and topical medications can be effective in treating mild-to-moderate cases of PFB, but more severe cases respond best to laser therapy. The Army, Navy, and Marine Corps advise laser therapy as a treatment option, but it has drawbacks. It is expensive and coded as a cosmetic procedure, and patients also may not have access to specialists experienced in performing the procedure in people with darker skin tones. Some patients may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons.
A survey of Air Force members with 10,383 responses suggested that the men who had medical shaving waivers experienced longer times to promotion than those with no waiver. Most in the waiver group were Black or African American.
The branches have handled the rule change in different ways. The Air Force, for example, which began tightening its standards on uniform and shaving waivers in January 2025, grants long-term shaving waivers only to airmen or guardians who have severe cases of PFB following consultation with medical practitioners. Air Force Surgeon General Lt. Gen. John DeGoes said in a video that the department’s 2020 (now expired) policy allowing 5-year shaving waivers did not give clinicians enough clarity on diagnosis by not differentiating between PFB and shaving irritation.
“They are 2 different things,” DeGoes said. “Ensuring a standardized approach to managing PFB is essential. And it is crucial that we provide consistent and effective care to our service members, enabling them to meet grooming standards while managing their condition.”
The new grooming policies leave many service members in an uncomfortable quandary: Keep the beard, run the risk of getting kicked out; keep shaving and put your skin and health at risk for complications; or receive laser treatment and have to deal with lack of beard hair after leaving the military.
Simply changing the rules isn’t enough. Candrice Heath, MD, told Federal Practitioner, “You need to always strike a balance. One of those points that’s always raised is about the facial equipment that's needed to protect during times of war.”
Heath called for more research funding to develop equipment, so people can have some facial hair if needed. “There is an opportunity to not just say, hey, this is an issue, but there's an opportunity for innovation here, to really think about it this problem in a different way, so that we are solution-focused.”
The US military has revised its grooming standards to remove medical exemptions for male facial hair, a policy change that may put careers at risk for thousands of service members. According to the updated guidelines, all soldiers must be clean-shaven on duty when in uniform or civilian clothes, with temporary exemptions for medical reasons and permanent exemptions for religious accommodations.
The Army is the latest service branch to update its guidelines about beards: Soldiers with skin conditions will no longer be granted permanent medical waivers that allow them to avoid shaving. The Air Force and Space Force updated their guidance on grooming waivers in January, as did the Marine Corps in March.
Defense Secretary Pete Hegseth, who ordered the guideline review, focused on grooming and appearance. In a Feb. 7 townhall with troops and department employees, he said, “It starts with the basic stuff, right? It’s grooming standards and uniform standards and training standards, fitness standards, all of that matters.”
Hegseth compared not enforcing grooming standards to the “broken windows” theory of policing: “I’m not saying if you violate grooming standards, you’re a criminal. The analogy is incomplete. But if you violate the small stuff and you allow it to happen, it creates a culture where the big stuff, you’re not held accountable for.”
The policy changes are particularly significant for soldiers who grow beards because they suffer from pseudofolliculitis barbae (PFB), an often-painful genetic condition that causes ingrown hairs. PFB produces flesh-colored or red follicular papules, which can be itchy, tender, and may bleed when shaved. Even if they heal, the lesions may lead to postinflammatory hyperpigmentation, scarring (including keloid scarring), and abscess.
Although the updated standards affect all service members with beards, they draw ire from those who claim the rules disproportionately affect men of African descent. Up to 60% of Black men have PFB, according to the American Osteopathic College of Dermatology. According to the US Department of Defense (DoD) 2023 Demographics: Profile of the Military Community, service members who self-identify as Black or African American make up 17% of the total DoD military force (N = 2,034,426). Of 1,273,382 active-duty members, 18% are Black. Of 1,038,909 active-duty enlisted members, 20% are Black, and 9% of 234,473 active-duty officers are Black.
“Almost 65% of the US Air Force shaving waivers are held by Black men. And PFB is one of the most common reasons,” DanTasia Welch, MS, told Federal Practitioner. She, along with Richard P. Usatine, MD, and Candrice R. Heath, MD, wrote a recent review of the impact of PFB that was published in Federal Practitioner.
“It is almost exclusively found in men of African descent,” Usatine said. “That just means if you have a policy that affects people with this condition, you are basically aiming that policy directly at Black men.”
“Pseudofolliculitis barbae, a lot of that just has to do with your shaving technique is what we’ve determined,” Steve Warren, an Army spokesman, told reporters in early July. “A vast majority of minority soldiers, African American soldiers, are within the standards all the time.”
Usatine disagreed: “[PFB] is genetic, and whether you shave with or against the direction of the hairs, the problem is still there, and you can't just shave it away by ‘shaving correctly.’ They're going after one racial/ethnic group who has this problem, because almost everyone that has the problem is of African descent.”
The most effective management for PFB is to discontinue shaving. Grooming techniques and topical medications can be effective in treating mild-to-moderate cases of PFB, but more severe cases respond best to laser therapy. The Army, Navy, and Marine Corps advise laser therapy as a treatment option, but it has drawbacks. It is expensive and coded as a cosmetic procedure, and patients also may not have access to specialists experienced in performing the procedure in people with darker skin tones. Some patients may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons.
A survey of Air Force members with 10,383 responses suggested that the men who had medical shaving waivers experienced longer times to promotion than those with no waiver. Most in the waiver group were Black or African American.
The branches have handled the rule change in different ways. The Air Force, for example, which began tightening its standards on uniform and shaving waivers in January 2025, grants long-term shaving waivers only to airmen or guardians who have severe cases of PFB following consultation with medical practitioners. Air Force Surgeon General Lt. Gen. John DeGoes said in a video that the department’s 2020 (now expired) policy allowing 5-year shaving waivers did not give clinicians enough clarity on diagnosis by not differentiating between PFB and shaving irritation.
“They are 2 different things,” DeGoes said. “Ensuring a standardized approach to managing PFB is essential. And it is crucial that we provide consistent and effective care to our service members, enabling them to meet grooming standards while managing their condition.”
The new grooming policies leave many service members in an uncomfortable quandary: Keep the beard, run the risk of getting kicked out; keep shaving and put your skin and health at risk for complications; or receive laser treatment and have to deal with lack of beard hair after leaving the military.
Simply changing the rules isn’t enough. Candrice Heath, MD, told Federal Practitioner, “You need to always strike a balance. One of those points that’s always raised is about the facial equipment that's needed to protect during times of war.”
Heath called for more research funding to develop equipment, so people can have some facial hair if needed. “There is an opportunity to not just say, hey, this is an issue, but there's an opportunity for innovation here, to really think about it this problem in a different way, so that we are solution-focused.”
End of Medical Exemptions for Grooming Impacts Black Soldiers
End of Medical Exemptions for Grooming Impacts Black Soldiers
