Jan Dyer

Recent research has revealed potential links between Agent Orange (AO) exposure and risk of acral melanoma (AM) among Vietnam War-era veterans, providing strong evidence of a relationship between the chemical and this type of cancer.

Localized to the palms, soles, and nail units, AM is a melanoma subtype less associated with UV radiation. From 1962 to 1971, the US military sprayed an estimated 18 million gallons of herbicides, including AO, over the fields and forests of Vietnam. Those herbicides have since been connected to numerous health issues, including cancer, though evidence of a relationship between AO and skin cancers has been weak. 

Vietnam War-era veterans have a higher melanoma burden than the general population, with the disease being the fourth-most common cancer among those who served. AM, however, is rare, representing about 2% to 3% of all melanomas. 

In a nested case-control study, Hwang et al used US Department of Veterans Affairs (VA) health care system data, including the VA Cancer Registry. The authors compared 1292 patients with AM and 2 pair-matched control groups: a group matched 4:1 to nonacral cutaneous melanoma controls, and a group without a melanoma diagnosis. 

Hwang et al found AO exposure was associated with increased odds of AM compared with each control group. In an accompanying editorial, Andrew Olshan, PhD, from Department of Epidemiology at the University of North Carolina Gillings School of Global Public Health, wrote, “The magnitude of the effects was modest (about 30%) but noteworthy.” 

A limitation of the study was that presumptive AOE status was based on whether the veteran filed a disability claim with evidence of officially recognized service in a period and place where Agent Orange was used—not on an assessment of the veteran’s individual AOE potential, including level of exposure. Because melanoma has never been included on the VA list of cancers presumed to be related to AO exposure, veterans do not automatically gain benefits by filing AOE claims after diagnosis. Even so, Olshan says, the reported study findings may underestimate the true effect of AO exposure on the risk of AM. 

Given the rarity of AM, the association (if causal) would translate to 0.4 to 0.8 new annual cases of AM per 1,000,000 veterans, according to the study. Narrowed down to Vietnam War-era veterans—who are dwindling in number—the attributable cases would be scarce.

Nevertheless, the search for a better understanding of a potential link between AOE and melanomas among Vietnam War-era veterans is important, Olshan wrote.

“The Hwang et al study provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community.”

Recent research has revealed potential links between Agent Orange (AO) exposure and risk of acral melanoma (AM) among Vietnam War-era veterans, providing strong evidence of a relationship between the chemical and this type of cancer.

Localized to the palms, soles, and nail units, AM is a melanoma subtype less associated with UV radiation. From 1962 to 1971, the US military sprayed an estimated 18 million gallons of herbicides, including AO, over the fields and forests of Vietnam. Those herbicides have since been connected to numerous health issues, including cancer, though evidence of a relationship between AO and skin cancers has been weak. 

Vietnam War-era veterans have a higher melanoma burden than the general population, with the disease being the fourth-most common cancer among those who served. AM, however, is rare, representing about 2% to 3% of all melanomas. 

In a nested case-control study, Hwang et al used US Department of Veterans Affairs (VA) health care system data, including the VA Cancer Registry. The authors compared 1292 patients with AM and 2 pair-matched control groups: a group matched 4:1 to nonacral cutaneous melanoma controls, and a group without a melanoma diagnosis. 

Hwang et al found AO exposure was associated with increased odds of AM compared with each control group. In an accompanying editorial, Andrew Olshan, PhD, from Department of Epidemiology at the University of North Carolina Gillings School of Global Public Health, wrote, “The magnitude of the effects was modest (about 30%) but noteworthy.” 

A limitation of the study was that presumptive AOE status was based on whether the veteran filed a disability claim with evidence of officially recognized service in a period and place where Agent Orange was used—not on an assessment of the veteran’s individual AOE potential, including level of exposure. Because melanoma has never been included on the VA list of cancers presumed to be related to AO exposure, veterans do not automatically gain benefits by filing AOE claims after diagnosis. Even so, Olshan says, the reported study findings may underestimate the true effect of AO exposure on the risk of AM. 

Given the rarity of AM, the association (if causal) would translate to 0.4 to 0.8 new annual cases of AM per 1,000,000 veterans, according to the study. Narrowed down to Vietnam War-era veterans—who are dwindling in number—the attributable cases would be scarce.

Nevertheless, the search for a better understanding of a potential link between AOE and melanomas among Vietnam War-era veterans is important, Olshan wrote.

“The Hwang et al study provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community.”

Recent research has revealed potential links between Agent Orange (AO) exposure and risk of acral melanoma (AM) among Vietnam War-era veterans, providing strong evidence of a relationship between the chemical and this type of cancer.

Localized to the palms, soles, and nail units, AM is a melanoma subtype less associated with UV radiation. From 1962 to 1971, the US military sprayed an estimated 18 million gallons of herbicides, including AO, over the fields and forests of Vietnam. Those herbicides have since been connected to numerous health issues, including cancer, though evidence of a relationship between AO and skin cancers has been weak. 

Vietnam War-era veterans have a higher melanoma burden than the general population, with the disease being the fourth-most common cancer among those who served. AM, however, is rare, representing about 2% to 3% of all melanomas. 

In a nested case-control study, Hwang et al used US Department of Veterans Affairs (VA) health care system data, including the VA Cancer Registry. The authors compared 1292 patients with AM and 2 pair-matched control groups: a group matched 4:1 to nonacral cutaneous melanoma controls, and a group without a melanoma diagnosis. 

Hwang et al found AO exposure was associated with increased odds of AM compared with each control group. In an accompanying editorial, Andrew Olshan, PhD, from Department of Epidemiology at the University of North Carolina Gillings School of Global Public Health, wrote, “The magnitude of the effects was modest (about 30%) but noteworthy.” 

A limitation of the study was that presumptive AOE status was based on whether the veteran filed a disability claim with evidence of officially recognized service in a period and place where Agent Orange was used—not on an assessment of the veteran’s individual AOE potential, including level of exposure. Because melanoma has never been included on the VA list of cancers presumed to be related to AO exposure, veterans do not automatically gain benefits by filing AOE claims after diagnosis. Even so, Olshan says, the reported study findings may underestimate the true effect of AO exposure on the risk of AM. 

Given the rarity of AM, the association (if causal) would translate to 0.4 to 0.8 new annual cases of AM per 1,000,000 veterans, according to the study. Narrowed down to Vietnam War-era veterans—who are dwindling in number—the attributable cases would be scarce.

Nevertheless, the search for a better understanding of a potential link between AOE and melanomas among Vietnam War-era veterans is important, Olshan wrote.

“The Hwang et al study provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community.”

Seeking to modernize treatment for traumatic brain injury (TBI), Reps. Jack Bergman (R-MI) and Sarah Elfreth (D-MD) introduced the bipartisan BEACON Act to Congress on January 9. The legislation aims to expand access to innovative, evidence-based, nonpharmacological therapies to treat TBI beyond medication-centered approaches that do not always address the long-term and individualized needs of these veterans. These current methods leave “gaps in recovery, wellness, and post-service outcomes,” Bergman and Elfreth argued.

During a March 5 House Committee on Veterans’ Affairs Subcommittee on Health hearing, discussion centered on the proposed BEACON Act, as well as the additional challenges Neurology Centers of Excellence (CoEs) face to address TBI in veterans.

The act proposes awarding $60 million in grants over 3 years to private entities for TBI treatment and research and establishing 2 US Department of Veterans Affairs (VA) grant programs. The TBI Innovation Grant Program would support clinical studies and partnerships between community health care institutions, academic institutions, and the VA. The Independent Research Grant Program would advance third-party research and “implementation of proven alternative treatments,” with oversight by an independent entity modeled after the VA National Center for PTSD.

The proposed legislation has drawn criticism. “I do not disagree that veterans may need support from several different avenues to support their recovery journeys and I don't discount the role that nonprofits and academic affiliates play in facilitating and supporting that care,” said Ranking Member Rep. Julia Brownley (D-CA) said. “However, I need to draw the line at legislation that will take money from existing VA programs and redirect it to outside organizations and providers to do essentially the very same thing VA is already doing.” 

Russell Gore, MD, a neurologist and chief medical officer of Avalon Action Alliance, called VA TBI care fragmented and said the BEACON Act offers an opportunity to enhance it.

“This legislation is designed to evaluate effective treatments and leverage civilian and academic TBI expertise that is aligned with the VA’s mission,” he said. “This is not an attempt to privatize care, but to complement VA research and clinical capacity… With smart, coordinated partnerships and targeted investment, we can reach more veterans earlier, treat them more effectively.”

The VA has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, and numerous clinics supporting > 110 TBI teams. It also has 42 CoEs related to neurology. 

In a prepared statement, Glenn Graham, MD, PhD, retired Executive Director of the VA’s Neurology Clinical Programs representing the Association of VA Neurology Services cited the CoEs’ contribution to standardization of care. “Without systemwide coordination, practice patterns can vary. A veteran in a rural facility should receive the same standard of neurological assessment and management as a veteran treated in one of our flagship medical centers,” he said, before highlighting the capabilities of tele-neurology, electronic consultation, and remote interpretation of diagnostic studies to reduce travel burdens and promote equity in access. 

Graham cautioned, though, that the CoEs face challenges with budgeting and recent VA reductions in force. The proposed legislation, Graham said, would use VA appropriations to fund extramural research and “could drain vital resources from ongoing research, training and clinical programs, diverting funds to institutions with uncertain track records and limited experience working with the veteran population.” 

Several people highlighted the world-renowned research coming out of the VA, efforts that both veterans and the general public endorse.

Russell Lemle, former chief psychologist for the San Francisco VA Healthcare System and a senior policy analyst at the Veterans Healthcare Policy Institute, wrote with Jasper Craven: “The private sector has nothing commensurate with this level of care. And yet this bill would push TBI treatment out to private grantees, part of the accelerating movement to privatize the entire VA—even its signature, best-in-class programs.

“The act aims to divert resources from the VA’s world-class TBI and PTSD programs by creating a parallel treatment framework.”

Gore, however, said the Avalon Action Alliance supports a “fill-the-void” approach of “capacity augmentation, not privatization.”

“The intent is to complement VA by partnering with high-performing programs capable of delivering comprehensive assessment, interdisciplinary treatment, and structured follow-up for veterans who are not effectively reached (or not successfully retained) within traditional pathways,” he said.

Seeking to modernize treatment for traumatic brain injury (TBI), Reps. Jack Bergman (R-MI) and Sarah Elfreth (D-MD) introduced the bipartisan BEACON Act to Congress on January 9. The legislation aims to expand access to innovative, evidence-based, nonpharmacological therapies to treat TBI beyond medication-centered approaches that do not always address the long-term and individualized needs of these veterans. These current methods leave “gaps in recovery, wellness, and post-service outcomes,” Bergman and Elfreth argued.

During a March 5 House Committee on Veterans’ Affairs Subcommittee on Health hearing, discussion centered on the proposed BEACON Act, as well as the additional challenges Neurology Centers of Excellence (CoEs) face to address TBI in veterans.

The act proposes awarding $60 million in grants over 3 years to private entities for TBI treatment and research and establishing 2 US Department of Veterans Affairs (VA) grant programs. The TBI Innovation Grant Program would support clinical studies and partnerships between community health care institutions, academic institutions, and the VA. The Independent Research Grant Program would advance third-party research and “implementation of proven alternative treatments,” with oversight by an independent entity modeled after the VA National Center for PTSD.

The proposed legislation has drawn criticism. “I do not disagree that veterans may need support from several different avenues to support their recovery journeys and I don't discount the role that nonprofits and academic affiliates play in facilitating and supporting that care,” said Ranking Member Rep. Julia Brownley (D-CA) said. “However, I need to draw the line at legislation that will take money from existing VA programs and redirect it to outside organizations and providers to do essentially the very same thing VA is already doing.” 

Russell Gore, MD, a neurologist and chief medical officer of Avalon Action Alliance, called VA TBI care fragmented and said the BEACON Act offers an opportunity to enhance it.

“This legislation is designed to evaluate effective treatments and leverage civilian and academic TBI expertise that is aligned with the VA’s mission,” he said. “This is not an attempt to privatize care, but to complement VA research and clinical capacity… With smart, coordinated partnerships and targeted investment, we can reach more veterans earlier, treat them more effectively.”

The VA has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, and numerous clinics supporting > 110 TBI teams. It also has 42 CoEs related to neurology. 

In a prepared statement, Glenn Graham, MD, PhD, retired Executive Director of the VA’s Neurology Clinical Programs representing the Association of VA Neurology Services cited the CoEs’ contribution to standardization of care. “Without systemwide coordination, practice patterns can vary. A veteran in a rural facility should receive the same standard of neurological assessment and management as a veteran treated in one of our flagship medical centers,” he said, before highlighting the capabilities of tele-neurology, electronic consultation, and remote interpretation of diagnostic studies to reduce travel burdens and promote equity in access. 

Graham cautioned, though, that the CoEs face challenges with budgeting and recent VA reductions in force. The proposed legislation, Graham said, would use VA appropriations to fund extramural research and “could drain vital resources from ongoing research, training and clinical programs, diverting funds to institutions with uncertain track records and limited experience working with the veteran population.” 

Several people highlighted the world-renowned research coming out of the VA, efforts that both veterans and the general public endorse.

Russell Lemle, former chief psychologist for the San Francisco VA Healthcare System and a senior policy analyst at the Veterans Healthcare Policy Institute, wrote with Jasper Craven: “The private sector has nothing commensurate with this level of care. And yet this bill would push TBI treatment out to private grantees, part of the accelerating movement to privatize the entire VA—even its signature, best-in-class programs.

“The act aims to divert resources from the VA’s world-class TBI and PTSD programs by creating a parallel treatment framework.”

Gore, however, said the Avalon Action Alliance supports a “fill-the-void” approach of “capacity augmentation, not privatization.”

“The intent is to complement VA by partnering with high-performing programs capable of delivering comprehensive assessment, interdisciplinary treatment, and structured follow-up for veterans who are not effectively reached (or not successfully retained) within traditional pathways,” he said.

Seeking to modernize treatment for traumatic brain injury (TBI), Reps. Jack Bergman (R-MI) and Sarah Elfreth (D-MD) introduced the bipartisan BEACON Act to Congress on January 9. The legislation aims to expand access to innovative, evidence-based, nonpharmacological therapies to treat TBI beyond medication-centered approaches that do not always address the long-term and individualized needs of these veterans. These current methods leave “gaps in recovery, wellness, and post-service outcomes,” Bergman and Elfreth argued.

During a March 5 House Committee on Veterans’ Affairs Subcommittee on Health hearing, discussion centered on the proposed BEACON Act, as well as the additional challenges Neurology Centers of Excellence (CoEs) face to address TBI in veterans.

The act proposes awarding $60 million in grants over 3 years to private entities for TBI treatment and research and establishing 2 US Department of Veterans Affairs (VA) grant programs. The TBI Innovation Grant Program would support clinical studies and partnerships between community health care institutions, academic institutions, and the VA. The Independent Research Grant Program would advance third-party research and “implementation of proven alternative treatments,” with oversight by an independent entity modeled after the VA National Center for PTSD.

The proposed legislation has drawn criticism. “I do not disagree that veterans may need support from several different avenues to support their recovery journeys and I don't discount the role that nonprofits and academic affiliates play in facilitating and supporting that care,” said Ranking Member Rep. Julia Brownley (D-CA) said. “However, I need to draw the line at legislation that will take money from existing VA programs and redirect it to outside organizations and providers to do essentially the very same thing VA is already doing.” 

Russell Gore, MD, a neurologist and chief medical officer of Avalon Action Alliance, called VA TBI care fragmented and said the BEACON Act offers an opportunity to enhance it.

“This legislation is designed to evaluate effective treatments and leverage civilian and academic TBI expertise that is aligned with the VA’s mission,” he said. “This is not an attempt to privatize care, but to complement VA research and clinical capacity… With smart, coordinated partnerships and targeted investment, we can reach more veterans earlier, treat them more effectively.”

The VA has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, and numerous clinics supporting > 110 TBI teams. It also has 42 CoEs related to neurology. 

In a prepared statement, Glenn Graham, MD, PhD, retired Executive Director of the VA’s Neurology Clinical Programs representing the Association of VA Neurology Services cited the CoEs’ contribution to standardization of care. “Without systemwide coordination, practice patterns can vary. A veteran in a rural facility should receive the same standard of neurological assessment and management as a veteran treated in one of our flagship medical centers,” he said, before highlighting the capabilities of tele-neurology, electronic consultation, and remote interpretation of diagnostic studies to reduce travel burdens and promote equity in access. 

Graham cautioned, though, that the CoEs face challenges with budgeting and recent VA reductions in force. The proposed legislation, Graham said, would use VA appropriations to fund extramural research and “could drain vital resources from ongoing research, training and clinical programs, diverting funds to institutions with uncertain track records and limited experience working with the veteran population.” 

Several people highlighted the world-renowned research coming out of the VA, efforts that both veterans and the general public endorse.

Russell Lemle, former chief psychologist for the San Francisco VA Healthcare System and a senior policy analyst at the Veterans Healthcare Policy Institute, wrote with Jasper Craven: “The private sector has nothing commensurate with this level of care. And yet this bill would push TBI treatment out to private grantees, part of the accelerating movement to privatize the entire VA—even its signature, best-in-class programs.

“The act aims to divert resources from the VA’s world-class TBI and PTSD programs by creating a parallel treatment framework.”

Gore, however, said the Avalon Action Alliance supports a “fill-the-void” approach of “capacity augmentation, not privatization.”

“The intent is to complement VA by partnering with high-performing programs capable of delivering comprehensive assessment, interdisciplinary treatment, and structured follow-up for veterans who are not effectively reached (or not successfully retained) within traditional pathways,” he said.

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

Fewer veterans died by suicide in 2023 than 2022, according to the recently released 2025 National Veteran Suicide Prevention Annual Report from the US Department of Veterans Affairs (VA).

More than half of suicides, the Veterans Health Administration (VHA) found, were driven by pain (52.3%) or sleep problems (51.5%). Increased health problems were factors in 43.1% of cases, particularly traumatic brain injury (TBI) and cancer diagnosis. The suicide rate was 77.6 per 100,000 for veterans with a recent diagnosis of TBI, 94.3% higher than the rate of individuals without such a diagnosis. The suicide rate following a cancer diagnosis was 10.3% higher than for other veterans in VHA care—emphasizing the need, according to the VHA, to continue to expand efforts to integrate suicide prevention resources across all areas serving high-risk veteran groups.

VA has published the National Veteran Suicide Prevention report annually since 2016, with its release typically occurring in December. Release of the 2025 report was delayed until February 2026. The VA attributed the delay, however, due to the federal government shutdown from October 1 to November 12, 2025. At a January 2026 Senate Veterans’ Affairs Committee hearing, VA Secretary Doug Collins denied that there was an effort to halt its release.

Veteran deaths by suicide have often been called an epidemic, with the suicide rate having risen faster for veterans than it has for nonveterans since 2005. Veterans are 1.5 times more likely to die by suicide, a statistic that led Collins, veteran advocates, and members of Congress to identify veteran suicide prevention as a top priority.

The report indicates that the number of veteran suicides per year has remained relatively constant in the 6 most recent years of available data: 6738 in 2018, 6510 in 2019, 6347 in 2020, 6429 in 2021, 6442 in 2022, and 6398 in 2023. The fewest veteran suicides in the last 25 years happened both in 2001 and 2004 (6021), while the most (6738) came in 2018.

Although the overall veteran population has declined over time, more veterans are enrolling in VHA care, increasing from 3.8 million in 2001 to 6.1 million in 2023. However, the VHA found that 61% of veterans who died by suicide in 2023 were not receiving VHA care in the final year of their life.

The suicide rate among veterans in VHA care with mental health or substance use disorder diagnoses fell 34.7%, highlighting “the importance of both strengthening VA’s direct care system and expanding outreach and suicide prevention efforts for veterans who are not engaged in VHA health care,” Sen. Richard Blumenthal (D-CT), Ranking Member on the Senate Veterans’ Affairs Committee, said in a Feb. 5 statement about the report. 

Aligning with previous VA data, the report presented information suggesting VHA services such as the Veterans Crisis Line (VCL) may reduce veteran suicide rates. Twelve months after the first contact with the VCL, the suicide rate for veterans in VHA care in 2022 was 16.1% lower than for those in 2021. 

More than 2800 local and state coalitions are “actively working to meet community needs, expand available resources, and raise awareness” about suicide risks and prevention, the report says. The Staff Sergeant Parker Gordon Fox Suicide Prevention Grants Program, for example, provides community-based services for veterans, service members, and their families.

“Veteran suicide has been a scourge on our nation for far too long,” Collins said in a press release. “Most veterans who die by suicide were not in recent VA care, so making it easier for those who have worn the uniform to access the VA benefits they have earned is key.”

Fewer veterans died by suicide in 2023 than 2022, according to the recently released 2025 National Veteran Suicide Prevention Annual Report from the US Department of Veterans Affairs (VA).

More than half of suicides, the Veterans Health Administration (VHA) found, were driven by pain (52.3%) or sleep problems (51.5%). Increased health problems were factors in 43.1% of cases, particularly traumatic brain injury (TBI) and cancer diagnosis. The suicide rate was 77.6 per 100,000 for veterans with a recent diagnosis of TBI, 94.3% higher than the rate of individuals without such a diagnosis. The suicide rate following a cancer diagnosis was 10.3% higher than for other veterans in VHA care—emphasizing the need, according to the VHA, to continue to expand efforts to integrate suicide prevention resources across all areas serving high-risk veteran groups.

VA has published the National Veteran Suicide Prevention report annually since 2016, with its release typically occurring in December. Release of the 2025 report was delayed until February 2026. The VA attributed the delay, however, due to the federal government shutdown from October 1 to November 12, 2025. At a January 2026 Senate Veterans’ Affairs Committee hearing, VA Secretary Doug Collins denied that there was an effort to halt its release.

Veteran deaths by suicide have often been called an epidemic, with the suicide rate having risen faster for veterans than it has for nonveterans since 2005. Veterans are 1.5 times more likely to die by suicide, a statistic that led Collins, veteran advocates, and members of Congress to identify veteran suicide prevention as a top priority.

The report indicates that the number of veteran suicides per year has remained relatively constant in the 6 most recent years of available data: 6738 in 2018, 6510 in 2019, 6347 in 2020, 6429 in 2021, 6442 in 2022, and 6398 in 2023. The fewest veteran suicides in the last 25 years happened both in 2001 and 2004 (6021), while the most (6738) came in 2018.

Although the overall veteran population has declined over time, more veterans are enrolling in VHA care, increasing from 3.8 million in 2001 to 6.1 million in 2023. However, the VHA found that 61% of veterans who died by suicide in 2023 were not receiving VHA care in the final year of their life.

The suicide rate among veterans in VHA care with mental health or substance use disorder diagnoses fell 34.7%, highlighting “the importance of both strengthening VA’s direct care system and expanding outreach and suicide prevention efforts for veterans who are not engaged in VHA health care,” Sen. Richard Blumenthal (D-CT), Ranking Member on the Senate Veterans’ Affairs Committee, said in a Feb. 5 statement about the report. 

Aligning with previous VA data, the report presented information suggesting VHA services such as the Veterans Crisis Line (VCL) may reduce veteran suicide rates. Twelve months after the first contact with the VCL, the suicide rate for veterans in VHA care in 2022 was 16.1% lower than for those in 2021. 

More than 2800 local and state coalitions are “actively working to meet community needs, expand available resources, and raise awareness” about suicide risks and prevention, the report says. The Staff Sergeant Parker Gordon Fox Suicide Prevention Grants Program, for example, provides community-based services for veterans, service members, and their families.

“Veteran suicide has been a scourge on our nation for far too long,” Collins said in a press release. “Most veterans who die by suicide were not in recent VA care, so making it easier for those who have worn the uniform to access the VA benefits they have earned is key.”

Fewer veterans died by suicide in 2023 than 2022, according to the recently released 2025 National Veteran Suicide Prevention Annual Report from the US Department of Veterans Affairs (VA).

More than half of suicides, the Veterans Health Administration (VHA) found, were driven by pain (52.3%) or sleep problems (51.5%). Increased health problems were factors in 43.1% of cases, particularly traumatic brain injury (TBI) and cancer diagnosis. The suicide rate was 77.6 per 100,000 for veterans with a recent diagnosis of TBI, 94.3% higher than the rate of individuals without such a diagnosis. The suicide rate following a cancer diagnosis was 10.3% higher than for other veterans in VHA care—emphasizing the need, according to the VHA, to continue to expand efforts to integrate suicide prevention resources across all areas serving high-risk veteran groups.

VA has published the National Veteran Suicide Prevention report annually since 2016, with its release typically occurring in December. Release of the 2025 report was delayed until February 2026. The VA attributed the delay, however, due to the federal government shutdown from October 1 to November 12, 2025. At a January 2026 Senate Veterans’ Affairs Committee hearing, VA Secretary Doug Collins denied that there was an effort to halt its release.

Veteran deaths by suicide have often been called an epidemic, with the suicide rate having risen faster for veterans than it has for nonveterans since 2005. Veterans are 1.5 times more likely to die by suicide, a statistic that led Collins, veteran advocates, and members of Congress to identify veteran suicide prevention as a top priority.

The report indicates that the number of veteran suicides per year has remained relatively constant in the 6 most recent years of available data: 6738 in 2018, 6510 in 2019, 6347 in 2020, 6429 in 2021, 6442 in 2022, and 6398 in 2023. The fewest veteran suicides in the last 25 years happened both in 2001 and 2004 (6021), while the most (6738) came in 2018.

Although the overall veteran population has declined over time, more veterans are enrolling in VHA care, increasing from 3.8 million in 2001 to 6.1 million in 2023. However, the VHA found that 61% of veterans who died by suicide in 2023 were not receiving VHA care in the final year of their life.

The suicide rate among veterans in VHA care with mental health or substance use disorder diagnoses fell 34.7%, highlighting “the importance of both strengthening VA’s direct care system and expanding outreach and suicide prevention efforts for veterans who are not engaged in VHA health care,” Sen. Richard Blumenthal (D-CT), Ranking Member on the Senate Veterans’ Affairs Committee, said in a Feb. 5 statement about the report. 

Aligning with previous VA data, the report presented information suggesting VHA services such as the Veterans Crisis Line (VCL) may reduce veteran suicide rates. Twelve months after the first contact with the VCL, the suicide rate for veterans in VHA care in 2022 was 16.1% lower than for those in 2021. 

More than 2800 local and state coalitions are “actively working to meet community needs, expand available resources, and raise awareness” about suicide risks and prevention, the report says. The Staff Sergeant Parker Gordon Fox Suicide Prevention Grants Program, for example, provides community-based services for veterans, service members, and their families.

“Veteran suicide has been a scourge on our nation for far too long,” Collins said in a press release. “Most veterans who die by suicide were not in recent VA care, so making it easier for those who have worn the uniform to access the VA benefits they have earned is key.”

The US Department of the Interior Bureau of Indian Affairs (BIA) workforce shrunk 11% through the first 6 months of 2025, a result of executive orders, hiring freezes, a voluntary deferred resignation program (DRP), and terminations of probationary employees, according to a recently US Government Accountability Office (GAO) report. Though these reductions are complete, GAO said it has not yet analyzed projected cost savings or operational impacts from these staff reductions, and the department has shown signs of growth so far in 2026.

The reduction in force (RIF) from 7470 to 6624 employees aligns with the February 2025 executive order aimed at “restoring accountability, eliminating waste, bloat, and insularity” and reforming the federal workforce to maximize efficiency and productivity. The directives also instructed agencies to develop plans for large-scale RIFs and reorganizations. GAO auditors reviewed workforce data from January 25, 2025, through July 31, 2025, interviewed BIA officials, and reviewed comments from Native American tribal representatives to compose the report. 

All BIA regions experienced a reduction in staff: 10% in the Western and Rocky Mountain regions, 29% in the Pacific region, and > 20% each in the Alaska, Midwest, and Southern Plains regions. Positions within law enforcement and social work agencies were excluded from the May program due to job functions and responsibilities.

A small portion of separations included resignations and retirements outside of the DRPs; of the staff separating from BIA after January 25, 2025, while 24% left for other reasons. Although the downsizing was not unexpected and some staff were already planning to retire, repercussions were felt immediately.

“Some remaining staff took on additional responsibilities to mitigate the effects of reductions,” the GAO report said. “Some Indian Affairs staff said the reductions would exacerbate preexisting staffing limitations in their offices and make it more difficult to carry out their responsibilities serving Tribes.”

Tribal leaders voiced concerns, claiming BIA already was understaffed to effectively carry out its responsibilities and that service delivery was impaired. Some BIA staff reported that departures forced them to take on duties beyond their main area of responsibility, compromising their primary work. Regional BIA staff also described confusion about which employees were leaving, which limited their ability to effectively plan for impending departures, and reported receiving limited guidance from superiors about how to cover the responsibilities of those departing, particularly those in leadership positions. As of June 2, 2025, 6 of 12 BIA regional directors were serving in an acting capacity, and 12 of the 24 deputy regional director positions were either vacant or acting.

BIA officials have said there are no plans to reorganize or enact additional RIFs, but existing functions “might need to be restructured or realigned to achieve administration priorities.”

As of 2024, the Indiana Health Service (IHS) had a near 30% vacancy rate. In 2025, it awarded > 1800 scholarships and loan repayments under programs aimed at educating and training health professionals for careers at IHS facilities. And in January 2026, IHS announced it was launching the “largest hiring effort in agency history.”

“[O]ur top priority is filling vacancies for positions essential to keeping our health care facilities operating smoothly, especially in some of the more rural and remote locations,” said IHS Chief of Staff Clayton Fulton. 

The US Department of the Interior Bureau of Indian Affairs (BIA) workforce shrunk 11% through the first 6 months of 2025, a result of executive orders, hiring freezes, a voluntary deferred resignation program (DRP), and terminations of probationary employees, according to a recently US Government Accountability Office (GAO) report. Though these reductions are complete, GAO said it has not yet analyzed projected cost savings or operational impacts from these staff reductions, and the department has shown signs of growth so far in 2026.

The reduction in force (RIF) from 7470 to 6624 employees aligns with the February 2025 executive order aimed at “restoring accountability, eliminating waste, bloat, and insularity” and reforming the federal workforce to maximize efficiency and productivity. The directives also instructed agencies to develop plans for large-scale RIFs and reorganizations. GAO auditors reviewed workforce data from January 25, 2025, through July 31, 2025, interviewed BIA officials, and reviewed comments from Native American tribal representatives to compose the report. 

All BIA regions experienced a reduction in staff: 10% in the Western and Rocky Mountain regions, 29% in the Pacific region, and > 20% each in the Alaska, Midwest, and Southern Plains regions. Positions within law enforcement and social work agencies were excluded from the May program due to job functions and responsibilities.

A small portion of separations included resignations and retirements outside of the DRPs; of the staff separating from BIA after January 25, 2025, while 24% left for other reasons. Although the downsizing was not unexpected and some staff were already planning to retire, repercussions were felt immediately.

“Some remaining staff took on additional responsibilities to mitigate the effects of reductions,” the GAO report said. “Some Indian Affairs staff said the reductions would exacerbate preexisting staffing limitations in their offices and make it more difficult to carry out their responsibilities serving Tribes.”

Tribal leaders voiced concerns, claiming BIA already was understaffed to effectively carry out its responsibilities and that service delivery was impaired. Some BIA staff reported that departures forced them to take on duties beyond their main area of responsibility, compromising their primary work. Regional BIA staff also described confusion about which employees were leaving, which limited their ability to effectively plan for impending departures, and reported receiving limited guidance from superiors about how to cover the responsibilities of those departing, particularly those in leadership positions. As of June 2, 2025, 6 of 12 BIA regional directors were serving in an acting capacity, and 12 of the 24 deputy regional director positions were either vacant or acting.

BIA officials have said there are no plans to reorganize or enact additional RIFs, but existing functions “might need to be restructured or realigned to achieve administration priorities.”

As of 2024, the Indiana Health Service (IHS) had a near 30% vacancy rate. In 2025, it awarded > 1800 scholarships and loan repayments under programs aimed at educating and training health professionals for careers at IHS facilities. And in January 2026, IHS announced it was launching the “largest hiring effort in agency history.”

“[O]ur top priority is filling vacancies for positions essential to keeping our health care facilities operating smoothly, especially in some of the more rural and remote locations,” said IHS Chief of Staff Clayton Fulton. 

The US Department of the Interior Bureau of Indian Affairs (BIA) workforce shrunk 11% through the first 6 months of 2025, a result of executive orders, hiring freezes, a voluntary deferred resignation program (DRP), and terminations of probationary employees, according to a recently US Government Accountability Office (GAO) report. Though these reductions are complete, GAO said it has not yet analyzed projected cost savings or operational impacts from these staff reductions, and the department has shown signs of growth so far in 2026.

The reduction in force (RIF) from 7470 to 6624 employees aligns with the February 2025 executive order aimed at “restoring accountability, eliminating waste, bloat, and insularity” and reforming the federal workforce to maximize efficiency and productivity. The directives also instructed agencies to develop plans for large-scale RIFs and reorganizations. GAO auditors reviewed workforce data from January 25, 2025, through July 31, 2025, interviewed BIA officials, and reviewed comments from Native American tribal representatives to compose the report. 

All BIA regions experienced a reduction in staff: 10% in the Western and Rocky Mountain regions, 29% in the Pacific region, and > 20% each in the Alaska, Midwest, and Southern Plains regions. Positions within law enforcement and social work agencies were excluded from the May program due to job functions and responsibilities.

A small portion of separations included resignations and retirements outside of the DRPs; of the staff separating from BIA after January 25, 2025, while 24% left for other reasons. Although the downsizing was not unexpected and some staff were already planning to retire, repercussions were felt immediately.

“Some remaining staff took on additional responsibilities to mitigate the effects of reductions,” the GAO report said. “Some Indian Affairs staff said the reductions would exacerbate preexisting staffing limitations in their offices and make it more difficult to carry out their responsibilities serving Tribes.”

Tribal leaders voiced concerns, claiming BIA already was understaffed to effectively carry out its responsibilities and that service delivery was impaired. Some BIA staff reported that departures forced them to take on duties beyond their main area of responsibility, compromising their primary work. Regional BIA staff also described confusion about which employees were leaving, which limited their ability to effectively plan for impending departures, and reported receiving limited guidance from superiors about how to cover the responsibilities of those departing, particularly those in leadership positions. As of June 2, 2025, 6 of 12 BIA regional directors were serving in an acting capacity, and 12 of the 24 deputy regional director positions were either vacant or acting.

BIA officials have said there are no plans to reorganize or enact additional RIFs, but existing functions “might need to be restructured or realigned to achieve administration priorities.”

As of 2024, the Indiana Health Service (IHS) had a near 30% vacancy rate. In 2025, it awarded > 1800 scholarships and loan repayments under programs aimed at educating and training health professionals for careers at IHS facilities. And in January 2026, IHS announced it was launching the “largest hiring effort in agency history.”

“[O]ur top priority is filling vacancies for positions essential to keeping our health care facilities operating smoothly, especially in some of the more rural and remote locations,” said IHS Chief of Staff Clayton Fulton. 

The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.

A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.

For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.

Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities. 

Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.

The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.

A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.

For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.

Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities. 

Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.

The more than 2 million women US veterans are the fastest-growing military population. While research into women veterans has traditionally lagged, more recently studies have begun to focus on their needs impacts of combat and service on women. These studies have found that women veterans preferred tailored solutions focused on women veterans.

A November 2025 study is one of the first to examine the impact of combat on women veterans. It found that those in combat roles had higher levels of depression, posttraumatic stress disorder (PTSD), dissociation, and overall poorer health compared with civilians and noncombat women military personnel. Previous research had found that women veterans had higher rates of lifetime and past-year PTSD (13.4%) compared with female civilians (8.0%), male veterans (7.7%), and male civilians (3.4%). A 2020 US Department of Veterans (VA) study of 4,928,638 men and 448,455 women similarly found that women had nearly twice the rates of depression and anxiety compared with men.

For many veterans, mental health issues may develop or be exacerbated in their return to civilian life. That transition can be especially confusing and isolating for women veterans, according to a 2024 study: “They neither fit in the military due to gendered relations centered on masculinity, or civilian life where they are largely misunderstood as ‘veterans.’ This ‘no woman’s land’ is poorly understood.” Few programs for transitioning veterans have been found effective for women veterans because they’ve been developed for a largely male veteran population. That includes mental health support programs.

Some women may prefer women-only groups, and even that choice may be dependent on their background, service history, socioeconomic level, and other factors. They may feel more comfortable in women-only groups if they’ve experienced MST. Others who have served in combat may choose mixed-gender programs. One study found that some women benefited from being in a mixed-gender group because it enabled them to work on difficulties with men in a safe environment. Other research has found that women veterans with substance use disorders are reluctant to seek help alongside men in the same facilities. 

Accessing care may be especially challenging for rural women veterans. However, separate facilities and women-only groups are not always available, particularly in rural areas where there may be very few women veterans. And even if they are available, rural women are often up against barriers that urban women do not face, such as having to travel long distances to get care. Clinicians also may be hard to find in rural areas. Some participants in a 2025 study were hampered not only by a lack of female practitioners, but practitioners who were well trained to understand and treat the unique needs of female veterans: “[It’s] incredibly difficult to find a mental health practitioner that understands a veteran’s unique experience as a woman,” a participant said.

Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage. 

According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.” 

In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.

Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered. 

Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study. 

Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.

Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.

Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.

Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”

Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage. 

According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.” 

In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.

Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered. 

Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study. 

Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.

Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.

Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.

Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”

Male veterans with breast cancer may have a more difficult time receiving appropriate health care due to a recently revised US Department of Veterans Affairs (VA) policy that requires each individual to prove the disease’s connection to their service to qualify for coverage. 

According to a VA memo obtained by ProPublica, the change is based on a Jan. 1 presidential order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” VA Press Secretary Pete Kasperowicz told ProPublica that the policy was changed because the previous policy “falsely classified male breasts as reproductive organs.” 

In 2024, the VA added male breast cancer (along with urethral cancer and cancer of the paraurethral glands) to its list of presumed service-connected disabilities due to military environmental exposure, such as toxic burn pits. Male breast cancer was added to the category of “reproductive cancer of any type” after experts pointed to the similarity of male and female breast cancers.

Establishing a connection between a variety of cancers and military service has been a years-long fight only resolved recently in the form of the 2022 PACT Act. The VA lists > 20 medical conditions as “presumptive” for service connection, with some caveats, such as area of service. The act reduced the burden of proof needed: The terms “presumptive conditions” and “presumptive-exposure locations” mean veterans only have to provide their military records to show they were in an exposure location to have their care for certain conditions covered. 

Supporters of the PACT Act say the policy change could make it harder for veterans to receive timely care, a serious issue for men with breast cancer who have been “severely underrepresented” in clinical studies and many studies specifically exclude males. The American Cancer Society estimates about 2800 men have been or will be diagnosed with invasive breast cancer in 2025. Less than 1% of breast cancers in the US occur in men, but breast cancer is notably higher among veterans: 11% of 3304 veterans, according to a 2023 study. 

Breast cancer is more aggressive in men—they’re more often diagnosed at Stage IV and tend to be older—and survival rates have been lower than in women. In a 2019 study of 16,025 male and 1,800,708 female patients with breast cancer, men had 19% higher overall mortality.

Treatment for male breast cancer has lagged. A 2021 study found men were less likely than women to receive radiation therapy. However, that’s changing. Since that study, however, the American Cancer Society claims treatments and survival rates have improved. According to the Surveillance, Epidemiology, and End Results database, 5-year survival rates are 97% for localized, 86% for regional, and 31% for distant; 84% for all stages combined.

Screening and treatment have focused on women. But the VA Breast and Gynecologic Oncology System of Excellence (BGSoE) provides cancer care for all veterans diagnosed with breast malignancies. Male veterans with breast cancer do face additional challenges in addressing a cancer that is most often associated with females. “I must admit, it was awkward every time I went [to the Women’s Health Center for postmastectomy follow-ups]” William K. Lewis, described in his patient perspective on male breast cancer treatment in the VA.

Though the policy has changed, Kasperowicz told ProPublica that veterans who previously qualified for coverage can keep it: “The department grants disability benefits compensation claims for male Veterans with breast cancer on an individual basis and will continue to do so. VA encourages any male Veterans with breast cancer who feel their health may have been impacted by their military service to submit a disability compensation claim.”

What does a successful military-to-civilian transition look like? How do we know if a veteran is sinking, treading water, or swimming? Two recent studies by the Penn State University Clearinghouse for Military Family Readiness sought to answer to those questions and more while determining how and when is the right time to step in to help a veteran in need.

The research analyzed The Veterans Metrics Initiative data (TVMI). This longitudinal study surveyed 9566 men and women who left active duty in 2016 over 3 years, answering questions about deployment histories, adverse childhood experiences (ACEs) and exposure to combat. They also reported whether they had symptoms related to anxiety and depression. 

The TVMI study found that ACEs predicted poor outcomes early on and when combined with warfare experience dramatically increased the likelihood of mental health issues, including posttraumatic stress disorder (PTSD), anxiety, and depression; moral injury impacted adjustment to civilian life (the degree varied by gender); and, many veterans have a “growth outlook” as a result of a trauma or crisis they experienced.

The TVMI study found that almost all veterans use transition resources in the first 2 years after military separation. Beyond that, however, those in high-risk categories (eg, PTSD and cumulative trauma experiences) need continued support. This may come in the form of a universal screener and linking it to a navigation infrastructure (eg, AmericaServes), “thereby identifying risk factors early and providing targeted supports, interventions, and components.”

Veterans often face a series of simultaneous challenges as they return to civilian life. Among them include getting used to family and friends again, finding jobs, losing their military identity, structure, and perhaps leaving military friends behind. In addition, veterans are likely dealing with physical and mental health challenges, which can significantly influence how well they readjust to civilian life and lead to inconsistency experiences for each individual.

A 2019 survey from the Pew Research Center found about 40% of veterans who suffered from PTSD said they frequently had difficulty dealing with the lack of structure in civilian life, compared with 5% of those who do not have PTSD. Another survey cited a large majority (78%) of pre-9/11 veterans said their readjustment was very or somewhat easy. However, 26% said adjusting to civilian life was difficult.

In 2011, 4 variables were identified that predicted easy civilian life re-entry: being an officer; having a consistently clear understanding of the missions while in the service; being a college graduate; and, for post-9/11 veterans, attending religious services frequently. Six variables were associated with a diminished probability of an easy transition: having had a traumatic experience; being seriously injured; serving in the post-9/11 era; serving in a combat zone; serving with someone who was killed or injured; and, for post-9/11 veterans, being married while in the service.

The probabilities of an easy re-entry dropped from 82% for those who did not experience a traumatic event to 56% for those who did—the largest change noted in the 2011 study.

The second Penn State study evaluated a model framework with a lifespan development perspective. The study surveyed veterans on their self-reported satisfaction or symptoms in 7 domains of well-being: employment, education, financial, legal problems, social, physical health, and mental health. Within 3 months of separation , 41% of respondents fell into the “problematic” category for the mental health domain. However, by 30 to 33 months postseparation, this proportion dropped to 34%. During the same period, the proportion of veterans in the at risk category increased from 28% at Wave 1 to 37% at Wave 6. About 30% of veterans fell into the successful category for symptoms across the 3 examined waves. Almost 60% were in the successful category across the 3 time points.

Both Penn State studies emphasize the importance of viewing veterans as individuals on their own timelines.

“These findings underscore that the transition to civilian life is not a single moment, but a process influenced by experiences across the life span,” said Mary M. Mitchell, research professor at the Clearinghouse and lead author on the predictors study. “By following veterans over 3 years, we were able to see how patterns emerge that would be invisible in a one-time survey.”

Current conceptualization “assumes that there are commonalities across veterans when evaluating the success of the transition to civilian life,” according to the authors of the framework study. “However, each veteran likely has his or her view of what a successful transition constitutes, and he or she may weigh domains differently when considering his or her own transition.”

The research highlights the need to find ways to encourage veterans to seek help—and not just in the first year, which is often the most stressful. The Pew Research Center survey identified a “significant break from the past,” in that nearly 70% of post-9/11 veterans said their superiors made them feel comfortable about seeking help with emotional issues resulting from their military service. 

However, ≤ 8% veterans in the TVMI study used any health programs, even when they screened positive for mental health problems. Veterans who did use counseling services, however, improved their depression symptoms. Engaging veterans at various time points could help keep mental health problems from worsening during—and beyond—the transition.

What does a successful military-to-civilian transition look like? How do we know if a veteran is sinking, treading water, or swimming? Two recent studies by the Penn State University Clearinghouse for Military Family Readiness sought to answer to those questions and more while determining how and when is the right time to step in to help a veteran in need.

The research analyzed The Veterans Metrics Initiative data (TVMI). This longitudinal study surveyed 9566 men and women who left active duty in 2016 over 3 years, answering questions about deployment histories, adverse childhood experiences (ACEs) and exposure to combat. They also reported whether they had symptoms related to anxiety and depression. 

The TVMI study found that ACEs predicted poor outcomes early on and when combined with warfare experience dramatically increased the likelihood of mental health issues, including posttraumatic stress disorder (PTSD), anxiety, and depression; moral injury impacted adjustment to civilian life (the degree varied by gender); and, many veterans have a “growth outlook” as a result of a trauma or crisis they experienced.

The TVMI study found that almost all veterans use transition resources in the first 2 years after military separation. Beyond that, however, those in high-risk categories (eg, PTSD and cumulative trauma experiences) need continued support. This may come in the form of a universal screener and linking it to a navigation infrastructure (eg, AmericaServes), “thereby identifying risk factors early and providing targeted supports, interventions, and components.”

Veterans often face a series of simultaneous challenges as they return to civilian life. Among them include getting used to family and friends again, finding jobs, losing their military identity, structure, and perhaps leaving military friends behind. In addition, veterans are likely dealing with physical and mental health challenges, which can significantly influence how well they readjust to civilian life and lead to inconsistency experiences for each individual.

A 2019 survey from the Pew Research Center found about 40% of veterans who suffered from PTSD said they frequently had difficulty dealing with the lack of structure in civilian life, compared with 5% of those who do not have PTSD. Another survey cited a large majority (78%) of pre-9/11 veterans said their readjustment was very or somewhat easy. However, 26% said adjusting to civilian life was difficult.

In 2011, 4 variables were identified that predicted easy civilian life re-entry: being an officer; having a consistently clear understanding of the missions while in the service; being a college graduate; and, for post-9/11 veterans, attending religious services frequently. Six variables were associated with a diminished probability of an easy transition: having had a traumatic experience; being seriously injured; serving in the post-9/11 era; serving in a combat zone; serving with someone who was killed or injured; and, for post-9/11 veterans, being married while in the service.

The probabilities of an easy re-entry dropped from 82% for those who did not experience a traumatic event to 56% for those who did—the largest change noted in the 2011 study.

The second Penn State study evaluated a model framework with a lifespan development perspective. The study surveyed veterans on their self-reported satisfaction or symptoms in 7 domains of well-being: employment, education, financial, legal problems, social, physical health, and mental health. Within 3 months of separation , 41% of respondents fell into the “problematic” category for the mental health domain. However, by 30 to 33 months postseparation, this proportion dropped to 34%. During the same period, the proportion of veterans in the at risk category increased from 28% at Wave 1 to 37% at Wave 6. About 30% of veterans fell into the successful category for symptoms across the 3 examined waves. Almost 60% were in the successful category across the 3 time points.

Both Penn State studies emphasize the importance of viewing veterans as individuals on their own timelines.

“These findings underscore that the transition to civilian life is not a single moment, but a process influenced by experiences across the life span,” said Mary M. Mitchell, research professor at the Clearinghouse and lead author on the predictors study. “By following veterans over 3 years, we were able to see how patterns emerge that would be invisible in a one-time survey.”

Current conceptualization “assumes that there are commonalities across veterans when evaluating the success of the transition to civilian life,” according to the authors of the framework study. “However, each veteran likely has his or her view of what a successful transition constitutes, and he or she may weigh domains differently when considering his or her own transition.”

The research highlights the need to find ways to encourage veterans to seek help—and not just in the first year, which is often the most stressful. The Pew Research Center survey identified a “significant break from the past,” in that nearly 70% of post-9/11 veterans said their superiors made them feel comfortable about seeking help with emotional issues resulting from their military service. 

However, ≤ 8% veterans in the TVMI study used any health programs, even when they screened positive for mental health problems. Veterans who did use counseling services, however, improved their depression symptoms. Engaging veterans at various time points could help keep mental health problems from worsening during—and beyond—the transition.

What does a successful military-to-civilian transition look like? How do we know if a veteran is sinking, treading water, or swimming? Two recent studies by the Penn State University Clearinghouse for Military Family Readiness sought to answer to those questions and more while determining how and when is the right time to step in to help a veteran in need.

The research analyzed The Veterans Metrics Initiative data (TVMI). This longitudinal study surveyed 9566 men and women who left active duty in 2016 over 3 years, answering questions about deployment histories, adverse childhood experiences (ACEs) and exposure to combat. They also reported whether they had symptoms related to anxiety and depression. 

The TVMI study found that ACEs predicted poor outcomes early on and when combined with warfare experience dramatically increased the likelihood of mental health issues, including posttraumatic stress disorder (PTSD), anxiety, and depression; moral injury impacted adjustment to civilian life (the degree varied by gender); and, many veterans have a “growth outlook” as a result of a trauma or crisis they experienced.

The TVMI study found that almost all veterans use transition resources in the first 2 years after military separation. Beyond that, however, those in high-risk categories (eg, PTSD and cumulative trauma experiences) need continued support. This may come in the form of a universal screener and linking it to a navigation infrastructure (eg, AmericaServes), “thereby identifying risk factors early and providing targeted supports, interventions, and components.”

Veterans often face a series of simultaneous challenges as they return to civilian life. Among them include getting used to family and friends again, finding jobs, losing their military identity, structure, and perhaps leaving military friends behind. In addition, veterans are likely dealing with physical and mental health challenges, which can significantly influence how well they readjust to civilian life and lead to inconsistency experiences for each individual.

A 2019 survey from the Pew Research Center found about 40% of veterans who suffered from PTSD said they frequently had difficulty dealing with the lack of structure in civilian life, compared with 5% of those who do not have PTSD. Another survey cited a large majority (78%) of pre-9/11 veterans said their readjustment was very or somewhat easy. However, 26% said adjusting to civilian life was difficult.

In 2011, 4 variables were identified that predicted easy civilian life re-entry: being an officer; having a consistently clear understanding of the missions while in the service; being a college graduate; and, for post-9/11 veterans, attending religious services frequently. Six variables were associated with a diminished probability of an easy transition: having had a traumatic experience; being seriously injured; serving in the post-9/11 era; serving in a combat zone; serving with someone who was killed or injured; and, for post-9/11 veterans, being married while in the service.

The probabilities of an easy re-entry dropped from 82% for those who did not experience a traumatic event to 56% for those who did—the largest change noted in the 2011 study.

The second Penn State study evaluated a model framework with a lifespan development perspective. The study surveyed veterans on their self-reported satisfaction or symptoms in 7 domains of well-being: employment, education, financial, legal problems, social, physical health, and mental health. Within 3 months of separation , 41% of respondents fell into the “problematic” category for the mental health domain. However, by 30 to 33 months postseparation, this proportion dropped to 34%. During the same period, the proportion of veterans in the at risk category increased from 28% at Wave 1 to 37% at Wave 6. About 30% of veterans fell into the successful category for symptoms across the 3 examined waves. Almost 60% were in the successful category across the 3 time points.

Both Penn State studies emphasize the importance of viewing veterans as individuals on their own timelines.

“These findings underscore that the transition to civilian life is not a single moment, but a process influenced by experiences across the life span,” said Mary M. Mitchell, research professor at the Clearinghouse and lead author on the predictors study. “By following veterans over 3 years, we were able to see how patterns emerge that would be invisible in a one-time survey.”

Current conceptualization “assumes that there are commonalities across veterans when evaluating the success of the transition to civilian life,” according to the authors of the framework study. “However, each veteran likely has his or her view of what a successful transition constitutes, and he or she may weigh domains differently when considering his or her own transition.”

The research highlights the need to find ways to encourage veterans to seek help—and not just in the first year, which is often the most stressful. The Pew Research Center survey identified a “significant break from the past,” in that nearly 70% of post-9/11 veterans said their superiors made them feel comfortable about seeking help with emotional issues resulting from their military service. 

However, ≤ 8% veterans in the TVMI study used any health programs, even when they screened positive for mental health problems. Veterans who did use counseling services, however, improved their depression symptoms. Engaging veterans at various time points could help keep mental health problems from worsening during—and beyond—the transition.

Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results 

The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.

Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.

“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.

“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”

IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.

Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention. 

Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.

“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.

“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”

Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results 

The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.

Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.

“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.

“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”

IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.

Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention. 

Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.

“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.

“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”

Repeated and frequent hospitalizations—sometimes referred to as the revolving door phenomenon— are a particular risk for patients during the first month after discharge. Early psychiatric readmission is a standard indicator of adverse outcomes. However, the results 

The quality of previous care has long been thought to be a driver of readmission. If that’s the case, a 2025 study suggests that on average veterans received high-quality inpatient psychiatric services at Veterans Health Administration (VHA) facilities across the nation and that may have been key to keeping readmissions down. Analyzing data from 88,954 veterans who received care at VHA Inpatient Mental Health (IMH) services, the researchers found a “relatively low” rate of readmission within 30 days: 7.1% compared with 8% to 31% of other psychiatric patients in the US. With 40,220 unique patients receiving IMH care per year on average between October 2019 and September 2022, a 7.1% readmission rate means > 2800 30-day readmissions annually.

Research has found that veterans who receive care at the VA have better outcomes than those treated in the private sector. Part of that has to do with practitioners who understand the unique needs of their patients. Veterans may have posttraumatic stress disorder or multiple diagnoses, such as depression, panic disorder, and a substance use disorder. Their mental health issues may also coexist with physical health problems, such as traumatic brain injuries due to explosions.

“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” Rodney R. Baker, PhD, retired mental health director and chief of psychology for the South Texas VA Health Care System, said recently. Community clinicians may not know how to collect and incorporate information about a patient’s military history, including details about deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.

“This is a unique population,” said Conwell Smith, the American Psychological Association’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning.”

IMH services aim to stabilize mental health crises and improve veterans’ functioning through patient-centered, evidence-based, and recovery-oriented approaches shown to reduce readmission rates. Treatment generally involves a minimum of 4 hours of interdisciplinary, therapeutic programming each day. And upon discharge, the inpatient care team facilitates the patient’s transition to appropriate outpatient services.

Follow-up care, particularly during the first 30 days, has proved critical in reducing readmissions. In studies that have analyzed postdischarge interventions (psychoeducation, mentoring, community-based hospital treatment, use of continuous follow-up and compulsory community treatment), all found fewer hospitalizations when compared to a control group, or a smaller number of admissions after the intervention. 

Mental health care for veterans should be provided by experienced practitioners—but those practitioners are leaving VA. According to the VA Office of Inspector General, 57% of medical centers report a shortage of psychologists. And according to the VA’s monthly Workforce Dashboard, the VHA lost 234 psychologists in the first 9 months of 2025. The VA has also announced plans to cut 30,000 jobs by the end of the year and impose caps on staff at every medical center.

“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” said Russell Lemle, PhD, a clinical psychologist and senior policy analyst for the Veterans Healthcare Policy Institute. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.

“Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years.”