Military service members and veterans have made sacrifices to our country, and they may face lots of different health issues. Some of the most common health problems they may have include chronic pain, sleep disorders, and mental health disorders.

But they may also face some different health risks than civilians. Serving to protect our country is a special job, and along with it comes some special risks and job hazards. These include different types of injuries and health problems from exposures.

What types of injuries do service members face?

During their service, members are at risk for various injuries. These injuries can happen during training or while in combat. Sometimes the injuries are life-threatening or serious enough to cause disability. Others may not be as serious, but they may be painful and can affect daily life.

Some of the specific types of injuries that service members may face include:

• Sprains and strains, especially in the ankles and knees. These injuries are often caused by exercise and running.
• Back and shoulder injuries, often from lifting and carrying.
• Tinnitus and hearing loss, typically from exposure to noise.
• Head injuries and traumatic brain injuries (TBIs).
• Shrapnel and gunshot wounds.
• Lost limbs.

What other special health problems do service members face?

There may also be a risk of health problems from exposure to environmental hazards, such as contaminated water, chemicals, infections, and burn pits. Sometimes the health problems caused by exposures don't develop until years later.

Some service members experience military sexual trauma (MST). This includes sexual assault and sexual harassment.

What mental health issues do service members and veterans face?

Being in combat and being separated from your family can be stressful. So can readjusting to civilian life after the military. All of this stress can put service members and veterans at risk for mental health problems, including:

• Depression
• Post-traumatic stress disorder (PTSD)
• Anxiety
• Alcohol and drug use disorders

There is also a risk of suicide. Veterans who are in crisis can get help from the Veteran's Crisis line by:

• Calling 988 and then pressing 1
• Texting to 838255
• Chatting with them online

What health care services are available to service members and veterans?

There are health care services especially for service members and veterans through:

• TRICARE, which is the Department of Defense's health care program. It has insurance plans and other services for uniformed service members, retirees, and their families around the world.
• The Veterans Health Administration, which is part of the Department of Veterans Affairs (VA). It provides medical and social support services to eligible veterans.
• The VA 's expanded health care and benefits for veterans exposed to burn pits, Agent Orange, and other toxic substances.

To better understand and treat the health needs of veterans in the future, the VA created the Million Veteran Program (MVP). This research program is looking at how genes, lifestyle, military experiences, and exposures affect health and wellness in veterans.

VA assumes that certain diseases can be related to a Veteran's qualifying military service. We call these "presumptive diseases."

VA has recognized certain cancers and other health problems as presumptive diseases associated with exposure to Agent Orange or other herbicides during military service. Veterans and their survivors may be eligible for benefits for these diseases.

AL Amyloidosis
A rare disease caused when an abnormal protein, amyloid, enters tissues or organs

Bladder Cancer 
A type of cancer that affects the bladder where urine is stored before it leaves the body

Chronic B-cell Leukemias
A type of cancer which affects white blood cells. This includes all chronic B-cell leukemias, including, but not limited to, hairy-cell leukemias and chronic lymphocytic leukemia.

Chloracne(or similar acneform disease)
A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers. Under VA's rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.

Diabetes Mellitus Type 2
A disease characterized by high blood sugar levels resulting from the body’s inability to respond properly to the hormone insulin

Hypertension 

Hodgkin's Disease
A malignant lymphoma (cancer) characterized by progressive enlargement of the lymph nodes, liver, and spleen, and by progressive anemia

Hypothyroidism 
A condition that causes the thyroid gland to not produce enough of certain important hormones

Ischemic Heart Disease
A disease characterized by a reduced supply of blood to the heart, that leads to chest pain

Monoclonal gammopathy of undetermined significance (MGUS)

Multiple Myeloma
A cancer of plasma cells, a type of white blood cell in bone marrow

Non-Hodgkin's Lymphoma
A group of cancers that affect the lymph glands and other lymphatic tissue

Parkinsonism  
Any condition that causes a combination of abnormal movements. These include slow movements, trouble speaking, stiff muscles, or tremors.

Parkinson's Disease
A progressive disorder of the nervous system that affects muscle movement

Peripheral Neuropathy, Early-Onset
A nervous system condition that causes numbness, tingling, and motor weakness. Under VA's rating regulations, it must be at least 10 percent disabling within one year of herbicide exposure.

Porphyria Cutanea Tarda
A disorder characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas. Under VA's rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.

Prostate Cancer
Cancer of the prostate; one of the most common cancers among men

Respiratory Cancers(includes lung cancer)
Cancers of the lung, larynx, trachea, and bronchus

Soft Tissue Sarcomas(other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma)
A group of different types of cancers in body tissues such as muscle, fat, blood and lymph vessels, and connective tissues

Children with birth defects

VA presumes certain birth defects in children of Vietnam and Korea Veterans are associated with Veterans' qualifying military service.

Veterans with Lou Gehrig's Disease

VA presumes Lou Gehrig's Disease (amyotrophic lateral sclerosis or ALS) diagnosed in all Veterans who had 90 days or more continuous active military service is related to their service, although ALS is not related to Agent Orange exposure.

“Airborne hazard” refers to any sort of contaminant or potentially toxic substance that we are exposed to through the air we breathe. While on active duty, military service members may have been exposed to a variety of airborne hazards including:

• The smoke and fumes from open burn pits
• Sand, dust, and particulate matter
• General air pollution common in certain countries
• Fuel, aircraft exhaust, and other mechanical fumes
• Smoke from oil well fires

VA understands that many Veterans are especially concerned about exposure to the smoke and fumes generated by open burn pits.

In Iraq, Afghanistan, and other areas of the Southwest Asia theater of military operations, open-air combustion of trash and other waste in burn pits was a common practice. The Department of Defense has now closed out most burn pits and is planning to close the remainder. 

Depending on a variety of factors, you may experience health effects related to this exposure. Factors that may indicate you have a greater or lesser risk of short or long-term health effects include:

• Types of waste burned
• Proximity, amount of time, and frequency of exposure
• Wind direction and other weather-related factors
• Presence of other airborne or environmental hazards in the area

Researchers, including experts at VA, are actively studying airborne hazards like burn pits and other military environmental exposures. Ongoing research will help us better understand potential long-term health effects and provide you with better care and services.

Many health conditions related to these hazards are temporary and should disappear after the exposure ends. Other longer-term health issues may be caused by a combination of hazardous exposures, injuries, or illnesses you may have experienced during your military service including blast or noise injuries.

Presumptive Conditions for Airborne Hazards and Burn Pit Exposures 

The following are presumptive conditions:

• Brain cancer
• Gastrointestinal cancer of any type
• Glioblastoma
• Head cancer of any type
• Kidney cancer
• Lymphatic cancer of any type
• Lymphoma of any type
• Melanoma
• Neck cancer
• Pancreatic cancer
• Reproductive cancer of any type
• Squamous cell carcinoma of the larynx
• Squamous cell carcinoma of the trachea
• Adenocarcinoma of the trachea
• Salivary gland-type tumors of the trachea
• Adenosquamous carcinoma of the lung
• Large cell carcinoma of the lung
• Salivary gland-type tumors of the lung
• Sarcomatoid carcinoma of the lung
• Typical and atypical carcinoid of the lung
• Respiratory (breathing-related) cancer of any type
• Asthma that was diagnosed after service
• Chronic bronchitis
• Chronic obstructive pulmonary disease (COPD)
• Chronic rhinitis
• Chronic sinusitis
• Constrictive bronchiolitis or obliterative bronchiolitis
• Emphysema
• Granulomatous disease
• Interstitial lung disease (ILD)
• Pleuritis
• Pulmonary fibrosis
• Sarcoidosis

Join the Registry

We encourage all Veterans who are eligible to participate in VA’s Airborne Hazards and Open Burn Pit Registry (AHOBPR). By joining the registry, you can provide information that can help us better understand the long-term effects of burn pit exposures. Even if you have not experienced any symptoms or illnesses you believe are related to burn pit exposure, your participation could help VA provide better care to all Veterans

• Participation in the registry does not mean you are applying for VA disability benefits or health care. To apply for VA disability compensation, please go to compensation. To apply for VA health care treatment, please go to health care.
• You can save and submit your registry questionnaire and notes from the optional health evaluation support your claim.
• You do not have to participate in the registry to be enrolled in VA health care or file a VA claim.
• You can participate even if you do not recall any exposure to airborne hazards during your military service at an eligible location.

Visit the registry page to learn more about eligibility and how to get started. 

Open Burn Pits – What Was Burned

Waste products commonly disposed of in open burn pits include:

• Chemicals, paint, medical and human waste
• Metal and aluminum cans
• Munitions and unexploded ordnance
• Petroleum and lubricant products
• Plastics, rubber, wood, and food waste

Exposure to smoke created by burning these materials may cause irritation and burning of eyes or throat, coughing, breathing difficulties, skin itching or rashes. Many of these conditions are temporary and resolve on their own when the exposure ends. However, if you were closer to burn pit smoke or were exposed for longer periods of time, you may be at greater risk for longer-term health conditions.

It is natural to worry and feel anxious about things — that presentation at work, your growing to-do list, a relationship. Anxiety can help you confront stresses in your life, and for many people the feeling is motivating and doesn’t last long. But when persistent worries start affecting your day-to-day activities, your work, your sleep, or your relationships, it may be time to do something about it.   

Anxiety problems are common and uncomfortable. Almost one-third of adults will experience some form of distressing anxiety at some point in their lifetime. Symptoms can include:

• Feeling restless, jumpy, or on edge
• Excessive worrying about everyday decisions
• Difficulty concentrating
• A racing heart or cold, clammy hands
• Trembling or twitching
• Having trouble catching your breath
• Feeling dizzy, nauseous, or lightheaded
• Difficulty sleeping

The good news is that there are effective treatment options for overcoming problems with anxiety.   

Types of Anxiety

Social Anxiety

Most people feel anxious in some social situations, some of the time, but for people with social phobia, that anxiety is strong and long-lasting. Social phobia can keep people from doing things they want to do, such as public speaking or attending a crowded event like a concert or a football game.

Generalized Anxiety

People with generalized anxiety feel as if they’re always worrying or anxious about a range of things in their daily lives. They have trouble controlling or stopping these worries — whether they're about work, school, money, relationships, or their health.

People with generalized anxiety sometimes describe themselves as “worry warts” and often are told that they worry too much. They may also experience symptoms of tension, including restlessness, tiring easily, difficulty concentrating, irritability, muscle tension, and sleep difficulties, and inability to relax.

Panic Attacks

People with panic disorder have recurrent, unexpected episodes of intense fear or discomfort called panic attacks. A panic attack is accompanied by symptoms such as heart palpitations, difficulty breathing, a racing or pounding heart, trembling, chest pain, stomach distress, dizziness or lightheadedness, and numbing or tingling. During a panic attack, people often feel afraid that they are out of control or even that their life is at risk.

Although most people experience a panic attack at some point, those with panic disorder worry about having more panic attacks and will often do things to try to prevent them. They might avoid situations that are difficult to leave, such as a client meeting or concert, because they fear having a panic attack. This can significantly limit a person’s ability to experience and enjoy life. When people avoid situations because they are afraid they will have a panic attack, they may be experiencing panic disorder with agoraphobia.

Specific Phobias

A person with a specific phobia experiences intense fear in response to a particular object or situation. For example, fear of blood or needles, of enclosed places, and of flying are common specific phobias.

Sometimes specific phobias arise or become more of an issue after a person relocates to an area with a higher risk of encountering what they fear. For example, if someone has a specific phobia of earthquakes, that fear may intensify after moving from Chicago to Los Angeles, where earthquakes are common. The key to coping with these phobias is recognizing when they are getting in the way of your everyday life.

Treatment

No matter what you are experiencing, effective treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can treat anxiety.

Evidence-based therapies are among the most effective treatments for anxiety. They can include the following — which are in many cases available at a local VA medical center.

• Cognitive Behavioral Therapy (CBT) is a short-term treatment that helps Veterans understand the anxiety they experience and address distressful thoughts and feelings. This treatment may help expose Veterans to anxiety-inducing situations to help develop response prevention strategies. CBT is focused on identifying and neutralizing unhelpful thoughts and also confronting fears through the mastery of new skills.

Veterans with bipolar disorder can experience a range of symptoms, including noticeable swings in energy, mood, or hours of sleep needed. Bipolar disorder involves distinct periods of unusually elevated, high energy lasting for at least several days (manic or hypomanic episodes), often accompanied by an overly good mood. Manic or hypomanic episodes are often followed by longer periods of low, depressed mood (depressive episodes).

Bipolar Episodes

Manic and hypomanic episodes include symptoms such as feelings of extreme energy and increases in mood, self-esteem, talkativeness, and activity level. Often, those experiencing manic or hypomanic episodes will have little need for sleep, as well as trouble turning off the racing thoughts in their minds. Many also report greater irritability during such times. This change in mood and behavior occurs for at least several days straight and is often very noticeable to others.

Episodes of depression include symptoms such as feeling sad or hopeless, having trouble concentrating, experiencing changes in sleep or appetite, and losing pleasure or interest in usual activities. These periods last for at least a few weeks and can make it hard to complete daily tasks.

If you have experienced any of the symptoms above on a regular basis, then you may have bipolar disorder.

Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can treat bipolar disorder.

Evidence-based therapies are among the most effective treatments for bipolar disorder. They can include the following — which are in many cases available at a local VA medical center.

• Cognitive Behavioral Therapy (CBT) can help Veterans diagnosed with bipolar disorder to identify and change negative thought patterns and behaviors that worsen their condition.
• Social Skills Training (SST) can help Veterans enhance their social skills with the goal of improving their community adjustment, quality of life, and ability to pursue personal goals. SST sessions and the skills SST teaches are tailored to meet real-life difficulties that affect your social experiences.
• Behavioral Family Therapy (BFT) helps Veterans diagnosed with bipolar disorder and their families learn about new communication and problem-solving skills, and also focuses on family education.

Service members may have been exposed to extreme cold in combat and military training missions. The major cold injuries they could suffer from include frostbite, non-freezing cold injuries, immersion foot (formerly called trench foot), and hypothermia.

The risk of cold injury depends on several environmental conditions including temperature, wind and moisture, in combination with physical activity, the duration of exposure, and amount of protection. The individual’s level of fitness and cold susceptibility also contribute to the risk.

If you are concerned about health problems associated with cold injuries, talk to your health care provider or contact your local VA Environmental Health Coordinator to help you get more information from a health care provider.

How Veterans may have had cold injuries

Veterans may have been exposed to extreme cold without adequate protection during:

• World War II: The Battle of the Bulge, fought in December 1944 through January 1945 under conditions of extreme cold
• Korean War: The Chosin Reservoir Campaign, conducted from October 1950 through December 1950 in temperatures that dropped to 50 degrees F below zero, with a wind chill factor of 100 degrees F below zero.
• Operation Enduring Freedom (OEF) in Afghanistan
• Other campaigns or circumstances during military service, including training.

Health problems associated with cold injuries

Cold injuries may result in long-term health problems, including the following signs and symptoms (at the site of exposure):

• Changes in muscle, skin, nails, ligaments, and bones
• Skin cancer in frostbite scars
• Neurologic injury with symptoms such as bouts of pain in the extremities, hot or cold tingling sensations, and numbness
• Vascular injury with Raynaud’s Phenomenon with symptoms such as extremities becoming painful and white or discolored when cold

Do you feel like you’re in a rut and you just can’t get out?

Everyone feels sad at times, but those feelings typically will pass within a few days. If you can’t seem to rally, and it’s starting to interfere with your daily life, it could be a sign of depression.

Depressive disorder can affect anyone. It may be marked by feelings of intense sadness or hopelessness, and some find that they lose interest or pleasure in activities that they used to enjoy. People with depression can experience feelings of guilt, unworthiness, or low self-esteem, and they may start avoiding being around people.

Depression is a common but serious disorder — one that typically requires some treatment to manage. The good news is that even the most severe cases of depression are treatable.

The signs and symptoms of depression may be hard to notice at first, so it’s important to be aware of your thoughts, moods, and behaviors and note if they start to change.

Common signs of depression

• Feeling sad or hopeless
• Losing interest in or not getting pleasure from most of your daily activities
• Gaining or losing weight
• Sleeping too much or not enough almost every day
• Feeling tired or as if you have no energy almost every day
• Eating more or less than usual almost every day

Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can treat depression.

Evidence-based therapies are among the most effective treatments for depression. They can include the following — which are in many cases available at a local VA medical center.

• Acceptance and Commitment Therapy for Depression (ACT-D) can help Veterans overcome their emotional pain by promoting positive actions and choices that align with their values. Through this therapy, you may increase your ability to recognize and achieve what truly matters most to you in life.
• Cognitive Behavioral Therapy for Depression (CBT-D) is a structured, time-limited therapy that can help Veterans with depression develop balanced and helpful thoughts about themselves, others, and the future. CBT-D can help you modify your thought patterns to change negative moods and behaviors. It can also help you achieve personal goals by developing new skills.
• Interpersonal Psychotherapy for Depression (IPT-D) is focused on identifying and evaluating relationship issues that may be the cause or result of depression. IPT-D can also help you build social skills to deal with problems in your relationships and improve your overall quality of life.
• Problem Solving Therapy (PST) helps Veterans recover from difficult situations and learn skills to improve their daily life. This therapy can improve your ability to cope with major life circumstances and stressors and develop a response plan.
• Behavioral Activation helps Veterans learn how their behaviors are connected to their moods, and how to develop responses to improve their daily satisfaction. This therapy will ask Veterans to identify their values and goals and engage in more meaningful activities to achieve them.

Veterans serving in hot, desert climates, such as in Iraq and Afghanistan, may have suffered from heat injuries. These heat injuries include heat stroke, heat exhaustion, and sunburn.

Heat stroke is a serious illness that occurs when the body is unable to control its own temperature.

Heat exhaustion is an illness caused by dehydration and salt loss, and can lead to heat stroke.

Sunburn occurs when skin is overexposed to ultraviolet radiation.

Health problems related to heat injuries

Veterans who have suffered from heat injuries during military service may be more susceptible to heat and more serious heat injuries in the future.

Veterans who were deployed to Southwest Asia (including Iraq) or Afghanistan may experience symptoms of infectious diseases while on active duty, or they may later develop symptoms of infectious diseases that were contracted overseas.

Diseases related to Gulf War, Iraq and Afghanistan service

VA presumes that the nine infectious diseases listed below are related to military service in the Southwest Asia theater of military operations during the Gulf War, August 2, 1990 to present, and in Afghanistan on or after September 19, 2001. Veterans must have the diseases within the time frames shown below and have a current disability as a result of that disease in order to receive disability compensation.

Malaria
An infectious disease caused by a parasite transmitted by mosquitoes. Symptoms include chills, fever, and sweats. It must be at least 10 percent disabling within one year from the date of military separation or at a time when standard or accepted treatises indicate that the incubation period began during a qualifying period of military service.

Brucellosis
A bacterial disease with symptoms such as profuse sweating and joint and muscle pain. The illness may be chronic and persist for years. It must be at least 10 percent disabling within one year from the date of military separation.

Campylobacter Jejuni
A disease with symptoms such as abdominal pain, diarrhea, and fever. It must be at least 10 percent disabling within one year from the date of military separation.

Coxiella Burnetii (Q Fever)
A bacterial disease with symptoms such as fever, severe headache, and gastrointestinal problems such as nausea and diarrhea. In chronic cases, the illness may cause inflammation of the heart. It must be at least 10 percent disabling within one year of the date of military separation.

Mycobacterium Tuberculosis
An illness that primarily affects the lungs and causes symptoms such as chest pain, persistent cough (sometimes bloody), weight loss and fever.

Nontyphoid Salmonella
A condition characterized by symptoms such as nausea, vomiting, and diarrhea. It must be at least 10 percent disabling within one year of the date of military separation.

Shigella
A condition characterized by symptoms such as fever, nausea, vomiting, and diarrhea. It must be at least 10 percent disabling within one year of the date of military separation.

Visceral Leishmaniasis
A parasitic disease characterized by symptoms such as fever, weight loss, enlargement of the spleen and liver, and anemia.

West Nile Virus
A disease spread by mosquitoes characterized by symptoms such as fever, headache, muscle pain or weakness, nausea, and vomiting. Symptoms may range from mild to severe. It must be at least 10 percent disabling within one year from the date of military separation.

VA uses the term “military sexual trauma” (MST) to refer to sexual assault or sexual harassment experienced during military service. MST includes any sexual activity during military service in which you are involved against your will or when unable to say no. Examples include:

• Being pressured or coerced into sexual activities, such as with threats of negative treatment if you refuse to cooperate or with promises of better treatment
• Sexual contact or activities without your consent, including when you were asleep or intoxicated
• Being overpowered or physically forced to have sex
• Being touched or grabbed in a sexual way that made you uncomfortable, including during “hazing” experiences
• Comments about your body or sexual activities that you found threatening
• Unwanted sexual advances that you found threatening

Impact

People of all genders, ages, sexual orientations, racial and ethnic backgrounds, and branches of service have experienced MST. Like other types of trauma, MST can negatively affect a person’s mental and physical health, even many years later. Things you may experience could include:

• Disturbing memories or nightmares
• Difficulty feeling safe
• Feelings of depression or numbness
• Using alcohol or other drugs to numb or escape from negative feelings
• Feeling isolated from other people
• Difficulties with anger, irritability, or other strong emotions
• Self-doubt, self-blame, or decreased self esteem
• Issues with sleep
• Physical health problems

If you are having any current difficulties related to MST, VA is here to support you in whatever way will help you best — from learning more about how MST affects people, to treatment that helps you cope with how MST is impacting your life currently, or if you prefer, treatment that involves discussing your experiences in more depth.

Treatment

Military sexual trauma can be a very difficult life experience, but recovery is possible. VA offers a range of services to meet MST survivors where they are in their recovery. Treatment for any physical or mental health condition related to MST is provided free of charge.

Eligibility for MST-Related Care

MST-related services are available to individuals with Veteran status and most former Service members with an Other Than Honorable or uncharacterized (entry-level) discharge. Standard length of service requirements do not apply to eligibility for MST-related care, and some individuals may be able to receive MST-related care even if they are not eligible for other VA care. Service connection (that is, a VA disability rating) is not needed.

MST-related care is also available to former National Guard and Reserve members with federal active duty service or a service-connected disability who were discharged under honorable conditions or with an Other Than Honorable discharge. The service-connected disability does not need to be related to their experiences of MST.

Current Service members also can receive services related to MST. At VA’s community-based Vet Centers, current Service members — including members of the National Guard and Reserves — can receive MST-related mental health counseling regardless of gender or era of service. No Department of Defense (DoD) referral is needed, and services are confidential with respect to DoD. In addition, current Service members can also receive MST-related care at VA medical facilities with a DoD referral and TRICARE authorization. General TRICARE copayment requirements may apply. Current Service members’ records from services at VA medical facilities are available to DoD through VA-DoD open health care record sharing.

Individuals do not need to have reported MST experiences when they happened or have other documentation that they occurred.

MST-Related Services

• Every VA health care facility has an MST Coordinator who serves as a contact person for MST-related issues and who can assist you with accessing care. For questions about treatment and health care options related to MST, contact the MST Coordinator nearest you.
• MST-related outpatient services are available at every VA medical center and many VA community-based outpatient clinics. Services are organized differently at different facilities, and MST-related care is available even if a facility does not have a specific MST treatment team. Mental health services include psychological assessment and evaluation, medication evaluation and treatment, and individual and group psychotherapy. Treatment for physical health conditions related to MST is also available.
• Community-based Vet Centers provide MST-related outpatient counseling and referral services in a nonmedical setting.  
• In some cases, VA may cover the costs of health care services with a non-VA community provider if a VA provider determines that receiving care from the community provider is in an individual’s best medical interest or if services are unavailable at a VA facility in the individual’s area. Talk with your local MST Coordinator to learn more.
• For individuals needing more intensive support, VA also provides MST-related mental health treatment in residential or inpatient settings. Because some individuals who experienced MST do not feel comfortable in mixed-gender treatment settings, some facilities have separate programs for men and women. All residential and inpatient programs have separate sleeping areas for men and women.
• Individuals can request a clinician of a particular gender if it helps them feel more comfortable.

Evidence-Based Therapies

MST is an experience, not a diagnosis. As with other forms of trauma, MST can impact you in different ways. No matter what you are experiencing, treatments and resources are available, and VA supports many paths to healing from the impact of MST.

For individuals who have mental health diagnoses such as PTSD or depression related to the experience of MST, evidence-based therapies are among the most effective treatments. They can include the following — which are in many cases available at a local VA medical center.

• Prolonged Exposure (PE) helps individuals with a diagnosis of PTSD to gradually approach and address traumatic memories, feelings and situations. By confronting these challenges directly, you may see PTSD symptoms begin to decrease.
• Cognitive Processing Therapy (CPT) helps individuals with a diagnosis of PTSD to identify how traumatic experiences have affected their thinking, to evaluate those thoughts, and to change them. Through CPT, you may develop more healthy and balanced beliefs about yourself, others and the world.
• Cognitive Behavioral Therapy (CBT) is a structured, time-limited therapy that can help individuals who experience depression, anxiety, substance use disorders or other mental health difficulties. This treatment can help you develop balanced and helpful thoughts about yourself, others and the future. CBT can help you modify your thought patterns to change negative moods and behaviors.
• Interpersonal Therapy (IPT) is a therapy that can help individuals who experience depression focus on identifying and evaluating relationship issues that may contribute to their depression. IPT can also help you build social skills to deal with problems in your relationships and improve your overall quality of life.
• Acceptance and Commitment Therapy (ACT) helps individuals overcome their emotional pain by promoting positive actions and choices that align with their values. Through this therapy, you may improve your ability to recognize and achieve what truly matters most to you in life.
• Motivational Enhancement Therapy (MET) helps individuals with substance use disorders focus on personal motivations for change. In this therapy, you’ll look at the reasons behind your desire to make a change and the potential benefits of that change.
• Dialectical Behavioral Therapy (DBT) helps individuals address stress and strong emotions, learn mindfulness and distress tolerance, and develop and practice new interpersonal skills.

Coping and Support

For some people, the experience of military sexual trauma (MST) may continue to affect them in significant ways, even many years later. If you are feeling increased stress or anxiety related to MST, the coping ideas on this page may help.  

Many coping and support resources are also available in Beyond MST. Beyond MST is a free, secure and private self-help mobile app created specifically to support the health and well-being of survivors of MST. Any personal information entered in the app is not shared with anyone, including VA.

Coping During Especially Difficult Times

Survivors of trauma may experience particularly distressing emotions at certain times or because of current events. For example, public discussion and media coverage related to sexual assault, harassment, physical violence and other issues may bring up painful memories and feelings for MST survivors. Increasingly, many Veterans and Service members have been speaking out about their experiences. Discussion and sharing about the reality of these experiences is important; and, it is often still emotionally painful to hear. 

Harassment and discrimination related to race, ethnicity, sexual orientation and gender can also affect healing from MST. For some survivors, learning about violence and harassment motivated by sexism, racism, homophobia, transphobia or other hatred can lead to distressing thoughts like, “It could have been me,” or images of their own unwanted sexual experiences or experiences of harassment or discrimination.

The multiple impacts of the COVID-19 pandemic can also be especially difficult for those who have experienced MST or other forms of trauma.

During stressful times, you may notice more sudden, strong emotions; trouble concentrating; poor sleep or nightmares; feeling helpless, anxious, or depressed; or other changes. If you are feeling increased distress, please take your reactions seriously.

Here are some coping strategies that may help:

• Remind yourself it is okay to feel upset. Your reactions are normal, and it does not mean there is something wrong with you or you’ve had a setback in your healing.
• Do what works for you. Try safe, healthy things that have helped you cope during difficult times in the past. Know that you may need to try more than one thing, and it may take more energy or effort than usual.
• Pace yourself. If you notice fatigue, irritability, poor focus, more anxiety or other signs you may be feeling stressed or overwhelmed, try to slow down, simplify or take a break.
• Connect with your communities. Connect with supportive people in your life and community. Even if you do not tell others about your own experiences, it can still help to connect with them. Some people may also choose to engage in local advocacy efforts or provide support to others with similar experiences.
• Limit exposure to media. Notice how the news or social media posts are affecting you, and if need be, limit how much you look at them. You can also focus on reading stories that give you hope or make you feel supported or less alone.
• Inspire yourself. Recalling past successes can be an effective way of reminding yourself of your strength. It may also help to view inspiring quotes or stories about others who have experienced similar difficulties, like those available on the VA websites Make the Connection and AboutFace.

Other General Coping Strategies

• Be kind to yourself. Practice being compassionate toward yourself, like how you might treat a friend or loved one. One way to do this is to ask yourself what gives you joy or meaning, and to do more of those activities.
• Try breathing, relaxation and meditation activities. Mindful breathing, guided imagery and meditation can reduce stress, improve sleep, reduce pain, generate confidence and enhance focus. VA’s Whole Health Library offers many educational materials and relaxation exercises.
• Maintain healthy habits as much as you can. As stress increases, your healthy habits may understandably decrease. It may take more effort to eat healthy meals, avoid substance misuse, prioritize exercise and get some sunlight each day, but these actions can be especially important during stressful times.
• Get rest. Strive for seven or more hours of sleep each night. Less sleep than that can make you tired and less able to manage stress.
• Increase mindful movement. Physical activity is vital for stress reduction. It doesn’t have to be extreme activity, either. Activities that help you mindfully reconnect to your body in a safe way, like yoga and tai chi, may help you feel particularly strong and steady.
• Get support. Spend time with people whose company you enjoy. You do not need tell them you’re feeling distressed, or about your MST experience, but you can if it helps. You can also just say, “I’m having a rough time right now,” without sharing details if that feels right. Or, you can spend time with someone without telling them how you are doing.
• Remind yourself healing is a journey. You will have ups and downs, and there will be some times that are harder than others. Please remember that over time, you can move forward.

Sometimes, when you experience a traumatic event — a car accident, an IED blast, military sexual trauma, or the death of a fellow Service member — that moment can continue to bother you weeks, months, and even years later.

That can mean reliving the event: constantly replaying it in your head. It can mean avoiding places or things that remind you of the experience. It can also mean nightmares, sleeplessness, or anxiety. You might feel numb or, conversely, feel hyperaware of your surroundings.

The symptoms and effects of posttraumatic stress disorder, commonly known as PTSD, can disrupt your everyday life. People with PTSD sometimes withdraw from their family members and friends. They can find it hard to concentrate, startle easily, and lose interest in things they used to care about. Some may try to dull their feelings by misusing alcohol or drugs.

If you think you might have PTSD, there are resources to help you recover. Even if your symptoms come and go — or surfaced months or years after the traumatic event — effective treatments are available. Explore this page to learn about treatment options, self-help tools, and more.

Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can help you to treat PTSD.  

Evidence-based therapies are among the most effective treatments for PTSD. They can include the following — which are in many cases available at a local VA medical center.

• Cognitive Processing Therapy (CPT) helps Veterans to identify how traumatic experiences have affected their thinking, to evaluate those thoughts, and to change them. Through CPT, Veterans may develop more healthy and balanced beliefs about themselves others, and the world.
• Prolonged Exposure (PE) helps Veterans to gradually approach and address traumatic memories, feelings, and situations. By confronting these challenges directly, Veterans may see PTSD symptoms begin to decrease.
• Cognitive Behavioral Conjoint Therapy (CBCT) helps couples understand the effect of PTSD on relationships and can improve interpersonal communications. Veterans may also experience a change in thoughts and beliefs related to their PTSD and relationship challenges.
• Eye Movement Desensitization and Reprocessing (EMDR) helps you process and make sense of your trauma. It involves calling the trauma to mind while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone).

SSRIs and SNRIs

PTSD may be related to changes in the brain that are linked to our ability to manage stress. Compared with people who don’t have PTSD, people with PTSD appear to have different amounts of certain chemicals (called neurotransmitters) in the brain. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are types of antidepressant medication that are believed to treat PTSD by putting these brain chemicals back in balance. They do not work as well as trauma-focused psychotherapy, but they can be effective.

Four SSRIs/SNRIs are recommended for PTSD:

• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluoxetine (Prozac)
• Venlafaxine (Effexor)

(Medications have two names: a brand name — for example, Zoloft — and a generic name — for example, sertraline.)

To receive medications for PTSD, patients need to meet with a provider who can prescribe the medications. Many different types of providers, including your family health care provider and some nurses and physician assistants, can prescribe SSRIs and SNRIs for PTSD. You and your provider can work together to determine which medication may be the most effective for you.

VA has recognized certain diseases as related to ionizing radiation exposure during military service. Veterans may be eligible for disability compensation and health care for these diseases. Their survivors also may be eligible for survivors' benefits.

Presumptive conditions for ionizing radiation

For Veterans who participated in a radiation-risk activity during service, VA assumes that certain cancers are related to their exposure. We call these "presumptive diseases."

• Cancers of the bile ducts, bone, brain, breast, colon, esophagus, gall bladder, liver (primary site, but not if cirrhosis or hepatitis B is indicated), lung (including bronchiolo-alveolar cancer), pancreas, pharynx, ovary, salivary gland, small intestine, stomach, thyroid, urinary tract (kidney/renal, pelvis, urinary bladder, and urethra)
• Leukemia (except chronic lymphocytic leukemia)
• Lymphomas (except Hodgkin’s disease)
• Multiple myeloma (cancer of plasma cells)

These Veterans don't have to prove a connection between these diseases and their service to be eligible for disability compensation. Their survivors also may be eligible for survivors' benefits if the Veteran dies as the result of one of these diseases.

Radiation Risk Activity

The above list of presumptive diseases applies to Veterans who served in any of the following “radiation risk activities”:

• Radiological cleanup of Enewetak Atoll (1977- 1980).
• U.S. Air Force plutonium cleanup mission near Palomares, Spain (1966).
• U.S. Air Force plutonium cleanup mission at Thule, Greenland (1968).
• Participated in the occupation of Hiroshima and Nagasaki, Japan between Aug. 6, 1945, and July 1, 1946.
• Were prisoners of war in Japan near Hiroshima and Nagasaki during World War II.
• Participated in atmospheric nuclear weapons tests conducted primarily in Nevada and the Pacific Ocean between 1945 and 1962.
• Participated in underground nuclear weapons testing at:
  • Amchitka Island, Alaska before Jan. 1, 1974.
  • Nevada Test Site for at least 250 days from January 1, 1963, through December 31, 1992.
• Service at one of the following gaseous diffusion plants for at least 250 days before Feb. 1, 1992: Paducah, Kentucky; Portsmouth, Ohio; or K25 in Oak Ridge, Tennessee.

Other diseases associated with radiation exposure

VA recognizes that the following diseases are possibly caused by exposure to ionizing radiation during service:

• All cancers
• Non-malignant thyroid nodular disease
• Parathyroid adenoma
• Posterior subcapsular cataracts
• Tumors of the brain and central nervous system

Eligibility for disability compensation or survivors' benefits are based on radiation type, radiation dose, and timing of the onset of illness. VA decides these claims on a case-by-case basis.

VA also will consider the possibility that other diseases not listed above were caused by radiation, if supported by medical or scientific evidence. To be eligible for compensation, VA must be able to establish that it is at least as likely as not that a Veteran’s disease was caused by his/her exposure to radiation during military service.

Are you having a tough time thinking clearly, or making sense when you speak? Do you feel like sometimes you see or hear things that might not actually be there? These symptoms can be scary, especially the first time you experience them, and they might be a sign of a mental illness called schizophrenia.

If you suspect you have experienced symptoms like these, it is important to consult your doctor. Schizophrenia may hinder your ability to make good decisions and affect your personal relationships, so it is important to share your experiences with a medical professional who can help.

Many people with schizophrenia can recover and live full lives when their condition is correctly diagnosed and treated. They are able to finish school, hold steady jobs, enjoy relationships, and live independently. But it’s important to seek help as soon as possible.

Symptoms of Schizophrenia

People with schizophrenia experience different symptoms, but here are some common signs to recognize:

• Hallucinations
• Delusions, such as feeling like you are being watched or followed when you are not
• Confused thinking
• Changes in feelings and behaviors
• Difficulty feeling and expressing positive emotions
• Reduced range of emotional expression, such as limited facial expressions or eye contact
• Difficulty getting out of the house, doing things with other people, or pursuing goals such as going to work, attending school, or maintaining relationships
• Trouble concentrating or paying attention, memory loss, or slow thinking

It’s important to discuss these signs with a doctor, as symptoms for schizophrenia can be similar to those of other mental health conditions.

Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can help treat schizophrenia.

Evidence-based therapies are among the most effective treatments for schizophrenia. They can include the following — which are in many cases available at a local VA medical center.

• Cognitive Behavioral Therapy (CBT) helps Veterans diagnosed with schizophrenia and psychosis to understand the relationships among their thoughts, feelings, and behaviors and to create new patterns of thinking to support positive feelings.
• Social Skills Training (SST) teaches Veterans ways to respond to others and better communicate their thoughts, feelings, and needs. This therapy can help you improve your personal relationships and functioning in society, make progress toward your recovery goals, and feel more independent again.
• Behavioral Family Therapy (BFT) helps Veterans diagnosed with schizophrenia and their families learn about new communication and problem-solving skills, and also focuses on family education.

Substance use can be a slippery slope, especially for those facing other challenges, including mental health concerns or life stressors. For instance, when people are stressed, anxious, depressed, or overwhelmed, they may be more likely to have trouble controlling alcohol and drug use. Despite the temporary relief a substance may seem to provide, increased substance use can lead to harmful consequences.

What Is Substance Use Disorder (SUD)?

Often referred to as "addiction," substance use disorder (SUD) is a disease that causes people to have difficulty controlling their use of alcohol, drugs, and other substances, including opioids. Untreated, this misuse can begin to influence many aspects of life.

Signs and Symptoms of SUD

• Increased urge to drink or to use drugs.
• Inability to stop drinking or using drugs.
• Drinking or using drugs in hazardous situations (e.g., drinking and driving).
• Change in relationships due to drinking or drug use.
• Feeling depressed or anxious about your substance use.
• Feeling sick and experiencing withdrawal symptoms when drinking or drug use stops.
• Increased tolerance, which refers to the need over time for more alcohol or stronger drugs to achieve the desired effect.

Fortunately, there are many ways to recover from alcohol or drug use disorders. Take the next step and learn about the many VA treatments available, including in- and outpatient care, medications, support groups, specialized therapy, and more.

Opioid Overdose

Overdose is the leading cause of accidental death in the U.S. Using opioids, whether prescribed or illegally, comes with a significant risk of overdose. It's important for Veterans and their family members and caregivers to know what to do in an emergency. Learn about the signs of overdose and about the medication naloxone below. Knowing how to use this medication could save a life.

What Is Naloxone?

Naloxone is a medication designed to rapidly reverse an opioid overdose. When used immediately after an overdose, naloxone can block the effects of the opioids and help prevent death. Naloxone's effects are temporary, so it is critical to seek medical assistance immediately after it is administered. Naloxone has no effect on someone who doesn't have opioids in their system.

How to get naloxone

If you or a family member uses opioids, you should have naloxone on hand.

• If you're a Veteran who uses opioids, ask your VA provider about prescribing you naloxone, which is provided free.
• If you are not enrolled in VHA care, or if you're a family member or friend of a Veteran who is interested in getting naloxone, talk to a local pharmacist, health department, or community group. Many can provide naloxone without a prescription, though there may be a fee in some states.

Signs and symptoms of an opioid overdose

Since naloxone is used in emergency situations, the person who is experiencing the overdose will need someone else to give them the medication.

The following are signs and symptoms to look for to identify a potential overdose:

• Loss of consciousness, limp body
• Slowed breathing, choking
• Small, "pinpoint" pupils
• Pale, blue, or cold skin
• Slowed heart rate

If you see someone exhibiting any of these symptoms, dial 911 immediately.

How to administer naloxone

Naloxone should be given to anyone who may be showing signs of an opioid overdose. It can be administered as a nasal spray or as an injectable medication, depending on the type prescribed. Talk to your provider about the options.

• Nasal spray — This needle-free device, approved by the Food and Drug Administration, allows for the quickest and easiest delivery in an emergency. The person with naloxone should make sure the person overdosing is lying on their back, then spray naloxone into one nostril.
• Auto-injectable — This prefilled auto-injection device is easy for anyone to use. The person administering naloxone should turn on the device to hear the instructions and inject naloxone into the overdosing person's thigh muscle.

What to do in an emergency

If someone you know is experiencing any symptoms of an opioid overdose — listed in the "Signs and symptoms of an opioid overdose" drop-down menu above — you should:

1. Dial 911 immediately.
2. Administer naloxone (if available).
3. Try to keep the person awake and breathing.
4. Turn the person on their side to prevent choking.

Stimulant Use Disorder

Stimulant use disorder is the continued use of stimulants despite harm to the user. Stimulants include cocaine, amphetamine, methamphetamine, MDMA (also known as ecstasy or molly), and prescription drugs such as Adderall and Ritalin.

In recent years, the rate of fatal overdose when using stimulants has increased, with more than half the deaths related to illicit stimulants like cocaine and methamphetamine involving fentanyl or other opioids.

Misuse of stimulants can cause users to experience the following side effects:

• Elevated heart rate
• Dilated pupils
• Increased blood pressure
• Sweating or chills
• Nausea or vomiting
• Chest pain

Stimulant misuse can lead to:

• Heart attack
• Stroke
• Severe weight loss or dental problems
• Violent behavior and psychosis
• Paranoia, anxiety, and confusion
• Loss of productivity at work
• Overdose
• Premature death

While there are no medications approved specifically for stimulant use disorder, VA offers proven, evidence-based treatments to treat Veterans diagnosed with stimulant use disorder. These include contingency management and cognitive behavioral therapy for substance use disorders.

Veterans using nonprescribed stimulants should also talk to their health care provider about having naloxone, a medication designed to rapidly reverse an opioid overdose, on hand.

Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can help treat substance use.   

Evidence-based therapies are among the most effective treatments for substance use. They can include the following — which are in many cases available at a local VA medical center.

• Cognitive Behavioral Therapy (CBT) helps Veterans with substance use disorders develop more balanced and helpful thoughts about themselves, others, and the future. It can help Veterans manage the urge to drink or use drugs, refuse opportunities to use substances, use a problem-solving approach to deal with substance use, and achieve personal goals.
• Motivational Interviewing (MI) helps Veterans with substance use disorders by focusing on conversations between the Veteran and their provider to detect and strengthen personal motivations for change. This therapy looks at the reasons behind your desire to make a change and the potential benefits of that change.
• Motivational Enhancement Therapy (MET) helps Veterans with substance use disorders by focusing on conversations between the Veteran and their provider to detect and strengthen personal motivations for change. This therapy looks at the reasons behind your desire to make a change and the potential benefits of that change. MET is a version of MI that focuses specifically on changing alcohol and/or substance use.

Medications

Substance use disorder is disease that needs treatment, medication, and sometimes counseling, just like other diseases such as diabetes and high blood pressure. VA offers proven options for controlling alcohol and drug addiction. These options include medications that can reduce cravings, prevent relapse, and reduce the risk of death related to substance use:

For Opioid Use Disorder

• Methadone
• Buprenorphine/Naloxone
• Naltrexone Injection

For Alcohol Use Disorder

• Acamprosate
• Disulfiram
• Naltrexone
• Topiramate

For Tobacco Use Disorder

• Nicotine Replacement Therapy
• Bupropion
• Varenicline

Methadone

What does it do?

• Methadone prevents and relieves withdrawal symptoms.
• Methadone reduces cravings for opioids without the high associated with other opioid drugs.

How do I take it?

• Take by mouth once daily.

Where do I get it?

• Only certified programs known as opioid treatment programs can prescribe methadone for opioid use disorder.

What are possible side effects?

• Constipation
• Upset stomach or vomiting
• Feeling drowsy or sleepy
• Lower testosterone
• Increased risk of overdose when combined with sedatives (including alcohol) or other opioids

What side effects should I report to my provider?

• Allergic reaction or swelling
• Chest tightness, heart palpitations, or trouble breathing
• Extreme dizziness, weakness, or sweating
• Seizures or cold clammy skin
• Slow or uneven heartbeat

Buprenorphine/Naloxone

What does it do?

• Buprenorphine/naloxone prevents and relieves withdrawal symptoms.
• Buprenorphine/naloxone reduces cravings for opioids without the high associated with other opioid drugs.

How do I take it?

• Dissolve under the tongue once daily, or ask your provider about an extended-release option that is injected into the abdomen.

Where do I get it?

• Doctors or other providers with a DEA waiver may prescribe buprenorphine/naloxone, which can be obtained from licensed opioid treatment programs.

What are possible side effects?

• Constipation
• Upset stomach or vomiting
• Feeling drowsy or sleepy
• Lower testosterone
• Increased risk of overdose when combined with sedatives (including alcohol) or other opioids
• Injection site pain (if using the extended-release option)

What side effects should I report to my provider?

• Extreme stomach pain, vomiting, or diarrhea
• Dark or tea-colored urine
• Light-colored bowel movements
• Yellowing of eyes or skin

Naltrexone Injection

What does it do?

• Naltrexone suppresses opioid craving by blocking the effects of opioid drugs.
• If you miss a dose or stop naltrexone, you may be more vulnerable to a fatal overdose if you take an opioid again.

How do I take it?

• Inject into the buttocks muscle every month.

Where do I get it?

• Doctors or other providers with a DEA waiver may prescribe naltrexone, which can be obtained from licensed opioid treatment programs.

What are possible side effects?

• Change in appetite
• Back, muscle, or joint pain
• Constipation or diarrhea
• Injection site pain

What side effects should I report to my provider?

• Allergic reaction or swelling
• Chest tightness or trouble breathing
• Anxiety, trouble sleeping, depression, or unusual thoughts
• Dark or tea-colored urine
• Yellowing of eyes or skin

Additional Medicine Information

While you’re on these medicines:

• Do not drink alcohol or take sedatives, tranquilizers, or other drugs that slow breathing (such as benzodiazepines) unless you are otherwise instructed by your provider.
• Ask your provider for naloxone, emergency medication used to reverse an opioid overdose.

Signs of an overdose (too much medication) include:

• Trouble breathing, including slow or shallow breathing
• Snoring, gurgling, or choking sounds
• Extreme tiredness or heavy nodding
• Clammy, sweaty skin
• Bluish or grayish lips, fingernails, or skin

You may take any of these the medications for days, months, or years — as long as is needed to prevent relapse. Talk to your provider about your treatment plan.

A relapse does not mean your treatment has failed. Instead, it means a change in your treatment plan is needed.

Opioid Use Disorder Treatment

Research has shown that behavioral therapy in combination with medication (commonly referred to as medication-assisted treatment, or MAT) is the most effective treatment for opioid use disorder. Patients undergoing therapy who also use MAT are more likely to remain in treatment and see improvements in social functioning. Talk to your VHA provider today to learn more about treatments for opioid use disorder.

If you or a Veteran you know has been diagnosed with opioid use disorder, it is important to learn about naloxone, an emergency overdose medication.

VA S.A.V.E. Training

VA S.A.V.E. Training will help you act with care and compassion if you encounter a Veteran who is in crisis or experiencing suicidal thoughts. The acronym S.A.V.E. helps you remember the important steps involved in suicide prevention.

Signs of suicidal thinking should be recognized

There are behaviors that may be signs a Veteran needs support. Learn to recognize these warning signs:

• Hopelessness, feeling like there is no way out
• Anxiety, agitation, sleeplessness or mood swings
• Feeling like there is no reason to live
• Rage or anger
• Engaging in risky activities without thinking
• Increasing alcohol or drug use
• Withdrawing from family and friends

The presence of the following signs in a Veteran requires immediate attention:

• When asked, they express a desire to hurt or kill themselves
• When prompted, they reveal that they are looking for ways to kill themselves
• They talk about death, dying, or suicide
• They begin to exhibit self-destructive behavior, such as increased drug or alcohol use, talking about acquiring/using weapons for self-harm, and stockpiling medication

Ask the most important question of all – Are you thinking of killing yourself?

There are behaviors that may be signs a Veteran needs support. Know how to ask the most important question of all:

"Are you thinking of killing yourself?"

Other ways to ask the question include:

"Are you thinking of suicide?"
"Have you had thoughts about taking your own life?"

When asking the question, remember:

• DO ask the question if you've identified warning signs or symptoms
• DO ask the question in such a way that is natural and flows with the conversation
• DO NOT ask the question as though you are looking for a "no" answer ("You're not thinking of killing yourself, are you?")
• DO NOT wait to ask the question until he or she is halfway out the door

Validate the Veteran's experience

As you listen to the Veteran, ask him or her do the talking and use supportive, encouraging comments. Use the following steps to let the Veteran know that you are listening and acknowledge his or her experience.

• Talk openly about suicide – Be willing to listen and allow the Veteran to express his or her feelings
• Recognize the situation is serious
• Do not pass judgement
• Reassure them that help is available

Encourage treatment and expedite getting help

If a Veteran is having suicidal thoughts, remain calm and reassure them that help is available.

• DO NOT keep the Veteran's suicidal behavior a secret
• DO NOT leave him or her alone
• Try to get the person to seek immediate help from his or her doctor or the nearest hospital or emergency room, OR
• Call 911

You can also call the confidential Veterans Crisis Line at 988 and Press 1.

Evidence-Based Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can help you reduce risk for suicide.

Evidence-based therapies are among the most effective treatments for suicide-related thoughts and behavior. They can include the following — which are in many cases available at a local VA medical center.

• Cognitive Behavioral Therapy (CBT) helps Veterans with suicide-related thoughts and behavior to understand the relationships among their thoughts, feelings, and behaviors and to create new patterns of thinking to support positive feelings.
• Safety Planning Intervention helps Veterans develop and maintain a sense of control when it comes to suicide-related thoughts and behavior. This intervention will help you learn coping strategies and find resources to keep you safe during a suicidal crisis.
• Problem Solving Therapy (PST) helps Veterans recover from difficult situations and learn skills to improve their daily life. This therapy can improve your ability to cope with major life circumstances and stressors and develop a response plan.
• Dialectical Behavioral Therapy (DBT) helps Veterans with suicide-related thoughts and behaviors to address stress and strong emotions, learn mindfulness and distress tolerance, and develop and practice new interpersonal skills.

Coping with a Suicide Loss

Sadly, many people know someone who died by suicide. Coping with death is hard. It can be especially hard when a loss is untimely and traumatic.  

While grieving, it's normal to experience intense and distressing thoughts and emotions, such as denial, anger, sadness, and loneliness. You may also struggle to understand why that person took their own life or worry that you missed a warning sign.

These thoughts and feelings may be hard to talk about and may last a long time, change over time, and resurface on holidays, anniversaries, and birthdays. It's not uncommon to develop certain mental conditions, such as depression and anxiety, that make it even harder to cope.

Remember: People who lose someone to suicide can develop posttraumatic stress disorder. Symptoms include feeling stressed or frightened long after you've experienced a traumatic event. And you may have suicidal thoughts yourself, especially if you feel lonely.

There is a long history of smoking and other tobacco use in the military. Many Veterans used tobacco while they served, particularly during deployment. Now seven out of every 10 Veterans who smoke would like to quit — for both the physical benefits and their mental health.

A majority of them are successful.

If you’re one of those Veterans, or if the Veteran in your life is trying to quit, you’ve come to the right place. VA offers resources for making a quit plan and sticking to it.

It’s been said before and it’s true: You can quit smoking. And we want to be there when you do.

Smoking Affects Everyone Differently

Mental Health and Tobacco

People who smoke are more likely than nonsmokers to have experienced anxiety, panic, stress, depression, or suicidal thoughts. The challenges of quitting smoking can also lead to increased stress and anxiety. Quitting, though, can increase the effectiveness of certain medications — particularly those used for depression, anxiety, and psychotic disorders — as tobacco smoke affects how some are absorbed and how fast they are used by your body.

Substance Use and Tobacco

For some people, smoking and drinking alcohol go together. In fact, approximately 70 percent of people with an addictive disorder also use tobacco products. The combination of smoking and alcohol heightens your risk for oral, throat, and esophageal cancers. But quitting can help: Scientific studies have shown that quitting smoking will increase the chance that you can also successfully stop using alcohol and other drugs. In addition, those who quit smoking in recovery are less likely to relapse to alcohol or other drugs.

HIV and Tobacco

Managing HIV can be difficult, and that hard work can be undone by tobacco. Smoking can affect how antiretroviral medications work as well as increase the risk for both non-AIDS-related and AIDS-related illnesses. Quitting smoking can decrease the risk of heart disease, pneumonia, and HIV-related symptoms such as fatigue, nausea, and body pain.

Women and Tobacco

Women who smoke can face unique health effects — as well as unique challenges in quitting. These health effects can include difficulty getting pregnant, early menopause, osteoporosis, cervical cancer, and breast cancer. When coupled with birth control pills, smoking can also increase the risk for blood clots, stroke, and heart problems. Let your VA health care provider know if you use tobacco and are pregnant or thinking about becoming pregnant, as smoking can cause serious problems for both pregnant women and their babies.

Why Quit

There are many reasons people want to quit tobacco — better physical and mental health, saving money, setting a good example, starting a family — and the great part is the benefits of quitting begin almost immediately.

Within 20 minutes of quitting, your heart rate drops, and within days, you will notice improvements in your sense of taste and smell as well as your breathing. That’s just the start, because quitting will also:

• Reduce your risk for cancer.
• Lower your blood pressure and cholesterol.
• Reduce stress and improve your mental health.
• Boost the effectiveness of some anxiety and depression medications.
• Make it easier to stop using drugs and alcohol.
• Increase your energy.
• Improve your lung function, skin, and night vision.
• Strengthen your immune system, muscles, and bones.
• Help you manage HIV and other chronic health conditions.

The Risks of Tobacco Use

Just as the benefits of quitting are broad, so are the risks of continued tobacco use. The U.S. Surgeon General reports that smoking harms almost every organ in the body, including the brain.

Using tobacco exposes you to harmful chemicals that can:

• Increase your risk for many types of cancer, including lung, pancreatic, kidney, stomach, and bladder cancer, as well as cancers of the blood, throat, and mouth.
• Decrease the effectiveness of medications for depression, anxiety, and psychotic disorders.
• Increase your risk for erectile dysfunction.
• Cause difficulties in getting pregnant.

When you smoke, whether at home, in the car, or in public places, you expose those around you to secondhand smoke, which in turn can cause them health problems:

• In the United States, secondhand smoke is responsible for more than 40,000 deaths a year. Breathing in even a little of it can be dangerous.
• It affects babies before and after they are born.
• It can affect lung development and make asthma worse in infants and children.
• It causes cancer in adults.
• It increases the risk of heart disease in those who don’t smoke.
• It can lead to cancer in cats, dogs, and other pets.

The Risks of Using Smokeless Tobacco

Even though some tobacco products do not produce smoke, they still can cause harm. Smokeless tobacco contains at least 28 cancer-causing chemicals, including arsenic, lead, formaldehyde, and the particularly harmful tobacco-specific nitrosamines (TSNAs). The levels of TSNAs can be up to 100 times higher in smokeless tobacco than in cigarettes.

Some people think that using smokeless tobacco can help them stop smoking. In fact, it does not reduce dependence on nicotine, the highly addictive chemical found in tobacco. Compared with the nicotine in cigarettes, nicotine in smokeless tobacco stays in the bloodstream even longer.

The health risks associated with smokeless tobacco include:

• Cancers of the mouth, esophagus, and pancreas
• Increased risk for stroke and heart disease
• Gum disease and painful precancerous mouth sores
• Tooth decay and tooth loss

How to Quit

The research is clear — you have your best chance at quitting tobacco when you get behavioral counseling and use cessation medication. Counseling helps you make long-term changes to your behavior so that you can remove tobacco from your life, and medication helps with the physical cravings caused by nicotine addiction.

When you are trying to quit tobacco, treatment that includes counseling and medication increases your chance of success.

Counseling

Tobacco cessation counseling involves talking with a health care provider or counselor about your tobacco use and the role it plays in your daily routine so that you can figure out how to quit. VA can provide you with this type of counseling so you can make the behavioral changes needed to break free of tobacco, whether it be cigarettes or smokeless tobacco.

VA provides in-person individual and group tobacco cessation counseling and telephone and video counseling for Veterans. These counseling sessions can be brief (less than 5 minutes) or more intensive (longer than 10 minutes) and may involve multiple sessions.

Triggers are an example of something you may discuss during tobacco cessation counseling. In this instance, triggers are things that make you want to use tobacco. These could include talking on the phone, drinking a cup of coffee, drinking alcohol, feeling bored, or needing a break. Counseling will help you figure out how you can avoid or cope with your triggers so you don’t relapse and start using tobacco again after you quit.

Contact your VA health care provider to learn about available local tobacco cessation clinics and group counseling sessions. To receive counseling over the phone, call 1‑855‑QUIT‑VET (1‑855‑784‑8838) to receive support from a trained Quit VET counselor.

Medication

Tobacco contains nicotine, a highly addictive chemical. When you stop using tobacco, you’ll likely experience withdrawal symptoms from the lack of nicotine, which can include irritability, anxiety, depression, hunger, restlessness, insomnia, and cravings. Using medications approved by the Food and Drug Administration can help you manage these withdrawal symptoms and cope with the urge to smoke or use smokeless tobacco.

• Nicotine Replacement Therapy (NRT)
  The nicotine patch, gum, lozenge, inhaler, and nasal spray, collectively referred to as nicotine replacement therapy (NRT), contain medicinal nicotine to reduce your withdrawal symptoms. The patch, which offers long-acting relief from withdrawal symptoms, can be combined with the short-acting gum, lozenge, inhaler, or nasal spray for more effective results.
• Bupropion
  Bupropion (Zyban®) is a pill that reduces your urge to use tobacco. Bupropion contains no nicotine and is started one to two weeks before you stop using tobacco.
• Varenicline
  Varenicline is a pill that blocks the effects of nicotine on the brain, making smoking and smokeless tobacco less enjoyable and reducing your withdrawal symptoms.

Evidence-Based Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can help treat the effects of tobacco use.

Evidence-based therapies are among the most effective treatments for tobacco cessation. They can include the following — which are in many cases available at a local VA medical center.

• Cognitive Behavioral Therapy (CBT) helps Veterans trying to quit tobacco develop more balanced and helpful thoughts about themselves, others, and the future. It can help Veterans manage the urge to smoke and achieve personal goals.

Support From Family and Friends

Family and friends can be a great source of encouragement when you quit tobacco. Let them know you are trying to quit and ways they can support you as you make this huge change in your life. Share with them the following tips on how to help someone who is trying to quit tobacco:

• Ask what you can do to help. Every person who uses tobacco is different!
• If you use tobacco yourself, consider quitting at the same time.
• Emphasize that even people who live tobacco-free have doubts. Cigarettes and smokeless tobacco can be constant companions for Veterans, and it can be difficult to imagine a life without them. Remind Veterans of the positive changes that will occur in their lives after they quit.
• Be ready to help, especially during the first few days after the Veteran stops using tobacco. Veterans may need distractions or extra help with a tough situation. For instance, they may need support when going to a party or hanging out with other people who use tobacco.
• Let them know they can take their time. Sometimes it takes a few tries for a person to become tobacco-free for good. Each attempt to quit tobacco is a learning experience, making success more likely.
• Be positive. Keep your statements upbeat and focused on the Veteran’s efforts to quit. Adding pressure or guilt only creates stress for Veterans, which they may want to relieve by using tobacco.
• Stay positive. Every attempt at living tobacco-free is a step forward, and relapsing does not mean failure. If a relapse occurs, help the Veteran figure out what caused it. Be encouraging, and let them know that you are proud of them for trying and that you will support them in another attempt to quit.
• Share reasons for quitting. There are many positive physical and mental health reasons for quitting. Let the Veteran know about them.

Motor vehicle crashes. Blasts and explosions. Falls.

Many events can deliver a blow or jolt to your head, potentially causing a traumatic brain injury (TBI). In fact, between 2000 and 2017, the Department of Defense reported more than 375,000 diagnosed cases of TBI among members of the U.S. armed forces around the world.

The brain affects how you think; how you feel; how you act. So a TBI can affect your physical functions, thinking abilities, behaviors, and more. The injury can range from mild to severe, and it may increase your risk for mental health conditions such as anxiety and depression, as well as sleeping problems.

What Causes TBI?

A traumatic brain injury can result from:

• A blow to your head by an object, such as a fist during a fight
• Your head striking an object, such as the inside of a vehicle during a crash
• The impact to your head of a nearby blast or explosion

Common Symptoms

Most TBI injuries are considered mild, but even mild cases can involve serious long-term effects on areas such as thinking ability, memory, mood, and mental focus. Common symptoms may include:

• Headaches
• Blurred vision
• Hearing problems
• Difficulty speaking
• Dizziness
• Changes in your sense of taste or smell
• Difficulty concentrating or remembering things
• Repeating yourself
• Becoming easily angry or frustrated

While most people with mild TBI have symptoms that resolve within hours, days, or weeks, a minority may experience persistent symptoms that last for several months or longer.

Treatment

No matter what you are experiencing, treatments and resources are available. VA offers treatment options that are proven to be very effective for most people, and many types of professionals at VA can help treat the effects of TBI.

Evidence-based therapies are among the most effective treatments for the effects of TBI. 

Vaccines are an important part of protecting your health and making sure you’re able to serve.

That’s because you may be more likely to live in close quarters with others and travel to certain countries where you could eat contaminated (unclean) food or water or be bitten by an infected mosquito. These are just a few of the things that can put you at increased risk for serious, vaccine-preventable diseases.

As a member of the military, you’ll get vaccines when you enter basic training and before you deploy to protect you from serious diseases. Vaccines are a safe and effective way to stay healthy and help protect your fellow military members, your family, and your community.

Which vaccines are recommended for military members?

Most military members receive the same recommended vaccines as everyone else based on age, vaccination history, health conditions, and travel plans.

Depending on where you’ll be deployed, you may also need additional vaccines. Find vaccine recommendations by area of responsibility (military geographic region).