Putting “Have You Ever Served?” Into Practice
Dr. Gowda’s question deserves a place in more of our exam rooms. Once the ceremonies end, most veterans go back to getting their care in offices like ours. Roughly three in four U.S. veterans receive some or all of their outpatient care outside the VA health system, and Maryland is home to more than 327,000 veterans. Many of them are already on our schedules, whether or not their charts say so.
The trouble is that we rarely ask. In one study, more than half of family physicians said they never or rarely ask patients about military service. Closing that gap takes about a minute. VA clinicians recommend asking “Have you or a loved one ever served in the military?” instead of “Are you a veteran?” Younger veterans, along with Guard and Reserve members, often don’t think of themselves by that label. Asking about a loved one also matters, since it can surface a veteran spouse or parent whose health shapes the whole household.
From there, a few follow-up questions about branch, era, deployments and exposures go a long way. They can explain symptoms that would otherwise look unrelated. The VA’s Military Health History Pocket Card is a useful guide for those conversations. It lays out the health risks tied to each era of service, from Agent Orange to burn pits, and includes questions about military sexual trauma, stress reactions and a veteran’s living situation. As Dr. Gowda’s patient showed, the answers are not always in the chart, and sometimes a family member holds the piece we’re missing.
Exposure history matters more now than it did a few years ago. Under the 2022 PACT Act, the VA screens every veteran enrolled in its health care for toxic exposures at least once every five years, in a conversation that takes five to ten minutes. The law also expanded VA eligibility for veterans of the Vietnam, Gulf War and post-9/11 eras, so a patient who assumes they don’t qualify may be wrong. If someone mentions burn pits, contaminated water or other service exposures, point them to VA.gov/PACT or have them call 1-800-MYVA411. Then note the history in their chart so it follows them to every specialist they see.
Some of what veterans carry won’t show up on any screening form. If a patient is in crisis, the Veterans Crisis Line is available around the clock by dialing 988 and pressing 1.
If your practice would like to see more veterans through the VA, community providers in Maryland can join the VA Community Care Network through Optum, which administers the network in our region. Call 888-901-7407 or visit Optum’s VA provider site to get started.
