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Looking out—and ahead—for America's wounded warriors

By Nancy Fontaine

A Marine injured in Afghanistan works with a trainer. The prevalence of serious injuries among veterans of the wars in Iraq and Afghanistan has raised concerns about long-term health-care costs.

Treating veterans of past wars at the White River Junction VA Medical Center got James Geiling thinking about the future. "One thing that struck me at the VA, where I'm taking care of Vietnam-era vets, is the long-term medical effects of war injuries," he says. "And I started to think about what that means for today's vets."

In a recent article published in the journal Military Medicine, Geiling, a Geisel professor of medicine; Joseph Rosen, a Geisel professor of surgery; and health economist Ryan Edwards discussed the potentially enormous long-term costs of caring for veterans of the wars in Iraq and Afghanistan and what might be done to reduce those costs.

Over 2.3 million active-duty military personnel and reservists have served in Iraq or Afghanistan through September 2011. The Congressional Budget Office (CBO) has estimated the health-care costs for veterans of these wars will be about $40 billion to $55 billion through 2020, and estimates of the total health-care costs over the next 30 to 40 years range from $600 billion to $1 trillion.

Geiling and his coauthors note that patterns of injury and a higher survival rate than in previous conflicts both play a role in these estimates. Many veterans of the recent wars survived injuries that might have killed them in previous conflicts. The prevalence of improvised explosive devices (IEDs) in these wars has led to many polytraumatic injuries, such as the loss of multiple limbs, severe facial injuries, traumatic brain injury (TBI), blindness, deafness, or some combination of these injuries. There is also the potential for post-traumatic stress disorder (PTSD), which can be expensive to treat. According to the CBO, about one-fourth of veterans treated from 2004 to 2009 were diagnosed with PTSD.

About 50,000 men and women have been wounded in action while serving in Iraq or Afghanistan, and hundreds of thousands of veterans have received treatment from the Veterans Health Administration. By 2035, these veterans will be middle-aged, with health issues similar to those Geiling now sees in Vietnam veterans.

Geiling, who is a 25-year veteran of the Army, argues that being aware of these issues should lead to preventive measures. "We should help an amputee to reduce his cholesterol and maintain his weight at age 30 to 40 rather than treating his coronary artery disease or diabetes at age 50," he says. "If we treat a veteran's PTSD at age 21 with counseling and lifestyle interventions, we may help her to reduce suicidal thoughts and avoid the use of tobacco or alcohol. This will save us from having to fund her treatment for chronic obstructive pulmonary disorder or alcoholic liver disease."

Geiling believes that drawing attention to these issues is important. "Today's veterans are clearly at risk for long-term illness, and there's data to show that," he says. "We just need to think about these things and keep them in mind today so we might prevent them from appearing in 2035."

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Geisel School of Medicine at DartmouthDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College