The Fatality Rate From Combat May Extend for Decades After a War’s End

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The Journal of the American Medical Association  has confirmed that veterans of the Iraq and Afghanistan War have a significantly higher prevalence of all cardiovascular risk factors such as smoking, hypertension, high cholesterol, obesity, and diabetes.  The medical community, and perhaps most seasoned veterans disability lawyers, have known for a while that veterans who have PTSD are more likely to develop and die from heart disease. 

 The study took a look at the diagnoses of over 300,000 veterans who used VA health services between 2001 and 2008. 88% of the participants were male and the average age was 31. 24% of the study participants had PTSD  the majority of which was also diagnosed with depression, anxiety, adjustment disorder, alcohol abuse, and other psychiatric disorders.  In other words, these veterans had multiple co-existing psychiatric problems. This study also shows that veterans from the Iraq Afghanistan War have a significantly higher incidence of the heart disease risk factors described above.

The study results suggest that the true mortality rate of the Iraq Afghanistan conflict may not be accurately determined for many years to come.  If the Middle East conflict has caused a high percentage of veterans to develop PTSD and other mental conditions, then it is logical to conclude that these veterans are also more likely to develop and  die from cardiovascular disease.  This means that the effects of the Iraq and Afghanistan War will have long-ranging health effects, resulting in the premature development of cardiovascular disease.  Cardiovascular disease takes time to develop and so the full consequences of the recent conflict will not be immediately realized. 

In addition, the Annals of Epidemiology has documented that Vietnam veterans with PTSD have higher rates of death from all medical causes.  The researchers used a random sample of U.S. Army veterans with PTSD and what they found was that these Vietnam veterans with PTSD had higher rates of cardiovascular disease, cancer, motor vehicle fatalities, accidental poisoning, suicide, homicide, and other injuries.  In short, PTSD appears to increase one’s risk of death from all possible causes.  Further, female veterans with PTSD were shown to utilize VA medical and surgical healthcare services at much higher rates, according to an article in the Journal of General Internal Medicine.

What this may mean is that far more medical problems may be linked to PTSD than what seems apparent on the surface.  For example, a few years ago I represented a widow whose DIC claim was denied.  We appealed the case to the U.S. Court of Appeals for Veterans Claims.  Her veteran husband was service-connected for PTSD but he died in a motorcycle accident.  The Board of Veterans Appeals analyzed whether he had a death wish and actually died of suicide.  The Board ruled out suicide because he did things like take time to put on his helmet.  An autopsy was done and showed that although he had been drinking, his blood alcohol content was well below the legal limit.  The Board concluded that alcohol usage due to the PTSD was not a factor and the Board denied the claim, stating that there was no possible connection between the PTSD and the cause of death.

As veterans disability attorneys, were not satisfied with this answer because we know that one of the symptoms of PTSD is impaired judgment.  So when we look at the science we find that with just a single drink and a blood alcohol level of just 0.02 percent there is a blunting of the brain’s frontal lobe capacities resulting in a decrease in judgment and inhibitions.  (See Hammond, RL, editor.  Almost all you ever wanted to know about alcohol but didn’t know who to ask! Special Issue of The Bottom Line on Alcohol in Society, 1991 11(2):34-35.) Also, most veterans disability lawyers know that disabled veterans with PTSD often use alcohol to self-medicate their PTSD symptoms.  We reasoned that the impaired judgment associated with PTSD, combined with the alcohol, may have been enough to cause him to take an unreasonable risk on the road with his motorcycle, resulting in the fatal crash. 

When you realize how much drugs and alcohol are utilized to self-medicate PTSD, and when you consider the effects these substances have on one’s judgment, it is easy to understand why deaths even from accidental causes are so much higher in veterans with PTSD.

The conclusion to take away from this research is that PTSD, and particularly combat-related PTSD, has wide-ranging health effects that increase the risk of mortality from numerous causes–both medical and accidental.  The research suggests that the true fatality rate of an armed conflict may not be measureable until many decades later. 

Because of this, the VA’s responsibility for our veterans is far-reaching and long-term.  Beyond merely treating the acute injuries associated with combat, VA must consider the chronic illnesses –like heart disease–as part and parcel of PTSD residuals.

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Eric Gang

Eric A. Gang, Esq. is a veterans’ disability attorney who represents disabled veterans nationwide in their appeals for VA disability benefits. He has litigated over 500 appeals at the U.S. Court of Appeals for Veterans Claims and has recovered millions of dollars in retroactive benefits for disabled veterans. His work has been mentioned in media outlets across the country. He publishes and lectures widely in the area of veterans benefits. You can reach him at (888) 878-9350 or www.veteransdisabilityinfo.com.



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