What are the most common diagnoses among Veterans Affairs (VA) patients, including post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and musculoskeletal disorders?

Most Common Diagnoses Among Veterans Affairs (VA) Patients

Post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and musculoskeletal disorders are among the most prevalent diagnoses in Veterans Affairs patients, with PTSD affecting approximately 30% of veterans treated for psychiatric disorders in the VA system.

PTSD in Veterans

PTSD is exceptionally common in the veteran population:

• Approximately 30% of veterans treated for psychiatric disorders in the VA are diagnosed with PTSD 1
• Lifetime prevalence of PTSD in the general population is 4% in men and 8% in women, but significantly higher in veterans 2
• Military personnel with combat exposure have reported insomnia symptoms as high as 41%, compared to 25% in non-combatants 2
• Veterans with PTSD utilize 91% more non-mental health medical services than veterans without mental disorders 3

PTSD Comorbidities

PTSD rarely occurs in isolation among veterans:

• Only 29.8% of veterans diagnosed with PTSD have PTSD alone 1
• 36.7% have one concurrent psychiatric diagnosis
• 21.3% have two concurrent psychiatric diagnoses
• 12.2% have three or more concurrent psychiatric diagnoses
• Anxiety disorder and major depressive disorder are the most common concurrent diagnoses 1

Traumatic Brain Injury (TBI)

TBI is considered a "signature injury" of recent military conflicts:

• Approximately 20% of veterans returning from Iraq and Afghanistan conflicts had a single or multiple blast TBI injuries 2
• PTSD prevalence rates in veterans with blast TBI range from 33-65%, compared to 11-20% in veterans without TBI 2
• TBI commonly co-occurs with chronic pain conditions, particularly headache, neck pain, and back pain 4

Musculoskeletal Pain Disorders

Chronic pain conditions are highly prevalent among veterans:

• 66% of veterans seeking treatment for PTSD have comorbid chronic pain diagnoses 5
• 79% of veterans with TBI report frequent experiences with pain 4
• Most common pain locations include:
  • Headaches
  • Lower back pain
  • Joint pain 4

Mental Health and Medical Comorbidities

Veterans with mental health diagnoses show significantly higher utilization of medical services:

• Veterans with mental disorders have 42-146% greater utilization of medical services than those without mental disorders 3
• Those with PTSD have the highest utilization in all categories: 71-170% greater than those without mental disorders 3
• Veterans with higher levels of psychiatric multimorbidity are more likely to have:
  • Homelessness
  • Substance use disorders
  • Diverse medical diagnoses
  • Increased mental health and medical service use
  • Greater psychotropic medication use 1

Sleep Disorders

Sleep disturbances are extremely common in veterans:

• 48.6% of military personnel report poor sleep quality 2
• Sleep-disordered breathing is the most frequently diagnosed sleep disorder in military personnel referred for sleep evaluations 2
• The incidence of both insomnia and obstructive sleep apnea increased over 600% in U.S. Army soldiers from 1997 to 2011 2

Clinical Implications

The high comorbidity rates among veterans have important treatment implications:

• Trauma-focused psychotherapies are strongly recommended as first-line treatments for PTSD over pharmacotherapy 2, 6
• SSRIs (paroxetine and sertraline) and SNRIs (venlafaxine) are recommended as first-line medications when pharmacotherapy is indicated 6
• Benzodiazepines should be avoided in PTSD as they may worsen outcomes 6
• Treatment for PTSD should continue for at least 12-24 months after achieving remission to prevent relapse 6
• A multidisciplinary treatment approach is necessary given the high rates of comorbidity 7

Pitfalls to Avoid

• Failing to screen for comorbid conditions, particularly pain disorders and TBI in veterans with PTSD
• Using benzodiazepines for PTSD treatment, which can worsen outcomes 6
• Premature discontinuation of treatment before the recommended 12-24 month period after remission 6
• Overlooking PTSD-related nightmares, which may require specific treatment approaches 6
• Ignoring the need for coordinated care across multiple specialties given the high rates of comorbidity

Understanding these common diagnoses and their interconnections is essential for providing comprehensive care to veterans in the VA system.