Serving Vietnam Veterans Hospitalized Outside the VA System: A Scoping Review of Presumptive Service-Related Illnesses and Presentations

Abstract

Background: Recent legislation, the MISSION Act and the PACT Act, expanded access to and utilization of non-Department of Veterans Affairs (VA) health care; more Veterans now receive care from non-VA healthcare providers. Hospitalists outside the VA may be less familiar with Veterans' service-related exposures and presumptive service-related conditions. We aimed to summarize research findings on service-related exposures and conditions among Vietnam War Veterans.

Methods: Using Arksey and O'Malley's methodological framework for scoping reviews, we searched PubMed, EMBASE, and Web of Science databases in June 2023. References were imported into EndNote and screened using Covidence collaborative review software. Two reviewers assessed eligibility, with disagreements resolved by a third, then one extracted data. We included papers published in 1998 or later focused on US Vietnam Veterans, excluding genetic/modeling studies, study protocols, case reports/series, clinical trials, and papers without relevance to hospital medicine.

Results: We identified 1185 papers; 251 were duplicates, 450 were excluded through title/abstract review, and 335 were excluded after full-text review. A total of 149 studies were included. The exposures mentioned most frequently were Agent Orange/unspecified herbicides (n = 55), violence/combat (n = 14), and infectious disease (n = 9). The most common conditions were PTSD (n = 39), neuropsychiatric conditions (n = 35), cancer (n = 19), metabolic/endocrine disease (n = 11), and neurological dysfunction (n = 11). Overall mortality was addressed in 13 studies.

Conclusions: The current literature highlights numerous service-related exposures and conditions recognized by the VA, which may assist hospitalists caring for Vietnam Veterans outside the VA.

Keywords: Vietnam Veterans; hospital medicine; scoping review; service-related conditions.

Figure 1

PRISMA diagram: PRISMA flow diagram illustrating the study selection process. Out of 1185 studies initially identified from database searches, 251 duplicate references were removed, leaving 935 studies screened by title and abstract. After screening, 450 studies were excluded, and 485 studies were assessed for eligibility. Of these, 335 studies were excluded due to various criteria, including irrelevance to hospitalist practice, publication date prior to 1998, non-US Veteran populations, and focus on non-Vietnam War Veterans. The final review included 149 studies relevant to service-related exposures and conditions among Vietnam War Veterans.

Figure 2

Heat map of articles describing potential associations between exposures (horizontal axis) and conditions (vertical axis): Heatmap depicting the frequency of reported service-related exposures and associated health conditions among Vietnam War Veterans. Rows represent health conditions (e.g., PTSD, neuropsychiatric disorders, cancer), while columns indicate specific exposures (e.g., Agent Orange, combat experience, infectious disease). Color intensity reflects the frequency of mention in the literature, with red indicating the highest frequency and green the lowest. Note: Per methodological guidelines for scoping reviews, we did not assess the strength of evidence for each study included, but instead noted their relative frequency to demonstrate where research to date has been concentrated.