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Director's Letter

The VA motto, derived from Lincoln's second inaugural address, includes the obligation "to care for him who shall have borne the battle..." Although some of the injuries associated with modern military deployments have changed in the era of OEF and OIF—for example, the prevalence of blast-related TBI—others such as PTSD have been described as far back as the Civil War and earlier. Indeed, some writers have noted classic features of PTSD in Homer's description of the grief of Achilles after the death of Patroclus in The Iliad. Given that the health consequences of deployment may persist long after active service, post deployment health is a critical area of focus for VA research. Outside funders have recently increased their support of research on high-profile conditions such as TBI and PTSD, but VA has a unique stake in improving treatment for the full range of health problems affecting returning servicemen and women, from tinnitus to severe polytrauma.

Understanding the various manifestations of post-deployment health problems—and how VHA can best address them—is a fundamental health services research challenge. Research is needed to delineate the complicated interactions between and among initial stressors, the susceptibility or resilience of returning Veterans, the post-deployment environment into which Veterans return, and the models of care available to them. Research can help VA learn how to do a better job at the front end—the transition from active duty to engagement with VA services—while remaining focused on the goal of helping Veterans successfully reintegrate into a full life in their family, their work, and their community regardless of any health challenges. Such research requires an understanding of the unique experience of each Veteran, his or her needs and capabilities, and the clinical and social resources that can best support the individual. This is the ultimate definition of patient-centered care.

David Atkins, M.D., M.P.H., Director, HSR&D