Armed With Information: New VVA Initiative Helps Close the Gap in Veterans' Health Histories

BY Paul Rogers

Around two-thirds of America’s veterans do not use the VA for their total health care, and that number is expected to grow. Accordingly, Vietnam Veterans of America has long been concerned about the medical implications of community health care providers being unaware of the military service of millions of their patients. To help address that gap, VVA launched the ambitious Note to Doctor: I am a Veteran program at its National Convention in New Orleans last year.

“Past President Jack McManus saw the enormous need to bring the veteran experience into the community health care arena,” said Marsha Four, a strategic advisor to the VVA National President who heads the Note to Doctor program. “Without the knowledge of the veteran’s military exposures and health-related information, the veteran’s medical history record is incomplete. Vital information could be lost. It could also be compounding the veteran’s current medical history and diagnosis.”

One of the first pieces of information a veteran should share with a community, or non-VA, health care provider is the “where, when, and how” of military service. It is imperative that providers understand how a veteran’s service may have affected health, including possible exposure to toxins or chemicals and conditions associated with specific geographic locations.

A complete military health record can make a significant contribution to a physician’s understanding of a veteran’s current health status, helping to eliminate gaps that can lead to underdiagnosis and mismanagement of conditions.

“At VVA, we’re well aware of the particular health concerns that veterans face, concerns the general population may not,” said Mokie Porter, VVA’s longtime director of communications, who has been involved with Note to Doctor since its inception. “The concern is that if they’re going to a practitioner who has no knowledge of the hazards of military service, then they won’t know to look for various conditions.”

The Note to Doctor program is aimed at veterans of all eras and conflicts, but it may be particularly pertinent to Vietnam War veterans, many of whom were distrustful of the VA as a government agency following their experiences during and immediately after their service. They can find valuable resources on the program’s website, veteranhealthconcerns.org, including service-era pages, exposure information, and a downloadable version of the Note to Doctor card.

The program has both virtual and very literal components. Four and Porter created a simple yet comprehensive and highly portable trifold card that veterans can carry in a wallet and present to health care providers.

Only the size of a business card when folded, the Note to Doctor card includes reminders of the importance of telling doctors you are a veteran, a list of conditions that may be related to military service, and, perhaps most important, a QR code that health care providers can scan for direct access to the program’s website. There, medical professionals can click on a veteran’s service era to learn more about potential health concerns and related exposures. The site also includes a downloadable file of the card that veterans can print themselves.

When a veteran or physician visits the Note to Doctor website, they can click on the service ribbon for five major military campaign groupings involving U.S. forces: Korea, Vietnam, Expeditionary, Persian Gulf, and the Global War on Terror. Future conflict eras and their associated illnesses can be added as needed.

“Once you’re on the website, it’s far more expansive and much more descriptive than you could ever possibly put on this little Note to Doctor card,” said Four, who served as a nurse at the Army’s 18th Surgical Hospital in Vietnam from 1969 to 1970 and is acutely aware of the medical conditions related to the war.

One of the strengths of the Note to Doctor card is that veterans do not need to carry around wads of paper to explain their service history and its possible medical implications. The intent is for a veteran to leave a Note to Doctor wallet card with a physician so it can be placed in the medical file, allowing the doctor to scan the QR code and quickly gain access to information related to that veteran’s service.

The website provides examples of service-related conditions and exposures, along with links to more detailed information about them. It also includes PACT Act brochures, a downloadable Note to Doctor card, and other materials useful to veterans, their families, and their physicians.

One of the major challenges of creating Note to Doctor: I am a Veteran was the timeline. Jack McManus identified the need to get the cards into circulation as urgent, and Four moved quickly to help develop the program in time for the National Convention in New Orleans just a few months later.

“This was something we wanted to get out on the streets and get in place as quickly as possible,” Four said, “because it had been lacking for a very long time.”

With the wallet cards designed and an initial batch printed, the Note to Doctor team began distributing them at last August’s Convention in New Orleans. Over those four days, close to 1,000 packets, each containing ten cards, were distributed to members to take back to local chapters and distribute. More were passed out at the next quarterly VVA National Board meeting.

“It’s amazing, the thought of coordinating it, getting it produced, and getting it packaged up in only three months,” said Four. “It just goes to show that you really can do a great deal in a very small amount of time, with the correct motivation.”

Some veterans may not use VA health care because they live too far from VA facilities, do not qualify, or feel more comfortable returning to a practitioner they saw before their service. Others may still carry outdated impressions of VA health care.

“The VA of today is very different from the VA that my dad didn’t go to because back then many veterans saw it as a last resort,” Porter said. “But now it’s state of the art, because of people like Marsha and others who’ve been advocating for improvement, testifying on Capitol Hill and on all fronts.”

Whatever the reason an individual veteran may not use VA facilities for all medical needs, Note to Doctor: I am a Veteran is designed to help make sure community health care providers understand what military service may mean for that veteran’s health.

While Note to Doctor is a VVA initiative, its web-based design means it can be updated as new conflicts arise and as new medical information emerges about past wars. That futureproofing is one of the program’s greatest strengths. It also makes the program a lasting gift from VVA to veterans of every generation.

“This is historic. It goes forward through time, indefinitely,” Four said. “What a gift it was for us to be able to put this out and have it be a forever thing.”

That inbuilt futureproofing is another way VVA can honor its guiding principle — “Never again will one generation of veterans abandon another” — long after there are no Vietnam War veterans to do so in person. In that sense, Note to Doctor becomes part of VVA’s legacy.

“I’ve always thought that this is a gift of a Vietnam nurse, and I like that piece of the story,” said Porter, who has served VVA for 40 years. “Because this really is Marsha Four’s passion and mission.”

But Four is far from done in her effort to have Note to Doctor reach as many of America’s veterans and their community medical providers as possible. Her immediate goals include getting thousands more cards into the hands of trade unions, major medical schools, and county directors of veterans affairs across the country.

“The program costs money, and the production of the cards is extremely important,” she said. “So, we’re trying to get help with the production, because this is such a major program. I just don’t want this to be lost because we couldn’t find the money to get these cards out there.”

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