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

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.

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.

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.

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.