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Veterans Law

Musculoskeletal Conditions Among Women Veterans

March 15, 2020
woman with musculoskeletal pain

Musculoskeletal conditions include those that affect muscles, bones, joints, and associated tissues such as tendons and ligaments.  They range from those that arise suddenly and are short-lived, such as fractures, sprains, and strains, to lifelong conditions associated with ongoing pain and disability.  Musculoskeletal conditions are typically characterized by pain, often persistent, and limitations in mobility, dexterity, and functional ability.  Some of the most common and disabling musculoskeletal conditions are osteoarthritis, back and neck pain, fractures associated with bone fragility, injuries, and systemic inflammatory conditions (e.g., rheumatoid arthritis).

While management of some musculoskeletal conditions may require specialist and/or surgical care, many musculoskeletal conditions can be managed in primary care through a combination of core non-pharmacologic interventions (such as exercise, weight management, psychological therapies), and pharmacologic therapies.  However, more severe musculoskeletal conditions can lead to early retirement from work, reduced ability to participate in social roles, and the onset of mental health conditions, such as depression and anxiety.

Broadly speaking, musculoskeletal conditions are the leading contributor to disability worldwide, with low back pain being the single leading cause of disability globally.  It is important to note that there are significantly high prevalence rates of musculoskeletal conditions among veterans as well, and women veterans in particular.

Post-Deployment Pain: Musculoskeletal Conditions in Male and Female OEF/OIF Veterans

Musculoskeletal conditions are among the most common diagnoses of men and women veterans returning home from deployment.  Studies of Persian Gulf War veterans as well as Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans show that diseases of the musculoskeletal system are the most frequent diagnoses in cumulative reports of both inpatient and outpatient healthcare encounters.  More than 200,000 women have now been deployed in support of the wars in Iraq and Afghanistan, representing up to 15 percent of the armed forces.  Like their male counterparts, female soldiers are subjected to the many physical stresses of war.  VA researchers utilized VA administrative data to examine pain and musculoskeletal conditions in male and female veterans after deployment to see if women veterans might be at particular risk for the development of chronic musculoskeletal pain.

Findings Reveal Differences Between Pain in Male and Female Veterans

The study population was composed of veterans from the VA’s OEF/OIF roster provided by the Defense Manpower Data Center-Contingency Tracking System Deployment File.  Data from the OEF/OIF roster was linked with the VA National Patient Care Database, Decision Support Systems, and the Corporate Data Warehouse.  Records for 19,520 female veterans and 144,292 male veterans were evaluated.  The findings showed that back problems, joint disorders, and musculoskeletal conditions were among the most frequent diagnoses for both men and women.

A subsequent study evaluated pain numeric rating scores, which are recorded along with vital signs at each clinical encounter in VA.  Researchers evaluated records for all male and female veterans who had one year of observation after the end of their last deployment.  Results indicated that 60 percent of both men and women were assessed for pain.  Men (44 percent) were more likely to report pain than women (38 percent), but among those with pain, women were more likely to report moderate to severe pain than men.

A final study examined the prevalence of back, musculoskeletal, and joint conditions in female compared to male veterans in years 1-7 after return from deployment.  For both male and female veterans, the prevalence of painful musculoskeletal conditions increased each year after deployment.  However, women were more likely than men to have back problems, musculoskeletal problems, or joint problems and the odds of having these conditions increased each year for women compared to men in years 1-7 after deployment.  Among patients who had been seen in VA for 7 years, 20 percent of women (compared to 17 percent of men) had back problems; 12 percent of women and 10 percent of men had musculoskeletal conditions; and 19 percent of women and 17 percent of men had joint problems.

Women Veterans Seeking VA Healthcare for Musculoskeletal Conditions

Consistent with the data above, musculoskeletal conditions were the most commonly diagnosed conditions in fiscal year 2015.  The Veterans Health Administration (VHA) recognizes that being female is a risk factor for injury during basic training.  Basic combat training injury rates may be two times higher in women relative to men.  Approximately 75 percent of basic combat training injuries in women are overuse injuries, including stress fractures, shin pain, patellar femoral pain syndrome, patellar or achilles tendonitis, and iliotibial band (ITB) friction syndrome.  In fiscal year 2015, approximately 439,791 women veterans received treatment through VHA.  As such, VHA must continue to address gender differences in the prevalence and occurrence of musculoskeletal conditions.