Utilization, attitudes, and experiences of Vietnam Era veterans with Veterans Administration health facilities: the American Legion experience.

A random sample of American Legion members in six states who had served in the Armed Forces during the Vietnam Era was conducted through a mailed questionnaire, in order to determine patterns of usage of Veterans Administration health facilities, as well as attitudes toward the VA and experiences at these facilities. Of the 6810 male respondents, 42.0% had served in Southeast Asia. These subjects were categorized according to their level of combat in South Vietnam. Thirty-six percent of those who had served in Southeast Asia had used VA health facilities, compared to only 18% of men who served elsewhere. Among Southeast Asia veterans, combat level was an important predictor of extent of usage of VA facilities for problems of both physical and mental health. Combat level was also associated with lack of basic and major medical insurance. While men with lower incomes tended to make greater use of VA mental health facilities, nearly one-fourth of mental health users had family incomes above $30,000. Despite their greater usage of the VA, men with higher combat levels expressed lower feelings of security about this agency, and rated its staff less helpful and of lower quality than did men who experienced lower levels of combat. On the other hand, higher combat veterans thought themselves better informed about VA services. Men who had gone to the VA for mental health assistance reported a disturbingly low frequency of having been asked basic questions that relate to possible diagnosis of post-traumatic stress disorder (PTSD), questions related to combat, which may be one of its etiologic factors, or other questions relating to their military history. Because combat level in Vietnam veterans is a major determinant of both attitudes toward and utilization of VA health facilities, the VA as well as other health agencies which deal with Vietnam veterans should be especially sensitive to this factor, and should take it into consideration when evaluating veterans' physical and mental health.