Open Access Research article

A retrospective cohort study of U.S. service members returning from Afghanistan and Iraq: is physical health worsening over time?

Michael J Falvo12*, Jorge M Serrador134567, Lisa M McAndrew18, Helena K Chandler1, Shou-En Lu9 and Karen S Quigley1011

Author Affiliations

1 War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07108, USA

2 Department of Physical Medicine and Rehabilitation, New Jersey Medical School - University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

3 Veterans Biomedical Research Institute, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA

4 Department of Pharmacology & Physiology, New Jersey Medical School - University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

5 Department of Neurology, Stroke Division, Brigham and Women’s Hospital, Boston, MA, USA

6 Harvard Medical School, Boston, MA, USA

7 Department of Electrical & Electronic Engineering, National University of Ireland Galway, Galway, Ireland

8 Department of Psychiatry, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Boston, MA, USA

9 School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA

10 Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers (Bedford) VA Memorial Hospital, Bedford, MA, USA

11 Department of Psychology, Northeastern University, Boston, MA, USA

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BMC Public Health 2012, 12:1124  doi:10.1186/1471-2458-12-1124

Published: 28 December 2012



High rates of mental health disorders have been reported in veterans returning from deployment to Afghanistan (Operation Enduring Freedom: OEF) and Iraq (Operation Iraqi Freedom: OIF); however, less is known about physical health functioning and its temporal course post-deployment. Therefore, our goal is to study physical health functioning in OEF/OIF veterans after deployment.


We analyzed self-reported physical health functioning as physical component summary (PCS) scores on the Veterans version of the Short Form 36 health survey in 679 OEF/OIF veterans clinically evaluated at a post-deployment health clinic. Veterans were stratified into four groups based on time post-deployment: (1Yr) 0 – 365 days; (2Yr) 366 – 730 days; (3Yr) 731 – 1095 days; and (4Yr+) > 1095 days. To assess the possibility that our effect was specific to a treatment-seeking sample, we also analyzed PCS scores from a separate military community sample of 768 OEF/OIF veterans evaluated pre-deployment and up to one-year post-deployment.


In veterans evaluated at our clinic, we observed significantly lower PCS scores as time post-deployment increased (p = 0.018) after adjusting for probable post-traumatic stress disorder (PTSD). We similarly observed in our community sample that PCS scores were lower both immediately after and one year after return from deployment (p < 0.001) relative to pre-deployment PCS. Further, PCS scores obtained 1-year post-deployment were significantly lower than scores obtained immediately post-deployment (p = 0.02).


In our clinical sample, the longer the duration between return from deployment and their visit to our clinic, the worse the Veteran’s physical health even after adjusting for PTSD. Additionally, a decline is also present in a military community sample of OEF/OIF veterans. These data suggest that, as time since deployment length increases, physical health may deteriorate for some veterans.

Veterans; Military personnel; Veterans health; Quality of life; Operation enduring freedom; Operation iraqi freedom; Health surveys