Summary: The Long Road Home

James Patterson has not slept through the night since 1969. He was nineteen when the mortar hit his position outside Da Nang. Now he is 74 with Parkinson’s disease, possibly related to Agent Orange exposure, and nightmares that still come. His wife Eleanor has learned how to wake him without startling him.

Approximately seventeen million veterans live in the United States. PTSD affects 10 to 30 percent depending on era and combat exposure. Symptoms can remain dormant for years, triggered by retirement, loss of a spouse, or cognitive changes that loosen the controls keeping memories contained. Traumatic brain injury, another signature wound, has cumulative effects on aging brains only now becoming clear.

Toxic exposures create long tails: Agent Orange linked to cancers, diabetes, and Parkinson’s decades later; Gulf War illness that took years for military medicine to acknowledge; burn pits in Iraq and Afghanistan. The 2022 PACT Act expanded VA coverage, but for many veterans recognition came after years of being told symptoms were imaginary. Moral injury, the psychological damage from violating one’s own moral code, does not respond to conventional PTSD treatments.

The VA has specialized expertise in veteran-specific conditions and integrated records, but access varies by geography. Rural veterans may live hours from the nearest facility. Women veterans, roughly 10 percent of the population and the fastest-growing segment, encounter a system designed for men. One quarter of women veterans report experiencing military sexual trauma.

Veteran communities offer connection, but their organizations are aging. The VFW and American Legion members who built them are dying. Younger veterans often do not join. Suicide rates among older veterans remain elevated.

James will see his VA doctor next month. He will not describe everything. There are things from fifty-five years ago he will take to his grave. The war ended a long time ago. Its consequences have not.