Providing High-Quality Palliative Care for Veterans with Serious Illness

Veterans across the United States live with higher rates of chronic conditions that often reflect the long-term impact of military service and combat exposure - while navigating the challenges of utilizing Veteran Affairs (VA) and non-VA health care systems. Palliative care teams play a key role in supporting veterans and their families by addressing symptoms, honoring their service and identity, and improving quality of life throughout the course of illness. This resource describes who veterans are, what they may experience during serious illness, the gaps in care many face, and concrete steps that palliative care teams can take to provide inclusive and high-quality care.

If you’re a member of a palliative care team in a civilian setting, you will likely have the opportunity to care for a veteran. It’s important to consider how to truly address their unique needs.

Antonio Graham, MD
Atlanta VA Medical Center

Who Are Veterans

A veteran is defined as: “A person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable.” (Under Title 38 of the United States Code). This includes people who have served in the United States Armed Forces in active duty, reserve, or National Guard roles.

  • There are more than 18 million living veterans in the United States, representing about 6% of the country’s adult population.
  • Veterans represent a diverse group across, gender, race/ethnicity, and service experiences.

Experience of Serious Illness Among Veterans

Serious illness for veterans is shaped by unique life experiences, cultural values, and health system realities. Common themes include:

  • Higher rates of chronic conditions such as cancer, hypertension, and arthritis especially among veterans aged 65 and older.
  • Lasting effects of combat and training injuries, including chronic pain and mobility limitations.
  • Co-occurring mental health conditions such as posttraumatic stress disorder (PTSD), depression, anxiety, and substance use disorders are also common.
  • Complex navigation between VA and non-VA systems, which can affect continuity of care, benefits, and access to specialty services.
  • Strong military identity and values of loyalty, resilience, and self-reliance that may influence communication, coping, and decision making.

Current Gaps in Health Care for Veterans

Many veterans experience gaps in care during serious illness that can shape their comfort, trust, and ability to access high quality palliative care. The following issues commonly affect veterans and may require additional attention from palliative care teams:

  • Access to palliative care varies across VA facilities and may be limited in many rural areas where 4.4 million veterans reside.
  • Evidence shows that some veterans’ health conditions linked to service or exposures remain under-recognized as being service-connected or attributable to military service. This may delay diagnosis, limit benefits and support, and increase symptom burden, especially when clinicians are not familiar with military exposures or deployment history.
  • Stigma related to mental health care, shaped by service norms and lived experience, can deter some veterans from seeking needed support – especially after being diagnosed with a serious illness.
  • Communication barriers may arise if clinicians do not routinely ask about military service or do not understand how military identity influences patient values and decision making.
  • Many health systems lack standardized processes for identifying veteran status during intake or assessment, which can delay access to appropriate benefits or tailored palliative care services.

Best Practices for Palliative Care Teams

Palliative care clinicians and programs can improve quality of life for veterans by integrating veteran informed practices into care delivery. This includes:

  • Ask every patient if they have served in the military to identify veteran status early.
  • Incorporate a brief military health history into the assessment, including service era, deployment, injuries, and exposures.
  • Screen for post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), moral injury, substance use, and depression, as part of a comprehensive palliative care assessment.
  • Approach each interaction with respect for military identity, values, and decision-making preferences. Consider asking questions like:
    • “Can you share a little about your military service and what aspects of that experience are most important for me to understand as your clinician?”
    • When facing a difficult choice, do you prefer detailed information, a clear recommendation, or a shared approach?
  • Engage spouses, partners, and caregivers in conversations – as they have often shared the burden of military life and illness – alongside the veteran.
  • Establish partnerships with local VA facilities, Vet Centers, and veteran service organizations to coordinate care and share resources.
  • Offer staff educational training in military cultural competency and veteran centered communication. For example, the ELNEC – For Veterans Project is a 7-module curriculum designed to educate clinicians on how to provide better palliative care for Veterans with serious, complex illnesses and their families.
  • Program administrators should work with clinical teams to embed questions about military service into intake forms, EHR templates, and quality improvement systems.
  • Create clear pathways for referring veterans to VA benefits, mental health services, and financial counseling.
  • Incorporate veteran stories and peer support programs into care models by inviting trained peers to participate in care conversations, integrating veteran narratives into education materials, and connecting patients with peer-led groups that reflect their military experiences.
  • Work toward smoother coordination between VA and non‑VA palliative care programs, especially as the VA MISSION Act of 2018 (Veterans Community Care Program) enables veterans to receive care from community-based providers when their VA facility cannot offer timely or conveniently located services.
  • Join or establish a Hospice-Veteran Partnerships (HPV). The mission of HPVs is to improve Veterans’ access to hospice and palliative care across all sites and levels of care to assure that every Veteran can receive optimal care during their serious illness.
  • Ensure health systems and care teams understand eligibility criteria, including how VA coverage supports access to concurrent care, allowing eligible veterans to receive hospice services alongside disease‑directed treatments, reducing care disruptions and improving symptom management.
  • Incorporate veteran status into quality measurement and reporting systems to identify gaps in care, monitor outcomes, and drive targeted improvements in care.

Content Contributors/Acknowledgements:

Gene DeCastro, MD
Palliative Care Physician, James J. Peters Veterans Affairs Medical Center
Assistant Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN
Adult Care Nurse Practitioner, James J. Peters Veterans Affairs Medical Center

Andrew Johnstone, MD
Staff Physician, Palliative Medicine, James J. Peters VA Medical Center
Assistant Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

Siobhán James, LCSW, APHSW-C
Palliative Care Social Worker and Social Work Fellowship Program Director, James. J Peters Veteran Affairs Medical Center

William W. Hung, MD
Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
Physician Investigator, Geriatric Research, Education and Clinical Center (GRECC), James J Peters VA Medical Center

Rayna Ross, CHES
Health Equity Program Manager, CAPC

Brittany Chambers, MPH, CHES
Senior Director of Health Equity, CAPC

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