Most veterans get some health care from private doctors.
But most doctors outside the Veterans Affairs system aren't trained to identify service-related illness, according to a physician working to educate clinicians on the issues.
"While everybody seems to be mostly focused on the health care that veterans are getting at the VA, it sort of went unnoticed that 80 percent of veterans get most of their health care from civilian providers," said Jeffrey L. Brown, M.D., a clinical professor of pediatrics at New York Medical College who also teaches at Weill Cornell Medicine.
While about 40 percent of veterans get some health care from the VA, only about 20 percent of all veterans rely totally on the VA, according to a 2015 government survey of health and health care use.
Dr. Brown, a pediatrician and retired U.S. Army medic, carried a .45 pistol and treated wounded and sick soldiers and, at times, local children in Vietnam. Late in his post-military private practice career, a New York Times article alerted him that anyone who served in Vietnam should consider themselves exposed to Agent Orange, a carcinogenic defoliant used to kill thick plant growth and expose hiding Vietnamese fighters. Those veterans risked serious illness like cancer, diabetes and heart disease.
He learned of the risk from a newspaper, not his doctor, which he thinks is a big problem.
The revelation prompted a new quest to educate physicians about service-specific ailments.
"The biggest deficiency: Most health care providers don't ask patients as they come through the door if they've ever served in the military," he said.
Dr. Brown, whose early opinion on the matter appeared in a 2012 edition of the Journal of the American Medical Association, will speak during a symposium at the Commonwealth Medical College from 8 a.m. to 12:30 p.m. Saturday.
Service-related issues also could affect women's health, especially when it comes to bearing and delivering children, Dr. Brown said.
Pediatricians also seldom are trained to identify psychological and learning problems among veterans' children related to their parents' service or the effects after returning from deployment, he said.
About 800,000 veterans live in Pennsylvania, according to 2015 data from the U.S. Census Bureau. And on average, they get only 29 percent of their care through the VA, according to the administration's survey. The rest comes from outside providers.
More often, veterans get private insurance either through work or a spouse's job, or they're on Medicare or Medicaid. Traveling to a non-military practitioner often is easier than to a VA facility.
"Unless you speak up and say you are a veteran or your spouse is a veteran, the issue might not even come to light," said Richard R. Silbert, M.D. , a psychiatrist and senior medical director for the Community Care Behavioral Health Organization.
Dr. Silbert also will be speaking at Saturday's symposium along with other mental health and VA clinicians.
"There's just so many other things that they're (asking) in a doctor's office. 'Do you drink? Do you smoke? How's your diet?'" he said. "Everything's kind of competing."