Shaken world: coping with transition to civilian life.

Abstract: A 30-year-old female Canadian Forces (CF) Veteran* presents to a family physician for a first visit. She complains of back and knee pain and feelings of depression. She has a grade-12 education. She served as an infanteer for 12 years, including a 6-month tour in Afghanistan. She voluntarily left the CF 3 years earlier at the corporal rank, after developing back and bilateral knee pain. She has been struggling since moving her family “back home” after leaving the CF. She is estranged from her family of origin, misses her “military family,” and feels socially isolated. She has not had a regular family physician since leaving the CF, obtaining prescriptions through walk-in clinics and hospital emergency departments. Owing to pain, she is unable to work in the physically demanding occupations for which she was trained. Her husband believes she should contribute to the family income and says she is irritable and sleeping poorly. She is taking opioid analgesics and a muscle relaxant. With the patient’s consent, the physician obtains her medical service records from the CF. After assessing her symptoms with history, physical examination, and appropriate investigations, he diagnoses chronic mechanical low back pain, bilateral patellofemoral syndrome, and an unclear mental health condition. He arranges referral to a provincially funded pain clinic with a 1-year waiting list and books follow-up visits to review her pain medications. After hearing about the New Veterans Charter programs, he refers her to a Veterans Affairs Canada (VAC) district office to see if she is eligible for the VAC Rehabilitation Program and mental health assessment, and sends a letter describing her history and the reason for referral.