Caring for Those Who Serve: A Brief History of Veterans Affairs Research

Throughout its history, the government of the United States has traditionally expanded services to veterans after the outbreak of a major conflict. Whereas individual states initially carried the majority of the burden of caring for wounded soldiers, the federal government has gradually expanded its responsibility in this arena. During the Revolutionary War, disabled soldiers received pensions from the Continental Congress (although Congress did not have money to provide for many of them); however, hospital medical care was the responsibility of an individual soldier’s home state. During the Civil War, some states began to establish centers specifically designed to care for the large number of wounded soldiers returning home from the battlefield. In 1865, the National Home for Disabled Soldiers was founded by Congress to care for wounded Union soldiers (Confederate soldiers were not eligible for federal benefits until 1958).

It was not until World War I that the federal government began to formally administer a full benefits system for veterans, and it initially did so through three agencies scattered among a few different federal cabinet departments. In 1930, the activities of these agencies were combined to form the Veterans Administration. Throughout the next 50 years, each major conflict the United States engaged in resulted in an expansion of benefits for veterans after the war. Increasing federal responsibility for the care of wounded veterans led in 1989 to the creation of the Department of Veterans Affairs, a cabinet-level agency, which continues to expand today with the influx of new veterans from the wars in Iraq and Afghanistan. Swelled by these recent conflicts, and by the baby boomer generation cohort of veterans who are now advancing in age and increasingly consuming medical care, the VA system has greatly expanded to become a significant provider of medical care in the nation (Table 1).

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The VA’s office of research and development is today one of this government’s health care research entities, along with the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality. However, the relationship between the VA and the NIH remains collaborative rather than competitive, inasmuch as the NIH is the most prominent source of additional funding for VA investigators.

In addition to NIH funds, the VA Research and Development Program received $590 million in congressional appropriations in 2011, with 90 percent of the funds going to support investigator-initiated research (1). VA hospitals are an idea forum for conducting research projects because the VA system has leading researchers on staff and the physical facilities to conduct long-term research projects. Of the 153 medical centers in the VA system, 116 have the capacity to conduct research.

Knowledge about the causes and treatment of kidney disease has greatly benefited from research performed at the Department of Veterans Affairs facilities. Annually, 7500 articles based on VA-sponsored research are published (1), many of which have an effect on the causes and progression of kidney disease. In 1970, one such published study was the VA Cooperative Study on Hypertension, which demonstrated the effectiveness of drug treatment in controlling blood pressure (1). Reducing hypertension, a major risk factor for kidney disease, through medication has undoubtedly reduced the number of Americans with kidney disease in the past 40 years. Clinical trials are currently under way to determine the efficacy of an automated wearable artificial kidney that was developed by researchers at the VA Research and Development Program. The device could hold significant hope for dialysis patients because it would allow additional freedom of movement by eliminating the need for stationary dialysis machines by some patients.

In recognition of the past, present, and future contributions of the VA Research and Development Program to kidney disease research, the ASN made certain to include representatives from the VA research program in the recently formed ASN Research Advocacy Committee (RAC). Linda F. Fried MD, FASN, a member of the RAC and an associate professor of medicine and epidemiology in the VA health care system in Pittsburgh, sums up the VA program’s contribution: “The VA has become a major research partner in studying the causes of and treatment for kidney disease. I have no doubt VA researchers will play a pivotal role in the next major breakthrough for patients suffering from the disease.”

Reference

1. VA Research and Development Program, State of VA Research 2011