How military service affects the health of veterans

Between 1939 and 1945, over 200,000 New Zealanders served in the armed forces with over 140,000 of those serving overseas in every theatre of the conflict. Only between 600 to 1000 Second World War veterans remain. Most of these veterans are known to Veterans' Affairs, but not all. 

Second World War veterans are now aged in their 90s, with some over 100 years old. They have all the problems we expect to see in people of their age, and many of these problems may either have their origins in their service or have been exacerbated by it.

Conditions can be associated with service but may not be recognised as such by either the veteran, their family, or their health care providers, including:

• ischaemic heart disease
• osteoarthritis
• diabetes
• psychological disorders — including dementia.

In June 1950, the Democratic People's Republic of Korea invaded the Republic of Korea. A US-led United Nations response resulted in the deployment of approximately 4,300 New Zealanders to the peninsula between 1950 and 1957, with a further 1,300 deployed offshore on RNZN frigates.

The Korean War was a bitter conflict fought, often at close quarters, in a hostile and physically challenging environment. The conditions in which the Korean War veterans fought were as arduous as those experienced less than a decade before in the Second World War.

The combination of these conditions and the constant threat of trauma contributed to a significant number of Korean War veterans with both physical and psychological conditions associated with service.

Like their Second World War comrades, the Korean War veterans are now an elderly population with the proliferation of age-related conditions expected in their cohort.

Some of these conditions are ubiquitous in service populations, while many may have been caused or exacerbated by service:

• Noise Induced Hearing Loss (NIHL)
• Ischaemic heart disease
• osteoarthritis
• diabetes
• psychological disorders, including dementia.

The Malayan Emergency was declared in 1948 in response to communist insurgency in Malaya threatening the post-war stability of the peninsula.

New Zealand became involved in 1949 and maintained forces of varying size on the peninsula between 1949 and 1966, including involvement in the following:

• Malayan Emergency
• Indonesian Confrontation
• Malay / Thai border.

In that time, approximately 4,000 NZ service people served in Malaya and Borneo.

Unlike the Korean War, these were counterinsurgency campaigns fought in the dense jungles of Southeast Asia. New Zealand service people would later experience similar conditions in Viet Nam.

Use of defoliants

The British military carried out a programme of jungle and crop defoliation in Malaya between 1952 and 1954. This involved using the sprayed defoliant Trioxone — a chemical structurally similar to the chemicals used in Agent Orange.

It is possible that some New Zealand service personnel deployed to Malaya during this period were exposed to these chemicals.

If a veteran with service in Malaya presents with any of the conditions identified as Conclusively Presumed Conditions for Viet Nam veterans, they should be encouraged to register a claim with us.

Conclusively Presumed Conditions for Viet Nam veterans include:

• Acute & Sub Acute Peripheral Neuropathy
• AL Type Amyloidosis
• Chloracne
• CLL
• Hodgkins disease
• Hypertension
• Ischaemic Heart Disease
• Malignant Neoplasm of the Prostate
• Multiple Myeloma
• Non Hodgkins Lymphoma
• Parkinson’s Disease
• Porphyria Cutanea Tarda
• Respiratory Tract Malignancies
• Soft Tissue Sarcoma
• CVA / TIA
• Type II Diabetes

List of Conclusively Presumed Conditions

More than 3,000 New Zealand civilian and military personnel were deployed to Viet Nam between 1963 and 1975. New Zealand committed combat troops in 1965.

Between 1965 and 1973, NZ deployed an artillery battery (161 Battery) and two infantry companies (V and W companies) along with supporting units, including RNZAF aircraft and crew, to the conflict. Smaller non-combat commitments, including a civilian surgical team and engineers, preceded the combat deployment and continued throughout the period of involvement.

Of the several thousand personnel who deployed to Viet Nam, the majority are now aged in their 70s or older. Like Malaya, the Viet Nam conflict was predominantly a jungle counter-insurgency campaign dominated by mobile light infantry. The training for these and supporting roles was intense, and the physical loads borne by those deployed were often immense. This is reflected in the almost ubiquitous incidence of chronic degenerative musculoskeletal conditions in these veterans. Similarly, unprotected exposure to harmful noise was common in both training and deployment, and noise-induced hearing loss occurs in many, if not most, Viet Nam veterans.

The Viet Nam veteran cohort appears to be a relatively healthy group. However, as they age and the size of their population inevitably decreases, problems such as loneliness and social isolation may become increasingly prevalent.

A relatively large number of Viet Nam veterans continue to smoke compared to the same non-veteran demographic. The reasons for this aren’t clear, but when caring for Viet Nam veterans, it may be useful in focussing interventions.

Similarly, an awareness of the nature of the veteran's experience, including the social status of Viet Nam veterans following their return and the possibilities of exposure to trauma, may allow for the early identification and treatment of conditions more prevalent in an aging veteran population.

Use of defoliants

The US military engaged in a programme of jungle deforestation using a number of chemicals that were subsequently found to be toxic — collectively described as 'Agent Orange'

Since then, significant research has been conducted into the potential harmful effects of exposure to these chemicals. This has identified a number of related conditions. 

These conditions are reflected in the list of Conclusively Presumed Conditions relating to all Viet Nam Veterans. If these conditions occur in Viet Nam veterans, they will be automatically accepted as service-related. They include:

• Acute & Sub Acute Peripheral Neuropathy
• AL Type Amyloidosis
• Chloracne
• CLL
• Hodgkins disease
• Hypertension
• Ischaemic Heart Disease
• Malignant Neoplasm of the Prostate
• Multiple Myeloma
• Non Hodgkins Lymphoma
• Parkinson’s Disease
• Porphyria Cutanea Tarda
• Respiratory Tract Malignancies
• Soft Tissue Sarcoma
• CVA / TIA
• Type II Diabetes

New Zealand deployed approximately 1,000 service people to peacekeeping in the former republic of Yugoslavia between 1992 and 2007, including the first company-sized infantry deployments since Viet Nam between September 1994 and December 1995.

New Zealand personnel were exposed to the numerous atrocities inflicted on both combatants and non-combatants during this period. Some will have a long-term risk of trauma-related psychological disorders.

The nature of conflict in a modern peacekeeping environment differs from that experienced by the generations of veterans that preceded them. With a mandate requiring strict neutrality and stringent rules of engagement, the psychological strain of dealing with individuals and communities not only hostile to each other but also sometimes to the peacekeepers themselves can take a psychological toll on the veteran. This can contribute to difficulties transitioning back to a ‘peacetime’ defence force and society.

Gulf War syndrome

New Zealand deployed over a hundred personnel in support of US-led forces responding to the invasion of Kuwait in 1992.

Veterans of this conflict, particularly US veterans, reported an increase in unexplained complex conditions affecting multiple systems. This became known as 'Gulf War Syndrome' and is now recognised as a complaint affecting not just Gulf War veterans but veterans of other conflicts as well.

The Veterans' Support Regulations 2014 recognise Gulf War syndrome as a Conclusively Presumed condition in Gulf War veterans.

Gulf War veterans who have experienced 6 months or more of:

• medically unexplained chronic multi-symptom illnesses
• chronic fatigue syndrome
• fibromyalgia
• Irritable bowel syndrome

Or signs or symptoms of an undiagnosed illness that include:

• fatigue
• skin symptoms
• headaches
• muscle pain
• joint pain
• neurological symptoms
• respiratory symptoms
• sleep disturbance
• gastro-intestinal symptoms
• cardiovascular symptoms
• weight loss
• menstrual disorders.

Other veterans with similar symptoms may claim for Chronic Multisymptom Illness as it is codified in the Australian Repatriation Medical Authority Statement of Principles.

Australian Repatriation Medical Authority Statement of Principles(external link)(external link)

In August 1999, following a UN-sponsored referendum, Timor-Leste claimed independence from Indonesia. Pro-Indonesian militia supported by the Indonesian Military responded with brutal retaliation, including massacres of Timorese civilians and mass destruction of property.

In September 1999, New Zealand, with Australia, responded to a request from the United Nations for peacekeeping forces. By October, New Zealand had deployed 1,100 service people to the region, including land forces, airframes and support personnel, and 3 RNZN vessels. This was the largest deployment of NZDF personnel since the Korean War.

By the end of New Zealand’s commitment to Timor-Leste in 2018, approximately 6,500 personnel had served in the region.

Personnel serving in the early missions to Timor-Leste were witnesses to the destruction and atrocities performed by the militias. The early period was also marked by the risk of armed contact with both the Indonesian military and militias. This included the first combat death of a New Zealand service person since Viet Nam. For some, this has had lasting consequences, with long-term psychological harm.

Patrolling in dense jungle continued throughout the mission. Most Timor-Leste veterans are now in their 40’s, and the physical strains of the task and the environment will contribute to an increased likelihood of musculoskeletal conditions as these veterans age.

Following the overthrow of the ruling Taliban in 2001, the new Afghan government was supported in the establishment of democracy and the reconstruction of a country impacted by decades of war by the militaries of the US and other allies.

Between 2003 and 2013, New Zealand deployed approximately 1,300 service people to the Provincial Reconstruction Team in Bamiyan, Afghanistan.

The decade-long deployment was marked by increasing risk to the deployed personnel as the efforts to support the Afghan government were met by increasing resistance from the Taliban. Ultimately, this culminated in the combat deaths of 8 service people, including New Zealand’s first female combat casualty since Viet Nam.

For some, these experiences have resulted in life-changing physical injury and long-term psychological impacts. Some of these impacts may only become apparent as these veterans age. The nature of modern deployments, though different from previous missions and conflicts, creates new problems for veterans. The impacts of social isolation and the psychological and social impacts of deployment to complex social and political conflicts are part of an ongoing investigation of the effects modern service has had on veterans.

Following the end of the Second World War, New Zealand deployed approximately 12,000 service people to Japan, including the deployment of two RNZN vessels — HMNZS Achilles and HMNZS Hawera. The government’s intent was for this to be a wholly volunteer force. However, the first draft of 4,000 personnel was conscripted from drafts of replacements for New Zealand Forces in Europe.

The force was deployed in southern Honshu, including the city of Hiroshima, which was destroyed by the first of the nuclear weapons used by the United States of America in 1945.

The last of Jayforce returned home by the end of 1948. However, this arduous service wasn’t recognised as wartime service. Jayforce veterans were ineligible to join the RSA or receive war pensions until 1964.

Between May 1957 to September 1958, the UK performed a series of nuclear tests on Christmas Island with yields between 24 kT and 240 mT.

New Zealand deployed the RNZN vessels HMNZS Pukaki and HMNZS Rotoiti to observe these tests.

The third labour government under Norman Kirk protested continuing French nuclear testing in the Pacific by deploying two New Zealand frigates to the area. The crews of HMNZS Otago witnessed the detonation of a device on 21 July 1973 and those of HMNZS Canterbury on 28 July.

While the yield of these devices was relatively low and the risk of irradiation of the vessels and crew was unlikely, there remains considerable concern for the wellbeing of these veterans.