I N T R O D U C T I O N The Nature of War Is Changing; Medical Care Advances to Meet the Challenges 2 0 2 6 C O M P E N D I U M O F F E D E R A L M E D I C I N E 1 Brenda L. Mooney Editorial Director, U.S. Medicine The DoD hasn’t shared much information, and the news coverage has been spotty, but we now know that, as of May 2026, about 400 U.S. military personnel had been injured in the war with Iran, which began at the end of February. Sadly, 13 died. Most of the injuries were from Iranian drone and missile strikes targeting U.S. bases in the Middle East. Those include shrapnel wounds, burns, and traumatic brain inju- ries (TBIs). Of course, battlefield medicine as practiced by U.S. military clinicians is amazing, and many of the injured already had returned to duty by mid-May, accord- ing to reports. Still, if past history is any indication, we likely will be talking and writing about some of these injured service- members – as well as others whose adverse effects will show up in the longer term – a half-century from now. The last decades have taught us an important lesson: Immediate injuries suffered during a war are only part of the story. For example, the Vietnam War officially ended in 1973, 53 years ago, but thousands of U.S. veterans are still being treated for illnesses, especially cancer, presumed to be related to exposure to Agent Orange, the defoliant widely used during that conflict. The Gulf War ended in 1991, 35 years ago, but as many as 250,000 patients under VA care still suffer from so-called Gulf War Illness (GWI), a chronic, multi-system condition. Veterans who served in Afghanistan and Iraq following the 9/11 terror- ist attack make up a growing number of the million veter- ans the VA treats for pulmonary issues, although evidence is still emerging on connections to military service. It is obvious that war has changed, and some pundits have even suggested that the burden of veteran care will likely be reduced as fewer servicemembers are directly in the line of fire. We now use drones and targeted strikes and technology to wage war without always endangering individual warfighters, they argue, and the use of individ- ual combatants is much more limited and strategic. I respectfully disagree that deployed military person- nel have to be on the frontlines to suffer health conse- quences. Many of the patients the VA treats for traumatic brain injury (TBI) received during the 1990s conflicts weren’t on top of explosive devices in war zones but around 33 feet away. Toxic exposures linked to a range of cancer types most often came from defoliants like Agent Orange, fumes from burn pits or even contaminated water at military bases, not illegal poisonous gas used by the enemy. Deployment itself has been connected to a range of mental health issues and problems in managing pain. And, even the recently injured servicemembers were protecting their own military bases when they took a hit, not on a battlefield. As the nature of war changes, so does the knowledge required to provide optimal care to U.S. military servicemembers and veter- ans. That is why the DoD and the VA -- and the deep insights of their clinicians and researchers -- are more important than ever. The articles in the 2026 Compendium of Federal Medicine don’t just demonstrate how medical care for ser- vicemembers is being altered but how that care is advanc- ing and improving. Even in a high-pressure environment with staff shortages and financial cutbacks, medical professionals are finding new ways to provide cutting- edge care. Examples include survival-extending therapies now available for blood cancers like chronic lymphocytic leu- kemia, multiple myeloma, as well as an array of B-cell lymphomas. Innovation also continues in treatment of solid tumor malignancies such as lung cancer, prostate cancer and anal cancer. Other Compendium articles elucidate the efforts to improve quality of life for veterans with neurological con- ditions like Parkinson’s disease and ALS. As with most healthcare systems, VHA and MHS continue a strong focus on managing chronic conditions, from promoting better prescribing for depression to treat- ing unique types of high-cholesterol, combating obesity in a growing number of servicemembers and identifying optimal therapies for eczema. Especially with a large patient population 65 and older with many co-morbidities, the VA also makes a concerted effort to help prevent seasonal infections such as respira- tory syncytial virus (RSV) and COVID-19. And an important review offers an update on the opioid epidemic, which has been a perennial challenge in federal medicine. We reveal that it’s improved but not resolved. Writing on behalf of the entire team at U.S. Medicine, we hope you find the articles interesting and useful in improving your patients’ care. It is clear to us that, while warfare might be changing, the commitment of federal medicine health professionals is not.
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