Veteran's Day is Nov. 11, 2021. It's a time to express our gratitude to the women and men who have proudly served in the military to preserve our freedoms.

For many Americans, the holiday can mean a parade down Main Street or a day of shopping Veteran's Day sales. But for millions of veterans, it can be another day struggling with a serious health issue tied to their service.

There are more than 18 million U.S. veterans and that population grows by 200,000 each year. The irony of veteran health is that upon entering service, most are at the peak of health and fitness; however, after leaving the service some veterans can face a myriad of health issues such as post-traumatic stress disorder (PTSD), the effects of traumatic brain injury (TBI), musculoskeletal injuries, mental health challenges, and illnesses as a result of environmental exposure. In addition, when compared to the enlisted population, veterans are more likely to report higher incidences of alcohol and tobacco use, diabetes and chronic disease. COVID-19 has also uniquely impacted the health of veterans. Veterans may worry about getting COVID, feel the effects of isolation or face increased family demands. For veterans with PTSD, worry about the pandemic can have an impact on the symptoms of PTSD or trigger PTSD.

Veteran health issues are complex and they are driven by many factors including age, race, gender, if the veteran saw combat or not, the geographic location where the veteran served, and the conflict itself. For example, according to the U.S. Census' 2019 American Community Survey, those who served in the past 20 years, post 9/11, have a 43% chance of having a disability connected to their time in the military.

Veteran statistics on PTSD vary based on the era in which the veteran may have served. Eleven-to-20% of Operations Iraqi Freedom and Enduring Freedom have PTSD in a given year. Gulf War veterans, 12%, and it's estimated as high as 30% of Vietnam veterans have had PTSD in their lifetime.

Each veteran's health profile is unique. Working as a team with the individual, health-care providers can devise a strategy to meet the patient's health needs.

To help veterans live their best lives and improve their health, we take an approach of healthy living practices and prevention. The U.S. Veterans Administration offers the following evidence-based recommendations:

• Get high-quality sleep each night and seek help for sleep difficulties.
• Keep your recommended screenings and immunizations up-to-date.
• Be active in your healthcare and work with your health-care team to meet your specific needs.
• Manage stress.
• Cut out tobacco use.
• Limit alcohol use.
• Take measures to protect yourself and family from harm and injury, including self-harm or domestic abuse.
• Maintain a healthy weight and eat right.
• Stay physically active.

Veterans Day is a day to honor those who answered the call. And it can also be used as a reminder to our veterans that help is out there, whether their wounds are physical or in the form of mental health challenges, or both. If you are a veteran or take care of someone who served, it's important to take an active role in your health with your health care provider.

Most importantly, if you are a veteran and are experiencing increased stress due to the pandemic and need immediate help, there are crisis resources available at cdc.gov/mentalhealth/stress-coping/veterans-support.

Dr. Jennifer Ziouras is the senior medical director for Optum Care Network of Colorado