Letters to the Editor

Resources on Environmental Exposures for Military Veterans

 

Am Fam Physician. 2020 Jun 15;101(12):709-710.

Original Article: Care of the Military Veteran: Selected Health Issues

Issue Date: November 1, 2019

See additional reader comments at: https://www.aafp.org/afp/2019/1101/p544.html

To the Editor: The article by Dr. Yedlinsky and colleagues provides an excellent review of health issues affecting military veterans. This letter provides additional resources on environmental exposures, which are a common concern for veterans and family members. One in three veterans who deploy reports definite or probable exposure to environmental hazards,1 and one in four believes that a major health concern has occurred because of the exposure.2 The U.S. Department of Veterans Affairs (VA) offers resources and health registry evaluations, which are outlined at https://www.publichealth.va.gov/exposures/benefits/registry-evaluation.asp.

Environmental health registry evaluations have three main goals: to allow veterans to talk to a clinician about their exposures and possible implications to their health; to assist research; and to facilitate veteran notifications for updates. Registry evaluations are not for compensation or benefit purposes and are not required to submit a claim to the Veterans Benefits Administration.

Participation in the Gulf War, Ionizing Radiation, or Agent Orange registries requires a VA environmental health clinical appointment. Veterans should contact their local VA facility Environmental Health Coordinator to make an appointment (https://www.publichealth.va.gov/exposures/coordinators.asp).

The Airborne Hazards and Open Burn Pit Registry is the fastest growing registry in the VA, with about 500 new participants weekly.

Veterans and service members can join the registry by completing a survey at https://veteran.mobilehealth.va.gov/AHBurnPitRegistry/#page/home. Guidance for completing the survey is available at https://www.publichealth.va.gov/docs/exposures/Registry-Steps.pdf. After completing the survey, an in-person examination is available if necessary.

The Depleted Uranium Follow-up Program and Toxic Embedded Fragment Surveillance Center examinations are managed by the Baltimore VA Medical Center. Veterans interested in either of these programs should contact their local Environmental Health Coordinator. Registry examinations must be completed at a VA facility to capture data so that the VA can assess trends and to support research.

The VA’s War Related Illness and Injury Study Centers specialize in complex veteran care secondary to postdeployment issues and are located in Palo Alto, Calif.; Washington, DC; and East Orange, N.J. (https://www.warrelatedillness.va.gov/). The War Related Illness and Injury Study Center in New Jersey houses the new Airborne Hazards and Burn Pits Center of Excellence.

Veterans may not want to join a registry but may still want to talk to a physician about their exposures. To support community clinicians and family physicians in understanding exposure-related concerns, the VA has developed resources (Table 1), including a five-module curriculum, to aid postdeployment health. Additional recorded webinars are also accessible at https://www.train.org/main/welcome.

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TABLE 1.

Caring for Veterans with Environmental Exposure Concerns

Registry namePeriodEligibility by place or conflictWebsite

Agent Orange

1960 to 1970s

Vietnam, Korean Demilitarized Zone, and other select populations

https://www.publichealth.va.gov/exposures/agentorange/benefits/registry-exam.asp

Airborne Hazards and Open Burn Pit

1990 to 2000s to present

Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn; Djibouti, Africa, on or after September 11, 2001; Operations Desert Shield or Desert Storm; Southwest Asia theater of operations on or after August 2, 1990

https://www.publichealth.va.gov/exposures/burnpits/registry.asp

Depleted Uranium

1990 to present

Gulf War, Bosnia, Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn

https://www.publichealth.va.gov/exposures/depleted_uranium/

Gulf War

1990 to 1991; 2000 to present

Veterans who served in the Persian Gulf during Operation Desert Shield, Operation Desert Storm, Operation Iraqi Freedom, or Operation New Dawn

https://www.publichealth.va.gov/exposures/gulfwar/benefits/registry-exam.asp

Ionizing Radiation

1940 to 1960s

Veterans who participated near above- and (some) belowground nuclear bomb tests, prisoners of war, and those who served in Japan in World War II

https://www.publichealth.va.gov/exposures/radiation/benefits/registry-exam.asp

Toxic Embedded Fragments

2000 to present

Operation Enduring Freedom and Operation Iraqi Freedom veterans who have toxic embedded fragments in their bodies

https://www.publichealth.va.gov/exposures/toxic_fragments/index.asp

Go to train.org for training resources and recorded webinars for the VA/non-VA providers (login required).

War Related Illness & Injury Study Center-Post Deployment Health Services

Airborne Hazards Registry Updates and Outreach Activities

https://www.train.org/main/course/1072391/

Communicating with Veterans on Deployment-Related Exposure Issues

https://www.train.org/main/course/1072414/

Military Culture—Experiences, Reintegration, and Whole Health

https://www.train.org/main/course/1072371/

Post-9/11 Deployment-Related Exposures

https://www.train.org/main/course/1072379/

Pre-9/11 Deployment-Related Exposures

https://www.train.org/main/course/1072415/

Mod 1—Assessing Deployment-Related Environmental Exposures

https://www.train.org/main/course/1070234/

Mod 2—Airborne Hazards

https://www.train.org/main/course/1070422/

Mod 3—Gulf War Illness

https://www.train.org/main/course/1074205/

Mod 4—Chronic Multisymptom Illness (CMI)

https://www.train.org/main/course/1084440/

Mod 5—Depleted Uranium and Toxic Embedded Fragments

https://www.train.org/main/course/1087697/

Go to https://www.publichealth.va.gov/exposures/coordinators.asp to see a directory of Environmental Health Coordinators listed by state and facility.


VA = U.S. Department of Veterans Affairs.

TABLE 1.

Caring for Veterans with Environmental Exposure Concerns

Registry namePeriodEligibility by place or conflictWebsite

Agent Orange

1960 to 1970s

Vietnam, Korean Demilitarized Zone, and other select populations

https://www.publichealth.va.gov/exposures/agentorange/benefits/registry-exam.asp

Airborne Hazards and Open Burn Pit

1990 to 2000s to present

Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn; Djibouti, Africa, on or after September 11, 2001; Operations Desert Shield or Desert Storm; Southwest Asia theater of operations on or after August 2, 1990

https://www.publichealth.va.gov/exposures/burnpits/registry.asp

Depleted Uranium

1990 to present

Gulf War, Bosnia, Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn

https://www.publichealth.va.gov/exposures/depleted_uranium/

Gulf War

1990 to 1991; 2000 to present

Veterans who served in the Persian Gulf during Operation Desert Shield, Operation Desert Storm, Operation Iraqi Freedom, or Operation New Dawn

https://www.publichealth.va.gov/exposures/gulfwar/benefits/registry-exam.asp

Ionizing Radiation

1940 to 1960s

Veterans who participated near above- and (some) belowground nuclear bomb tests, prisoners of war, and those who served in Japan in World War II

https://www.publichealth.va.gov/exposures/radiation/benefits/registry-exam.asp

Toxic Embedded Fragments

2000 to present

Operation Enduring Freedom and Operation Iraqi Freedom veterans who have toxic embedded fragments in their bodies

https://www.publichealth.va.gov/exposures/toxic_fragments/index.asp

Go to train.org for training resources and recorded webinars for the VA/non-VA providers (login required).

War Related Illness & Injury Study Center-Post Deployment Health Services

Airborne Hazards Registry Updates and Outreach Activities

https://www.train.org/main/course/1072391/

Communicating with Veterans on Deployment-Related Exposure Issues

https://www.train.org/main/course/1072414/

Military Culture—Experiences, Reintegration, and Whole Health

https://www.train.org/main/course/1072371/

Post-9/11 Deployment-Related Exposures

https://www.train.org/main/course/1072379/

Pre-9/11 Deployment-Related Exposures

https://www.train.org/main/course/1072415/

Mod 1—Assessing Deployment-Related Environmental Exposures

https://www.train.org/main/course/1070234/

Mod 2—Airborne Hazards

https://www.train.org/main/course/1070422/

Mod 3—Gulf War Illness

https://www.train.org/main/course/1074205/

Mod 4—Chronic Multisymptom Illness (CMI)

https://www.train.org/main/course/1084440/

Mod 5—Depleted Uranium and Toxic Embedded Fragments

https://www.train.org/main/course/1087697/

Go to https://www.publichealth.va.gov/exposures/coordinators.asp to see a directory of Environmental Health Coordinators listed by state and facility.


VA = U.S. Department of Veterans Affairs.

Author disclosure: No relevant financial affiliations.

References

1. Westat. National survey of veterans, active duty service members, demobilized National Guard and Reserve members, family members, and surviving spouses. Contract GS-23F-8144H, Task Order 101-G87089. October 8, 2010. Accessed December 4, 2019. https://www.va.gov/SURVIVORS/docs/NVSSurveyFinalWeightedReport.pdf

2. Armed Forces Health Surveillance Center, Naval Health Research Center, U.S. Army Public Health Command (Provisional). Epidemiological studies of health outcomes among troops deployed to burn pit sites. May 2010. Accessed December 4, 2019. https://www.vetshq.com/wp-content/blogs.dir/files/sites/11/2013/10/Epidemiological-Studies-of-Health-Outcomes-Among-Troops-Deployed-to-Burn-Pit-Sites.pdf

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