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Am Fam Physician. 2020;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.

Registry namePeriodEligibility by place or conflictWebsite
Agent Orange1960 to 1970sVietnam, Korean Demilitarized Zone, and other select populationshttps://www.publichealth.va.gov/exposures/agentorange/benefits/registry-exam.asp
Airborne Hazards and Open Burn Pit1990 to 2000s to presentOperation 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, 1990https://www.publichealth.va.gov/exposures/burnpits/registry.asp
Depleted Uranium1990 to presentGulf War, Bosnia, Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawnhttps://www.publichealth.va.gov/exposures/depleted_uranium/
Gulf War1990 to 1991; 2000 to presentVeterans who served in the Persian Gulf during Operation Desert Shield, Operation Desert Storm, Operation Iraqi Freedom, or Operation New Dawnhttps://www.publichealth.va.gov/exposures/gulfwar/benefits/registry-exam.asp
Ionizing Radiation1940 to 1960sVeterans who participated near above- and (some) belowground nuclear bomb tests, prisoners of war, and those who served in Japan in World War IIhttps://www.publichealth.va.gov/exposures/radiation/benefits/registry-exam.asp
Toxic Embedded Fragments2000 to presentOperation Enduring Freedom and Operation Iraqi Freedom veterans who have toxic embedded fragments in their bodieshttps://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).

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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