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MILITARY
EXPOSURES &
YOUR HEALTH
INFORMATION FOR VETERANS WHO SERVED DURING
THE GULF WAR ERA (1990-PRESENT) AND THEIR FAMILIES
2020 ISSUE #2
INTRODUCTION
Welcome to “Military Exposures & Your Health,” a biannual newsletter for Veterans who served from 1990 to the present. This
issue highlights Sergeant Major Brian Davis, a Veteran with an impressive military career and experience with environmental
health registries. This issue also presents Dr. Anisa Moore, an Environmental Health Clinician who has personally conducted
almost 300 Airborne Hazards and Open Burn Pit Registry health exams through February 2020. In addition, you will find
information about garrison exposures and health effects, an update on work on developing a single case definition for Gulf
War illness, news on research findings, and more. You can find issues of “Military Exposures & Your Health” at https://www.
publichealth.va.gov/exposures/meyh/publications/index.asp.
At the time of publication of this newsletter, the Coronavirus (COVID-19) has been affecting the nation. VA is committed
to the health and safety of Veterans. During this pandemic, environmental health registry evaluations are deferred or
offered via telehealth, depending on the location. Read the latest information on the Coronavirus (COVID-19) at:
https://www.va.gov/coronavirus/
IN THIS ISSUE an updated summary of self-reported health information
from the Airborne Hazards and Open Burn Pit Registry. Page 6
What is a registry? VA offers a registry for you
VA conducts research to develop a single case definition
Learn about registries, including VA’s six environmental
for Gulf War Illness VA is conducting studies and analyzing
health registries. Page 2
data in an effort to develop a single case definition for Gulf
Sergeant Major Brian Davis – Seventeen deployments and War illness. Page 6
eligibility for three registries Sergeant Major Brian Davis has
Golden VA clinic in Colorado excels in completing Airborne
had an impressive military career in the Army. He has joined
Hazards and Open Burn Pit Registry medical exams VA’s
environmental health registries related to his service. Page 3
Post Deployment Health Services interviewed Anisa Moore,
VA and DOD - Working to encourage registry awareness MD, about Airborne Hazards and Open Burn Pit Registry
and enrollment VA and DoD are planning focus groups, health exams and her experience conducting them. Page 7
meetings, and more to increase awareness and encourage
The French Veterans’ Health Observatory - Addressing
enrollment in the Airborne Hazards and Open Burn Pit
military exposure concerns in France The French Veterans’
Registry. Page 4
Health Observatory focuses on the health risks associated
Gulf War Presumptions - VA presumes service connection with environmental exposures among the French military
and provides disability payments and health care benefits community. Page 8
for certain medically unexplained illnesses and infectious
DOD identifies Veterans potentially exposed to chemical
diseases. Page 4
warfare agents Some Veterans were exposed to chemical
Epidemiology program research highlight: Risk of warfare agents while handling or demolishing explosive
mortality among Veterans with service In Bosnia/Kosovo ordinance during Operation Iraqi Freedom or Operation New
Researchers studied the cause-specific mortality risks Dawn. Page 8
among Veterans who deployed to Bosnia/Kosovo as part of
VA researchers find Gulf War-Era Veterans’ health is worse
peacekeeping forces. Page 5
among females compared to males Researchers compared
WRIISC research highlight: Study sheds light on what Gulf health problems among male and female Gulf War-era
War Veterans want to hear from their provider Researchers Veterans. Page 9
studied communication from health care providers to
Garrison exposures and health concerns Veterans may
Veterans with Gulf War illness. Page 5
have concerns about health effects from garrison exposures,
Airborne Hazards And Open Burn Pit Registry: Summaries which are environmental exposures that may have been
of data available on the web Every six months, VA publishes experienced while stationed on a military base. Page 10
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 1
WHAT IS A REGISTRY? VA The Airborne Hazards and Open Burn Pit Registry
OFFERS A REGISTRY FOR YOU For each person who completes the registry, the actual exposure
A registry is defined as a system experience will be different. This depends on which military
for collecting and maintaining, in a base they lived, which year, local air pollution levels, activity, and
structured record, data on specific prevailing weather conditions. The disease outcomes in the registry
persons from a defined population, also vary. Currently, there are 55 broad disease categories in which
which allows for preliminary research participants have self-reported. One of these broad categories
analyses and reviews. Two broad is cancer, of which 29 different types have been reported. Learn
categories of health registries are more9 about findings about reported exposures and health
disease-based registries and exposure- conditions from the registry.
based registries. A disease-based
registry organizes data based on the airborne hazards-related illnesses can be Veterans who are interested in
cases of a specific disease or condition, caused by ambient air pollution, smoke, joining a registry should contact an
while an exposure registry organizes dust from the desert environment, or Environmental Health Coordinator7 near
data based on people who have had emissions from substances incinerated them. Find more information about
a common exposure. For example, a in burn pits. registries8 from VA’s Post Deployment
disease-based registry would focus on Health Services.
cases of multiple sclerosis or cancer, Registries have several advantages.
while the registry for the World Trade Participants who join and give their ARTICLE LINKS:
Center 9/11 workers is an exposure contact information provide a way for VA 1.https://www.publichealth.va.gov/
registry. to reach them with updates. Registries exposures/burnpits/registry.asp
VA’s Post Deployment Health Services can also be tools for surveillance.
oversees six exposure registries, also Individuals within the registry can be 2.https://www.publichealth.va.gov/
called environmental health registries. tracked and monitored for health trends exposures/gulfwar/benefits/
Veterans who have served since 1990 within the group. Registries can also registry-exam.asp
may be eligible for the four following generate ideas (hypotheses) for research
registries: on associations between exposures and 3.https://www.publichealth.va.gov/
disease. exposures/depleted_uranium/followup_
• The Airborne Hazards and Open
program.asp
Burn Pit Registry1 Self-reported registries, however,
• The Gulf War Registry 2 have limitations. They are subject to 4.https://www.publichealth.va.gov/
recall bias (misremembering), as the exposures/toxic_fragments/index.asp
• The Depleted Uranium Follow-Up deployment events may have happened
Program3 over a decade ago. Self-reported 5.https://www.publichealth.va.gov/
• The Toxic Embedded Fragment registries also tend to be self-selecting, exposures/agentorange/benefits/
Surveillance Center 4 meaning some types of people may registry-exam.asp
Veterans who served before 1990 may be more motivated to participate
be eligible for one of the other two than others. For example, those with 6.https://www.publichealth.va.gov/
registries offered by Post Deployment significant health issues may be more exposures/radiation/benefits/
Health Services: likely to participate compared those registry-exam.asp
who consider themselves healthy, and
• The Agent Orange Registry5 so the registry data may not represent 7.https://www.publichealth.va.gov/
the actual health of the population. exposures/coordinators.asp
• The Ionizing Radiation Registry6
Also, registry information can be
The Depleted Uranium Follow-Up used in research studies but are not 8.https://www.publichealth.va.gov/
Program, Toxic Embedded Fragment usually studies in themselves. Finally, exposures/benefits/registry-evaluation.
Surveillance Center, Ionizing Radiation participation in a registry does not asp
Registry, and Agent Orange Registry are suffice for a compensation and pension
for specific exposures, while the Gulf examination. One does not need to 9.https://www.publichealth.va.gov/
War Registry and Airborne Hazards and enter a registry to put in a compensation docs/exposures/va-ahobp-registry-data-
Open Burn Pit Registry address a broad claim. report-dec2019.pdf
spectrum of exposures. For example,
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 2
SERGEANT MAJOR BRIAN preliminary paperwork with help from
his wife. “It was easy to do everything.
On his last deployment, Davis was on a
convoy on top of a mountain, leading
DAVIS – SEVENTEEN I had a phone call to let me know what his men in a daylight raid. His vehicle
DEPLOYMENTS AND was going on.” was on top of an IED pressure plate,
and the IED exploded 12 feet from his
ELIGIBILITY FOR THREE The Depleted Uranium Follow-Up vehicle’s window. The pressure blinded
program screens and monitors Veterans
REGISTRIES for health problems associated with
him, and Davis was no longer able to
stay in the military.
Sergeant Major Brian Davis has had exposure to depleted uranium. Through
an impressive military career, having the program, Davis learned about “Now I just see the world through
served in the Army since graduating options for more in-depth testing, a different senses,” said Davis. “I get great
high school in 1989. He completed 16 chance to be a part of research studies, treatment from VA. I’ve had a great
deployments in 28 years, beginning his and treatment options. career, and I loved it.”
service as a sniper in Panama with the
Army Rangers and ending when he lost He also signed up for the Gulf War ARTICLE LINKS:
his vision during his 17th deployment to Registry in 1993 and saw a primary care 1. https://www.publichealth.va.gov/
Afghanistan on Thanksgiving Day, 2017. doctor as a part of the process. The Gulf exposures/gulfwar/benefits/registry-exam.
War registry includes an exposure and asp
To help address his health concerns, medical history and a physical exam. It
Davis joined the Gulf War Registry1 is for Veterans who served in the Gulf 2.https://www.publichealth.va.gov/
and the Depleted Uranium Follow-Up during Operations Desert Shield, Desert exposures/depleted_uranium/followup_
Program2. Both Environmental Health Storm, Iraqi Freedom, or New Dawn. program.asp
Registry programs are related to his
service and can provide information on Davis also plans to join the Airborne 3.https://www.publichealth.va.gov/
how his health conditions are related to Hazards and Open Burn Pit Registry4. As exposures/depleted_uranium/index.asp
exposures. a part of his service near Baghdad, he
was involved in burning trash, including 4.https://www.publichealth.va.gov/
Davis was wounded by shrapnel human waste and uniforms dipped in exposures/burnpits/registry.asp
containing depleted uranium3 while DEET to keep off sand flies.
serving in the 1990-1991 Gulf War. He “You had to stir it to keep it
was riding atop an armored personnel burning. The smell came up.
carrier because there wasn’t enough You put on a bandana, but
room for him inside the vehicle. Two still, the wind blew, and your
duffle bags were propped on either face would get black smut.”
side of him to keep him from falling off
the vehicle. During the journey, an M1 Veterans with service in
Abrams battle tank next to his vehicle the Southwest Asia theater
ran over a mine. of operations at any time
on or after August 2, 1990,
One hundred and twenty-one pieces of or Afghanistan or Djibouti
shrapnel from the tank armor blasted on or after September 11,
into Davis’s body. “The depleted 2001, can participate in
uranium was from the side of metal, the the Airborne Hazards and
armor on the M1 Abrams tank,” he said. Open Burn Pit Registry.
All the shrapnel was removed except for This registry includes an
three pieces, which were too close to online questionnaire and an
Davis’s liver and spine for safe removal in-person health exam.
and are regularly monitored by VA.
Davis also served in Somalia
“The duffle bags saved me,” said Davis. in 1993 as an Army ranger,
where he was shot in the
Davis signed up to participate in the
shoulder, and in Bosnia and
Depleted Uranium Follow-Up Program
Rwanda.
after he left the military. He filled out the
Sergeant Major Brian Davis
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 3
VA AND DOD - WORKING • VA and DoD staff met with GULF WAR PRESUMPTIONS
Veterans Service Organization
TO ENCOURAGE REGISTRY (VSO) representatives, including For Veterans who served in Southwest
AWARENESS AND representatives from the Iraq and Asia from August 2, 1990 to the present,
VA presumes service connection and
Afghanistan Veterans of America,
ENROLLMENT Disabled American Veterans, the provides disability payments and health
VA and the Department of Defense Wounded Warrior Project, and care benefits for certain medically
(DoD) have been working to increase Veterans of Foreign Wars, in October unexplained illnesses and infectious
awareness of and encourage enrollment 2019. Together, they discussed diseases.
in the Airborne Hazards and Open Burn the AHOBPR, including a registry
The following medically unexplained
Pit Registry1 (AHOBPR). overview and progress report,
illnesses potentially qualify as
benefits, and communications
presumptive conditions:
• VA is planning multiple focus efforts from VA and DoD.
groups across the U.S. to better • Chronic Fatigue Syndrome
understand Veterans’ and service • Fibromyalgia
members’ familiarity with the • VA and DoD hold the Airborne
Hazards Symposium, an annual • Functional gastrointestinal disorders
AHOBPR and barriers or facilitators
to participation. The focus meeting to discuss clinical care, • Undiagnosed illnesses, including
group sessions will also aim to surveillance, education and abnormal weight loss, headache,
generate ideas on messaging and outreach, and research on airborne and fatigue
distribution channels to promote hazards and the AHOBPR. The
Nine infectious diseases1 potentially
the registry. The focus groups will symposium includes subject
qualify as presumptive conditions (many
be invitation-only to ensure all matter experts from VA and DoD
must occur within a year of deployment):
potential audiences are represented and representatives from VSOs
and will include Veterans and active to provide insight on the needs • Malaria
duty or Reservist service members of Veterans. The symposium is
• Brucellosis
representing all military branches. not open to the public because
experts discuss internal processes • Campylobacter Jejuni
• DoD sent an electronic notification and in-progress research among • Coxiella Burnetii (Q Fever)
encouraging active duty service VA and DoD to improve care,
• Nontyphoid Salmonella
members to participate in the communication, and research for
AHOPBR in its August 2019 Veterans and service members. • Shigella
“Leave and Earnings Statement” • West Nile Virus
notification. This effort resulted in ARTICLE LINKS:
1.https://www.publichealth.va.gov/ • Visceral Leishmaniasis
a spike in the number of registry
participants in late August. exposures/burnpits/registry.asp • Mycobacterium Tuberculosis
VA provides additional information
about Gulf War Veterans’ illnesses2 and
about qualifying for benefits3.
ARTICLE LINKS:
1.https://www.publichealth.va.gov/
exposures/gulfwar/infectious_diseases.asp
2.https://www.publichealth.va.gov/
exposures/gulfwar/index.asp
3.https://www.publichealth.va.gov/
exposures/gulfwar/medically-
unexplained-illness.asp
A parked helicopter as a sandstorm passes by
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 4
EPIDEMIOLOGY PROGRAM
RESEARCH HIGHLIGHT: RISK
OF MORTALITY AMONG
VETERANS WITH SERVICE IN
BOSNIA/KOSOVO
Researchers from VA’s Epidemiology
Program, Post Deployment Health
Services, studied the cause-specific
mortality risks among Veterans who
deployed to Bosnia/Kosovo as a part
of peacekeeping forces between
1996-2002. The study focused on
causes of death found to be of concern
in studies of military personnel from Mostar Bridge, Bosnia
the U.S. and other countries who
served in Bosnia/Kosovo. Exposures of
WRIISC RESEARCH HIGHLIGHT: that specific recommendations for
managing Gulf War illness or its
concern included depleted uranium and STUDY SHEDS LIGHT ON symptoms were helpful. The findings
pollution resulting from the destruction
of industrial plants.
WHAT GULF WAR VETERANS also highlight missed communication
opportunities, with a third of Veterans
WANT TO HEAR FROM THEIR not finding anything helpful (63
Researchers compared the cause-specific
mortality among 53,320 Veterans who PROVIDER participants).
deployed to Bosnia/Kosovo to that of VA’s War Related Illness and Injury Study The New Jersey WRIISC is working to
117,267 non-deployed Veterans and Center (WRIISC) conducted a survey improve communication between
to the general U.S. population. They study, sampling 210 Veteran participants patients and health care providers
focused on mortality from leukemia, with Gulf War illness to determine what by teaching providers across VA to
respiratory disease, respiratory cancer, information shared by health care acknowledge, validate, and provide
and heart disease. providers is the most helpful. specific treatment recommendations
when treating Veterans with Gulf War
The overall mortality of both Veterans Veterans with Gulf War illness1 have
Illness.
who deployed to Bosnia/Kosovo and chronic, unexplained symptoms that
non-deployed Veterans was almost half can include fatigue, headaches, joint Learn more about this study,
of that of the U.S. population. Those who pain, indigestion, insomnia, dizziness, called “Helpful ways providers can
deployed did not have any increased risk respiratory disorders, and memory communicate about persistent medically
of mortality from the diseases of concern problems. Gulf War illness is also known unexplained physical symptoms” by
compared to either the U.S. population as “chronic multisymptom illness” or reading the abstract2. Find out more
or non-deployed Veterans, though “undiagnosed illness.” about the research and provider
researchers recommended continued education activities at the WRIISC3.
follow-up of this group because some Participants of the WRIISC study
illnesses can emerge after the time completed a questionnaire that asked ARTICLE LINKS:
period set for this study. them to explain the most helpful 1.https://www.publichealth.va.gov/
information gained during conversations exposures/gulfwar/medically-
Read the abstract with findings from with their health care providers. unexplained-illness.asp
this study1, “Mortality experience Participants thought acknowledgement
of US veterans following service as and validation and specific treatment 2.https://www.ncbi.nlm.nih.gov/
international peacekeepers in Bosnia/ recommendations were particularly pubmed/30651073
Kosovo theater, 1996-2002.” helpful, with 70 participants reporting
that it was most helpful when their 3.https://www.warrelatedillness.va.gov/
ARTICLE LINKS: provider offered acknowledgement and
1.https://www.ncbi.nlm.nih.gov/ validation, and 48 participants reporting
pubmed/31344627
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 5
AIRBORNE HAZARDS AND VA CONDUCTS RESEARCH 2. The Post Deployment Health
Services (PDHS) Epidemiology
OPEN BURN PIT REGISTRY: TO DEVELOP A SINGLE CASE Program is partnering with Robert
SUMMARIES OF DATA DEFINITION FOR GULF WAR Bossarte, PhD, MA, of the VISN 2
AVAILABLE ON THE WEB ILLNESS Center of Excellence for Suicide
Prevention at the Canandaigua
VA publishes an updated summary of Gulf War illness affects about 30 VA Medical Center and West
self-reported health information from percent of all Gulf War Veterans. Rather Virginia University, and with other
the Airborne Hazards and Open Burn Pit than a single condition, it is a cluster partners (e.g., Harvard University
Registry every six months. They include of medically unexplained chronic investigators and topic area
data on the exposures of most concern symptoms that can include fatigue, consultants) to conduct an analytic
to registry participants, the most headaches, joint pain, indigestion, project where large VA datasets
commonly reported medical conditions, insomnia, dizziness, respiratory including information on more than
and the demographic and military disorders, and memory problems. 500,000 Gulf War and Gulf Era (those
characteristics of the participants. who did not deploy to the Gulf War
Currently, there is no single case
According to the most recent report, definition for Gulf War illness. The but served during the same time
191,044 Veterans have participated in definitions that are most frequently period) Veterans will be combined
the registry as of December 31, 2019. used are referred to as the Centers for to identify the diagnoses, laboratory
Out of this group, 178,604 (92.6 percent) Disease Control and Prevention (CDC) results, and other health factors of
reported a burn pit exposure during definition and the Kansas definition. Gulf War Veterans with symptoms
deployment, and 113,714 (58.9 percent) It has been recommended by various consistent with Gulf War illness.
reported duties involving burn pits. groups, including the National Academy In addition, PDHS has been analyzing
Additionally, 132,379 (69.9 percent) were of Medicine and the Research Advisory data from the Gulf War Registry and
close enough to feel the blast from an Committee on Gulf War Veterans’ VA health care utilization records to
improvised explosive device (IED). Illnesses1, that VA develop a single determine the prevalence of various
case definition using information from illnesses among Gulf War and Gulf Era
The most common medical conditions VA’s vast data holdings. A single case
reported were insomnia (154,425 Veterans who use VA for healthcare.
definition would help VA improve the Illnesses that are being looked at
respondents or 80.8 percent), way in which they identify and treat Gulf
neurological problems (136,378 include respiratory diseases, cancers,
War illness, handle claims, and conduct and chronic medical conditions
respondents or 71.4 percent), and research on Gulf War Veterans.
allergies (75,713 respondents or 39.6 associated with Gulf War illness.
percent). VA has been working on developing a ARTICLE LINKS:
single case definition for Gulf War illness2.
Find the report with data through Currently, VA is conducting two major 1.https://www.va.gov/rac-gwvi/
December 31, 20191. New summaries studies towards this effort:
are posted on the bottom of the registry 2.https://www.publichealth.va.gov/
web page2 as they become available. 1. The War Related Illness and exposures/publications/gulf-war/
Injury Study Center (WRIISC) in East gulf-war-2018/va-dod.asp
ARTICLE LINKS: Orange, NJ, is conducting a chart
1.https://www.publichealth.va.gov/ review study of all
docs/exposures/va-ahobp-registry-data- Gulf War Veterans
report-dec2019.pdf who have visited
a WRIISC clinic
2.https://www.publichealth.va.gov/ between 2001-2018
exposures/burnpits/registry.asp to determine a case
definition that best
fits their clinical
presentation.
Louisiana National Gaurd, 1991
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 6
GOLDEN VA CLINIC IN concerns and perform a comprehensive research that could identify the
history and physical. In addition to a health impacts of deployment-
COLORADO EXCELS IN 90-minute visit with the Environmental related, inhalational exposures on
COMPLETING AIRBORNE Health Clinician, we also schedule all him and other Veterans.
HAZARDS AND OPEN BURN PIT AHOBPR Veterans for same-day, in-clinic
2. AHOBPR exams yield a high return
spirometry (breathing tests) and labs.
of individual diagnostic information.
REGISTRY MEDICAL EXAMS I have found all sorts of pathology
What are some health concerns that
The Airborne Hazards and Open Burn (thyroiditis, eosinophilic esophagitis,
Veterans have shared with you related to
Pit Registry1 (AHOBPR) allows Veterans Fanconi syndrome, various
airborne hazards?
who were deployed to Southwest Asia cancers, hypertrophic obstructive
and/or Afghanistan to document their Moore: In my experience, the top four cardiomyopathy, etc.) just by
environmental exposures in an online health concerns are: listening to Veterans and doing a
questionnaire and then address any careful history and physical with a
associated health concerns during a free, 1. Breathing problems (e.g., shortness review of systems.
in-person exam with an Environmental of breath, decreased exercise
tolerance, or chronic cough 3. Most importantly, the Veterans are
Health Clinician at their local VA medical
deeply appreciative of AHOBPR
center. 2. Congestion (e.g., runny nose or
exams. I frequently get hugs and
post-nasal drip)
The Golden VA Clinic began conducting thank you notes from Veterans
AHOBPR exams in September 2018 and 3. Gastrointestinal problems (e.g., after their exams. In fact, I had a
completed 687 exams as of February 1, difficulty swallowing, diarrhea, retired lieutenant colonel tell me
2020. Anisa Moore, MD, has personally constipation, or abdominal pain) his AHOBPR exam was the most
conducted almost 300 of these exams 4. Cancers (e.g., either an existing thorough medical exam he had ever
since the clinic opened. She was the cancer diagnosis or concerns about had.
only AHOBPR examiner at the site until developing cancer in the future) How does a Veteran go about
several others were hired in the summer
About how many exams do you conduct scheduling an exam at your clinic?
of 2019.
per week?
Moore: Veterans contact our
Dr. Moore, who is Section Chief of the
Moore: I conduct three to four AHOBPR Environmental Health Coordinator via
new Environmental Health Department phone or e-mail.
exams a day, and most of our other
at VA Eastern Colorado Health Care
examiners perform two to three
Services and Lead Environmental
AHOBPR exams a day. To increase our
Health Clinician for Veterans Integrated
productivity, we combine AHOBPR and
Service Network (VISN) 19, is passionate
Gulf War exams for Veterans who are
about helping Veterans by conducting
eligible for both.
AHOBPR exams. VA’s Post Deployment
Health Services talked to Dr. Moore What do you like most about your role in
about AHOBPR health exams and her conducting AHOBPR exams?
experience conducting them.
Moore: I absolutely LOVE doing AHOBPR
How long does the average exam take exams—in fact, they are my very favorite
for Veterans? registry exam to perform. Here’s why:
Moore: We schedule 90 minutes for 1. AHOBPR exams contribute to our
most AHOBPR exams. Many of the knowledge about the health impacts
Veterans who request these exams have of inhalational exposures. My own
done so because they have specific husband was deployed to Kuwait
symptoms or concerns that they want and Saudi Arabia in 1990-1991 as a
to address, and we find that we need part of Desert Storm/Desert Shield,
a full 90 minutes to address these so you’d better believe I care about Anissa Moore, MD
continued on page 8
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 7
Is there anything else you would like the General
to tell me about your work with the Secretariat for
AHOBPR? Administration
Moore:AHOBPR exams are unique to of the Ministry of
the VA; these exams are simply not the Armed Forces.
available in the community or private Its activities focus
sector. Veterans who participate in on the health risks
AHOBPR exams should know that they associated with
are helping not only themselves, but all environmental
Veterans, by contributing to research exposures
on the health impacts of military among the
environmental exposures. French military
community. The
If you have completed an AHOBPR Observatory’s
questionnaire and would like to activities provide Paris, France Colonel Raphael Grippi
schedule your AHOBPR exam, contact us with a better understanding of similar the French Ministry of Health). A steering
your local VA Environmental Health issues faced by U.S. service members committee sets the Observatory’s
Coordinator2. Learn more about the and their allies. policy and approves proposals for
AHOBPR3. health studies. A scientific council of
The Observatory’s main activities are: independent experts guarantees the
ARTICLE LINKS:
1.https://www.publichealth.va.gov/ • To create a comprehensive database credibility of the work carried out by the
of deployed military personnel for Observatory.
exposures/burnpits/registry.asp
the use of health studies
2.https://www.publichealth.va.gov/ DOD IDENTIFIES VETERANS
• To manage scientific health studies,
exposures/coordinators.asp
including: POTENTIALLY EXPOSED TO
3.https://www.publichealth.va.gov/ CHEMICAL WARFARE AGENTS
exposures/burnpits/registry.asp ◊ Epidemiological research on the
health of Veterans involved in Some Veterans were exposed to
nuclear testing in the Pacific chemical warfare agents1 (CWAs) while
handling or demolishing explosive
THE FRENCH VETERANS’ HEALTH ◊ An epidemiological study on the ordinance during Operation Iraqi
OBSERVATORY - ADDRESSING health impacts of containment in Freedom or Operation New Dawn.
nuclear submarines They may have been exposed while
MILITARY EXPOSURE CONCERNS working as explosive ordinance disposal
IN FRANCE ◊ Studies on Gulf War illness
personnel, during an Improvised
and its potential link to the
By Colonel Raphael Grippi, PharmD, MBA, Explosive Device (IED) attack, or during
use of depleted uranium or
French Health Liaison Officer the open-air demolition or transport of
pyridostigmine as a prophylaxis
CWAs. Potential CWAs that Veterans may
Similar to U.S. military Veterans, French for neurotoxic chemical warfare
have been exposed to include sulfur
military Veterans have also encountered agents (findings demonstrated no
mustard, lewisite, and nerve agents,
environmental exposures during Gulf War illness among deployed
such as sarin. In addition, Veterans may
service and have concerns about the French soldiers)
have been exposed to weaponized toxic
impact of these exposures on their
The Observatory includes a network industrial chemicals, such as ammonia,
health. Much like VA’s Post Deployment
of civilian and military experts and chlorine, benzamine and nitric acid.
Health Services, the French have the
Veterans’ Health Observatory, an correspondents. It is headed by a
The Department of Defense (DoD)
interdepartmental body (including Delegate (a physician from the Armed
has worked hard to identify service
Defense, Health, and Veterans Forces Health Service, appointed by the
members potentially exposed
representatives) directly attached to French Secretary General) and assisted
by a Deputy Delegate (an executive of continued on page 8
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 8
to CWAs. DoD searched 1.8 Army Public Health Center at usarmy. that female Gulf War Veterans have
million Post-Deployment Health apg.medcom-aphc.mbx.emp@mail.mil. significant medical needs, particularly
Assessments (PDHAs) and 1.1 million among those who were deployed during
Post-Deployment Health Reassessments ARTICLE LINKS: the war.”
(PDHRa) using key words related to 1. https://www.publichealth.va.gov/
exposures/chemical-warfare-agents-oif.asp The findings from this study are
a chemical exposure. DoD identified illustrated in an infographic1.
7,923 individuals with medical records
that showed potential exposures. Since Dursa and her team obtained study
medical records may be incomplete,
VA RESEARCHERS FIND GULF findings from a survey that asked about
DoD created a hotline for Veterans and WAR-ERA VETERANS’ HEALTH the health and exposures of Gulf War era
Veterans at multiple points in time. The
service members to call in and report IS WORSE AMONG FEMALES findings came from 14,252 Veterans who
exposure to a CWA.
COMPARED TO MALES responded to the most recent survey, 20
These efforts resulted in DoD contacting percent of whom were female.
VA researchers conducted a national
and interviewing 1,790 Veterans and study on the health of Gulf War-era Read the abstract with findings from
service members using an in-depth Veterans and found that health this study2, “Health Status of Female and
telephone screening questionnaire problems, including migraine Male Gulf War and Gulf Era Veterans: A
about their exposure to CWAs. Next, headaches, dermatitis, and arthritis, Population-Based Study.” Read more
DoD invited 324 individuals to receive were more common among female about the overall study3, “Follow-up
an in-person medical examination at Veterans compared to male Veterans. Study of a National Cohort of Gulf War
Walter Reed National Military Medical The exception was for certain diseases and Gulf Era Veterans.” In addition, VA
Center in Bethesda, MD. This exam related to cardiovascular health and provides a variety of health care services
diabetes, which are generally more for female Veterans. Learn about these
was also available for all Veterans who
common among U.S. males. health care services4.
requested to be seen at Walter Reed. VA
documented these exams in VA medical Erin K. Dursa, PhD, MPH, and her ARTICLE LINKS:
records for those enrolled in VA health research team in VA’s Epidemiology
1. https://www.publichealth.va.gov/
care. Each Veteran who had an exam at Program, Post Deployment Health
epidemiology/studies/gw-health-compare.
Walter Reed also received a letter from Services, found that both deployed and
non-deployed females had more health asp
VA providing additional information.
These Veterans are encouraged to problems compared to males. 2. https://www.ncbi.nlm.nih.gov/
seek health care for conditions that are Females deployed to the Gulf War were pubmed/31253241
associated with their exposure and to 6.21 times more likely to have repeat
submit a claim for service-connected 3.https://www.publichealth.va.gov/
bladder infections, 3.27 times more likely
benefits. DoD will be sending out a to have fibromyalgia, and 1.82 times epidemiology/studies/gulf-war-follow-up.asp
follow-on letter approximately five years more likely to have asthma, compared to 4.https://www.womenshealth.va.gov/
after the original examination. deployed males.
WOMENSHEALTH/index.asp
If you are among those identified as Females who served during the Gulf
exposed to CWAs and you are enrolled War but were not deployed were 4.74
in VA’s health care system, please keep times more likely to have repeat bladder
your contact information up-to-date infections, 4.15 times more likely to
have fibromyalgia, and 2.09 times more
with VA. If you are not enrolled in VA’s
likely to have asthma, compared to
health care system, please contact your
non-deployed males.
local VA Medical Center for assistance.
If you have any additional concerns “Over 40,000 females were deployed
or questions regarding CWAs or toxic to the 1990-1991 Gulf War, serving in
industrial chemical exposure, please a variety of military occupations, an
contact VA’s Post Deployment Health unprecedented event at the time, and
Services at (202)-266-4695, or the U.S. little is known about their health,” said
Dursa. “This study highlights the fact Gulf War Veterans
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 9GARRISON EXPOSURES AND Camp Lejeune: Veterans who were
stationed or lived at Camp Lejeune for
Other potential garrison exposures have
raised concern among Veterans. Please
HEALTH CONCERNS at least 30 days between August 1, 1953 see “Potential Garrison Exposures” on
Veterans may have concerns about and December 31, 1987 are eligible the next page for more information.
health effects from garrison exposures, for health care and disability benefits For specific exposures at select
which are environmental exposures due to possible exposure to VOCs (i.e., military bases or garrisons, please see
that may have been experienced while trichloroethylene, perchloroethylene, “Exposures from Specific Garrisons” on
stationed on a military base. vinyl chloride, and benzene) in the the next page.
drinking water. This water contamination
Some examples of garrison exposure was a result of improper disposal VA consults with the Environmental
concerns that have recently been of dry-cleaning waste and leaking Protection Agency (EPA) on garrison
raised among Veterans are exposure underground storage tanks on the base. exposure issues. The EPA’s mission
to perfluoroalkyl and polyfluoroalkyl is to protect human health and the
substances (PFAS) on military bases and Health Care: Veterans are eligible for environment. If you want to know more
exposure to volatile organic compounds health care for 15 conditions, including about possible garrison exposures on
(VOCs) at the U.S. Marine Corps Base female infertility, hepatic steatosis, specific bases, visit EPA’s superfund3
Camp Lejeune in North Carolina. miscarriage, neurobehavioral effects, web pages.
myelodysplastic syndromes, renal
PFAS: PFAS are a large family of toxicity, scleroderma, and some cancers. ARTICLE LINKS:
synthetic chemicals found in many Family members are eligible for health 1. https://www.publichealth.va.gov/
manufactured products, including care funding assistance for these exposures/pfas.asp
carpets, food packaging, and adhesives. conditions.
Almost everyone has detectable levels 2.https://www.publichealth.va.gov/
of PFAS in their blood. Disability Benefits: VA has established exposures/camp-lejeune/index.asp
presumptive service connection for
Since the 1970’s, military firefighters Veterans, Reservists, and National Guard 3.https://www.epa.gov/superfund
have used fire-fighting foams containing members with a diagnosis of adult
PFAS to fight fuel fires during training leukemia, aplastic anemia and other
and emergency responses. This led to myelodysplastic syndromes, bladder
the contamination of ground water cancer, kidney cancer, liver cancer,
on several military bases, as well as in multiple myeloma, non-Hodgkin’s
surrounding communities. There have lymphoma, and Parkinson’s disease.
been several recent actions to address Read more about Camp Lejeune2.
the issue, including changes in DoD
policies and procedures to discontinue
the use of foams containing PFAS in
training activities and efforts to develop
new, fluorine-free alternatives.
Scientific and medical evidence on the
health effects of PFAS are currently
inconclusive, but research on these
chemicals is ongoing. VA is partnering
with other federal agencies to assess
published information and new findings
as they become available. Also, VA
researchers are exploring opportunities
to study the health of Veterans who
may have been exposed either through
their job duties (e.g., firefighters) or
contaminated water. Read more about
PFAS1.
Camp Lejeune
continued on page 11
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 10Potential Garrison Exposures
These exposures may have occurred in garrison or while deployed:
Industrial Solvents (https://www.publichealth.va.gov/exposures/solvents/index.asp)
CARC Paint (https://www.publichealth.va.gov/exposures/carc-paint/index.asp)
PFAS - Perfluoroalkyl and polyfluoroalkyl substances (https://www.publichealth.va.gov/exposures/pfas.asp)
Polychlorinated Biphenyls (PCBs) (https://www.publichealth.va.gov/exposures/pcb/index.asp)
Fuels (Petroleum, Oils, Lubricants) (https://www.publichealth.va.gov/exposures/fuels/index.asp)
LORAN Radiation (https://www.publichealth.va.gov/exposures/radiation/sources/loran.asp)
Asbestos (https://www.publichealth.va.gov/exposures/asbestos/index.asp)
Lead (https://www.publichealth.va.gov/exposures/lead/index.asp)
Military Occupational Exposure to Radiation (https://www.publichealth.va.gov/exposures/radiation/sources/occupational.asp)
Exposures from Specific Garrisons
Below are known exposures that occurred at specific garrisons. Being stationed at one of these bases does not necessarily
mean an exposure occurred. Exposure varies by timeframe and specific duties at the garrison.
Waste Incinerator in Atsugi, Japan (https://www.publichealth.va.gov/exposures/sand-dust-particulates/atsugi.asp)
Fukushima Nuclear Accident 2011 (https://www.publichealth.va.gov/exposures/radiation/sources/fukushima.asp)
Camp Lejeune: Past Water Contamination (https://www.publichealth.va.gov/exposures/camp-lejeune/index.asp)
Kunia “Tunnel” Field Station (https://www.publichealth.va.gov/exposures/kunia.asp)
Fort McClellan (https://www.publichealth.va.gov/exposures/fort-mcclellan/)
Qarmat Ali (https://www.publichealth.va.gov/exposures/qarmat-ali/index.asp)
C-123 Airplanes and Agent Orange Residue
(https://www.publichealth.va.gov/exposures/agentorange/locations/residue-c123-aircraft/index.asp)
MILITARY EXPOSURES & YOUR HEALTH | 2020 | ISSUE #2 11You can also read
