Public Health
Military Exposures & Your Health - Winter - Issue 15
In this issue:
- All About Environmental Health Registry Assessments
- VA’s Report on the Impact of Jet Fuel Exposure on Health
- VA Completes the First Stage of Military Working Dog Project to Enhance the Early Identification of Military Environmental Exposure Conditions
- Announcing the New Complex Exposure Threats Center of Excellence
All About Environmental Health Registry Assessments
Environmental health registry assessments are free, voluntary assessments for Veterans who were deployed to certain countries during specific time frames. During an assessment, a health care provider with expertise in military environmental exposures will provide you with personalized education and information about your exposures and health. Registry assessments are not required for VA disability compensation or other VA benefits.
You have two options for learning about your eligibility for an environmental health registry and scheduling your assessment:
1) Contact your local environmental health coordinator and schedule your assessment in-person or through telehealth; or
2) Contact the Veterans Exposure Team – Health Outcomes Military Exposures (VET-HOME), an intake center with a team of 40 clinicians across the country, to schedule your assessment through telehealth.
Three VET-HOME clinicians and one environmental health clinician shared their knowledge about environmental health registry evaluations, including what is involved in the assessment and its benefits.
Why should you have an environmental health registry assessment?
Environmental health registry assessments benefit both you and your fellow Veterans. “For Veterans, environmental health registry assessments provide an opportunity to proactively engage with a clinician to address personal concerns regarding exposures encountered during your military service,” said Kelly Hager, MD, MPH; an Internal Medicine and Occupational-Environmental Medicine Physician with VET-HOME.
Often, you spend all of your medical visit time addressing your immediate health concerns or ongoing medical conditions, explained David W. Parler, MD, a Physician Supervisor with VET-HOME. “Registry assessment visits can provide an opportunity ’free and clear‘ of your immediate treatment needs or chronic health maintenance to set aside time to discuss military environmental exposures,” he said.
In addition, these assessments allow for documentation of your health concerns in your medical record. “This allows VA or Care in the Community (CITI) providers to better understand your military service and environmental exposures,” said Tanya Sonderby, MS, PA-C, a Physician Assistant with VET-HOME. “It may not change future treatment, but it can impact diagnostic evaluation of future reported symptoms,” she added.
You may also receive counseling to help you live a better life, such as guidance on stress reduction, nutrition, quality sleep, and health care screening recommendations, and connections to follow-up care, explained Victoria Ramirez, MD, Lead Environmental Health Physician at the VA Palo Alto Health Care System.
An environmental health registry evaluation benefits not just you, but other Veterans as well. Your assessment provides data that can be used for research and to guide future care. Dr. Hager explained, the information obtained in a registry evaluation can be combined with data from other Veterans who participate, specifically, those who served at the same time as you or similar location. Together, this research helps VA better understand and respond to health problems for all Veterans and consider future presumptions.
What happens during and after an environmental health registry assessment?
To prepare, you should review and write down details about your exposures, including what, when, and how you were exposed; have your specific questions or concerns regarding your exposures written down; have a list of any medical conditions or symptoms you would like to discuss; and have a list of all medications that you are currently taking and a list of any drug allergies, explained Dr. Parler. You should also consider mentioning any major civilian exposures.
“During the appointment, a Veteran should expect an opportunity to review their historical exposures and symptoms with the provider, in addition to engaging in a personalized discussion including risk communication and recommendations moving forward,” Dr. Hager said.
During the visit, you and your provider should agree to an action plan regarding the next steps for follow-up. With the evaluation, VET-HOME or environmental health clinicians can recommend or order diagnostic testing, recommend behavior change, or point you to other care resources at VA. You will receive a summary of your visit with recommendations and resources and your clinician will leave a clinical note in your VA medical record.
Should I schedule a registry assessment though VET-HOME or with an Environmental Health Coordinator?
VET-HOME provides environmental health assessments via telehealth. With telehealth, you can have your assessment from the comfort of your own home and do not have to travel to a VA medical center, which may not be nearby. With VET-HOME, clinicians are available across the country and can offer early morning and evening hours. You can contact VET-HOME to schedule your assessment by calling 833-633-8846 or go to the VET-HOME portal.
You can contact a local Environmental Health Coordinator to schedule your assessment in person or via telehealth if your local facility has this capability.
Dr. Ramirez explained that there are benefits to having an environmental health registry assessment in-person. You can have a face-to-face experience with a clinician. In addition, your provider can potentially work with your VA care team, connect you to specialty care and other in-house services, and connect you to other medical center offices such as social services, the business office, or compensation and pension services. Also, your clinician can provide information on local resources that offer support services for Veterans.
“We have a relationship with our facility health care providers and resources and can effectively coordinate care with a patient’s care team,” said Dr. Ramirez. “Tests can be ordered and completed while at the facility. You would not have to make another trip to get these done.”
“The decision to complete the evaluation virtually or in person is based on a Veteran’s preference and the availability of clinicians at their home VA medical center. Ultimately, we encourage Veterans to schedule whichever modality is most comfortable!” said Dr. Hager.
Learn more:
Environmental Health Registries
Environmental Health Coordinator finder
VA’s Report on the Impact of Jet Fuel Exposure on Health
As a Veteran, you may have been exposed to jet fuels while performing certain jobs during your service, such as fueling an aircraft, transporting jet fuel, maintaining jet fuel storage tanks, fueling generators, or tending burn pits. You could have also been exposed to jet fuels due to accidental spills. Jet fuels can be absorbed through the skin, inhaled, or accidentally swallowed, and they can cause immediate symptoms such as skin, eye, and upper respiratory irritation.
To better understand how exposure to jet fuels may impact Veterans’ health, the Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act required VA to submit a report with information on
1) possible health effects by length of exposure to jet fuels,
2) health safeguards the Department of Defense (DoD) has put in place to reduce exposures to military personnel,
3) immediate symptoms that may indicate future health risks, and
4) areas of research to pursue in the future to better understand the relationship between jet fuel exposure and health. VA’s Health Outcomes Military Exposures, Exposure Science Program led a review of the available research on the health effects associated with military and occupational exposure to jet fuel and submitted a report with their findings to Congress in the Fall of 2023.
After reviewing the available research, VA found that there is some scientific information that links work-related exposure to jet fuels to possible health effects on specific parts of the body, including effects on the nervous system, mental health, respiratory system, and kidney and bladder cancers. However, there is not enough information to confidently connect jet fuel exposure during military service to specific health conditions, which could materialize months or years after exposure. There is also not enough information to understand how the length of exposure or immediate symptoms of exposure might be related to future health risks.
VA also reviewed documents from DoD and the Services to outline the historic and current health safeguards (e.g., policies and guidance) put in place to protect service members against jet fuel exposure. The documents primarily focused on general safety (e.g., guidance on the installation of safety showers within fuel laboratories); training and emergency standards (e.g., guidance on proper selection and use of personal protective equipment); and management programs and comprehensive guidance for managing and maintaining jet fuels and petroleum.
Additionally, VA identified several areas related to jet fuel exposure and associated health effects that would benefit from additional research, such as studies that follow participants over an extended period of time to inform researchers of any changes or improvements in symptoms and the development of long-term health effects long after exposure has ended. To accomplish this, VA, in collaboration with DoD, is currently conducting the Long-Term Impact of Fuel Exposure (LIFE) studies to better understand the long-term health effects associated with occupational jet fuel exposure. Findings from these studies are expected as soon as 2025. A follow-up report is due to Congress in 2028.
To access VA’s Congressionally Mandated Report: Health Effects of Jet Fuels Used by Armed Forces, please visit https://www.govinfo.gov/app/details/CMR-VA1-00189958. If you have concerns about possible health effects caused by contact with jet fuels during your military service, please talk with your VA health care provider or contact your local VA Environmental Health Coordinator.
VA Completes the First Stage of Military Working Dog Project to Enhance the Early Identification of Military Environmental Exposure Conditions
Military Working Dogs (MWDs) play a crucial role in military operations. They serve alongside their human counterparts at home and abroad, breathing the same air and encountering the same military environmental hazards. Just as a Veteran’s health will reflect the hazards they have faced during their service, the health outcomes of MWDs can also offer vital insights into the long-term effects of military exposures. In addition to working and living with service members, MWDs are a unique research population because they have a very controlled life with detailed records of their diet, training, and medical visits that allow for a whole-of-life record.
In June 2024, the Exposure Science Program (ESP), a program within VA’s Health Outcomes Military Exposures, completed a database of deceased MWD records for use in the early identification of military environmental exposure-related conditions in Veterans and service members. The VA-funded project was a collaboration with the Department of Defense (DoD) that was completed after a decade. The project not only required extensive coordination to find and convert paper records from the past 30 or more years into an electronic format, but also gathered the newer electronic health records into the database.
These efforts resulted in a database that includes vital information, such as breed, sex, permanent duty location, deployment locations and time frames, and health-related information, for each MWD. The health-related information not only covers events that occurred during their service, it also includes a comprehensive assessment of the MWD’s entire body at the end of their life. The database is the most comprehensive collection of MWD data to date and contains records for over 2,900 MWDs that served from 1990 forward. ESP and DoD’s Joint Pathology Center continue to collaboratively analyze these data to guide future research and enhance care for Veterans and their canine counterparts. Initial analyses will be published as early as 2025.
Announcing the New Complex Exposure Threats Center of Excellence
On September 3, 2024, VA designated the Complex Exposure Threats Center of Excellence (CETCE), a sub-center of the Washington, DC, War Related Illness and Injury Study Center (WRIISC-DC), as a new Center of Excellence.
CETCE’s clinical, educational, and research discoveries are key in preparing VA for new and emerging military exposure health threats. Their interdisciplinary team consists of health care professionals, research scientists, and environmental health experts, many of whom are Veterans. The Center focuses on the unique military occupational and environmental exposure health concerns of Explosive Ordnance Disposal personnel and Veterans experiencing poorly understood symptoms possibly related to Anomalous Health Incidents (or Havana Syndrome). The Center also addresses the long-term health surveillance needs and exposure concerns of certain groups with military exposures such as Veterans exposed to Chemical Warfare Agents and sodium dichromate at Qarmat Ali, Iraq. CETCE’s efforts align with the VA’s goals to better coordinate with the Department of Defense to understand new military exposure concerns.
