Public Health
Military Exposures and Your Health - 2022 - Issue 7
In this issue:
- Improvements to the Airborne Hazards and Open Burn Pit Registry
- The Cancer Moonshot and VA Collaborations
- The PACT Act
- The PACT Act and presumptions for particulate matter
- Radiation exposure locations and PACT Act additions
- Update: Qarmat Ali hexavalent chrominum exposure in Iraq (2003- 2004)
- New certification program on military exposures now available for health care providers
Improvements to the Airborne Hazards and Open Burn Pit Registry
Since 2014, VA’s Airborne Hazards and Open Burn Pit Registry has been an important tool for recent Veterans and service members to record their airborne hazard exposures and related health conditions, with an optional examination with a health care provider to learn more. A total of 341,763 Veterans and service members have joined the registry as of October 25, 2022, and this number continues to grow.
VA has made several changes to the registry to expand eligibility and make the registry easier to use. As of this summer, you are now eligible to participate if you were deployed to one of three new locations: Syria or Uzbekistan since September 11, 2001, or Egypt since August 1990. Other Veterans and service members who can participate include those who deployed to the Southwest Asia theater of operations any time after August 2, 1990, or Afghanistan or Djibouti on or after September 11, 2001.
In addition, VA has made several improvements to the registry process, such as:
- abbreviating questions about short deployments
- allowing registry participants to add additional deployments to their profile
VA is reviewing a congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine (NASEM), called Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. NASEM released this report on October 14 2022. Check back for updates about the report in the next issue of Military Exposures & Your Health.
For Veterans who choose to have in an in-person health exam, your local VA medical facility will contact you within 90 days to schedule the exam. You may also contact your local Environmental Health Coordinator to learn more or if you have changed mailing or email addresses since requesting an examination. If you have questions about the registry, including eligibility questions, contact the help desk at 1-877-470-5947 or vaburnpiter@va.gov.
Please note that the registry is separate from the VA disability compensation process and is not required to file a claim.
If you haven’t already participated in the Airborne Hazards and Open Burn Pit Registry, now is a great time to sign up. Learn more by visiting the secure registry portal at HOME - Airborne Hazards and Open Burn Pit Registry.
The Cancer Moonshot and VA Collaborations
As Vice President, Joe Biden launched the Cancer Moonshot in 2016 with the aim to end cancer through scientific discovery, collaboration, and data sharing. In February 2022, President Biden reignited the Cancer Moonshot effort (known as Cancer Moonshot 2.0) with new goals to reduce the death rate of cancer by at least 50% over the next 25 years and improve the experience of those living with and surviving cancer.
Since the relaunch of Cancer Moonshot, VA has initiated projects in collaboration with other government agencies and on its own to understand and defeat all cancer, including ones that may be associated with military environmental exposures. Other goals include improving integration between clinical care and research activities, as part of a more comprehensive approach to treating, preventing, and diagnosing cancer among Veterans.
One key project that began under the first Cancer Moonshot is a collaboration between VA, the Department of Defense (DoD), and the National Cancer Institute (NCI) to improve healthcare systems by leveraging each agency’s respective strengths in cancer. Recently, the team began to expand the Applied Proteogenomics OrganizationaL Learning and Outcomes (APOLLO) network, which is a collaboration between the agencies to analyze proteins and genomes in tumors to better improve treatment options. Currently VA, DoD, and NCI can collect samples at nine sites, with six more in preparation. Expansion of APOLLO to additional sites will advance the scientific workforce, adding speed and urgency to the study of rare cancers.
To better identify the origin or connection of military environmental exposures to cancer development, VA, DoD, and National Institute of Environmental Health Sciences (NIEHS) plan to develop a group of tumor samples for conducting whole genome/exome sequencing and mutational signature analysis. Through this process, the collaborators hope to identify genomic signatures that may be associated with carcinogens from military environmental exposures. An initial project will study tumor samples from a subpopulation of Veterans who served at Camp Lejeune.
Cancer Moonshot 2.0 will also be unique from the original effort, as partnerships with the Environmental Protection Agency and NIEHS will allow the creation of a foundational, integrated, longitudinal, early discovery-to-clinical healthcare implementation framework for monitoring and studying the short and long-term effects of toxic exposures, including respiratory illnesses, autoimmune disorders, and cancers. This effort is called PROMETHEUS (PROject for Military Exposures and Toxin History Evaluation in US service members). VA’s Health Outcomes Military Exposures is an integral partner in PROMETHEUS and is planning studies in support of this effort, such a pilot to investigate per- and polyfluoralkyl substances (PFAS) levels and related biomarkers of effect in service members and Veterans using dried blood spots.
Additionally, VA is developing a Rare Cancers Program. Rare cancers comprise 25% of all VA cancer diagnoses. The Rare Cancers Program focuses on providing high quality, evidence-based care regardless of where a Veteran lives by using National TeleOncology; equitable and comprehensive care through clinical decision support; molecular testing to guide precision oncology treatments; and rare cancer research.
Finally, to ensure that current and newly enrolled Veterans receive the most cutting-edge, accessible cancer care at VA, the VA Office of Research and Development, the VA National Oncology Program Office (which includes the National TeleOncology Program), and partners with the VA Office of Primary Care are leading an effort called ENACT – Enhancing Equity and Access to Clinical Trials. ENACT aims to provide more opportunities for Veterans to participate in clinical trials, which sometimes offer the most promising approaches to cancer treatment. ENACT will allow Veterans who may not be regularly involved in VA healthcare or research to better understand clinical trials, receive support in decision-making, and connect to clinical trials and research opportunities within VA.
The PACT Act
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, or PACT Act, is a new law that expands VA health care and benefits for Veterans exposed to burn pits and other military environmental exposures. It is perhaps the largest health care and benefit expansion in VA history.
The PACT Act was signed by President Biden on August 10, 2022. The PACT Act:
- Requires VA to provide an exposure screening for every Veteran enrolled in VA health care
- Helps VA improve research, staff education, and treatment related to military environmental exposures
- Adds more than 20 new presumptive conditions for burn pits and other military environmental exposures for Veterans who served during the Gulf War, and post-9/11 eras
- Extends and expands VA health care eligibility for post-9/11 combat Veterans
For more information see: https://www.va.gov/resources/the-pact-act-and-your-va-benefits/
The PACT Act and presumptions for particulate matter
The Promise to Address Comprehensive Toxics Act of 2022, or PACT Act, adds new presumptions for Veterans exposed to particulate matter. This means that for benefits, VA automatically presumes that your service caused your condition. The new presumptions include the following conditions:
Cancers:
- Brain cancer
- Gastrointestinal cancer of any type
- Glioblastoma
- Head cancer of any type
- Kidney cancer
- Lymphoma of any type
- Melanoma
- Neck cancer
- Pancreatic cancer
- Reproductive cancer of any type, including breast cancer in females and prostate cancer in males
- Respiratory (breathing-related) cancer of any type
Other illnesses:
- Asthma that was diagnosed after service
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Chronic rhinitis
- Chronic sinusitis
- Constrictive bronchiolitis or obliterative bronchiolitis
- Emphysema
- Granulomatous disease
- Interstitial lung disease (ILD)
- Pleuritis
- Pulmonary fibrosis
- Sarcoidosis
In addition, the following conditions were designated as presumptive conditions before the signing of the PACT Act:
Asthma, rhinitis, and sinusitis that started within 10 years of your separation from active service.
Nine rare respiratory cancers:
- Squamous cell carcinoma of the larynx
- Squamous cell carcinoma of the trachea
- Adenocarcinoma of the trachea
- Salivary gland-type tumors of the trachea
- Adenosquamous carcinoma of the lung
- Large cell carcinoma of the lung
- Salivary gland-type tumors of the lung
- Sarcomatoid carcinoma of the lung
- Typical and atypical carcinoid of the lung
Radiation exposure locations and PACT Act additions
VA presumes that you were exposed to radiation if you served at certain locations and times. This means you can receive health care and benefits from VA. Dependents and survivors may also be eligible for benefits.
With the passing of the PACT Act on August 10, 2022, VA added 3 new response efforts to the list of locations where presumptions of radiation exposure apply:
- Cleanup of Enewetak Atoll, from January 1, 1977, through December 31, 1980
- Cleanup of the Air Force B-52 bomber carrying nuclear weapons off the coast of Palomares, Spain, from January 17, 1966, through March 31, 1967
- Response to the fire onboard an Air Force B-52 bomber carrying nuclear weapons near Thule Air Force Base in Greenland from January 21, 1968, to September 25, 1968
The new locations are in addition to the following “radiation risk activities”:
- Participated in the occupation of Hiroshima and Nagasaki, Japan between Aug. 6, 1945, and July 1, 1946
- Were prisoners of war in Japan near Hiroshima and Nagasaki during World War II.
- Participated in atmospheric nuclear weapons tests conducted primarily in Nevada and the Pacific Ocean between 1945 and 1962.
- Participated in underground nuclear weapons testing at:
- Amchitka Island, Alaska before Jan. 1, 1974.
- Nevada Test Site for at least 250 days from January 1, 1963, through December 31, 1992.
- Service at one of the following gaseous diffusion plants for at least 250 days before Feb. 1, 1992: Paducah, Kentucky; Portsmouth, Ohio; or K25 in Oak Ridge, Tennessee.
Update: Qarmat Ali hexavalent chrominum exposure in Iraq (2003- 2004)
Qarmat Ali was a water treatment plant within Iraq’s oil infrastructure. Before U.S. occupation of Qarmat Ali, water was filtered and treated with sodium dichromate, a corrosion inhibitor, to increase the life of pipelines, pumps, and other equipment. Parts of the facility were contaminated with sodium dichromate before the war and also afterwards due to vandalism.
VA and the Department of Defense’s (DoD) Army Public Health Center have worked to monitor the health of military personnel who were on site at Qarmat Ali. Past efforts are described in a 2021 Military Exposures & Your Health article; no abnormalities specific to chromium exposure were found.
In 2022, VA reached out to a group of Qarmat Ali Veterans who were the focus of an initial round of examinations for another round of follow-up. They included Veterans from National Guard Units from Oregon, South Carolina, West Virginia, Indiana, and Ohio, amounting to approximately 700 Veterans who were with these units during the time of the exposure. VA aimed to start reaching out to this group beginning in 2020, but this was delayed due to the COVID-19 outbreak.
As of summer 2022, about half of the Veterans were contacted by the VA medical centers. The number of exams completed to date are as follows:
- Portland, Oregon - 68 exams
- Charleston, South Carolina -12 exams
- West Virginia - 20 exams
Based on the latest exams of Veterans who served at Qarmat Ali, no significant findings of disease from exposure to hexavalent chromium have been observed.
The number of exams completed to date (100) is comparable to the 124 exams that were conducted in 2012.
The next effort of outreach will occur in South Carolina outside Charleston and states that are not within the 4 National Guard hubs. Veterans can be a mobile group and finding their location can be a challenge. VA facilities in Ohio and Indiana have conducted outreach to about 51 Veterans so far. Some Veterans have declined this exam, likely because they are receiving health care with a primary care manager and have no current questions about Qarmat Ali.
For Veterans who served at Qarmat Ali, the most significant long-term health concern is lung cancer. If you served at Qarmat Ali, you should quit tobacco use and have your home checked for radon.
If you were in a National Guard unit that was exposed at Qarmat Ali and did not get notified about an exam or follow-up, please contact vaburnpiter@va.gov to facilitate this exam. Also, Qarmat Ali Veterans are eligible for the Airborne Hazard and Open Burn Pit Registry.
There are other personnel who may have traveled through and been on site at Qarmat Ali. The site was remediated and determined to be safe after November 2003. The DoD Inspector General in 2010 determined that the 4 National Guard units that were on site should be the priority of surveillance efforts.
New certification program on military exposures now available for health care providers
VA and the American College of Preventive Medicine (ACPM) created a formal certification program that gives health care providers the skills and knowledge needed to effectively identify, treat, and manage the effects of possible environmental exposures in Veterans. This training has been recognized by CDC for its content and depth.
The ACPM Level I certification is a five-module program developed by VA’s War Related Illness and Injury Study Center. It covers the following topics: assessing deployment-related environmental exposures, airborne hazards, Gulf War illness, chronic multi-symptom illness, depleted uranium, and toxic embedded fragments.
The Secretary of VA has mandated that all VA health care providers take the first module on assessing deployment-related environmental exposures by the end of 2022.This module on reviews deployment related exposure assessment, identifies steps for determining deployment related environmental exposures, provides available post deployment health resources and describes approaches to starting the conversation about exposure issues for Veterans.
VA and ACPM are now developing an advanced Level II certification program that builds on the Level one certification. The content will include a series of case studies and clinical exposure scenarios to equip providers with the ability to share, disseminate knowledge, and strengthen their skills in addressing concerns about military exposures.
VA providers can sign up for this free certification program. Learn more about the it at https://www.acpm.org/Education-Events/Military-Environmental-Exposures-Certification.
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