Attributing a medical diagnosis or set of symptoms to an environmental exposure that occurred years or decades ago is a challenge to medical science that is also a source of frustration for servicemembers and veterans alike. Over the last decade, DoD and VA have worked to share environmental exposure information that may be relevant to the health concerns or diseases that veterans may experience.

The Gulf War saw 697,000 US service members deploy to Southwest Asia from August 1990, to June 1991. Some of those individuals had medical concerns during and after their deployment, requiring DoD and VA to conduct medical testing. As a result, DoD, VA, and HHS teams worked together on clinical and research initiatives to determine if there were causal relationships or associations between known exposures and subsequent symptoms.

These excellent working relationships became permanent in 2003, when the DoD–VA Deployment Health Working Group (DHWG) was created as part of the DoD–VA Health Executive Council. The DHWG shares information and resources on deployment health surveillance, follow-up medical care, medical research, and health risk communication.

The DHWG also played a role in the establishment of the VA National Veterans’ Registry in 2009—now called the United States Veterans Eligibility Trends and Statistics—which has provided the most comprehensive database of the veteran population to support the analyses of long-term health effects from military services. USVETS includes almost 24 million living veterans and about 14 million deceased veterans.

A major focus for the DHWG is events related to current deployments to Iraq and Afghanistan, but the group has also been successful in coordinating investigations about chemical and biological agent testing of more than 400 chemical agents, pharmaceutical agents, and placebos. These studies were broken into three major groups: Project 112/SHAD conducted between 1962 and 1973, Mustard/Lewisite (blister agent) testing conducted in the 1940s, and chemical-biological agent testing conducted between 1942 and 1975.

Within each group, DoD searched archived records and provided VA with the names of individuals involved, the agent(s) to which they were exposed, and the location and time of ex-posure(s). DoD was able to identify 22,442 individuals involved and VA notified 8,200 individuals explaining the care and benefits available. A DoD website at fhpr.osd.mil/CBexposures describes the three testing programs.

One major area of concern for service members and veterans is whether embedded fragments may contain hazardous materials. These questions led DoD to begin analyzing fragments that were surgically removed in the combat theater. At the same time, VA expanded its Depleted Uranium Medical Follow-up Program to a Toxic Embedded Fragment Surveillance Center to conduct screening, biological monitoring, and clinical consultations on veterans with embedded fragments. Some 344 individuals have had fragments analyzed by DoD (nearly all were steel or iron). A shared DoD–VA registry of those with fragments identified in the combat theater will be implemented soon. A later phase of this registry will include inpatient and outpatient records of individuals with embedded fragments who are treated here at home.

The DHWG coordinated information sharing on a potential exposure to sodium dichromate at Qarmat Ali, Iraq, in the summer of 2003. Army soldiers were briefly assigned to provide security for contractors working to repair a damaged water treatment plant. This chemical, which prevents corrosion in pipes, is known to increase the risk of lung cancer in industrial workers with high level exposures for several years. Evaluation and testing was done on these exposed soldiers and no indication of significant chromium exposure was detected. The Army National Guard and VA have continued to provide information about this event to those concerned about possible exposures at Qarmat Ali.

Another key area of focus for the DHWG is particulate material in the air that has the potential to affect almost all deployed individuals. DoD has collected aerosol and bulk soil samples between December 2005 and June 2007 at 15 military sites in the Middle East. The samples were analyzed for size and chemical content, and by scanning electron microscopy for structure. The size of the particulates is important because those with a diameter less than 10 microns (Particulate Matter 10 or PM10) and those with even smaller particulates less than 2.5 microns (PM2.5) can reach deep into the lungs.

Analysis found that the recommended Military Exposure Guidelines for PM10 and PM2.5 were exceeded in all 15 sites during the entire sampling period. The mineral content and chemical composition of the particulate material was the same as that of the soil in the area, and the structures of these small particles were generally round, not jagged. Chemical contributions to these particles were also, to some degree, related to lead from leaded gasoline and battery manufacturing, and from products released in smoke from burn pits.

Those burn pits—disposing of trash or human waste—are a fourth health issue that has consistently raised concerns among deployed forces. While not preferred, this method of waste disposal is often necessary because options like trash hauling, sewage disposal and treatment, incineration and landfill use are not available in austere deployment situations. There are established guidelines barring dangerous or contaminating materials from being burned in these open pits (eg explosives, batteries, and electrical equipment). Under most circumstances, breathing smoke from such burn pits does not produce short-term or long-term health problems.

The burn pit at Joint Base Balad (formerly Balad Air Force Base), Iraq, was in use from 2003 to 2009. Due to complaints and health concerns from service members stationed at Balad, air sampling for an expanding list of chemicals downwind of the burn pit was done nine times between 2004 and 2009. Using the 2007 air sampling data, the Army’s Center for Health Promotion and Preventive Medicine produced a health risk assessment in 2008. This determined that the potential risks for cancer and non-cancer health outcomes were in the “acceptable” range, and the occupational and environmental health risk estimates were low. Furthermore, serum fat samples for dioxin, taken from a sample of service members who had been at Balad for at least one year, showed there was no accumulation of dioxin in their bodies. (A fact sheet on the Balad burn pit, as well as sheets concerning particulate matter and Qarmat Ali, are available at > http://phc.amedd.army.mil/HIOFS)

The DHWG has become the forum for DoD occupational and environmental health experts to provide VA health care leaders, researchers, and disability benefits experts with information on recognizing environmental exposures of deployed military personnel. As a result, VA will be able to inform DoD on areas where force health protection measures can be improved. The end result will be healthier service members and veterans.

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