b'PACT Act Ensures VA IPF CareFor Gulf War Era, Post-9/11 Veterans Exposure to Agent Orange Also Linked to ConditionFor veterans diagnosed with idiopathic pulmonary fibrosis due to exposure to toxins during military service, the new PACT Act could literally be a lifesaver. The law assumes a service connection between the condition for certain military servicemembers. That is especially important because the prevalence of IPF more than doubled among veterans over the last decade or so.By Mary Anne DunkinSAN FRANCISCOA new law that provides VAcases per 100,000 person-years using the broad case care for conditions presumed to be caused by expo- definition and from 73 to 210 cases per 100,000 per-sure to burn pits and other toxins could be a game- son-years using the narrow case definition. 1changerforveteranswithidiopathicpulmonaryA more recent study published in The American fibrosis.Journal of Respiratory and Critical Care Medicine IPF is one of a group of diseases referred to as inter- pointedoutthelimitedliteratureexploringthe stitiallungdiseases,whichinvolveinflammationrelationshipbetweenmilitaryexposuresandIPF, and scarring of the lung. Patients with IPF typicallyhowever. 2present with an unproductive cough and shortnessSome of the same researchers from San Francisco of breath. Over time, fibrosis progresses to a pointVeterans Affairs Healthcare and colleagues evalu-where the lungs are unable to expand sufficiently toated whether exposure to Agent Orange is associ-transport oxygen to the bodys organs and tissue.ated with an increased risk of IPF among veterans. While IPF is considered a rare disease, affectingTo do that, they used VHA data to identify male anestimated13to20outofevery100,000peo- VietnamveteransdiagnosedwithIPFbetween ple, or between 0.10%-0.20%, worldwide, a recent2010 and 2019. study found that, among 10.7 million veterans whoNoting that, among 3.6 million male Vietnam veter-received care from the VHA between 2010 and 2019,ans, 948,103 (26%) had presumptive Agent Orange 139,116 (1.26%) were diagnosed with IPF.exposure, the study team found that IPF occurred in ThePACTAct,whichcoversveteransfrom2.2% of veterans with Agent Orange exposure ver-Vietnam through Iraq and Afghanistan, is the mostsus 1.9% without exposure (odds ratio, 1.14; 95% significantexpansionofbenefitsandservicesforconfidence interval [CI], 1.12-1.16; P 0.001). toxic-exposed veterans in more than 30 years andTherelationshippersistedafteradjustingfor addressesabroadspectrumoftoxicexposures,known IPF risk factors (odds ratio, 1.08; 95% CI, according to the VA website.1.06-1.10;P0.001),thestudyreported.The The studywhich was the first comprehensive epi- attributableriskamongexposedveteranswas7% demiologic analysis of IPF among the U.S. veteran(95% CI, 5.3-8.7%; P 0.001). Numerically greater populationfurtherfoundthattheincidenceandrisk was observed when restricting the cohort to 1) prevalence of IPF among veterans has increased overVietnam veterans who served in the army and 2) a the past decade. Between 2010 and 2019, the preva- more specific definition of IPF.lence doubled (from 582 to 1,160 cases per 100,000Theauthorsemphasizedthat,afteraccount-using the broad case definition and from 276 to 725ing for the competing risk of death, veterans with cases per 100,000 using the narrow case definition),Agent Orange exposure were still more likely to and incidence more than doubled (from 141 to 331develop IPF.Continued on Page 101 u99'