Post on 16-Dec-2015
Office of Public Health &Environmental Hazards
Environmental Exposure Concerns of Veterans:
Agent Orange and BeyondWhat You Need to Know Caring for Veterans with Post Deployment
Health Concerns:Past, Present and Future
March 30-31, 2011
Ron Teichman, MD, MPH, FACP, FACOEM
Ron Teichman, MD, MPH, FACP, FACOEM
Associate Director – Clinical, Education and Risk Communication
War Related Illness and Injury Study Center (WRIISC)
VA New Jersey Health Care System – East Orange, NJ With the NJ WRIISC for 7 years Board certified in Internal Medicine and in Occupational
and Environmental Medicine
Disclaimer
The views expressed in this presentation are those of the author and do not necessarily represent the position of the Department of Veterans Affairs or the United States Government
I have no known conflicts of interest other than that I work for the Department of Veterans Affairs
Environmental Exposure Concerns of Veterans –
Are exposure concerns of Veterans new? What combat and military exposures are
Veterans concerned about?
Combat/Military exposures -
Burning trash Harsh Weather Conditions Poor Sanitary Conditions Pesticides and Insects Hazardous Weapons Systems Occupational Chemical Hazards
Which war am I talking about?
Which one?
Korean War (1950-1953)
Vietnam (1961-1975) Grenada (1983) Panama (1989) First Gulf War/Desert
Storm (1990-91)
Maybe one of these?
Somalia (1993) Bosnia (1993-95) Kosovo (1998-99) Operation Enduring Freedom/OEF (2001-
present) Operation Iraqi Freedom/OIF (2003-
present)
Vietnam Conflict
Signature environmental exposure??
Vietnam Conflict
Signature environmental exposure?? Correct – Agent Orange!
Vietnam Conflict
Signature environmental exposure?? Correct – Agent Orange! Other exposures?
Vietnam Conflict
Signature environmental exposure?? Correct – Agent Orange! Other exposures? Napalm Malaria, insects, insecticides Burning trash Poor hygiene and sanitary conditions
Vietnam – Agent OrangePresumptively Service Connected
Conditions
Acute and Sub-acute Peripheral Neuropathy AL Amyloid Chloracne Chronic Lymphocytic Leukemia Hodgkin’s Disease Multiple Myeloma Non-Hodgkin's Lymphoma Porphyria Cutanea Tarda Soft tissue Sarcoma
Vietnam – Agent OrangePresumptively Service Connected
Conditions
Prostate Cancer Respiratory Track Cancer Diabetes Mellitus-Type II B Cell Leukemias Ischemic Heart Disease Parkinson’s Disease Next – HTN?
All sequelae thereof!
Presumptions
Why?
Okay, so exposures are not new.
Are exposure concerns new?
Prevalence (%) of exposure concerns common to Vietnam,
Persian Gulf and Bosnia-Kosovo
0102030405060708090
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ct b
ites
Petr
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Mis
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Burn
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Perc
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VietnamPersian GulfBosnia-Kosovo
From Schneiderman, Lincoln, Wargo, et. al., APHA, 12-14-05
Top ten environmental exposures of concern: Gulf
War1. Protective gear/alarms (82.5%)
2. Diesel, kerosene, other petrochems (80.6%)
3. Oil well fire smoke (66.9%)
4. Local food (64.5%)
5. Insect bites (63.7%)
6. Harsh weather (62.5%)
7. Smoke from burning trash or feces (61.4%)
8. Within 1 mile of missile warfare (59.9%)
9. Repellants and pesticides (47.5%)
10. Paint, solvents (36.5%)
From Schneiderman, Lincoln, Wargo, et. al., APHA, 12-14-05
Multi-System, Medically Unexplained Symptoms
NOT GULF WAR SYNDROME GW1 Veterans have more symptoms than other groups.
These symptoms occur in no consistent cluster Most researchers have been unable to correlate specific
exposures to symptoms Symptoms may include:
Confusion Rash Cough
Headache SOB Fatigue
Memory problems Chest pain Parasthesia
Joint pains Diarrhea Sleep disorder
Muscle aches Abdominal pain Irritability
Multi-System, Medically Unexplained Symptoms
More possible causes than symptoms Anthrax vaccine Bites from insects and rodents Pesticides and fleas collars Oil well fires Multiple vaccinations Pyridostigmine Bromide Sarin gas (Nerve agent) MOPP suits Etc., etc., etc.
Perspective
23,532,000 US Veterans alive today. Total US service members deployed to Operation
Enduring Freedom/Operation Iraqi Freedom/ Operation New Dawn (OEF/OIF/OND)=2,100,000
Total US service members separated, i.e., now Veterans = 1,250,663 (~5% of total Veteran population)
OEF/OIF Veterans that have received some health care from VA over 9 years = 625,384 ~ 50% of returnees
Through 3rd Quarter FY 2010
Percentage of OEF/OIF service members who endorsed Exposure
Concerns on PDHA and PDHRA (9/07-10/08)
Active component Pre-Deployment n=245,378 0.0% Post-Deployment n=224,511 16.2% Reassessment n=189,933 21.2%
Reserve component Pre-Deployment n=85,843 0.0% Post-Deployment n=75,174 24.9% Reassessment n=96,886 34.8%
Frequency of exposure concerns rise after 3-6 monthsMSMR Vol. 15 / No. 7 – Sept. 2008
Top five Concerns of Veterans from Afghanistan and Iraq
1. Sand
2. Noise
3. Smoke from trash
4. Vehicle exhaust
5. JP8 or other fuelMSMR Vol. 12 / No. 8 – Nov. 2006
Frequency of OEF/OIF service member exposure concern
reported on the PDHRA (9/05-8/06)
MSMR Vol. 12 / No. 8 – Nov. 2006
San
d
No
ise
Sm
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fro
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Veh
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Pes
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30.0
25.0
20.0
15.0
10.0
5.0
0.0
Per
cen
t
Reserve
Active
San
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No
ise
Sm
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fro
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Veh
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Pes
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Per
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Reserve
Active
Top ten environmental exposures of concern: OEF/OIF1. Smoke from burning trash or feces (44.6%)-72. Sand and dust storms (41.5%)-63. Gasoline, Jet Fuel, Diesel Fuel (21.1%)-24. Depleted Uranium (19.0%)5. Paint, solvents, other petrochems (15.2%)-106. Oil well fire smoke (14.9%)-37. Contaminated food and water (14.4%)-48. Anthrax Vaccine (14.2%)9. Multiple Vaccinations (13.9%) [8+9>3]10. Vehicular Exhaust (10.3%)
Seen at NJ WRIISC, n=612. 1889 concerns, range 0-15
Combat/Military exposures -
Burning trash Harsh Weather Conditions Poor Sanitary Conditions Pesticides and Insects Hazardous Weapons Systems Occupational Chemical Hazards
Which war am I talking about?
Okay, so we know that combat and military exposures are not new.
We know what some of the exposure concerns have been over the years and conflicts.
Later we’ll talk about: What do we know about some of the more
common exposures of concern to the newest Veterans?
How to conduct an environmental exposure assessment of Veterans.