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will conduct a study of veterans to assess possible relationships between toxic exposures experienced during military service and mental health conditions and other health outcomes in accordance with PL117-168, Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act)
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and military characteristics (era and length of military service, military occupational specialty or specialties, service branch, service component) • History of toxic exposures during military service • Any diagnosis of a mental health condition or cognitive disorder • Any confounding traumatic experiences that could affect a veteran's mental health.
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Numerous factors in addition to deployment-related environmental and occupational exposures can contribute to the risk of developing mental, behavioral, and neurologic health outcomes, such as demographics, genetic profile, adverse childhood experiences, and traumas experienced during military service like 3 ADD was removed in prior versions of the Diagnostic and Statistical Manual of Mental Disorders and is no longer used for diagnosis. However, it is still used in common parlance and International Classification of Diseases (ICD)
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associations that meet this threshold are discussed; statistically significant point estimates less than 1.0 are not described because the committee chose to focus on identifying signals of potentially meaningful risk-conferring relationships. In recognition of the limitations of the data quality and availability and relying on any singular analysis and thus to facilitate a more holistic assessment of each possible relationship, the committee supplemented its original data analyses with a structured literature review limited to studies published in peer-reviewed, English-language journals in the last 10 years.
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The committee did not make conclusions about whether inadequate or insufficient evidence of a possible riskconferring relationship exists based on the literature alone, so there are no conclusions of inadequate or insufficient evidence for PM alone. The committee concluded that possible riskconferring relationships exist between dust and PM, exhaust, incinerator emissions, PM alone, or solvents and specific mental, behavioral, and neurologic conditions, and CMI.
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TABLE S-1 Summary of Conclusions by Outcome and Level of Evidence Committee Conclusion Inadequate or Insufficient Conclusion Health Possible Risk-Conferring Evidence of a Possible Risk Number Outcome Relationship Conferring Relationship Mental Health Outcomes 6-1 Adjustment There is a possible risk- There is inadequate or insufficient Disorders conferring relationship evidence of a possible risk-conferring between exposure to dust and relationship between exposure to PM, exhaust, or incinerator burn pits, fuels, metals, mold, emissions and adjustment radiation, or solvents and adjustment disorders. disorders.
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burn pits, dust, exhaust, fuels, incinerator emissions, metals, mold, radiation, or solvents and sleep disorders. 6-9 SUD There is a possible risk- There is inadequate or insufficient conferring relationship evidence of a possible risk-conferring between exposure to dust and relationship between exposure to PM, exhaust, or incinerator burn pits, fuels, metals, mold, emissions and SUD.
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Person-level exposure data that are systematically collected include information on exposure frequency, duration, and concentration; health outcome data that include symptom-based measures and capture care beyond VHA; and data on potential confounding factors such as prior traumas or mental health conditions would allow for more precise and accurate estimates of the relationships between adverse military exposures and mental, behavioral, and neurologic conditions, and CMI.
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