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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Image

Reassessment of the Department of
Veterans Affairs Airborne Hazards
and Open Burn Pit Registry

_____

Committee to Reassess the Department of
Veterans Affairs Airborne Hazards and Open
Burn Pit Registry

Board on Population Health and Public
Health Practice

Health and Medicine Division


Consensus Study Report

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and the Department of Veterans Affairs (36C2420C0186). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. https://doi.org/10.17226/26729.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
×

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
×

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
×

COMMITTEE TO REASSESS THE DEPARTMENT OF VETERANS AFFAIRS AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY

DAVID A. SAVITZ (Chair), Professor of Epidemiology, Brown University School of Public Health

JOHN R. BALMES, Professor of Medicine Emeritus, University of California San Francisco and Professor of Environmental Health Sciences Emeritus, School of Public Health, University of California, Berkeley

MICHELLE L. BELL, Mary E. Pinchot Professor of Environmental Health, Yale University

MICHAEL J. DANIELS, Andrew Banks Family Endowed Chair, Professor and Chair, Department of Statistics, University of Florida

MARIANTHI-ANNA KIOUMOURTZOGLOU, Associate Professor of Environmental Health Sciences, Columbia University Mailman School of Public Health

BHRAMAR MUKHERJEE, John D. Kalbfleisch Collegiate Professor of Biostatistics, Professor of Epidemiology, Professor of Global Public Health, Research Professor, University of Michigan

FRANCES M. MURPHY, President and Chief Executive Officer, Sigma Health Consulting, LLC

KRISTEN M. OLSON, Leland J. and Dorothy H. Olson Professor of Sociology and Director, Bureau of Sociological Research, University of Nebraska–Lincoln

TYLER C. SMITH, Professor and Statistical Epidemiologist, National University

Health and Medicine Division Staff

ANNE N. STYKA, Study Director, Senior Program Officer

ROBERTA WEDGE, Senior Program Officer (from August 2021)

AASHAKA A. SHINDE, Research Associate (from October 2021)

ALEXANDRA MCKAY, Senior Program Assistant (from March 2021)

CARY HAVER, Senior Program Officer (through July 2021)

ROSE MARIE MARTINEZ, Board Director, Board on Population Health and Public Health Practice

Consultants

JOSEPH GASPER, Westat

CAITLIN CARTER, Westat

CHRIS MANGLITZ, Westat

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
×

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

VICTORIA ARRANDALE, University of Toronto

ROBERT A. BARISH, University of Illinois Chicago

PATRICK BREYSSE, National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention

HERMAN GIBB, George Washington University

CHASE H. HARRISON, Harvard University

REBECCA HUBBARD, University of Pennsylvania

KENNETH W. KIZER, Stanford University and University of California, Davis

SUSAN PADDOCK, NORC at The University of Chicago

ARMISTEAD G. RUSSELL, Georgia Institute of Technology

MONICA SCHOCH-SPANA, Johns Hopkins University

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by SANDRO GALEA, Boston University School of Public Health, and MARYELLEN L. GIGER, The University of Chicago Department of Radiology. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
×

Preface

The impact of exposures encountered during military service, particularly during deployments, on the health of veterans and service members warrants sustained, intensive, rigorous attention, and the impact of airborne hazards and open burn pits remains at the forefront of those concerns. The committee appreciates that this was the basis for the congressional directive to develop the Airborne Hazards and Open Burn Pit (AH&OBP) Registry and that the Department of Veterans Affairs (VA) has conscientiously pursued its mission despite the considerable challenges in quickly developing and implementing a registry of this nature. Veterans and service members who incurred such exposures are highly deserving of information and health services based on their deployment histories. While it was a previous committee of the National Academies that provided the initial assessment and critique of the registry, the current committee has the charge to evaluate the ability of the AH&OBP Registry to perform the functions that Congress or VA specified or whether other sources of information are better able to fulfill a particular function. It is important at the outset to state that the committee strongly supports the need for continued research, surveillance, and health services that address the long-term impact of airborne hazards and open burn pit exposures and that we take seriously our charge to assess whether the registry is the most effective way to do so. Despite the laudable goals that were established for the AH&OBP Registry, where it falls short in its ability to provide a particular function or outcome, it is important to acknowledge this and seek other, more effective means of doing so. In the report that follows, the committee has not just examined the registry itself but the registry as a mechanism for responding effectively to veterans who have incurred these exposures.

The committee wishes to acknowledge the VA staff who responded to our many requests for information related to the registry: Dr. Eric Shuping, director, Post-9/11 Era Environmental Health Program, Post-Deployment Health Services, Department of Veterans Affairs; Dr. Michael Brumage, deputy chief consultant, Health Outcomes Military Exposures (HOME); Dr. Joe Salvatore, deputy director of operations, HOME; Dr. Michael Falvo, co-director, Airborne Hazards and Burn Pits Center of Excellence (AHBPCE); and Dr. Nisha Jani, epidemiologist, VA War Related Illness and Injury Study Center, VA New Jersey Health Care System. The committee is grateful to the many experts who presented and provided materials during and after the committee’s open sessions, including Dr. Shuping, who presented an overview of the AH&OBP Registry and the committee’s charge at our December 8, 2020, open session; Mr. Steven P. Jones, director, Force Readiness and Health Assurance Policy, Office of Deputy Assistant Secretary for Health Readiness Policy & Oversight, Department of Defense, and Mr. Larry Vandergrift II, Individual Longitudinal Exposure Record (ILER) project manager, Solution Delivery Division, Defense Health Agency, Clinical Support Management Office, who, together with Dr. Shuping, presented an overview of ILER

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
×

at our April 14, 2021 open session; Dr. Mark R. Farfel, director, World Trade Center Health Registry (WTCHR), New York City Department of Health and Mental Hygiene, Dr. James Cone, the medical director of WTCHR, and Dr. Robert Brackbill, WTCHR research director, who all presented an overview of the WTCHR; Dr. Rudy Rull, principal investigator, Millennium Cohort Study at Naval Health Research Center, and Dr. Edward J. Boyko, VA Puget Sound, director of VA’s Seattle Epidemiologic Research and Information Center and chair of VA Cooperative Study #505—The Millennium Cohort Study, who described the current status of data collection of the Millennium Cohort Study; and Dr. Falvo and Dr. Jani, who discussed the scope of the Airborne Hazards and Burn Pits Center of Excellence at our June 23, 2021, open session.

The data analyses contained in this report were performed by the research corporation Westat under the direction of the committee. The committee greatly benefited from the work performed by Dr. Joseph Gasper, Mr. Chris Manglitz, and Ms. Caitlin Carter and very much appreciates their rigor, their willing and able responses to repeated requests, and the clarity of the presented results.

Finally, we need to give a great deal of credit to the Health and Medicine Division staff who contributed profoundly to the committee’s report. The value of the support and leadership of Ms. Anne Styka in particular cannot be overstated, along with her extremely capable and conscientious colleagues, Ms. Roberta Wedge, Ms. Cary Haver, and Ms. Aashaka Shinde. They provided a critical understanding of the past work on other reports, kept the committee focused on its task of fully responding to the charge, and, more broadly, informed and guided the committee’s work without constraining its conclusions. The committee also thanks Ms. Alexandra McKay for generously and capably providing logistical support during and between its in-person, hybrid, and virtual meetings. The manner in which the Academies staff and committee members worked together was exemplary. A thank you is also extended to Ms. Misrak Dabi, financial business partner for this project; Dr. Michael Cohen, Ms. Rebecca Chevat, and Dr. Gillian Buckley, who assisted the committee on various aspects of the report; Ms. Anne Marie Houppert, senior librarian who assisted the committee with comprehensive literature searches; and Mr. Robert Pool, who assisted the committee with editing the report.

David A. Savitz, Chair
Committee to Reassess the Department of Veterans Affairs
Airborne Hazards and Open Burn Pit Registry

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
×

4-1 Example of an individual’s exposure summary as it appears in ILER

4-2 ILER dashboard showing data sources, date ranges of data, and additional resources that contain exposure and health information

7-1 Process for requesting and receiving an AH&OBP Registry health evaluation

TABLES

2-1 Limitations of Registries and Their Potential Effects

2-2 Number of AH&OBP Registry Participants by Era of Service

2-3 Countries and Areas of Deployment by Participants and Eligible Segments

2-4 Percent Differences of Select Demographic and Military Characteristics of Participants and Full Eligible Population, Stratified by Era of Service

2-5 Percent Distribution of Various Characteristics of Early and Late Participants

2-6 Percent User-Entered Deployments by Country of Deployment and Post-9/11

2-7 Percentage of Characteristics of Participants by Any Post-9/11 Deployment and Any User-Entered Deployment

2-8 Frequency and Item Nonresponse of Short-Duration Deployments

2-9 Distribution of Time to Complete the AH&OBP Registry Questionnaire

2-10 Median and Mean Time (in minutes) to Complete the AH&OBP Registry Questionnaire by Number of Deployment Segments

2-11 Last Questionnaire Section Viewed Among Eligible Noncompleters

2-12 Demographic and Military Characteristics of AH&OBP Registry Participants by Use of VA Health Care, 2001–2021

2-13 Health Outcomes Collected by the AH&OBP Registry by Early (June 1, 2014–July 31, 2015) and Late (August 1, 2015–February 1, 2022) Participants

2-14 Types of Cancer Diagnoses Reported

2-15 Deployment and Military Service Exposures Collected by the AH&OBP Registry by Early (June 1, 2014–July 31, 2015) and Late (August 1, 2015–February 1, 2022) Participants

2-16 Number and Percent of Responses to Exposure Questions of AH&OBP Registry Participants Who Used VA Health Care 2001–2021

2-17 Percentage of Self-Reported Exposure to Burn Pits on Deployments Before, During, and After Incinerator Installation at Joint Base Balad

2-18 Percentage of Self-Reported Exposure to Burn Pits on Deployment by Location Cohort

3-1 Selected Timeline of the AH&OBP Registry

3-2 Exposure Questions with Limited Variability in Response (Reported by >80%) by Early (June 1, 2014–July 31, 2015) and Late (August 1, 2015–February 1, 2022) Participants

3-3 Number of Exposures Reported by Early and Late Participants

3-4 Number of Reported Health Conditions of Early and Late Participants

3-5 Nonresponse Rate for Core Exposure and Health Outcome Questions

3-6 Type of Nonresponse (Missing, Do Not Wish to Answer, Don’t Know) by Question

3-7 Nonresponse Rate of Deployment-Related Burn Pit Exposure (Question 1.2.D) by Selected Military Characteristics

3-8 Number of Participants Missing Three Core Exposure Questions on Deployment Segment by Number of Deployments

3-9 Number of Years between Questionnaire Completion and Deployment, by Early and Late Participants

3-10 Last Section View for Noncompleters

Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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4-1 Gulf War Registry Demographic Characteristics by Study Group

4-2 Selected Current Department of Defense Data Sources for the Individual Longitudinal Exposure Record

4-3 Response Rates for Initial Enrollment and Follow-Up Surveys for Millennium Cohort Study Panels

5-1 Examples of Limitations of Potential Comparison Populations

5-2 Number of Years between Last Deployment and Questionnaire Completion

5-3 Comparison of Self-Reported Health Conditions with VA Medical Records

5-4 Hobbies on the AH&OBP Registry Self-Assessment Questionnaire Reported by Participants

6-1 Examples of National Population Health Surveillance Systems or Surveys

7-1 Number of Veterans and Veterans Health Administration Users by Era, 2010–2019

7-2 Percentage of Registry Participants Using VHA in the Year Prior to, the Year of, and the Year after Completing the Registry Questionnaire

7-3 AH&OBP Registry Participants by Calendar Year

7-4 Percentage of Registry Participants (n = 208,854) Using VHA in the Year Prior to, the Year of, and the Year after Completing the Registry Questionnaire and Receipt of a Health Evaluation

7-5 Time between Registry Questionnaire Completion and Date of Health Evaluation

7-6 Cross-Tabulation of Discussing Concerns and Last Seeing a Provider versus Receiving a Health Evaluation

7-7 Most Prevalent ICD-10 Diagnostic Codes Among AH&OBP Registry Participants

7-8 Interest in Health Evaluations and Health Evaluations Received, by Number of Reported Health Conditions

9-1 Contact Preferences Among AH&OBP Registry Participants

Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Acronyms and Abbreviations

AHBPCE Airborne Hazards and Burn Pits Center of Excellence
AH&OBP Airborne Hazards and Open Burn Pit
AHRQ Agency for Healthcare Research and Quality
AIMES AHBPCE IQuEST Military Exposure Surveillance
ATSDR Agency for Toxic Substances and Disease Registry
BRFSS Behavioral Risk Factor Surveillance System
CDC Centers for Disease Control and Prevention
CDMRP Congressionally Directed Medical Research Programs
CDW Corporate Data Warehouse
CI confidence interval
COPD chronic obstructive pulmonary disease
CTS Contingency Tracking System
DEERS Defense Enrollment Eligibility Reporting System
DMDC Defense Manpower and Data Center
DMSS Defense Medical Surveillance System
DoD Department of Defense
DOEHRS-IH Defense Occupational and Environmental Health Readiness System—Industrial Hygiene
EHR electronic health record
FY fiscal year
GPS global positioning system
HIPAA Health Insurance Portability and Accountability Act
HOME Health Outcomes Military Exposures
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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ICD-9 International Classification of Diseases, Ninth Revision
ICD-10 International Classification of Diseases, Tenth Revision
IED improvised explosive device
ILER Individual Longitudinal Exposure Record
IOM Institute of Medicine
IQuEST Center for Innovations in Quality, Effectiveness and Safety
IT information technology
MESL Military Exposure Surveillance Library
NASEM National Academies of Sciences, Engineering, and Medicine
NDAA National Defense Authorization Act
NHANES National Health and Nutrition Examination Survey
NHIS National Health Interview Survey
NHS National Health Survey of Gulf War Veterans and Their Families
NIEHS National Institute of Environmental Health Sciences
NIH National Institutes of Health
NIOSH National Institute for Occupational Health and Safety
OEF Operation Enduring Freedom
OFS Operation Freedom’s Sentinel
OIF Operation Iraqi Freedom
OIG Office of Inspector General
OIR Combined Joint Task Force-Operation Inherent Resolve
OMB Office of Management and Budget
OND Operation New Dawn
OR odds ratio
PDCEN Post-Deployment Cardiopulmonary Evaluation Network
PL public law
POEMS Periodic Occupational and Environmental Monitoring Summary
PTSD posttraumatic stress disorder
SAQ self-assessment questionnaire
SEER Surveillance, Epidemiology, and End Results Program
SME subject-matter expert
STAMPEDE Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures
USVETS United States Veterans Eligibility Trends and Statistics
VA Department of Veterans Affairs
VADIR Veterans Affairs/Department of Defense Identity Repository
VET-HOME Veteran Environmental Team Health Outcomes Military Exposures
VHA Veterans Health Administration
VINCI Veterans Affairs Informatics and Computing Infrastructure
VISN Veterans Integrated Services Network
VSO veteran service organization
WRIISC War Related Illness and Injury Study Center
WTCHR World Trade Center Health Registry
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/26729.
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Beginning with the 1990–1991 Gulf War, more than 3.7 million U.S. service members have been deployed to Southwest Asia, where they have been exposed to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand, diesel exhaust, and poor-quality ambient air. Many service members, particularly those who served in Iraq and Afghanistan, have reported health problems they attribute to their exposure to emissions from open-air burn pits on military installations.

In 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to "ascertain and monitor" the health effects of such exposures. This report serves as a follow-up to an initial assessment of the AH&OBP Registry completed by an independent committee of the National Academies in 2017. This reassessment does not include any strength-of-the-evidence assessments of potential relationships between exposures to burn pits or airborne hazards and health effects. Rather, this report assesses the ability of the registry to fulfill the intended purposes that Congress and VA have specified for it.

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