More than 3.7 million U.S. service members have participated in the Southwest Asia theater of military operations1 since 1990 (NASEM, 2020). These operations include the 1990–1991 Gulf War, a post-war stabilization period spanning 1992 through September 2001, and the campaigns undertaken in response to the September 11, 2001, terrorist attacks (i.e., post-9/11 conflicts).2 Although burn pits are only one of many possible sources of airborne hazards that may be encountered during deployment to Southwest Asia, they are the most well-recognized and -documented sources of smoke and fumes for a large number of service members. Thus, burn pits are often the focus of veteran and congressional concerns and attention and of deployment-related exposures research. Deployed personnel might also have been exposed to other airborne hazards including diesel and jet fuels and exhaust, local industrial sources of air pollution, and particulate matter from desert dust and sand suspended in the air. It is difficult to differentiate the contributions of the multiple sources of airborne hazards to the ambient air quality in theater (IOM, 2011). The adverse effects of these environmental contaminants may have been compounded by exposure to other environmental and physiological factors such as temperature extremes, stress, and noise (NASEM, 2017).
Concerns over possible adverse effects of exposure to smoke from oil-well fires and other combustion sources such as trash burning in the theater were first expressed in the wake of the 1990–1991 Gulf War, while concerns about exposures to airborne hazards—and to open burn pit emissions particularly—were amplified for post-9/11 service members and veterans. Deployment locations and occupational duties might increase the likelihood that a service member would be exposed to burn pits or other sources of hazardous materials. Open burn pits were large, constructed holes that were used for waste disposal via combustion, with jet fuels often used as accelerants. These pits were intended to be a temporary measure but became the waste disposal method of choice for the U.S.
1 The Department of Veterans Affairs defines the Southwest Asia theater of military operations as comprising Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, the United Arab Emirates, and the waters of the Persian Gulf, the Arabian Sea, and the Red Sea (VA, 2019). As deployments to other countries in this region, including Afghanistan, Syria, Uzbekistan, Djibouti, Egypt, and others may be added to eligibility criteria for different VA programs or policy decisions, for the sake of brevity, this report follows previous National Academies reports on the topic and refers to this region as the “Southwest Asia theater” or simply the “theater.”
2 These operations include Operation Desert Shield (August 7, 1990–January 17, 1991); Operation Desert Storm (January 17, 1991–Febru-ary 28, 1991); Operation Enduring Freedom (October 7, 2001–December 28, 2014); Operation Iraqi Freedom (March 20, 2003–August 31, 2010); Operation New Dawn (September 1, 2010–December 15, 2011); Combined Joint Task Force–Operation Inherent Resolve (October 17, 2014–present); and Operation Freedom’s Sentinel (January 1, 2015–August 31, 2021) (CRS, 2019; DoD, 2022a,b).
military in Iraq and Afghanistan due to their low cost of operation and ability to rapidly eliminate solid waste while maintaining operational security (IOM, 2011).
The Department of Defense (DoD) cataloged 63 open burn pit sites in Iraq as of November 2009 and 197 sites in Afghanistan as of 2011 (DoD, 2011). DoD estimated that at large bases the sites burned collectively approximately 60,000–85,000 pounds of solid waste per day, including plastics, electronics, wood, metal, rubber tires, and—according to some sources—materials such as chemicals (paints, solvents), petroleum products, wood, medical waste, munitions, and human waste (IOM, 2011). At many military facilities, land-filling, recycling, and incinerating these items were not feasible. Incomplete burning of such waste can generate large amounts of toxic byproducts.
Incinerators were installed at some of the larger bases beginning in 2009, which led to the eventual closing of some burn pits. Based in part on the accumulating scientific evidence regarding the hazards of combustion products, the National Defense Authorization Act for Fiscal Year 2010 (PL 111-84 §317; enacted October 28, 2009) included a provision that prohibited DoD from disposing of waste in open-air burn pits except when alternative disposal methods are not available, and called for the department to issue appropriate regulations concerning them. By the end of 2010 their use in Iraq had been phased out (IOM, 2011). However, open burn pits continued to be used in locations where other disposal methods were not possible. A DoD list of over 400 burn pits in Iraq, Afghanistan, Syria, and Egypt indicates that most of them were closed as of 2019, but the actual date of closure for many of them is unknown (VA, 2021).
Emissions from burn pits are only one of the many potential exposures experienced by military personnel deployed to Southwest Asia. Other exposures include agents used as preventive measures (such as vaccines, pesticides, and insecticides), hazards of the ambient environment (such as sand, insects, air pollution, and endemic diseases), job-specific agents (such as paints, solvents, and diesel and jet fuels and exhaust), war-related agents (such as smoke from oil-well fires and depleted uranium), and hazards associated with cleanup operations in the 1990–1991 Gulf War (such as sarin and cyclosarin) (IOM, 2011). The number and combination of these sources make it difficult to examine whether any agent or combination of agents may have caused or exacerbated health problems in deployed military personnel.
Neither DoD nor the Department of Veterans Affairs (VA) has detailed information on all the agents to which military personnel might have been exposed during deployment, at what doses, or for what amount of time. For example, Joint Base Balad in Iraq, which had a large burn pit, functioned as a transit stop, resulting in short-duration exposures for many service members as they passed through, but service members who were stationed at the base had more prolonged exposures (IOM, 2011). Moreover, meteorological conditions varied, affecting the direction in which the airborne hazards were transported as well as their concentrations. Thus, service members could experience large variations in the duration, frequency, and magnitude of their exposures, making it difficult to characterize any individual’s exposure over a period of time (NASEM, 2017). The complexities of determining causal relationships between deployment exposures and the need for more rigorous exposure monitoring have been discussed at length in several National Academies reports, and are not revisited here (IOM, 2011; NASEM, 2017; NRC, 2010).
In August 2021, VA issued an interim final rule that established a presumptive service connection for three chronic respiratory health conditions (asthma, rhinitis, and sinusitis, to include rhinosinusitis) in association with exposures to fine particulate matter (Federal Register, 2021). The presumption of exposure to fine particulate matter was created in order to establish a service connection for various chronic conditions when the evidence for this environmental exposure and associated health risks was strong in the aggregate but hard to prove on an individual basis. These presumptions apply to veterans with a qualifying period of active military service in the Southwest Asia theater of operations during the 1990–1991 Gulf War as well as those who served in the Southwest Asia theater of operations, Afghanistan, Syria, Djibouti, or Uzbekistan, on or after September 19, 2001. To be eligible for VA benefits, an individual must have been diagnosed with one of these conditions within 10 years of separation from the last period of military service that included a qualifying period of service (Federal Register, 2021). On April 25, 2022, VA established another presumptive service connection for nine rare respiratory cancers (squamous cell carcinoma of the larynx, squamous cell carcinoma of the trachea, adenocarcinoma of the trachea, salivary gland-type tumors of the trachea, adenosquamous carcinoma of the lung, large cell carcinoma of the lung,
salivary gland-type tumors of the lung, sarcomatoid carcinoma of the lung, typical and atypical carcinoid of the lung) in association with exposure to fine particulate matter. These presumptions will be applied to veterans who served in the Southwest Asia theater of operations from August 2, 1990, to the present or in Afghanistan, Uzbekistan, Syria, or Djibouti from September 19, 2001, to the present (Federal Register, 2022).
This chapter introduces previous National Academies reports that have examined the associations between airborne hazards and health effects among U.S. service members and veterans deployed to the Southwest Asia theater. It also describes the federal laws that called for the National Academies to study veterans’ health and that provided the impetus for and conduct of the current study.
Gulf War and Health Series
With the passage of two laws in 1998—PL 105-277, the Persian Gulf War Veterans Act, and PL 105-368, the Veterans Programs Enhancement Act—the secretary of VA was required to contract with the National Academies to assess the evidence on the health outcomes associated with exposure to airborne hazards during military service in the 1990–1991 Gulf War. Those laws required the Institute of Medicine (IOM)3 to review and evaluate the scientific and medical literature regarding associations between illness and exposure to numerous biologic, chemical, and physical agents; environmental or wartime hazards; and preventive medicines or vaccines associated with Gulf War service. VA was to treat those illnesses and to consider the National Academies’ conclusions when making decisions about compensation.
In response to PL 105-368, the National Academies has produced 11 Gulf War and Health and related reports to examine veterans’ deployment exposures as identified in the legislation and associated health effects. Reports that cover exposures to airborne hazards include:
- Gulf War and Health, Volume 2: Insecticides and Solvents (IOM, 2003)
- Gulf War and Health, Volume 3: Fuels, Combustion Products, and Propellants (IOM, 2005)
- Gulf War and Health, Volume 9: Long-Term Effects of Blast Exposures (IOM, 2014)
- Gulf War and Health, Volume 11: Generational Health Effects of Serving in the Gulf War (NASEM, 2018)
The reports in the Gulf War and Health series focused primarily on specific deployment exposures. Volumes 4 (IOM, 2006), 8 (IOM, 2010), and 10 (NASEM, 2016) sequentially reviewed the literature through 2015 to summarize what was known about the then-current status of veterans’ health based on deployment status rather than specific exposures.
The National Academies has also prepared other reports on Gulf War veterans. In Health Consequences of Service During the Persian Gulf War: Recommendations for Research and Information Systems, IOM reviewed how DoD and VA collected and maintained data on Gulf War veterans and how that data might be used (IOM, 1996). DoD and VA also asked IOM to assess important health issues in Gulf War veterans and design a study to address those issues in Gulf War Veterans: Measuring Health (IOM, 1999).
Reports on Airborne Hazards
In addition to 1990–1991 Gulf War and Health reports, the National Academies convened several expert committees at the request of VA that examined exposures of the post-9/11 veteran population or that examined a combination of 1990–1991 Gulf War and post-9/11 exposures. The most recent report, Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations (NASEM, 2020), identifies
3 As of March 2016 the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine continues the consensus studies and convening activities previously undertaken by the Institute of Medicine.
gaps in the evidence for respiratory health outcomes, describes research that could feasibly be conducted to address outstanding questions and emerging technologies that could aid these research efforts, and discusses organizations that VA might partner with to accomplish this work. That committee also examined 27 respiratory health outcomes in particular. Of these outcomes, none met the criteria for sufficient evidence of an association with airborne hazards exposure. The evidence for respiratory symptoms—which included chronic persistent cough, shortness of breath (dyspnea), and wheezing—met the criteria for limited or suggestive evidence of an association for both veterans who served in the 1990–1991 Gulf War and those who served in the post-9/11 conflicts. Limited or suggestive evidence of no association was found between deployment to the 1990–1991 Gulf War and changes in lung function. That committee found that there was inadequate or insufficient information to evaluate the association between service in the Southwest Asia theater and each of the remaining respiratory health outcomes it examined, primarily due to inadequate exposure characterization; lack of temporal health, physiologic, behavioral, and biomarker data information (both pre- and post-deployment); and the length of time that had passed since exposure.
Given those limitations, that committee concluded that a new approach was needed to better examine whether certain respiratory outcomes are associated with deployment. This new approach was not intended to suggest that the only alternative is to undertake work that will take many years to bear useful results. Rather, well-conducted epidemiologic studies are currently possible using retrospective designs that better account for confounding factors such as smoking habits, that combine and analyze existing data in innovative ways, that standardize outcome ascertainment methods to better compare results, and that improve exposure estimates. That committee further stated, “While burn pit–related research will certainly be a part of this work, it will likely be challenging to attribute specific respiratory effects to this exposure alone” (NASEM, 2020, p. 9). It also emphasized that the more important question is whether deployment to the Southwest Asia theater—with all of the hazardous airborne exposures it entails—may be responsible for adverse respiratory outcomes.
The first National Academies consensus study on military burn pit emissions began in 2009 with a request from VA to identify any long-term health effects that might result from exposure to burn pits in Iraq and Afghanistan and to evaluate the feasibility and design of an epidemiologic study of veterans exposed to burn pit emissions (IOM, 2011). Using DoD air-sampling data from Joint Base Balad in Iraq, a location with a large burn pit, as well as peer-reviewed literature on other populations with similar exposures to combustion products, the 2011 report committee concluded that there was limited/suggestive evidence of an association between exposure to combustion products and reduced pulmonary function. However, it also determined that there was inadequate or insufficient evidence of an association between exposure to combustion products and cancer, respiratory diseases, circulatory diseases, neurologic diseases, and adverse reproductive and developmental outcomes in the studied populations (i.e., service members and veterans, firefighters, and incinerator workers).
That committee recommended that a tiered approach be used to conduct epidemiologic studies to characterize burn pit exposures and to account for other sources of air pollutants in the ambient environment. The committee concluded that a tiered approach was feasible for studying health outcomes that might result from burn pit exposures, but it also realized that producing useful and actionable results would depend on any such study having a well thought-out design, thorough exposure assessments, and careful follow-up. The three tiers were characterized by decreasing specificity of exposure and would answer different research questions. In response to the 2011 National Academies report, VA began planning an epidemiologic study on the long-term health effects of exposure to fine particulate matter in the Southwest Asia theater (Federal Register, 2013).
The Airborne Hazards and Open Burn Pit Registry
In January 2013 the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012 (PL 112-260) was enacted. Section 201 of the law (reproduced in Appendix A) directed the secretary of VA to coordinate with DoD to establish and maintain an open burn pit registry for eligible individuals who may have been exposed to toxic airborne chemicals and fumes from open burn pits, and it specified that the registry should include information to ascertain and monitor health outcomes in exposed service members. The law further instructed VA to develop a public information campaign to inform individuals about the registry—including how to register and the benefits of registering—and to periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to toxic airborne chemicals. The law also called for an independent
scientific organization to prepare a report assessing the establishment and conduct of the registry and the use of registry data; a reassessment of the registry was to be conducted 5 years after the initial assessment. VA asked the National Academies to conduct those assessments.
The initial assessment of the Airborne Hazards and Open Burn Pit (AH&OBP) Registry required a National Academies committee to analyze the first several months of data collected by the registry and to offer recommendations on ways to improve the registry’s self-assessment questionnaire and to best use the information collected by the registry. That committee’s report, Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry, was published in February 2017. Specific results, conclusions, and recommendations from that report are described throughout this report; this section provides only a summary of the most salient information.
The initial assessment committee carried out analyses of the first 13 months (June 2014–July 2015) of data gathered from the 46,404 respondents who had completed the registry questionnaire. These respondents accounted for approximately 1.0% of the 1990–1991 Gulf War veterans and 1.7% of post-9/11 veterans who met the registry’s eligibility criteria4 (NASEM, 2017). That committee’s analyses included a descriptive characterization of self-reported health outcomes and self-reported exposures to burn pits and other airborne hazards. The analyses also used DoD data on country, number, and duration of deployments to synthesize additional exposure metrics that were used by the committee to conduct a series of multivariable regression analyses to describe potential exposures and health outcomes.
The initial assessment report detailed a number of quality issues and limitations of the registry’s information (see Chapter 3). The committee that produced that report concluded that the results of its analyses could not be relied on and that any associations (or lack thereof) might be an artifact of the registry participants’ self-selection and the limitations of voluntary participation, self-reported exposure and health outcome data, and other factors unrelated to exposure–disease associations, such as genetic predisposition. Those issues would continue to affect the use of the registry. That committee further stated that the registry analyses were not generalizable and could only describe what exposures and health conditions the registry participants were reporting; the registry data could not be used to determine cause or to estimate prevalence of health conditions in the total eligible population of service members or veterans. The committee emphasized that improving the self-assessment questionnaire depended on the registry’s intended purpose(s) and that in its current configuration the AH&OBP Registry could not fulfill VA’s stated purposes for it (NASEM, 2017).
The initial assessment committee made nine recommendations that touched on multiple areas (see Box 1-1). These included how the purpose and intent of the AH&OBP Registry could be clarified, with the necessary addition of explicit messaging about its limitations; how to improve the questionnaire; how to improve the registry’s data collection, administration, and management efforts; what analyses should be undertaken, such as whether questionnaire completers differ from noncompleters, and what external evaluations might be useful, including the need for a well-designed epidemiologic study of exposed veterans; and how to make it easier for participants to schedule and receive the free optional health evaluation. VA’s responses to the committee’s recommendations and changes made to the AH&OBP Registry since the initial assessment report are discussed throughout this report.
Since the 2017 initial assessment report, several improvements to the AH&OBP Registry have been proposed or advocated for by veterans, veteran service organizations (VSOs), and Congress. Suggested improvements include:
- Increase AH&OBP Registry enrollment. Low enrollment relative to the eligible population has been attributed to the voluntary nature of the registry. Proposed solutions have included more aggressive outreach to potentially exposed veterans and military personnel by VA and DoD, respectively (IAVA, 2021).
- Allow registry access for family members to enroll on behalf of deceased veterans who met the eligibility criteria.
4 Veterans and service members are eligible to participate in the AH&OBP Registry if they served in the Southwest Asia theater as defined in footnotes 1 and 2.
- Allow participants to update their information after they initially complete and submit the questionnaire.
- Amend the AH&OBP Registry to include information on mortality and to link it to epidemiologic studies (Thayer, 2021).
In response to veteran and VSO concerns, several state governments have proposed legislative solutions that would complement the activities of the AH&OBP Registry or create a separate data collection mechanism for burn pit and other exposures (e.g., Master Sergeant Jessey Baca Military Airborne Hazards and Open Burn Pit Registry Act, 2015; The Service Member and Veteran Open Burn Pit Registry Act, 2019). One VSO, Burn Pits 360, created its own registry of approximately 20,000 participants which allows veterans to report changes in their health and for family members to report the death of a service member or veteran (Burn Pits 360, 2021).
The committee conducted a search of Congress.gov and found that the AH&OBP Registry was mentioned in 13 pieces of legislation introduced in the 117th Congress (2021–2022), 12 pieces of legislation in the 116th Congress (2019–2020), and 6 pieces of legislation in the 115th Congress (2018–2019) (accessed June 13, 2022). The proposed changes to the AH&OBP Registry included expanding eligible deployment locations, allowing family members to participate in the registry on behalf of a deceased veteran or service member, having an opt-out registry structure rather than the current opt-in structure, and requiring periodic health evaluations of service members to include assessments of burn pit and airborne hazard exposures. Only four of the proposed laws related to the AH&OBP Registry were passed: the National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2019 (PL 115-232), NDAA for FY 2020 (PL 116-92), NDAA for FY 2021 (PL 116-283), and NDAA for FY 2022 (PL 117–81). PL 115-232 required that DoD establish an annual education campaign to reach individuals who may be eligible to enroll in the AH&OBP Registry.
PL 116-92 required that any periodic health assessment conducted by DoD or VA include an evaluation to determine if the individual has been stationed near an active open burn pit and whether that individual was exposed to toxic airborne hazards. For evaluations that confirm such individual exposures, PL 116-92 directed that DoD and VA share that data and information. PL 116-92 also required that all DoD medical personnel have access to AH&OBP Registry data. When asked how VA will respond to this latter directive, it stated that every AH&OBP Registry participant has a PDF of the completed questionnaire that is sent monthly to DoD Public Health Command. The DoD Public Health Command will pull that data into the Defense Occupational and Environmental Health Readiness System to be available in the Individual Longitudinal Exposure Record (ILER; described in Chapter 4). Alternatively, VA is considering whether a direct feed of the completed questionnaires into ILER is possible (VA, 2022).
PL 116-283 included three sections that referenced the registry:
- Sec. 720 ensures that electronic health records of military personnel or veterans enrolled in the registry are updated with any information relevant to the registry.
- Sec. 734 states that a registry of covered TRICARE beneficiaries who have been diagnosed with COVID-19 shall include information regarding the beneficiary that is contained in the AH&OBP Registry.
- Sec. 735(2) states that if upon receiving a health assessment it is established that the individual was based or stationed at a location where an open burn pit was used, or that the individual was exposed to toxic airborne chemicals or other airborne contaminants, the individual will be enrolled in the AH&OBP Registry unless the individual elects to not enroll in the registry.
Section 6602 of the NDAA for FY 2022 (PL 117-81) also referenced the registry and stated that the scope of the AH&OBP Registry will be expanded to include burn pits in Egypt and Syria by amending § 201(c)(2) of the Dignified Burial and Other Veterans’ Benefits Improvement Act of 2012.
In addition to the four public laws, the 115th Congress (2017–2018) passed two amendments to House Report 115–712—the Welch Amendment-A057 (H. Amdt. 770) and the Ruiz Amendment-A053 (H. Amdt. 766)—the first of which provided $5 million to improve the existing registry and to increase clinical research on burn pit exposure. The second amendment increased VA health services funding to increase veteran education and outreach for greater enrollment in the registry, to promote research using registry data, and to fund registry maintenance.
On February 16, 2022, the U.S. Senate passed the Health Care for Burn Pit Veterans Act (S.3541) to expand access to health care for post-9/11 combat veterans, including those with exposure to burn pits, and to require that VA implement clinical screenings for veterans to identify potential exposure to toxic substances. This act is part of a plan to expand access to health care for veterans exposed to toxic substances, and will include the creation of a public relations outreach plan to contact veterans who were unable to enroll during the initial period of eligibility.
On August 10, 2022, PL 117-168, Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022, was signed into law to secure benefits and services for veterans exposed to toxic substances while serving overseas. Section 808 requires VA submit an annual report to Congress
on cases of burn pit exposures by “covered” (i.e., registry eligible) veterans that includes a comprehensive list of the top 10 conditions from each body system for which the secretary awarded service connection for covered veterans and any updates or trends with respect to the total number of covered veterans. It further states that the secretary of VA shall ensure that a VA medical professional informs a veteran of the registry if the veteran presents at a VA medical facility for treatment that the veteran describes as being related to exposure to toxic airborne chemicals and fumes caused by open burn pits. PL 117-168 specifies that the number of registry participants will be displayed by state and congressional district for public transparency.
This law has widespread support from VSOs including the Military Officers Association of America, the American Legion, Veterans of Foreign Wars, Disabled American Veterans, Wounded Warrior Project, and Iraq and Afghanistan Veterans of America. In addition to establishing the presumption of service connection for certain conditions, the law will allow veterans diagnosed with these conditions to receive VA benefits for which they were not previously eligible. The law will also expand health care for the estimated 3.7 million veterans exposed to burn pits and other toxins.
The impact of legislative changes to the AH&OBP Registry will be discussed where relevant elsewhere in this report. The legislative initiatives are current as of August 10, 2022. The committee recognizes that some of the recommendations provided in this report will need to be reconciled with current and future federal legislation.
In accordance with PL 112-260 § 201(b)(1), VA requested that the National Academies form an expert committee to conduct an updated assessment (reassessment) of several areas related to the AH&OBP Registry or information collected by it. The committee’s full Statement of Task is shown in Box 1-2.
Similar to the initial assessment committee, the reassessment committee included experts in epidemiology, environmental and occupational health, exposure assessment, military and veterans’ health, statistics, and survey methodology. It comprised nine members (see Appendix C for members’ biographical sketches), who held nine full committee meetings and numerous subgroup meetings between December 2020 and June 2022 to consider evidence and write this report. The committee meetings included open sessions with presentations by VA representatives to elucidate the committee’s charge and to describe relevant VA programs, centers, and processes as well as invited presentations from representatives of ILER, the Millennium Cohort Study, and the World Trade Center Health Registry (see Appendix B for the agendas and speakers for all public information gathering sessions).
Chapter 2 describes the committee’s approach and methods for responding to its Statement of Task, including its interpretation of the task, information gathering, considerations of exposure registries, the state of research on burn pits health effects, and a descriptive review of AH&OBP Registry data. Chapter 3 summarizes the development and operations of the AH&OBP Registry and explores how it has changed since the initial assessment report was published in 2017. In Chapter 4 the committee reviews other sources of airborne hazards exposures data and programs that may be considered for improving the AH&OBP Registry or may be alternatives to it with respect to determining health effects that may result from exposure to burn pits and other airborne hazards. Chapters 5 through 9 discuss the AH&OBP Registry’s ability to support or fulfill the five purposes as specified by Congress and VA. Other stakeholders include individual veterans and service members and VSOs. The committee assesses whether the AH&OBP Registry, as it is currently configured, is able to address each purpose. If not, the committee considers whether improvements could be made to it or if alternatives are available to better address that purpose. Those purposes are:
- To improve clinical care for veterans who have health concerns related to their deployment exposures (Chapter 7);
- To support VA policies and processes, including benefits claims, and VA programs to help veterans with deployment exposure concerns (Chapter 8); and
- To communicate with veterans, health care providers, and other stakeholders (Chapter 9).
Chapter 10 presents the committee’s synthesis of the current and potential uses of the AH&OBP Registry in fulfilling its stated purposes as well as alternative methods for achieving the registry’s goals. PL 112-260, which mandated the creation of the AH&OBP Registry is presented in Appendix A, public meeting agendas and presenters are listed in Appendix B, and committee and staff biographical sketches are given in Appendix C.
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CRS (Congressional Research Service). 2019. U.S. periods of war and dates of recent conflicts. https://crsreports.congress.gov/product/pdf/RS/RS21405/30 (accessed June 27, 2022).
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Federal Register. 2013. Notice: Department of Veterans Affairs initial research on the long-term health consequences of exposure to burn pits in Iraq and Afghanistan. Federal Register 78(23):7860–7861.
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IOM. 2005. Gulf War and health: Volume 3: Fuels, combustion products, and propellants. Washington, DC: The National Academies Press.
IOM. 2006. Gulf War and health: Volume 4: Health effects of serving in the Gulf War. Washington, DC: The National Academies Press.
IOM. 2010. Gulf War and health: Volume 8: Update of health effects of serving in the Gulf War. Washington, DC: The National Academies Press.
IOM. 2011. Long-term health consequences of exposure to burn pits in Iraq and Afghanistan. Washington, DC: The National Academies Press.
IOM. 2014. Gulf War and health: Volume 9: Long-term effects of blast exposures. Washington, DC: The National Academies Press.
NASEM (National Academies of Sciences, Engineering, and Medicine). 2016. Gulf War and health: Volume 10: Update of health effects of serving in the Gulf War, 2016. Washington, DC: The National Academies Press.
NASEM. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press.
NASEM. 2018. Gulf War and health: Volume 11: Generational health effects of serving in the Gulf War. Washington, DC: The National Academies Press.
NASEM. 2020. Respiratory health effects of airborne hazards exposures in the Southwest Asia Theater of military operations. Washington, DC: The National Academies Press.
NRC (National Research Council). 2010. Review of Department of Defense Enhanced Particulate Matter Surveillance Program. Washington, DC: The National Academies Press.
Thayer, R. L. 2021. Burn pit registry now has 200,000 signers, VA says. https://www.military.com/daily-news/2020/05/12/burn-pit-registry-now-has-200000-signers-va-says.html (accessed June 15, 2021).
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VA. 2022. Response to the Committee to Reassess the Department of Veterans Affairs Airborne Hazard and Open Burn Pit Registry information request. Provided by Dr. Eric Shuping, director, Post-9/11 Era Environmental Health Program, Health Outcomes Military Exposures, VA, January 6. Available from the project public access file at https://www8.nationalacademies.org/pa/managerequest.aspx?key=HMD-BPH-20-06.