Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2017) / Chapter Skim
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7 Findings, Conclusions, and Recommendations
7 Findings, Conclusions, and Recommendations
Pages 157-164
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From page 157... ...
OPENING OBSERVATIONS VA was presented with a challenge when it was directed by Congress to design, test, and implement an environmental health registry for "individuals who may have been exposed to toxic airborne chemicals and fumes caused by open burn pits" in 12 months. It set a goal to create a Web-only instrument that would cover military personnel who served in the Southwest Asia theater of operations from the beginning of the Gulf War conflict in 1990 through the present (2016)
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From page 158... ...
going forward. VA has articulated several different purposes in various documents: to help monitor health conditions affecting eligible veterans and service members; to improve VA programs to help veterans and service members with deployment exposure concerns; to generate potential hypotheses about exposure–response relationships; to improve programs in the Veterans Health Administration; and to provide outreach to veterans who may have experienced adverse health outcomes as a result of their exposures.
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From page 159... ...
Eliminating these categories would make the questionnaire easier and faster to complete and would better focus it on the needs of the eligible population. More generally, the AH&OBP Registry's data collection, administration, and management efforts would be improved by taking these steps: The committee recommends that once VA clarifies the intent and purpose of the registry, it develop a specific plan for more seamlessly integrating relevant VA and DoD data sources with the registry's data, with the goals of reducing future participant burden, increasing data quality by restructuring questions to minimize recall and other biases, and improving the usefulness of the registry database as an information source for health care professionals and researchers.
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From page 160... ...
Analyses were adjusted for demographic and military characteristics, but factors such as the older age of Gulf War veterans might be more salient when examining associations with respiratory and cardiovascular diseases, which are more likely to become more prevalent as the population ages. Among the most notable of the observations that can be drawn from these data are that nearly all respondents reported one or more airborne hazards encountered in theater: 96% of all respondents reported being exposed to a burn pit on at least one deployment, and 85.6% of Gulf War era respondents reported exposure to smoke from oil-well fires, while 85.2% of all respondents reported exposure to dust storms.
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From page 161... ...
Such outcomes strongly suggest that the results of analyses of the registry data cannot be taken at face value and that the identified associations may be an artifact of the population's selection and the limitations of the self-reported exposure and disease data. Again, the bottom line is that registry analyses are not generalizable and can only describe what exposures and conditions the population of registry respondents are reporting: registry data cannot be used to determine cause or to estimate prevalence in the total eligible population of service members or veterans.
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From page 162... ...
Addressing the issues identified by the committee would, though, improve the registry's utility as a means of • generating a roster of concerned individuals that VA can use for targeted outreach, surveillance, and health risk communication; • creating, via the completed questionnaire, a record of potential exposures and health concerns that is recorded in the participant's VA electronic health record; and • allowing VA users and nonusers who take part in the optional clinical exam to articulate concerns they may have to a health care provider and, if warranted, undergo appropriate diagnostic testing or referral, and begin treatment to improve symptoms. OTHER FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS The committee was also asked to offer observations on some additional issues surrounding the registry and the actions being taken by DoD and VA to address airborne hazards and open burn pit questions.
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From page 163... ...
The registry questionnaire collects a number of pieces of information that would facilitate conversations between a patient and a health care provider, without regard to whether the information might be relevant to AH&OBP exposures. For example, someone who reported difficulty walking long distances or climbing stairs might be experiencing joint pain, respiratory problems, atherosclerotic vascular disease, congestive heart failure, obesity, or even anxiety.
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From page 164... ...
As its analysis has made clear, though, there are inherent features of registries that rely on voluntary participation and self-reported information that make them fundamentally unsuitable for addressing the question of whether these exposures have, in fact, caused health problems. All parties -- service members, veterans, and their families; VA; Congress; and other concerned people -- would benefit from having a realistic understanding of the strengths and limitations of registry data so that they can make best use of them and, if desired, conduct the kind of investigations that might yield salient health information and enhance health care for those affected.
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