Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2017) / Chapter Skim
Currently Skimming:
Appendix C: Airborne Hazards and Open Burn Pit Registry Self-Assessment Questionnaire
Appendix C: Airborne Hazards and Open Burn Pit Registry Self-Assessment Questionnaire
Pages 171-202
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 171... ...
Appendix C Airborne Hazards and Open Burn Pit Registry Self-Assessment Questionnaire 171
|
From page 173... ...
We ant ticipate that th time he expende by all individuals who co ed omplete this questionnaire will average 40 minutes. This includes q s the time it will take to read instructio ons, gather th necessary f he facts and fill o the form.
|
From page 174... ...
25 7. Health Care Utilization ...........................................................................................
|
From page 175... ...
APPENDIX C 175 DRAFT – Working Document 15 December 2014 Note: items in square parenthesis, "[] ", and item selection number are not displayed to the user.
|
From page 176... ...
Report Section Report Field Note Deployment Periods Service User Validates GWVIS Note Note Indicates Operation Desert Storm and Operation Desert Shield service 1.2. Location Specific Deployment Exposures "Tell us about potential exposures while you were deployed." [Note: Section 1.2 questions are asked for each deployment or deployment segment in the VADIR data]
|
From page 177... ...
[If ‘D' = yes] Did your duties during these dates include the burn pit (examples include trash burning, hauling trash to the burn pit, burn pit security, trash sorting at the burn pit)
|
From page 178... ...
Did you do anything differently during your deployment(s) , when you thought or were informed air quality was bad (for example during dust storms or heavy pollution days)
|
From page 179... ...
Please list all conditions even if you don't think they're related to a deployment exposure." 2.1. Functional Limitations and Reported Cause [Source: NHIS Adult Health Status & Limitations starting with AHS.091_01.000]
|
From page 180... ...
I do not wish to answer, 8. Don't know [Source: NHIS: Adult Health Status & Limitations AHS.200_00.000, selection 14 modified]
|
From page 181... ...
B Have you ever been told by a doctor or other health care professional that you had asthma?
|
From page 182... ...
E Have you ever been told by a doctor or other health care professional that you had chronic obstructive pulmonary disease also called COPD?
|
From page 183... ...
Chest pain, chest discomfort or chest tightness 9. Chronic sinus infection/sinusitis 10.
|
From page 184... ...
[if any A-E = yes] , When you were told you had hypertension, coronary artery disease, angina pectoris, a heart attack, or some other heart condition by a doctor or other health care professional, were you told before, during, or after deployment?
|
From page 185... ...
Don't know E During the past 12 months, have you been told by a doctor or other health professional that you had any a chronic multi-symptom illness (examples include irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia)
|
From page 186... ...
1 Enter X pounds, 2 I do not wish to answer, 3 Don't know 2.4. Cancer History [Source NHIS ACN.130_00.000]
|
From page 187... ...
APPENDIX C 187 DRAFT – Working Document 15 December 2014 7 Colon 8 Esophagus 9 Gallbladder 10 Kidney 11 Larynx-windpipe 12 Leukemia 13 Liver 14 Lung 15 Lymphoma 16 Melanoma 17 Mouth/tongue/lip 18 Ovary 19 Pancreas 20 Prostate 21 Rectum 22 Skin (non-melanoma) 23 Skin (Don't Know what kind)
|
From page 188... ...
188 ASSESSMENT OF THE DEPARTMENT OF VETERANS AFFAIRS AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY DRAFT – Working Document 15 December 2014 12 Leukemia 13 Liver 14 Lung 15 Lymphoma 16 Melanoma 17 Mouth/tongue/lip 18 Ovary 19 Pancreas 20 Prostate 21 Rectum 22 Skin (non-melanoma) 23 Skin (Don't Know what kind)
|
From page 189... ...
APPENDIX C 189 DRAFT – Working Document 15 December 2014 17 Mouth/tongue/lip 18 Ovary 19 Pancreas 20 Prostate 21 Rectum 22 Skin (non-melanoma) 23 Skin (Don't Know what kind)
|
From page 190... ...
190 ASSESSMENT OF THE DEPARTMENT OF VETERANS AFFAIRS AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY DRAFT – Working Document 15 December 2014 2.5. Tobacco Exposure [Source: NHIS Adult Health Behaviors: AHB.010_00.000]
|
From page 191... ...
APPENDIX C 191 DRAFT – Working Document 15 December 2014 2.
|
From page 192... ...
192 ASSESSMENT OF THE DEPARTMENT OF VETERANS AFFAIRS AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY DRAFT – Working Document 15 December 2014 2.6. Deployment Smoking History [Source: modified from DoD USAPHC DARE H2-5c]
|
From page 193... ...
APPENDIX C 193 DRAFT – Working Document 15 December 2014 3. Health Concerns "Help us focus our efforts on health issues you care about." A
|
From page 194... ...
I do not wish to answer G Have you discussed this concern with your health care provider, medical professional or team?
|
From page 195... ...
? Please include the city, state, zip code, and country.
|
From page 196... ...
Work History "Exposures in your non-military jobs may impact how deployment exposures affect you." 5.1. Current Occupational Status A
|
From page 197... ...
Automotive, aircraft and 3. Construction trade workers, fishing/hunting marine mechanics and service helpers and other construction workers technicians related workers 4.
|
From page 198... ...
Forest conservation and 9. Police and sheriff's logging workers patrol officers 10.
|
From page 199... ...
Automotive, aircraft and 3. Construction trade fishing/hunting workers marine mechanics and workers, helpers and service technicians other construction related workers 4.
|
From page 200... ...
Don't know 6. Home Environment and Hobbies "Exposures in your home environment or hobbies may impact how deployment exposures affect you." A
|
From page 201... ...
Don't know B Do you wish to see a DoD or VA health care provider to discuss your health concerns related to airborne hazards during deployment?
|
From page 202... ...
VA Web site 3. Through my health care provider 4.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.