Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2022) / Chapter Skim
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, and to the present.2 Deployments to Southwest Asia have exposed service members to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, airborne dust and sand, diesel exhaust, and poor-quality ambient air. Many military personnel, particularly those who served in Iraq and Afghanistan post-9/11, have reported health problems that they attribute to their exposure to emissions from openair burn pits on military installations or operations in those countries and elsewhere.
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VA added other purposes, so that the AH&OBP Registry currently has five purposes: • Etiologic (causal relationships) research on health effects associated with deployment exposures to airborne hazards; • Population health surveillance to monitor the health of veterans exposed to airborne hazards while deployed; • Improving clinical care for veterans who have health concerns related to their deployment exposures;
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Given the significant costs of maintaining the current registry and a participant burden with few benefits, as detailed in this report, the goals and functions of the registry need to be modified so that they are attainable and provide value to this veteran population in an efficient manner. The effort and resources currently devoted to the registry would be better directed toward alternative, more effective mechanisms for etiologic research and population health surveillance, with sufficient resources to support a greatly streamlined registry for generating and maintaining a roster of individuals who are interested in or concerned about the health effects of airborne hazards exposures.
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The health evaluation will continue to be an opportunity for participants to talk with knowledgeable clinicians about their deployment-related health concerns. It can also give VA health care providers information about the range and frequency of health conditions reported by registry participants, advise them on health risks, and recommend medical screening and follow-up activities, regardless of VHA enrollment status.
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A very conservative estimate is that participants invested at least 200,000 person-hours in completing AH&OBP Registry questions outside of their deployment history. USE FOR ETIOLOGIC RESEARCH To assess the registry's ability to support etiologic research on the association between deployment exposures to airborne hazards and burn pits and health outcomes, the committee identified six characteristics that any exposure registry to be used for etiologic research should have and then applied them to the AH&OBP Registry: • a sufficient sample size for precise estimation of causal effects; • a representative sample of the population of interest; • identification of an appropriate comparison population; • an exposure assessment of adequate quality; • a health outcome assessment of adequate quality; and • identification of other contributing factors that might impact the association.
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The committee also finds that, with some modifications to the number and type of exposure questions the Millennium Cohort Study asks, it could capture the airborne hazards in the AH&OBP Registry questionnaire, and it could be an improved resource for etiologic research on airborne hazards exposures for post-9/11 vet erans and service members. Recent epidemiologic studies on burn pit exposures vary with respect to both methods and quality but they illustrate that studies of burn pit exposures and associated health outcomes continue to be undertaken.
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The committee finds that the AH&OBP Registry does not satisfy all four of the criteria necessary to conduct population health surveillance for service members and veterans potentially exposed to burn pits or other airborne hazards in the Southwest Asia theater. Furthermore, given its fundamental design, the committee concludes that refinements or improvements will not allow the AH&OBP Registry to serve as a population health surveillance system.
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No information is available on whether the in-depth health evaluations for the small, select number of participants evaluated by the VA Airborne Hazards and Burn Pits Center of Excellence have improved clinical care for veterans or resulted in better clinical guidance. INFORMING VA POLICIES AND PROCESSES VA does not use the AH&OBP Registry for internal policy decisions beyond the standardization of registry procedures in VHA Directive 1307,6 which directs administrative and clinical procedures and processes for the registry health evaluation, although how the registry informed the directive is unclear.
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. and periodically notify eligible individuals of significant developments in the study and treatment of conditions associated with exposure to toxic airborne chemicals and fumes caused by open burn pits." VA has made some efforts to meet the mandate of informing eligible individuals about the registry, but it has not been consistently proactive about informing them about research developments, the treatment of conditions related to airborne hazards, or about new programs and benefits designed for them.
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The committee expects that such studies would be cost-effective in terms of discovering associations between airborne hazards and burn pit exposures and health outcomes. The 2020 National Academies report, Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations, identified gaps in the research, diagnosis, and treatment of the possible respiratory health effects stemming from exposure to airborne hazards and burn pits during deployment.
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