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Environmental Exposure Concerns of Veterans: Agent Orange and Beyond What You Need to Know . Caring for Veterans with Post Deployment Health Concerns: Past, Present and Future March 30-31, 2011 Ron Teichman, MD, MPH, FACP, FACOEM. Ron Teichman, MD, MPH, FACP, FACOEM.

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environmental exposure concerns of veterans agent orange and beyond what you need to know

Environmental Exposure Concerns of Veterans:Agent Orange and BeyondWhat You Need to Know

Caring for Veterans with Post Deployment Health Concerns:

Past, Present and Future

March 30-31, 2011

Ron Teichman, MD, MPH, FACP, FACOEM

ron teichman md mph facp facoem
Ron Teichman, MD, MPH, FACP, FACOEM
  • Associate Director – Clinical, Education and Risk Communication

War Related Illness and Injury Study Center (WRIISC)

VA New Jersey Health Care System – East Orange, NJ

  • With the NJ WRIISC for 7 years
  • Board certified in Internal Medicine and in Occupational and Environmental Medicine
disclaimer
Disclaimer
  • The views expressed in this presentation are those of the author and do not necessarily represent the position of the Department of Veterans Affairs or the United States Government
  • I have no known conflicts of interest other than that I work for the Department of Veterans Affairs
environmental exposure concerns of veterans
Environmental Exposure Concerns of Veterans –
  • Are exposure concerns of Veterans new?
  • What combat and military exposures are Veterans concerned about?
combat military exposures
Combat/Military exposures -
  • Burning trash
  • Harsh Weather Conditions
  • Poor Sanitary Conditions
  • Pesticides and Insects
  • Hazardous Weapons Systems
  • Occupational Chemical Hazards

Which war am I talking about?

which one
Which one?
  • Korean War (1950-1953)
  • Vietnam (1961-1975)
  • Grenada (1983)
  • Panama (1989)
  • First Gulf War/Desert Storm (1990-91)
maybe one of these
Maybe one of these?
  • Somalia (1993)
  • Bosnia (1993-95)
  • Kosovo (1998-99)
  • Operation Enduring Freedom/OEF (2001-present)
  • Operation Iraqi Freedom/OIF (2003-present)
vietnam conflict
Vietnam Conflict
  • Signature environmental exposure??
vietnam conflict1
Vietnam Conflict
  • Signature environmental exposure??
  • Correct – Agent Orange!
vietnam conflict2
Vietnam Conflict
  • Signature environmental exposure??
  • Correct – Agent Orange!
  • Other exposures?
vietnam conflict3
Vietnam Conflict
  • Signature environmental exposure??
  • Correct – Agent Orange!
  • Other exposures?
  • Napalm
  • Malaria, insects, insecticides
  • Burning trash
  • Poor hygiene and sanitary conditions
vietnam agent orange presumptively service connected conditions
Vietnam – Agent OrangePresumptively Service Connected Conditions
  • Acute and Sub-acute Peripheral Neuropathy
  • AL Amyloid
  • Chloracne
  • Chronic Lymphocytic Leukemia
  • Hodgkin’s Disease
  • Multiple Myeloma
  • Non-Hodgkin's Lymphoma
  • Porphyria Cutanea Tarda
  • Soft tissue Sarcoma
vietnam agent orange presumptively service connected conditions1
Vietnam – Agent OrangePresumptively Service Connected Conditions
  • Prostate Cancer
  • Respiratory Track Cancer
  • Diabetes Mellitus-Type II
  • B Cell Leukemias
  • Ischemic Heart Disease
  • Parkinson’s Disease
  • Next – HTN?
  • All sequelae thereof!
slide15

Okay, so exposures are not new.

  • Are exposure concerns new?
prevalence of exposure concerns common to vietnam persian gulf and bosnia kosovo
Prevalence (%) of exposure concerns common to Vietnam, Persian Gulf and Bosnia-Kosovo

From Schneiderman, Lincoln, Wargo, et. al., APHA, 12-14-05

top ten environmental exposures of concern gulf war
Top ten environmental exposures of concern: Gulf War
  • Protective gear/alarms (82.5%)
  • Diesel, kerosene, other petrochems (80.6%)
  • Oil well fire smoke (66.9%)
  • Local food (64.5%)
  • Insect bites (63.7%)
  • Harsh weather (62.5%)
  • Smoke from burning trash or feces (61.4%)
  • Within 1 mile of missile warfare (59.9%)
  • Repellants and pesticides (47.5%)
  • Paint, solvents (36.5%)

From Schneiderman, Lincoln, Wargo, et. al., APHA, 12-14-05

multi system medically unexplained symptoms not gulf war syndrome
Multi-System, Medically Unexplained SymptomsNOT GULF WAR SYNDROME
  • GW1 Veterans have more symptoms than other groups.
  • These symptoms occur in no consistent cluster
  • Most researchers have been unable to correlate specific exposures to symptoms
  • Symptoms may include:

Confusion Rash Cough

Headache SOB Fatigue

Memory problems Chest pain Parasthesia

Joint pains Diarrhea Sleep disorder

Muscle aches Abdominal pain Irritability

multi system medically unexplained symptoms
Multi-System, Medically Unexplained Symptoms
  • More possible causes than symptoms
    • Anthrax vaccine
    • Bites from insects and rodents
    • Pesticides and fleas collars
    • Oil well fires
    • Multiple vaccinations
    • Pyridostigmine Bromide
    • Sarin gas (Nerve agent)
    • MOPP suits
    • Etc., etc., etc.
perspective
Perspective
  • 23,532,000 US Veterans alive today.
  • Total US service members deployed to Operation Enduring Freedom/Operation Iraqi Freedom/ Operation New Dawn (OEF/OIF/OND)=2,100,000
  • Total US service members separated, i.e., now Veterans = 1,250,663(~5% of total Veteran population)
  • OEF/OIF Veterans that have received some health care from VA over 9 years = 625,384 ~ 50% of returnees

Through 3rd Quarter FY 2010

percentage of oef oif service members who endorsed exposure concerns on pdha and pdhra 9 07 10 08
Percentage of OEF/OIF service members who endorsed Exposure Concerns on PDHA and PDHRA (9/07-10/08)
  • Active component
    • Pre-Deployment n=245,378 0.0%
    • Post-Deployment n=224,511 16.2%
    • Reassessment n=189,933 21.2%
  • Reserve component
    • Pre-Deployment n=85,843 0.0%
    • Post-Deployment n=75,174 24.9%
    • Reassessment n=96,886 34.8%
  • Frequency of exposure concerns rise after 3-6 months

MSMR Vol. 15 / No. 7 – Sept. 2008

top five concerns of veterans from afghanistan and iraq
Top five Concerns of Veterans from Afghanistan and Iraq
  • Sand
  • Noise
  • Smoke from trash
  • Vehicle exhaust
  • JP8 or other fuel

MSMR Vol. 12 / No. 8 – Nov. 2006

frequency of oef oif service member exposure concern reported on the pdhra 9 05 8 06

30.0

30.0

Reserve

Reserve

Active

Active

25.0

25.0

20.0

20.0

Percent

Percent

15.0

15.0

10.0

10.0

5.0

5.0

0.0

0.0

Noise

Sand

Noise

Sand

Solvents

Solvents

JP8 or Fuel

JP8 or Fuel

DEET on skin

DEET on skin

Vehicle exhaust

Vehicle exhaust

Smoke from trash

Smoke from oil fire

Industrial pollution

Industrial pollution

Smoke from trash

Excessive vibration

Smoke from oil fire

Excessive vibration

Blast / Vehicle accident

Pesticide treated uniform

Blast / Vehicle accident

Pesticide treated uniform

Frequency of OEF/OIF service member exposure concern reported on the PDHRA (9/05-8/06)

MSMR Vol. 12 / No. 8 – Nov. 2006

top ten environmental exposures of concern oef oif
Top ten environmental exposures of concern: OEF/OIF
  • Smoke from burning trash or feces (44.6%)-7
  • Sand and dust storms (41.5%)-6
  • Gasoline, Jet Fuel, Diesel Fuel (21.1%)-2
  • Depleted Uranium (19.0%)
  • Paint, solvents, other petrochems (15.2%)-10
  • Oil well fire smoke (14.9%)-3
  • Contaminated food and water (14.4%)-4
  • Anthrax Vaccine (14.2%)
  • Multiple Vaccinations (13.9%) [8+9>3]
  • Vehicular Exhaust (10.3%)

Seen at NJ WRIISC, n=612. 1889 concerns, range 0-15

combat military exposures1
Combat/Military exposures -
  • Burning trash
  • Harsh Weather Conditions
  • Poor Sanitary Conditions
  • Pesticides and Insects
  • Hazardous Weapons Systems
  • Occupational Chemical Hazards

Which war am I talking about?

slide26

Okay, so we know that combat and military exposures are not new.

We know what some of the exposure concerns have been over the years and conflicts.

Later we’ll talk about:

What do we know about some of the more common exposures of concern to the newest Veterans?

How to conduct an environmental exposure assessment of Veterans.