National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

Assessment of the
Department of Veterans Affairs
Airborne Hazards and
Open Burn Pit Registry

David A. Savitz, Anne N. Styka, and David A. Butler, Editors

Committee on the Assessment of the Department of Veterans Affairs
Airborne Hazards and Open Burn Pit Registry

Board on the Health of Select Populations

Board on Population Health and Public Health Practice

Health and Medicine Division

A Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This study was supported by Contract No. VA241-P-2024 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-45117-8
International Standard Book Number-10: 0-309-45117-5
Digital Object Identifier: 10.17226/23677

Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2017 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Cover photo by E. B. Boyd. Used with permission.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
images

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
images

Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and committee deliberations. Reports are peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine.

Proceedings chronicle the presentations and discussions at a workshop, symposium, or other convening event. The statements and opinions contained in proceedings are those of the participants and have not been endorsed by other participants, the planning committee, or the National Academies of Sciences, Engineering, and Medicine.

For information about other products and activities of the National Academies, please visit nationalacademies.org/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

COMMITTEE ON THE ASSESSMENT OF THE DEPARTMENT OF VETERANS AFFAIRS AIRBORNE HAZARDS AND OPEN BURN PIT REGISTRY

DAVID A. SAVITZ (Chair), Vice President for Research, Professor of Epidemiology, and Professor of Obstetrics and Gynecology, Brown University, Providence, RI

VINÍCIUS C. ANTÃO, Director of Patient Registries, Healthcare Research Institute, Hospital for Special Surgery, New York, NY

JANE E. CLOUGHERTY, Associate Professor and Director of Exposure Science, University of Pittsburgh, PA

MONTSERRAT FUENTES, Dean of College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA

RICHARD A. KULKA, Consultant, Richard A. Kulka Consulting, Raleigh, NC

FRANCES MURPHY, President and CEO of Sigma Health Consulting, LLC, Silver Spring, MD

CECILE S. ROSE, Professor of Medicine in the Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO

ARMISTEAD G. RUSSELL, Howard T. Tellepsen Chair and Regents’ Professor, Georgia Institute of Technology, Atlanta, GA

DAVID H. TRUMP, Chief Deputy Commissioner for Public Health and Preparedness, Virginia Department of Health (retired), Richmond, VA

JOYCE S. TSUJI, Principal Scientist, Exponent, Bellevue, WA

MARK J. UTELL, Professor of Medicine and Environmental Medicine, Director of Occupational and Environmental Medicine, University of Rochester Medical Center, Rochester, NY

Study Staff

DAVID A. BUTLER, Study Director. Scholar and Director, Office of Military and Veterans Health

ANNE N. STYKA, Program Officer

CARY HAVER, Program Officer (from July 2016)

PAMELA RAMEY-McCRAY, Administrative Assistant (from October 2016)

SULVIA DOJA, Research Associate (through August 2016)

NICOLE FREID, Senior Program Assistant (August 2015–September 2016)

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

Reviewers

This report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Ronald Blanck, Martin, Blanck & Associates

Babette Brumback, University of Florida

Don A. Dillman, Washington State University

Herman Gibb, Gibb Epidemiology Consulting, LLC

Grace LeMasters, University of Cincinnati

Shari Beth Libicki, Ramboll Environ

Dylan Small, University of Pennsylvania

Tyler C. Smith, National University School of Health and Human Services

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Frank E. Speizer, Harvard Medical School; Ellen Wright Clayton, Vanderbilt University; and Chris Whipple, Environ (retired). They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

Preface

Women and men who were deployed to Iraq, Afghanistan, and other locations in Southwest Asia were subjected to an extensive array of health threats beyond those directly resulting from combat. Environmental exposures, in particular, have been of great concern to many of those who served, and understandably so, and there is perhaps no more worrisome issue in this area than the potential health consequences from exposure to emissions from open burn pits. Undoubtedly, for some period of time, the disposal of all waste materials through uncontrolled incineration led to the exposure of large numbers of service personnel to particulate matter and other health hazards, which in turn created a high probability of both acute and chronic health consequences in these individuals. Congress mandated that the Department of Veterans Affairs (VA) create a registry that would acquire exposure and health information on service members and veterans exposed to burn pits and other airborne hazards. Despite a number of daunting challenges in doing so in a short time frame, VA was fully responsive and developed an ambitious program to enroll volunteer participants. With a substantial volume of information now in hand, our committee was asked to evaluate the effectiveness of this program along a number of dimensions. As the report indicates, we have a number of major concerns and suggestions for improvement, but we acknowledge that we are addressing these issues with the luxury of hindsight, sufficient time to examine and evaluate the work, and the range of expertise needed to make such an assessment. VA faced a much more daunting task and deserves the gratitude of the Congress, service members, and veterans for its efforts, which we applaud. We also want to be clear that as we critically examine the nature of the registry and the data VA has produced, we fully appreciate and support the need to be responsive to the concerns of those who served, and we acknowledge that some of those who were exposed to burn pits and airborne hazards undoubtedly have suffered and continue to suffer adverse health consequences. Our assessment is focused on the registry itself as a means of answering questions about the health consequences of that exposure in a scientifically informative and constructive manner.

The committee wishes to acknowledge the VA staff who responded to our many requests for information related to the registry: Drs. Paul Ciminera, Nicholas G. Lezama, and Michael A. Montopoli; and Mr. Vincent Mitchell. The data analyses contained in this report were performed by the research corporation Westat under the direction of the committee. The committee greatly benefited from the work performed by Dr. Joseph Gasper, Mr. Jason Liu, and Ms. Jennifer Kawata and very much appreciates their rigor, their willing and able response to repeated requests, and the clarity of their presentation. The committee is grateful to the many veterans and experts who attended and provided input or materials during and after the committee’s May 2015 workshop. Finally, we need to give a great deal of credit to the Health and Medicine Division staff who contributed profoundly to the

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

committee’s report. Dr. David Butler, Ms. Anne Styka, and Ms. Cary Haver provided a critical understanding of the past work on other reports related to burn pits as well as evincing a nuanced ability to inform and guide the committee’s work without constraining its conclusions. We also thank Ms. Sulvia Doja, Ms. Pam McCray, and Ms. Nicole Fried for generously and capably providing logistical support to the committee. A thank you is also extended to Mr. Daniel Bearss, who conducted database and literature searches, and Ms. Ellen Kimmel, who assisted the committee with fact checking the report.

David A. Savitz, Chair
Committee on the Assessment of the Department of Veterans Affairs
Airborne Hazards and Open Burn Pit Registry

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

3 THE AIRBORNE HAZARDS AND OPEN BURN PIT QUESTIONNAIRE AND REGISTRY

SCIENTIFIC BASIS AND CONGRESSIONAL DIRECTIVE

DEVELOPING THE REGISTRY

Personnel and Expertise

Questionnaire Development

Optional In-Person Exam

Open Comment Period and Pilot Testing

RECRUITMENT AND ENROLLMENT

Eligibility

Process for Participation

COMMUNICATIONS AND OUTREACH

QUESTIONNAIRE QUALITY

Registry Questionnaire Basic Characteristics

Questionnaire Design

Evaluation of Questions

LINKING OTHER DATA TO REGISTRY DATA

SYNOPSIS AND CONCLUSIONS

REFERENCES

4 ANALYSIS METHODS AND DESCRIPTIVE STATISTICS

DATA REQUESTED AND RECEIVED

DATA ON AH&OBP REGISTRY PARTICIPANTS

Characterizing Eligibility

Unavailable Data

ANALYSIS METHODS

Assuring Quality Control of Analyses

PARTICIPATION RATES

REPRESENTATIVENESS

Demographic and Military Characteristics Comparisons

Comparisons of Differences Between Respondents and Total Eligible Population

Effect of Nonresponse

OVERVIEW OF QUESTIONNAIRE RESULTS

Questions with Limited Variability in Responses

Questions with High Rates of Nonresponse

SYNOPSIS AND CONCLUSIONS

REFERENCES

5 ANALYSIS AND INTERPRETATION OF EXPOSURES DATA

INTRODUCTION

Sources and Nature of Exposures

Limitations of Exposure Information

EXPOSURE INFORMATION COLLECTED BY THE AH&OBP REGISTRY

Location-Specific Deployment Exposures

General Military Occupational Exposures

Environmental Exposures and Regional Air Pollution

Limitations of AH&OBP Registry Questionnaire Exposure Information

THE COMMITTEE’S ANALYSIS OF AH&OBP EXPOSURE INFORMATION

Descriptive Statistics

Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×

Acronyms and Abbreviations

AFHSC Armed Forces Health Surveillance Center
AFIOH Air Force Institute for Occupational Health
AH&OBP Airborne Hazards and Open Burn Pit
AOR adjusted odds ratio

BMI

body mass index

CAD

coronary artery disease

CHPPM Center for Health Promotion and Preventive Medicine
CI confidence interval
CMI chronic multisymptom illness
COPD chronic obstructive pulmonary disease
CTS Contingency Tracking System

DEERS

Defense Enrollment Eligibility Reporting System

DMDC Defense Manpower and Data Center
DoD Department of Defense
DOEHRS Defense Occupational Environmental Health Readiness System

EPMSP

Enhanced Particulate Matter Surveillance Program

GAO

Government Accountability Office

ICD-9

International Classification of Diseases, Ninth Revision

IED improvised explosive device
IOM Institute of Medicine
IRR incidence rate ratio

MI

myocardial infarction

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
NHIS National Health Interview Survey

OEF

Operation Enduring Freedom

OIF Operation Iraqi Freedom
OMB Office of Management and Budget
OND Operation New Dawn
OR odds ratio

PAH

polycyclic aromatic hydrocarbons

PCDD/F polychlorinated dibenzo-p-dioxins and dibenzo-p-furans
PM particulate matter

SSC

Sergeant Thomas Joseph Sullivan Center

VA

Department of Veterans Affairs

VHA Veterans Health Administration
VOC volatile organic compound
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R14
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R15
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press. doi: 10.17226/23677.
×
Page R16
Next: Summary »
Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry Get This Book
×
Buy Paperback | $75.00 Buy Ebook | $59.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Military operations produce a great deal of trash in an environment where standard waste management practices may be subordinated to more pressing concerns. As a result, ground forces have long relied on incineration in open-air pits as a means of getting rid of refuse. Concerns over possible adverse effects of exposure to smoke from trash burning in the theater were first expressed in the wake of the 1990–1991 Gulf War and stimulated a series of studies that indicated that exposures to smoke from oil-well fires and from other combustion sources, including waste burning, were stressors for troops. In January 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain a registry for service members who may have been exposed to toxic airborne chemicals and fumes generated by open burn pits.

Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry analyzes the initial months of data collected by the registry and offers recommendations on ways to improve the instrument and best use the information it collects. This report assesses the effectiveness of the VA’s information gathering efforts and provides recommendations for addressing the future medical needs of the affected groups, and provides recommendations on collecting, maintaining, and monitoring information collected by the VA’s Airborne Hazards and Open Burn Pit Registry.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!