Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry (2022) / Chapter Skim
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3 Airborne Hazards and Open Burn Pit Registry Development and Operations
3 Airborne Hazards and Open Burn Pit Registry Development and Operations
Pages 65-102
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From page 65... ...
The final section of this chapter presents four of the nine recommendations made by the initial assessment committee (NASEM, 2017) that pertain to the information presented in this chapter (the other five recommendations from the initial assessment are presented in the following chapters where relevant, and all nine recommendations are presented in Chapter 1)
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From page 66... ...
NOTES: AHBPCE = Airborne Hazards and Burn Pits Center of Excellence; PL = public law; OMB = Office of Management and Budget; VHA = Veterans Health Administration; VA = Department of Veterans Affairs. An individual is considered a "registrant" until he or she completes and submits the self-assessment questionnaire, at which time the status changes to "participant." The rolling number of participants is found on the registry website https://veteran.mobilehealth.va.gov/AHBurnPitRegistry/index.html#page/help.
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From page 67... ...
. Once participants submit their responses to the registry questionnaire, the data are saved on a VA server, regardless of whether the individuals are active-duty service members or veterans.1 As of January 2021, VA's Airborne Hazards and Burn Pits Center of Excellence (AHBPCE)
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From page 68... ...
6 Personal Communication -- Open Burn Pit Registry/Airborne Hazards Exposure Assessment Working Group charter, Dr. Nicolas Lezama, deputy chief consultant, Post-Deployment Health Services, Patient Care Services, VHA.
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From page 69... ...
The initial assessment committee concluded that the exposure data are of insufficient quality or reliability to make them useful for anything other than the most general evaluations of exposure potential, and even then such exposure information should be viewed with extreme caution. Additional information, including other occupational and environmental sources of airborne pollutants (as ascertained by well-designed and validated questions)
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. An estimate of how many service members and eligible deployment segments would be affected by this change was not provided (VA, 2022b)
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From page 71... ...
Information about the health evaluation at the bottom of the page following this question was also revised. VA's intention in making this change was to clarify a participant's interest in the optional health evaluation.10 Outreach efforts had found that some participants did not understand the previous question (which asked "Do you wish to see a DoD or VA health care provider to discuss your health concerns related to airborne hazards during deployment?
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From page 72... ...
VA had indicated to the initial assessment committee that a small number of persons who were not eligible under these criteria have also been permitted to participate (NASEM, 2017)
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From page 73... ...
A registry help desk is available for service members and veterans who are experiencing difficulties registering for an account or accessing the online questionnaire (VA, 2022d)
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From page 74... ...
and DoD. It provides access to information from VBA's corporate Rating Board Automation 2000, Compensation and Pension Benefits Delivery Network for veterans, and VBA's Beneficiary Identification and Locator System, and Veterans Affairs/Department of Defense Identity Repository (VADIR)
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From page 75... ...
Another example of changes to AH&OBP Registry enrollment concerns § 704 of PL 116-92, which states: If a covered evaluation of a member of the Armed Forces establishes that the member was based or stationed at a location where an open burn pit was used or that the member was exposed to toxic airborne chemicals or other airborne contaminants, the member shall be enrolled in the Airborne Hazards and Open Burn Pit Registry unless the member elects to not so enroll. Automatic enrollment in the registry with an opt-out option is a very different mechanism than the current voluntary opt-in method.
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From page 76... ...
Although participating in the registry was simple for some who viewed their experience of the optional health evaluation positively, more often the comments or experiences was negative. For example, some in-depth interview and focus group participants felt that those who had the most severe exposures or health concerns were eligible or deserving; others thought that only those who had burn pit exposures were eligible for the registry, not those who had served more generally.
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From page 77... ...
, which did not include the time needed for verifying or manually entering eligible deployment segments, a very conservative estimate is that participants have invested a minimum of 200,000 person-hours in providing information for the AH&OBP Registry on questions other than deployment history. This does not include the time invested by the more than 30,000 participants who received the AH&OBP Registry health evaluation between June 2014 and February 2022 and the additional time they spent contacting and scheduling the health evaluation, traveling to the VA facility for evaluation, waiting to be seen or the time of the evaluation itself and any associated laboratory tests, and discussing or following-up on results with primary care providers.
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From page 78... ...
The committee examined several indicators of questionnaire data quality, including questions that have limited variability in responses, questions with high item nonresponse rates (i.e., don't know, refused, or missing) , and differences in responses between participants who completed the questionnaire and those who began but did not complete or submit their responses (i.e., partial completers)
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From page 79... ...
Therefore, the denominator changes for questions asked of individuals versus eligible deployment segments, and this affects the proportion of veterans who report 14 Exposure to soot, ash, smoke, or fumes from oil-well fires in the 1990–1991 Gulf War were not included in this count, as the question was not asked of every participant.
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TABLE 3-3 Number of Exposures Reported by Early and Late Participants All Participants Early Participants Late Participants (n = 278,645)
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From page 81... ...
. In the initial assessment 89% of participants who served in the 1990–1991 Gulf War reported that they were exposed to soot from oil-well fires, but this exposure was now reported by 63% of all eligible individuals and for only 31% of eligible deployment segments.
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From page 82... ...
For those who used a mobile device to complete the questionnaire, some nonresponses may be due to bad design or formatting on the device. Consistent with the initial assessment, nonresponse rates remain high on many questions.
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From page 83... ...
The committee used 15% as the cutoff for determining a high item nonresponse rate. Whereas responding affirmatively to an exposure at least once across deployment segments was considered affirmative exposure for an individual, this method does not work for determining a summary of nonresponse to these questions across an individual's deployment segments.
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From page 84... ...
1.2.A* + – Were you exposed to soot, 72,148 48,729 46,769 35 1,925 ash, smoke, or fumes from the Gulf War (67.5%)
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2.2.1.B – Have you ever been told by a 278,645 16,584 2,098 2,354 12,132 doctor or other health care professional (6.0%)
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From page 86... ...
I'm… 2.2.2.A – Have you ever been told by a 278,645 13,645 1,554 1,713 10,378 doctor or other health care professional (4.9%)
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2.4.A – Have you ever been told by a 278,645 7,954 1,359 1,314 5,281 doctor or other health professional that (2.9%)
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88 REASSESSMENT OF THE VA AH&OBP REGISTRY TABLE 3-6 Continued Overall Do Not Wish to Nonresponse Missing Answer Don't Know Question Number and Text Eligible n (%)
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3.G – Have you discussed this concern 256,621 3,770 3,770 N/A N/A with your health care provider, medical (1.5%)
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From page 90... ...
(96.8%) military service?
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From page 91... ...
Thus, the most critical exposure information concerning those with multiple deployments is at least partially missing for about one in six participants. A previous analysis of registry data found that nonresponse rates were significantly higher for deployment segments that were asked about later in the questionnaire than those that were asked about earlier, a pattern that suggests that the nonresponse may be due to respondent fatigue (Gasper and Kawata, 2015a)
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From page 92... ...
Overall 1,190,888 322,548 27.1 Data Source System-generated 921,203 266,276 28.9 User-entered 269,685 56,272 20.9 Era of Service 1990-1991 Gulf War 10,638 1,644 15.5 Peacetime 15,457 5,313 34.4 OEF/OIF/OND 1,045,957 270,200 25.8 OIR/OFS 94,928 40,375 42.5 Multiple eras 23,908 5,016 21.0 Country Iraq or Afghanistan 620,625 98,049 15.8 Other 570,263 224,499 39.4 Service Branch Army 819,338 216,194 26.4 Marine Corps 88,588 14,721 16.6 Air Force 207,755 72,380 34.8 Navy 67,222 17,063 25.4 Number of Deployment Segments 1 278,645 67,518 24.2 2–5 581,796 161,838 27.8 6–9 210,764 58,991 28.0 10 or more 119,683 34,201 28.6 Length of Deployment Segment 0 days 71,388 27,502 38.5 1–30 days 389,889 146,250 37.5 31–90 days 184,334 47,279 25.6 91–180 days 264,568 53,896 20.4 181–270 days 194,743 34,656 17.8 271 days or more 85,966 12,965 15.1
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From page 93... ...
has a nonresponse rate of 20%, with 94% of those attributable to "Don't know." The lower nonresponse rate on most questions assessing health outcomes compared with exposures may indicate that respondents know or are aware of many health diagnoses prior to completing the registry questionnaire. Two questions that assess health beliefs with regard to exposures encountered during deployment(s)
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From page 94... ...
; the majority of multiple-era deployments were OEF/OIF/OND and OIR/OFS. Late participants had fewer eligible deployment segments and shorter cumulative deployment durations than early participants.
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From page 95... ...
Initial Assessment Recommendation: 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. VA Response: DoD and VA are working on the Individual Longitudinal Exposure Record (ILER)
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From page 96... ...
The committee is aware of several updates and data linkages made to the AH&OBP Registry for improved data collection since the initial assessment of the AH&OBP Registry was published in 2017. These have included IT and system updates, such as changes to the database platform, enhancements to the VHA staff portal, adding capabilities for ad hoc reporting, linkage with VHA's Corporate Data Warehouse to incorporate racial and ethnic and other selected demographic information and to better integrate registry data with health care and VHA enrollment data, adding VHA and DoD identifiers to facilitate linking with other datasets, and, where applicable, adding date of death from the VA Vital Status File.
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From page 97... ...
Specific language in the contract is that the Contractor shall convene a panel of experts to evaluate and analyze current web-based Airborne Hazards and Open Burn Pit Registry questionnaire and resulting information from interview process. • Include subject matter experts (SMEs)
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From page 98... ...
Although the Westat contract addresses the initial committee's recommendation, the following chapters address how implementing this action at this late stage after more than 317,000 individuals have participated is unlikely to create substantial improvements in the registry such that it can be used for the five purposes VA intends. Initial Assessment Recommendation: The committee recommends that VA evaluate whether and how registrants who did not complete the questionnaire differ from those who did, analyze the determinants of non-completion, and use this information to formulate strategies to encourage registrants to finish and submit their responses and improve the completion rate for future participants.
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From page 99... ...
Later participants were more likely to have served in the Air Force and Navy and less likely to have served in the Army, although there was little difference in the proportion who served in the Marine Corps or Coast Guard. Late participants had fewer eligible deployment segments and shorter cumulative deployment durations than early participants, and more time had elapsed between military service and participation in the registry for late participants than for early participants.
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From page 100... ...
Avail able from the public access file of the Committee on the Assessment of the Department of Veterans Affairs Airborne Hazards and Open burn Pits Registry. Guidance for requesting available athttps://www.nationalacademies.org/about/ institutional-policies-and-procedures/project-comments-and-information.
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From page 101... ...
Prepared for the Department of Veterans Affairs Office of Public Health, Post-Deployment Health Group by Westat. Available from the public access file of the Committee on the Assessment of the Department of Veterans Affairs Airborne Hazards and Open burn Pits Registry.
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From page 102... ...
2021b. Response to the Committee to Reassess the Department of Veterans Affairs Airborne Hazard and Open Burn Pit Registry Information Request: Current Guidance For Requesting an Eligibility Review.
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