From evaluation to treatment, what Veterans should know about toxic exposure

The following story is an example of the treatment a Veteran may receive for health concerns related to toxic exposure from airborne hazards and burn pits.

After experiencing a worsening of shortness of breath over the past 15 years, a 37-year-old Veteran visited her primary care doctor to try to find answers and relief. She told her doctor she becomes short of breath with any level of exertion and that she has chronic nasal congestion and difficulty sleeping. Even though she was once quite active, she has not been physically able to exercise—even at low intensity—for at least five years.

She reported moderate improvement with the use of an inhaler but her symptoms always came back. Despite these persistent symptoms, the results of all tests and evaluations came back normal.

Registry established after service members and Veterans experience adverse health effects from deployment-related exposures

She deployed to northern Iraq in the early 2000s. During the deployment she was exposed to a fire in a sulfur mine as well as dust storms and burn pits.

Knowing her symptoms could be related to her exposure, she added her information to the Airborne Hazards and Open Burn Pit Registry online.

After adding her information to the Registry, she received a letter in the mail from the VA Post-Deployment Cardiopulmonary Evaluation Network (PDCEN) inviting her to participate in a specialty evaluation. She asked her doctor if she should consider moving forward with it.

Although her doctor was not familiar with the PDCEN, they wanted to find out more about how best to care for her and recommended participating in the evaluation.

Relationship between Registry and Evaluation Network

The Airborne Hazards and Open Burn Pit Registry was established in 2014 in response to mounting concerns that service members and Veterans were experiencing adverse health effects that might be attributable to deployment-related exposures. The Registry consists of an online questionnaire to document deployment and medical history, exposure concerns and symptoms.

After signing up for the Registry, Veterans can request an in-person or virtual clinical health evaluation at their local VA medical center or military treatment facility.

The optional Registry evaluation explores deployment history, symptoms, medical history, health concerns, residential history, civilian occupational history, civilian environmental exposures and health care utilization. Although these evaluations can help address some concerns, numerous Veterans may have unexplained respiratory symptoms that warrant further investigation. This is where the PDCEN comes in.

In May 2019, VA established the Airborne Hazards and Burn Pits Center of Excellence. One of the center’s objectives is to deliver specialized care and consultation for Veterans with concerns about their post-deployment health, including—but not limited to—unexplained shortness of breath.

Post-Deployment Cardiopulmonary Evaluation Network (PDCEN)

To meet this objective, PDCEN was established. PDCEN is a national network that consists of VA physician scientists at six VA medical centers across the country who conduct specialized research and clinical evaluations for Veterans with concerns about their post-deployment health. Staff at PDCEN screen the Registry to identify Veterans with complex cases of unexplained shortness of breath or difficulty breathing. They invite them to participate in a specialty evaluation at the site that is most convenient to their location.

After completing a detailed questionnaire as the first step of the PDCEN evaluation, Veterans undergo a series of comprehensive tests. The results are closely evaluated by physician scientist experts and then provided to the Veteran at a final summary review visit.

The primary objectives of this final review are to:

1. Inform the Veteran of what respiratory and related conditions they have
2. Determine whether the conditions are deployment-related
3. Inform the Veteran of what treatments or follow-up care are recommended

PDCEN then provides these care recommendations to the Veteran’s primary care physician to improve the ongoing management of the Veteran’s conditions.

Collected data to create standard practices for medical evaluations of Veterans exposed to respiratory hazards during deployment

While the Registry and related examinations address the needs of many Veterans, others may require the more in-depth and comprehensive evaluation provided by PDCEN. These clinical evaluations are the first objective of PDCEN. The second objective is to learn from these evaluations by analyzing the collected data.

These collected data are shared with the Airborne Hazards and Burn Pits Center of Excellence and across PDCEN to include in studies on deployment-related respiratory disease and to learn more about how to diagnose and treat deployment-related conditions. PDCEN hopes not only to improve the health of individual Veterans but to also create standard practices for both VA and non-VA medical evaluations of Veterans exposed to respiratory hazards during deployment.

From evaluation to treatment

The Veteran decided to move forward with the invitation to participate in the PDCEN evaluation. Her evaluation uncovered nonallergic rhinitis and symptoms consistent with small airways disease. Both were reported as most likely related to her significant environmental exposures during deployment.

After reviewing the findings from the PDCEN evaluation, her primary care physician started her on a treatment plan to address her diagnoses. After several weeks of this treatment combined with pulmonary rehabilitation, she reported an improvement in sleep and nasal symptoms but continued to experience some difficulty when exercising.

This case, described in greater detail in an article published by PDCEN researchers, shows the significant limitations that a previously healthy and active Veteran may experience following exposures to airborne hazards during deployment. But through her participation in the Airborne Hazards and Burn Pits Center of Excellence and subsequent PDCEN evaluation, she received two important diagnoses that were instrumental in helping her provider prescribe appropriate treatment.

Data from her evaluation and others will help the Airborne Hazards and Burn Pits Center of Excellence and PDCEN establish best practices for evaluation and treatment of deployment-related respiratory concerns for Veterans across the country.