The Department of Veterans Affairs will review a registry that tracks veterans who have been exposed to burning fireplaces and other air pollution following two reports highly critical of the database, one of which was released on October 13 which recommended that it be completely deleted in its current form.
The report, from the National Academies of Sciences, Engineering and Medicine, described the VA’s Airborne Hazards and Open Burn Pit Registry as “not helpful” and suggested that its resources and efforts spent on the database would be better used for better patient monitoring. research system and platform.
The academies’ report followed an assessment by the VA’s office of the inspector general in July that called the registry’s required questionnaire too cumbersome to complete and criticized the VA for not ensuring veterans understood the requirements to obtain registry-related health assessments – voluntary exams they must schedule themselves.
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VA Secretary Denis McDonough said Tuesday that the VA had “a lot to think about” with the findings of the two reports.
“We have a group of veterinarians that we work with, and I will say their anecdotal experience matches the results,” McDonough said at a press conference in Washington, DC. think we now have the tools to do it right.”
More than 270 fireboxes have been used in Iraq, Afghanistan and elsewhere to dispose of waste generated during military operations. The pits – some as large as 10 acres wide – have been used to incinerate trash, medical waste, computer equipment and batteries, plastic bottles, tires and more, generating clouds of smoke at the above the installations and their inhabitants.
Servicemen often returned from deployment struggling to catch their breath or coughing up black phlegm – what many called “Iraqi filth”. Thousands of people have developed respiratory illnesses, skin conditions and cancers that may be linked to exposure.
The VA was ordered to establish the Airborne Hazards and Open Pit Registry by Congress in 2013 to track the general health status of veterans who had potentially been exposed and identify trends. The registry was also to serve as a database for research and the development of treatments and medical policies as this group of veterans aged.
From the start, however, the register was troubled. VA officials fought the idea before it even became law, saying the program had little value because a link between the burning fireplaces and any disease was unproven.
Over the past year, the Department of Veterans Affairs has designated several respiratory illnesses as presumed to be caused by burn pit exposure, such as asthma and chronic sinusitis, as well as several rare types of lung cancer. . The PACT Act added more — 23 additional illnesses in total — allowing afflicted veterans to seek expedited health care and benefits.
Following the registry’s rollout in 2014, advocacy groups questioned the length and scientific rigor of its mandatory questionnaire and challenged its many questions about smoking and personal habits, saying the information could be used to blaming illnesses on unhealthy behaviors, blaming the veterans instead of the burning hotspots, which were run by the Department of Defense.
Critics also noted that relatives of deceased veterans were unable to join and enter data about their veterans’ deaths to count as part of the monitoring.
Eight years later, the National Academies panel of scholars agreed that the process, including surveying 140 questions, was too cumbersome. Panelist Kristin Olson, director of the Office of Sociological Research at the University of Nebraska-Lincoln, said the questionnaire was difficult to understand and complete.
“The more deployments you have had, the longer it will take you to complete the questionnaire,” she said. “Many veterans are unaware of the information requested in the questionnaire and … either don’t know or completely refuse to answer the question,” Olson said during a briefing on the report.
More than 3.7 million veterans and military personnel are eligible to enroll in the registry but, as of July 1, only 10% had completed the process, according to the report. Another 130,000 veterans had started the registration process but never completed the questionnaire.
Of those who had completed their registration, about half had requested their health assessment, but only 30,000 had undergone this examination.
The academies panel also noted that the registry does not allow for updating by veterans, which makes it useless from a health surveillance perspective to track individuals’ health conditions or disease clusters. , as health issues may develop once veterans complete registration.
Further, panelists noted, the VA does not use the register to guide policy decisions, nor does it analyze or interpret the data provided by participants, opting instead to summarize their responses.
“The health issues faced by the many veterans who have been deployed to Southwest Asia warrant continued and rigorous attention and must be addressed, but the Airborne Hazards and Open Pit Register is the wrong mechanism. to meet all needs,” said David Savitz, professor. of epidemiology at the Brown University School of Public Health and chair of the committee, said in a news release.
The VA Inspector General’s review came to similar conclusions. Auditors found that veterans were not aware that they were responsible for scheduling their own exams, nor had they completed the questionnaire at an alarming rate.
“Improvements in the registry review process would help ensure that more eligible and interested veterans receive them,” the IG noted.
The National Academies have recommended that the registry be modified so that it meets the needs of the veteran population and provides value to researchers and policy makers studying and developing guidance for caring for this veteran population. as she ages.
The panel suggested that the VA find “alternative and more efficient mechanisms for researching the health effects that may result from these exposures and monitoring the health of the population. Members suggested a streamlined registry to maintain a list of veterans and focus research resources elsewhere.
“The committee recommends that the AH&OBP Registry be terminated in its current form, as its stated purposes have largely been to support research and surveillance of population health, which it cannot do,” they said. they wrote in the report.
McDonough said Tuesday that the VA will begin exposure screening of patients enrolled in VA health care beginning Nov. 8. He added that the review, along with extended benefits under the Promise to Treat Complete Toxics, or PACT, Act, approved in August, will help veterans access health benefits.
[VA Under Secretary for Health Dr. Shereef] Elnahal and his team are looking very closely at how we can make it more efficient to shorten the distance between exposure identification and specialist treatment if necessary, and in any case, a rapid review of the attribution of claims of the VBA where those are earned and deserved,” McDonough said.
— Patricia Kime can be reached at [email protected] Follow her on Twitter @patriciakime
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