WASHINGTON — While the U.S. Department of Veterans Affairs’ (VA) Airborne Hazards and Open Burn Pit Registry is currently unable to fulfill its primary intended purposes of supporting research and population health surveillance, it has the potential to contribute to other important areas, says a new congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine. The VA should end the registry in its current form and initiate a new phase that would build on information gained from the first seven years of registry operations and optimize the registry to be a user-friendly, efficient, and effective resource to provide two-way communication between participants and the VA and enhance health care access and quality.

Beginning with the 1990-1991 Gulf War, more than 3.7 million U.S. service members have been deployed to Southwest Asia, where they have been exposed to a number of airborne hazards, such as smoke from oil-well fires, emissions from open burn pits, dust and sand, and diesel exhaust. Many service members, particularly those who served in Iraq and Afghanistan, report health problems they attribute to their exposures to emissions from open-air burn pits, which were routinely used to dispose of waste on military installations. More than 270 burn pits are known to have been in operation in Southwest Asia.

In 2013, Congress directed the VA to establish and maintain the Airborne Hazards and Open Burn Pit Registry to “ascertain and monitor” the health effects of such exposures, requiring an initial independent assessment of the registry and a reassessment five years later. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry follows the National Academies’ initial assessment report from 2017. The new report does not include assessments of potential relationships between exposures to burn pits or airborne hazards and health effects.

“The health problems experienced by the many veterans who deployed to Southwest Asia warrant sustained and rigorous attention and need to be addressed, but the Airborne Hazards and Open Burn Pit Registry is not the right mechanism to meet all the needs,” said David Savitz, professor of epidemiology at Brown University School of Public Health and chair of the committee that wrote the report. “Our report specifies what a new, more efficient phase of the registry should entail. Implementing this new phase will require thoughtful and deliberate efforts and careful alignment of the specific goals of enhancing communication and improving health care with the data collection process.”

Given the significant costs of maintaining the current registry and a participant burden with few benefits, the goals and functions of the registry need to be modified so that they are attainable and provide value to this veteran population, the report says. The effort and resources currently devoted to the registry would be better directed toward alternative, more effective mechanisms for research on health effects potentially resulting from these exposures and population health surveillance. This would include sufficient resources to support a streamlined registry for generating and maintaining a roster of individuals who are interested in or concerned about the health effects of airborne hazards exposures. The registry resources should then be focused on the two meaningful areas to which it can contribute: communications and health care — especially for those enrolled in VA health care.

As of July 1, 2022, more than 317,000 participants had completed the registry questionnaire, and more than 130,000 individuals had begun but not completed it. The committee recommended that the current self-assessment questionnaire, which contains approximately 140 questions, be replaced with one that is shorter, more efficient, user friendly, and limited in scope to collect only information that can be used to support communication or health care. In the recommended new phase, the information generated by the registry should be presented in a manner that is helpful in informing participants, health care providers, non-participating veterans, Congress, and the public about participants’ collective concerns.

Using objective criteria and analyzing registry data collected over the past seven years, the committee determined whether the registry is accomplishing or capable of accomplishing its five intended purposes:

• etiologic (causal relationships) research on health effects associated with deployment exposures to airborne hazards. Registry data are not appropriate for etiologic research, and even substantial changes to the questionnaire would be insufficient to make the registry appropriate for this use. In considering other sources that might fulfill this research function, the committee found that the U.S. Department of Defense’s Millennium Cohort Study could be modified to capture relevant information on airborne hazards currently in the registry questionnaire and could be an improved resource for etiologic research on airborne hazards exposures for post-9/11 veterans and service members.

• population health surveillance to monitor the health of veterans exposed to airborne hazards while deployed. The registry does not monitor veterans’ health and should not be promoted as doing so, the report says. Participation in the registry is a one-time self-assessment, and no subsequent data are collected that might signal changes in an individual’s health status. Further, the VA summarizes participant responses to the questionnaire, but does not interpret these data summaries to detect signals in health problems.

• improving clinical care for veterans who have health concerns related to their deployment exposures. The committee concluded that the registry health evaluation may enhance a veteran’s knowledge of his or her health status, but it does not currently improve a veteran’s access to or continuity of health care. The report recommends ways that the VA should use the registry to improve clinical care for veterans.

• supporting VA policies and processes, including benefits claims and VA programs to help veterans with concerns about their deployment exposures. VA does not use the registry for internal policy decisions beyond the standardization of registry procedures. However, it could use registry data to inform program development and budgeting processes, for example, by identifying bottlenecks in clinical care, such as long wait times for health evaluation or insufficient clinical capacity. Registry data could also be used to identify health concerns among veterans, using those concerns to formulate a research agenda. The Veterans Benefits Administration’s claims review process is completely separate from a veteran’s registry participation. Veterans may use the questionnaire responses and results of the health evaluation to support a disability claim, but the registry health evaluation does not replace the disability rating examination.

• communications and outreach from the VA to veterans, health care providers, and other stakeholders, and from participants to the VA. The VA has made some efforts to meet the mandate of informing eligible individuals about the registry, but it has not been consistently proactive about informing them about research developments, the treatment of conditions related to airborne hazards, or about new programs and benefits designed for them. The committee concluded that notifications about deployment exposures and health outcomes could be one of the primary benefits of registry participation. It also recommended that the VA periodically assess whether its communications and outreach materials and activities provide value to registry participants and health care providers. A bidirectional communication strategy should include both written and verbal communications among VA experts, participants, and other interested stakeholders.

• etiologic (causal relationships) research on health effects associated with deployment exposures to airborne hazards. Registry data are not appropriate for etiologic research, and even substantial changes to the questionnaire would be insufficient to make the registry appropriate for this use. In considering other sources that might fulfill this research function, the committee found that the U.S. Department of Defense’s Millennium Cohort Study could be modified to capture relevant information on airborne hazards currently in the registry questionnaire and could be an improved resource for etiologic research on airborne hazards exposures for post-9/11 veterans and service members.

• population health surveillance to monitor the health of veterans exposed to airborne hazards while deployed. The registry does not monitor veterans’ health and should not be promoted as doing so, the report says. Participation in the registry is a one-time self-assessment, and no subsequent data are collected that might signal changes in an individual’s health status. Further, the VA summarizes participant responses to the questionnaire, but does not interpret these data summaries to detect signals in health problems.

• improving clinical care for veterans who have health concerns related to their deployment exposures. The committee concluded that the registry health evaluation may enhance a veteran’s knowledge of his or her health status, but it does not currently improve a veteran’s access to or continuity of health care. The report recommends ways that the VA should use the registry to improve clinical care for veterans.

• supporting VA policies and processes, including benefits claims and VA programs to help veterans with concerns about their deployment exposures. VA does not use the registry for internal policy decisions beyond the standardization of registry procedures. However, it could use registry data to inform program development and budgeting processes, for example, by identifying bottlenecks in clinical care, such as long wait times for health evaluation or insufficient clinical capacity. Registry data could also be used to identify health concerns among veterans, using those concerns to formulate a research agenda. The Veterans Benefits Administration’s claims review process is completely separate from a veteran’s registry participation. Veterans may use the questionnaire responses and results of the health evaluation to support a disability claim, but the registry health evaluation does not replace the disability rating examination.

• communications and outreach from the VA to veterans, health care providers, and other stakeholders, and from participants to the VA. The VA has made some efforts to meet the mandate of informing eligible individuals about the registry, but it has not been consistently proactive about informing them about research developments, the treatment of conditions related to airborne hazards, or about new programs and benefits designed for them. The committee concluded that notifications about deployment exposures and health outcomes could be one of the primary benefits of registry participation. It also recommended that the VA periodically assess whether its communications and outreach materials and activities provide value to registry participants and health care providers. A bidirectional communication strategy should include both written and verbal communications among VA experts, participants, and other interested stakeholders.

The study — undertaken by the Committee to Reassess the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry — was sponsored by the U.S. Department of Veterans Affairs. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

Contact:
Dana Korsen, Director of Media Relations
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