1. Toxic Exposure Correlation to Military Service Presented by Sharon Dougherty RN,BC MSN

2. Do you know what to do when a Veteran says they were Toxic Exposed?

3. Professionals Need for Information  Information for Professionals is not readily available to use at patient appointments.  Training in Toxic Exposure Evaluation during an appointment is not part of a a providers routine office visit  Documentation in the medical record is lacking to help the veteran pursue compensation  Providers are not trained on how to help the veteran pursue service connection what steps are needed and who to contact.  Follow-up referrals on possible Toxic Exposure Medical Problems are not always completed and documented.

4. What Information is Available for Professionals?  Exposure Education App from app stores to download free from the Department of Veteran Affairs: https://mobile.va.gov/app/exposure-ed  Documentaries about Agent Orange History and our Vietnam Veterans  Health and Medicine Reports concerning Toxic Exposure and our Veterans  War Related illness and injury Study Centers

5.  Chemical and Biological Weapons  Chemical Warfare Agents  Mustard Gas  Nerve Agents  Project 112/Project SHAD Radiation  Edgewood/Aberdeen Experiments  Herbicide Tests and Storage War Agents Used

6. Chemicals  Agent Orange  Burn Pits  Sulfur Fire  Camp Lejuene Water Supplies  Pesticides  Chromium  Industrial Solvents  PCB’s  Depleted Uranium

7. How are Veterans Exposed to Toxic Materials

8. Presumptive Diseases Related to Exposure to Agent Orange  Al AmyloidosisChronic B cell Leukemia's  ChloracneDiabetes Mellitus  Hodgkin’s DiseaseIschemic Heart Disease  Multiple MyelomaNon-Hodgkins Lymphoma  Parkinson’s DiseasePeripheral Neuropathy  Porphyria Catenae TardaProstate Cancer  Respiratory CancersSoft Tissue Sarcomas  Agent Orange Review Vol26 No. 1 2012 Department of Veteran Affairs

9. Professional Self Education Tools  Exposure Education App  Provides information on military related exposures for VA Providers and Non-VA Providers  Explains to Provider what is Chemical physical and environmental hazards were used during military service  Helps provider talk to their patient on how these exposures could affect their health  Povides tips for providers on related programs and benefits offered by the VA  Help providers help veterans determine eligibility to VA services by referring them to appropriate contacts  Provides questions and tips for providers to use during their interview with the patient

10. Exposure Education App for Professionals  Provides education on a List of Exposure Agents  Agent Orange  Asbestos  Burn Pits  Chemical Agents  Depleted Uraniaum  Just to name a few…..

11. What Can YOU Do NOW!  Contact your Clinical Application Coordinators to help develop templates for CPRS to document in the medical record information about the veterans exposure history  Document Medical History about health problems since exposure  Decide whether a referral is needed to a specialty consult for pulmonary, ear nose and throat, dermatology to establish possible associations to exposures  When you talk with veterans LISTEN to and Respect their Health concerns about their exposures  Take your time to establish TRUST and RAPPORT

12. What YOU CAN DO NEXT!  Review lab work and radiology as it relates to an exposure  Assess for recent weight loss health problems and determine if its association to an exposure (Most chemical agents are collected in the body’s blood cells and fat stores and released with weight loss).  The professionals documentation is crucial to help establish explanations on health problems that are presented that could be related to exposures  Have referral information available to explain and provide guidance where the patient could learn more about exposures  Continue to educate yourself on the latest research and outcomes related to up to date treatments for toxic exposures  Remember- IF ITS NOT DOCUMENTED IN THE MEDICAL RECORD THE INFORMATION YOU RECEIVED FROM THE VETERAN DID NOT HAPPEN !

13. Questions?

14. References  Service-Connected Disability Compensation for Exposure to Agent Orange- VVA Self Help Guide: Available through the Vietnam Veteran of America; local chapters  VA Agent Orange Webpage: www.publichealth.va.gov/exposure/agentorangewww.publichealth.va.gov/exposure/agentorange  Vietnam Veterans of America Agent Orange and Other Toxic Substances: www.vva.org/Committees/AgentOrange www.vva.org/Committees/AgentOrange  Veteran Service Officers: Every County has a list of officers available in your area  Department of Veteran Affairs HCA’s and CBOC’s locally Environmental Exposure Coordinators.