1. Exposures of Concern to Veterans of Operation Enduring Freedom/ Operation Iraqi Freedom Exposures of Concern to Veterans of Operation Enduring Freedom/ Operation Iraqi Freedom Ron Teichman, MD, MPH, FACP, FACOEM

2. Operation Enduring Freedom  Referred to as OEF  Primary theater of combat is Afghanistan  Began October 7, 2001

3. Operation Iraqi Freedom  Referred to as OIF  Primary theater of combat is Iraq  Many troops in Kuwait, Saudi Arabia, etc.  Began March 20, 2003

4. Perspective  Total number of US service members deployed = 1,700,000  Total number of US service members separated, i.e., Veterans = 1,016,213  Received some health care from VA = 454,121; ~ 45% of returnees  95% outpatient, 5% inpatient

5. Perspective – cont’d.  VHA sees approximately 5,500,000 Veterans per year  454,121 OEF/OIF Veterans seen over 7.5 years  OEF/OIF Veterans seen over 7.5 years = approximately 8% of Veterans seen in a single year

6. Seamless Transition  The transfer of personnel from the Department of Defense to the Department of Veterans Affairs  DoD DVA  Service Member to Veteran  Post-Deployment Health Assessment upon return (PDHA)  Post-Deployment Health Re-Assessment in 3-6 months (PDHRA)

7. Percentage of OEF/OIF service members who endorsed Exposure Concerns on PDHA and PDHRA (9/07-10/08)  Active component  Pre-Deployment n=245,378 0.0%  Post-Deployment n=224,511 16.2%  Reassessment n=189,933 21.2%  Reserve component  Pre-Deployment n=85,843 0.0%  Post-Deployment n=75,174 24.9%  Reassessment n=96,886 34.8%  Frequency of exposure concerns rise after 3-6 months MSMR Vol. 15 / No. 7 – Sept. 2008

8. Proportion of service members who endorse exposure concerns on post-deployment health assessments (1/04-8/08) MSMR Vol. 15 / No. 7 – Sept. 2008

9. Top five Concerns of Veterans from Afghanistan and Iraq 1.Sand 2.Noise 3.Smoke from trash 4.Vehicle exhaust 5.JP8 or other fuel MSMR Vol. 12 / No. 8 – Nov. 2006

10. Frequency of OEF/OIF service member exposure concern reported on the PDHRA (9/05-8/06) MSMR Vol. 12 / No. 8 – Nov. 2006 Sand Noise Smoke from trash Vehicle exhaust JP8 or Fuel Smoke from oil fire Excessive vibration Industrial pollution Pesticide treated uniform DEET on skin Blast / Vehicle accident Solvents 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Percent Reserve Active Sand Noise Smoke from trash Vehicle exhaust JP8 or Fuel Smoke from oil fire Excessive vibration Industrial pollution Pesticide treated uniform DEET on skin Blast / Vehicle accident Solvents 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Percent Reserve Active

11. Top ten environmental exposures of concern: OEF/OIF 1.Smoke from burning trash or feces (44.6%)* 2.Sand and dust storms (41.5%)* 3.Gasoline, Jet Fuel, Diesel Fuel (21.1%) 4.Depleted Uranium (19.0%)* 5.Paint, solvents, other petrochems (15.2%) 6.Oil well fire smoke (14.9%)* 7.Contaminated food and water (14.4%) 8.Anthrax Vaccine (14.2%)* 9.Multiple Vaccinations (13.9%) [8+9>3]* 10.Vehicular Exhaust (10.3%) Seen at NJ WRIISC, n=612. 1889 concerns, range 0-15

12. Top ten environmental exposures of concern: Gulf War 1.Protective gear/alarms (82.5%) 2.Diesel, kerosene, other petrochems (80.6%)-3 3.Oil well fire smoke (66.9%)-6 4.Local food (64.5%)-7 5.Insect bites (63.7%) 6.Harsh weather (62.5%)-2 7.Smoke from burning trash or feces (61.4%)-1 8.Within 1 mile of missile warfare (59.9%) 9.Repellants and pesticides (47.5%) 10.Paint, solvents (36.5%)-5 From Schneiderman, Lincoln, Wargo, et. al., APHA, 12-14-05

13. Prevalence (%) of exposures common to Vietnam, Persian Gulf and Bosnia-Kosovo

14. Thank you