Environmental Health Registries
Gulf War – Airborne Hazardous/Open Burn Pit – Agent Orange – Ionizing Radiation –
Depleted Uranium – Toxic Embedded Fragments
Matthew Boles
Special Programs Coordinator
PRESENTATION 1
PACT ACT
• PACT Act is a law that was signed on August 10, 2022.
• The acronym stands for: Sergeant First Class Heath
Robinson Honoring Our Promise to Address
Comprehensive Toxics (PACT) Act of 2022
• The PACT act expands and extends eligibility for VA health
care and benefits for Veterans with toxic exposure from
Vietnam era, Gulf War era and Post 9/11 era.
• It has added over 20 new presumptive conditions to help
Veterans connect their ailments to their service.
PRESENTATION 2
PACT ACT
As a general matter, there are several types of possible exposures or hazards
Veterans may have experienced during military service, including:
• AIR POLLUTANTS: Burn pits, oil well fires, sulfur fire, sand, dust, and
particulates
• CHEMICALS: Agent Orange or other herbicides, burn pits, Camp
Lejeune water supplies, pesticides, depleted uranium, chromium, or
industrial solvents
• RADIATION: Nuclear weapons testing, x-rays, or depleted uranium
• WARFARE AGENTS: Chemical warfare agents, nerve agents, mustard
gas, herbicide tests, and storage
• OCCUPATIONAL HAZARDS: Asbestos, lead, fuels, industrial
solvents, radiation, vibration, noise, special paint on military vehicles,
and some coolants or insulating fluids
PRESENTATION 3
EVALUATIONS
• Toxic Exposure Screening: for all Veterans, every
5 years (clinical reminder)
• Registry exams: Documents service exposure and
extensive review of systems (ROS) ; educate Veterans
on exposure and potential follow-up by PCP
• Compensation & Pension exams: document
disability resulting from military service;
presumptives; VBA determines service connection.
PRESENTATION 4
WHAT’S THE DIFFERENCE?
PRESENTATION 5
Registry
Evaluations
PRESENTATION 6
ENVIRONMENTAL HEALTH REGISTRY EXAMS
Congressionally Mandated Registries:
• Agent Orange
• Airborne Hazards/Open Burn Pit
• Depleted Uranium
• Gulf War
• Ionizing Radiation
• Toxic Embedded fragments
Garrison Exposures:
• Camp Lejeune contaminated water
• PFOS/PFOA contaminated water
• Mefloquine
• Chemical weapons
• Sodium dichromate – Qarmat Ali
• PFAS (firefighting foam, etc.)
• Asbestos
• Other toxic exposures
PRESENTATION 7
WHAT IS A VA REGISTRY
• The VA Environmental Health Registry is a free, voluntary medical
assessment for Veterans who may have been exposed to environmental
toxins during military service.
– History and physical exam with special attention to symptoms/concerns
related to exposures
– Labs, imaging, diagnostic procedures, Pulmonary Functionality Test (PFTs),
specialty referrals
– Clinical data collection
• Evaluations alert Veterans to possible
long-term health problems that may be
related to toxic exposures.
• Helps VA understand and respond to
health problems
Veterans do not need to be eligible or enrolled in VA
Separate from filing a claim for disability benefits
PRESENTATION 8
AIRBORNE HAZARDOUS/OPEN BURN PIT - LOCATIONS
Southwest Asia theater of operations:
(on or after August 2, 1990)
• Iraq
• Kuwait
• Saudi Arabia
• Bahrain
• Qatar
• The United Arab Emirates (U.A.E.)
• Oman
• Egypt*
• The neutral zone between Iraq and Saudi Arabia
• Gulf of Aden
• Gulf of Oman
• Waters of the Persian Gulf, Arabian Sea, and Red Sea
• The airspace above these locations
Other Countries:
(on or after September 11, 2001)
• Afghanistan
• Djibouti
• Uzbekistan*
• Syria*
*Additional locations added in the PACT Act
Only registry that requires Veteran to self-register online & fill out questionnaire prior to clinical
assessment
PRESENTATION 9
AIRBORNE HAZARDS/OPEN BURN PIT REGISTRY
• Airborne Hazards – potential contaminant/toxic substances
in the air
– Open Burn Pits – smoke and fumes
• Common waste disposal practice at military sites outside of the U.S.
– Air pollution common in certain countries
– Dust, sand, and particulate matter
– Fuel, aircraft exhaust, and other mechanical fumes
– Smoke from oil well fires
www.publichealth.va.gov/exposures/burnpits
PRESENTATION 10
AIRBORNE HAZARDOUS/OPEN BURN PIT
PRESUMPTIVES
Served on or after Sept. 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, or
Yemen or if you served in the *Southwest Asia theater of operations, or Somalia, on or after Aug. 2, 1990,
Asthma that was diagnosed after service Chronic sinusitis
Chronic rhinitis Chronic bronchitis
Chronic obstructive pulmonary disease (COPD) Pleuritis
Brain cancer Bronchiolitis
Glioblastoma Emphysema
Respiratory cancer of any type Granulomatous disease
Gastrointestinal cancer of any type Interstitial lung disease (ILD)
Head cancer of any type Pulmonary fibrosis
Lymphoma of any type Sarcoidosis
Lymphatic cancer of any type Kidney cancer
Neck cancer Melanoma
Pancreatic cancer Reproductive cancer of any type
PRESENTATION 11
GULF WAR REGISTRY
• Gulf War service in Southwest Asia theater of operations from August
2, 1990 to present
• Medically unexplained illnesses – “Gulf War Syndrome”
• Presumptive conditions examples:
– Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
– Fibromyalgia
– Functional gastrointestinal disorders
– Undiagnosed illnesses
• Abnormal weight loss, fatigue, cardiovascular disease, joint pain, headaches,
menstrual disorders, sleep disturbances, respiratory conditions, dizziness,
skin conditions, memory problems
www.publichealth.va.gov/exposures/gulfwar
PRESENTATION 12
GULF WAR AND POST 9/11 VETERAN PRESUMPTIVE
Presumptive conditions depend on where/when the Veteran served
Served in the Southwest Asia theater of operations, Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan,
during the Persian Gulf War
• Medically unexplained chronic multi-symptom illness for >6mo.
Chronic fatigue syndrome Irritable bowel syndrome
Fibromyalgia
• Diagnosed or undiagnosed illness that warrants presumption, determined by SecVA
• Signs or symptoms of an undiagnosed illness include:
Symptoms involving upper or lower respiratory
Fatigue system
Skin symptoms Sleep disturbance
Headaches Gastrointestinal symptoms
Muscle pain Cardiovascular symptoms
Joint pain Weight loss
Neurological or neuropsychological
symptoms Menstrual disorders
Served in the Southwest Asia theater of operations or in Afghanistan on or after September 19, 2001
• Manifest one of the following infectious diseases to a degree of >10% within 1 year of separation:
Brucellosis Shigella
Campylobacter jejuni West Nile virus
Coxiella burnetii (Q fever) Malaria
Nontyphoid Salmonella Visceral leishmaniasis
PRESENTATION 13
AGENT ORANGE
• Tactical herbicide used by the US military for control of
vegetation, sprayed during Vietnam War
• Veterans who served in Vietnam, Korean Demilitarized
Zone, Laos, Cambodia, Guam and Thai Air Force Bases,
flew/worked on C-123 Aircrafts
• Presumptive conditions for Veterans
– Birth defects in children of Vietnam Veterans (Spina Bifida)
– Amyotrophic Lateral Sclerosis (ALS) – “Lou Gehrig’s Disease” for
all Veterans with 90+ days of continuous military service
www.publichealth.va.gov/exposures/agentorange
PRESENTATION 14
VIETNAM VETERANS - PRESUMPTIVES
Vietnam Veterans (Agent Orange and other tactical herbicides)
Monoclonal gammopathy of undetermined significance
Hypertension (MGUS)
AL Amyloidosis Non-Hodgkin's Lymphoma
Bladder Cancer Parkinsonism
Chronic B-cell Leukemias Parkinson's Disease
Chloracne or similar acneform disease* Peripheral Neuropathy, early-onset*
Diabetes Mellitus type 2 Porphyria Cutanea Tarda*
Hodgkin's Disease Prostate Cancer
Hypothyroidism Respiratory Cancers
Ischemic Heart Disease Soft Tissue Sarcomas
Multiple Myeloma Chronic lymphocytic leukemia
*presumed, if condition becomes >10% debilitating w/in 1 year of exposure
Veterans Agent Orange Exposure Equity Act – “covered service” means active military,
naval, air or space service
• Expands Thailand Military bases “without regard to where on the base the Veteran was located or what
military job specialty the Veteran performed”
• Adds Laos from Dec 1, 1965, to Sept 30, 1969
• Adds Cambodia at Mimot or Krek, Kampong Cham Province, April 16,1969 to April 30, 1969
• Adds Guam and American Samoa, and territorial waters thereof, from Jan 9, 1962, to July 31, 1980; or
service on Johnston Atoll or on a ship that called at Johnston Atoll from Jan 1, 1972, to Sept 30, 1
PRESENTATION 15
IONIZING RADIATION REGISTRY
• Veterans involved with nuclear weapons testing
• Participation in the occupation of Hiroshima or Nagasaki (Aug 6, 1954 - Jul 1,
1946)
• Receipt of nasopharyngeal (NP) – nose and throat- radium irradiation treatment
while in the military
• Involvement in “radiation-risk activities”
– Service at Department of Energy gaseous diffusion plants at Paducah, KY, Portsmouth,
OH, or the K25 area at Oar Ridge, TN for 250+ days before Feb 1, 1992
– Proximity to “Longshot”, “Milrow”, or “Cannikin” underground nuclear tests at
Amchitka Island, before Jan 1, 1974
www.publichealth.va.gov/exposures/radiation
PRESENTATION 16
IONIZING RADIATION - PRESUMPTIVES
• All forms of leukemia, except chronic lymphocytic leukemia
• Bronchioloalveolar carcinoma
• Multiple myeloma
• Lymphomas, other than Hodgkin’s disease
• Primary liver cancer, except if there are indications of cirrhosis or hepatitis
B
• Cancer of the thyroid, breast, pharynx, esophagus, stomach, small intestine,
pancreas, bile ducts, gall bladder, salivary gland, urinary tract, brain, bone,
lung, colon or ovary
PRESENTATION 17
ATOMIC VETERANS – IONIZING RADIATION
Ionizing Radiation Registry Criteria
• Participated in atmospheric nuclear testing
• Occupied/were prisoners of war in Hiroshima or Nagasaki
• Served before Feb. 1, 1992, at a diffusion plan in Paducah, Kentucky, Portsmouth, Ohio, or
Oak Ridge, Tennessee
• Served before Jan. 1, 1974, at Amchitka Island, Alaska
• Veterans who participated in cleanup of Eniwetok/Enewetok Atoll as radiation-exposed
Veterans (Jan 1, 1977, to Dec 31, 1980)
• Veterans who participated in nuclear response near Palomares, Spain, (Jan 17, 1966 - March
31, 1967) or Thule, Greenland (Jan 21, 1968 - Sept 25, 1968) as radiation-exposed Veterans
PRESENTATION 18
DEPLETED URANIUM & TOXIC EMBEDDED FRAGMENTS
• Depleted Uranium Registry / DU Follow-Up Program
– GW Era Veterans, OEF/OIF/OND, Bosnia, K2
– DU deployed on a large-scale during GW, used for tank armor and some
bullets
– DU is a potential health hazard if it enters the body through embedded
fragments, contaminated wounds, inhalation, or ingestion
• Toxic Embedded Fragment Registry / TEF Surveillance
Center
– Some Veterans have retained toxic embedded fragments in their bodies
after blast injuries sustained during military service – IEDs, bombs,
mines, shells
• Toxic fragments may contain depleted uranium
www.publichealth.va.gov/exposures/depleted_uranium
www.publichealth.va.gov/exposures/toxic_fragments
PRESENTATION 19
OTHER ENVIRONMENTAL TOXIC EXPOSURES
• Camp Lejeune contaminated water
• PFOS/PFOA* contaminated water
• Mefloquine (Treatment for Malaria)
• Chemical weapons
• Sodium dichromate – Qarmat Ali
• PFAS (firefighting foam, etc.)
• Other toxic exposures
www.publichealth.va.gov/exposures
PRESENTATION 20
VBA SERVICE CONNECTION & PRESUMPTIVE CONDITIONS
• Monetary benefit for Veterans with disabilities that are the result of a
disease or injury incurred in/aggravated during active military service
– Post-service disabilities that are related/secondary to service-connected disabilities
– Presumptive conditions
• Presumptives - VA presumes certain diseases or illnesses can be related
to a Veteran’s military service
– Veterans don’t need to prove that their service led to the condition
• All Veterans exposed to toxins should file a disability benefits claim
– VA Form 21-526EZ Application for Disability Compensation & Related Compensation Benefits
– VA Form 20-0095 Decision Review Request: Supplemental Claim
• VBA may consider all Veteran records - need to gather medical evidence,
request a disability exam, or medical opinion;
Previously denied claims will NOT be automatically reviewed
PRESENTATION 21
ENVIRONMENTAL HEALTH RESOURCES
• VA Public Health Site – Military Exposures
https://www.publichealth.va.gov/exposures
• Airborne Hazards and Open Burn Pit Registry
https://veteran.mobilehealth.va.gov/AHBurnPitRegistry
• Directory of Environmental Health Coordinators
https://www.publichealth.va.gov/exposures/coordinators.asp
• Provider Resources on Military Exposures
https://www.publichealth.va.gov/exposures/providers
• Exposure Ed VA Mobile App for Healthcare Professionals
https://mobile.va.gov/app/exposure-ed
PRESENTATION 22
AGENT ORANGE
If you were in Vietnam, Laos, Cambodia, Guam and/or Thailand from the
following dates, you were possibly exposed to Agent Orange. Please notate
this registry and time periods that you were present prior to being
scheduled for an exam.
• Vietnam – January 9, 1962 – May 7, 1975
• Korean DMZ – September 1, 1967 - August 31, 1971
• Thailand – January 9, 1962 – June 30, 1976
PRESENTATION 23
GULF WAR
If you were in the Southwest Asia Theater from the following dates, you were
possibly exposed. Please notate this registry and the time period you were
present in the Southwest Asia Theater prior to being scheduled for an exam.
Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, U.A.E, Oman,
Afghanistan, Israel, Egypt, Turkey, Syria, Jordan, Waters of the
Persian Gulf, Arabian Sea and/or the Red Sea or the airspace
above these locations – August 2, 1990 to Present
PRESENTATION 24
AIRBORNE HAZARDS AND OPEN BURN PIT
If you were in the Southwest Asia Theater from the following dates, you
were possibly exposed. Please notate this registry and the time periods
you were present in the Southwest Asia Theater prior to being scheduled
for an exam.
Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, U.A.E, Oman,
Afghanistan, Egypt, Syria, Djibouti, Uzbekistan, Waters of the
Persian Gulf, Arabian Sea and/or the Red Sea or the airspace
above these locations – September 11, 2001 to Present
PRESENTATION 25
IONIZING RADIATION
If you were in these areas from the following dates, you were possibly
exposed to radiation. Please notate this registry and the time periods you
were present prior to being scheduled for an exam.
• Participated in atmospheric nuclear testing
• Occupied/were prisoners of war in Hiroshima or Nagasaki
• Paducah, Kentucky, Portsmouth, Ohio, or Oak Ridge, Tennessee -
BEFORE February 1, 1992
• Amchitka Island, Alaska - BEFORE Jan 1, 1974
• Eniwetok/Enewetok Atoll - (Jan 1, 1977, to Dec 31, 1980)
• Palomares, Spain - (Jan 17, 1966 - March 31, 1967)
• Thule, Greenland - (Jan 21, 1968 - Sept 25, 1968)
PRESENTATION 26
OTHER ENVIRONMENTAL TOXIC EXPOSURES
If you were exposed to these environmental toxic exposures, please go to
the VBA located near the Patriot Store to file a claim regarding your
exposure.
There is no registry here at the VA for the following exposures, but a claim
can be filed at anytime with the VBA which is NOT Compensation and
Pension.
• Camp Lejeune contaminated water
• PFOS/PFOA* contaminated water
• Mefloquine (Treatment for Malaria)
• Chemical weapons
• Sodium dichromate – Qarmat Ali
• PFAS (firefighting foam, etc.)
• Other toxic exposures not listed
PRESENTATION 27
CONTACT US
Matthew Boles
Special Programs Coordinator
702-791-9000 ext:15840
Jennifer Gilley Program Analyst
David M. Finkelstein, MBA (Vet)
Administrative Officer
702-791-9000 ext: 15494
PRESENTATION 28
THANK YOU
I salute you for your loyal and unselfish
service to our great nation!!!
PRESENTATION 29
