The Department of Veterans Affairs will reexamine a registry that tracks veterans who were exposed to burn pits and other airborne pollution following two reports that were highly critical of the database, including one released Oct. 13 that recommended it be scrapped in its current form altogether.
The report, from the National Academies of Science, Engineering and Medicine, described the VA's Airborne Hazards and Open Burn Pit Registry as "not helpful" and suggested that its resources and the effort spent on the database would be better used for an improved patient surveillance system and research platform.
The academies' report followed a VA Office of Inspector General assessment in July that faulted the registry's required questionnaire as too cumbersome to complete and criticized the VA for failing to make sure veterans understood the requirements for getting registry-related health assessments -- voluntary exams they must schedule themselves.
VA Secretary Denis McDonough said Tuesday that the VA has "a lot to think about" with the findings of both reports.
"We have a bunch of vets that we work with, and I will say their anecdotal experience comports with the findings," McDonough said during a press conference in Washington, D.C. "We want to get this right; we will get this right. I think we now have the tools to get it right."
More than 270 burn pits were used in Iraq, Afghanistan and elsewhere to dispose of waste generated during military operations. The pits -- some as large as 10 acres wide -- were used to incinerate garbage, medical waste, computer hardware and batteries, plastic bottles, tires and more, generating clouds of smoke over installations and their inhabitants.
Service members often returned from deployment having trouble catching their breath or coughing up black phlegm -- what many referred to as the "Iraqi crud." Thousands have developed respiratory diseases, skin conditions and cancers that may be related to exposure.
The VA was ordered to establish the Airborne Hazards and Open Burn Pit Registry by Congress in 2013 to track the overall health of veterans who had potentially been exposed and identify trends. The registry was also to serve as a database for research and for developing medical treatments and policies as this veteran group aged.
From the start, however, the registry was troubled. VA officials fought the idea even before it became law, saying the program had little value since a connection between the burn pits and any illnesses was unproven.
In the past year, the Department of Veterans Affairs designated several respiratory illnesses as presumed to be caused by burn pit exposure, such as asthma and chronic sinusitis, as well several rare types of lung cancers. The PACT Act added more -- 23 additional diseases in total -- allowing afflicted veterans to apply for expedited health care and benefits.
Following the registry's rollout in 2014, advocacy groups questioned the length and scientific rigor of its required questionnaire and took issue with its numerous questions on smoking and personal habits, saying the information could be used to attribute illnesses to unhealthy behaviors, laying the blame on the veterans instead of the burn pits, which were managed by the Department of Defense.
Critics also noted that the loved ones of deceased veterans weren't able to join and input data about their veterans' deaths, to be counted as part of the surveillance.
Eight years later, the panel of researchers with the National Academies agreed that the process, including the 140-question survey, was too cumbersome. Panelist Kristin Olson, director of the Bureau of Sociological Research at the University of Nebraska-Lincoln, said the questionnaire was difficult to comprehend and complete.
"The more deployments you have had, the longer it will take to complete the questionnaire," she said. "Many veterans don't know the information asked about in the questionnaire and ... don't know or refuse to answer the question altogether," Olson said during a briefing on the report.
More than 3.7 million veterans and service members are eligible to enroll in the registry but, as of July 1, just 10% had completed the process, according to the report. Another 130,000 veterans had begun the registration process but never finished the questionnaire.
Of those who had completed registration, roughly half had asked for the health evaluation, but only 30,000 had undergone that exam.
The academies panel also noted that the registry doesn't allow for updating by the veterans, making it useless from a health surveillance standpoint for tracking individuals' health issues or disease clusters as health issues may develop after veterans complete the registration.
Furthermore, the panelists noted, the VA does not use the registry to guide policy decisions, nor does it analyze or interpret the data provided by the participants, electing instead to summarize their responses.
"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," David Savitz, professor of epidemiology at Brown University School of Public Health and committee chair, said in a press release.
The VA Inspector General's review had similar findings. Auditors found that veterans weren't aware they were responsible for scheduling their own exams and also failed to complete the questionnaire at alarming rates.
"Improvements in the registry exam process would help ensure more eligible and interested veterans receive them," the IG noted.
The National Academies recommended that the registry be modified so it meets the needs of the veteran population and provides value to researchers and policymakers who study and craft guidance to care for this veteran population as it ages.
The panel suggested that the VA find "alternative, more effective mechanisms for research on the health effects potentially resulting from these exposures and population health surveillance. Members suggested a streamlined registry for maintaining a roster of veterans and concentrating resources for research elsewhere.
"The committee recommends that the AH&OBP Registry be ended in its current form as its stated purposes have largely been to support research and population health surveillance, neither of which it can do," they wrote in the report.
McDonough said Tuesday that the VA will begin screenings for exposures in patients enrolled in VA health care beginning Nov. 8. He added that the exam, along with expanded benefits under the Promise to Address Comprehensive 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 effective to shorten the distance between identification of exposure and specialized treatment when necessary, and in all cases, prompt review of an awarding of claims from VBA where those are earned and deserved," McDonough said.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime