2. Recognize the value of performing a toxic exposure screen for veterans of military service.
3. Understand the process used by VA to determine whether a medical condition is presumed to be associated with a toxic exposure during military service.
Military service is known to involve dangerous assignments, usually associated with combat. However, active-duty service members may also experience various military environmental exposures in training or garrison environments that can range from infectious agents to toxins to occupational hazards. As a result of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), nearly 6 million veterans have now been screened for multiple different military environmental exposures, including: Airborne Hazards and open burn pits, Gulf War Illness (Chronic Multi-symptom Illness), depleted uranium and toxic embedded fragments, herbicides (including Agent Orange), radiation, Camp Lejeune contaminated water and others. More than 40% of veterans who have completed the Toxic Exposures Screen have reported concerns and possibly at least one such exposure. An Exposure Informed Care (EIC) approach is critical in the delivery of excellence and high quality health care. EIC can potentially improve health outcomes, enhance trust between the patient and their clinician and clinical healthcare system, empower patients to better manage their own care and assure that clinicians have the education and knowledge to not only deliver appropriate and timely care, but also offer additional benefits and services. Part of that care is assuring that clinicians have the needed training to evaluate these exposures, evaluate health conditions, address risk concerns and connect veterans with needed medical referrals/workups and potential benefits. The first presentation will review the training modules that VA developed to provide this information to clinicians. Those modules are available to both VA and non-VA providers and, once completed, can lead to a Level 1 Certification in Military Environmental Exposures from the American College of Preventive Medicine. The second presentation will share the elements of Exposure Informed Care that VA has implemented, including the Toxic Exposures Screen, use of Environmental Health Coordinators and Toxic Exposure Screening Navigators to provide specialty information to both providers and veterans on health outcomes of Military Environmental Exposures, and connecting veterans in VA health care with information on applying for benefits from the Veterans Benefits Administration. The PACT Act also resulted in hundreds of health conditions (mainly cancers) now presumptively associated with airborne hazards and open burn pits and added hypertension and MGUS as presumptive conditions associated with Agent Orange exposure. In 2022, VA implemented a series of changes to the process used to evaluate the evidence for an association between medical conditions and possible military exposures, known as the Presumptive Decision Process. The third presentation will review these changes, which are intended to ensure that decisions regarding presumptive status are scientifically driven and evidence based, consistently applied, fair, transparent, timely and veteran-centered.