Exposures to environmental hazards during military service are not uncommon, occurring as a part of training activities, performance of many military occupation specialties, as well as in deployment and combat environments. Many veterans have concerns about the potential health impacts of such exposures. Occupational and environmental hazards may be encountered in many forms: fuels, petrochemicals, solvents, hydraulic fluids, sand, dust, pesticides, herbicides as well as biological/chemical weapons and various forms of radiation. Military service in general is a risk factor for toxic environmental pulmonary exposures.
In WWI, there was large-scale use of chemical weapons including mustard gas and chlorine gas. In the recent conflicts in the Persian Gulf region, cholinesterase inhibiting nerve agents appear to have been used although the extent of the use and potential exposures to such chemical weapons is not clear; there were also concerns about and preparations made to respond to the potential use biological weapons, specifically anthrax and smallpox.
The 1990–1991 Gulf War (Operation Desert Shield/Desert Storm), following Iraq’s invasion of Kuwait, led to extensive debates regarding the etiology of Gulf War syndrome, also known as chronic multisystem illness. Veterans were exposed to numerous potentially toxic environmental agents (e.g., oil fires, depleted uranium, pesticides, multiple vaccinations, prophylactic medications), the psychological stress of deployment to a war zone where there was prolonged anticipation of combat, repeated chemical/biological weapons alerts, and use of impermeable full-body protective uniforms (made from rubber, vinyl, charcoal-impregnated polyurethane, and other materials) under desert conditions in extreme temperatures. Although no singular clinical syndrome with clearly established etiology has yet been definitively identified among the nearly 1 million coalition forces service members who deployed in 1990–1991, studies consistently found that military personnel who served in the Gulf experienced significantly elevated rates of multisystem, undiagnosed symptoms impacting all health domains (e.g., physical, cognitive, neurologic, psychological) compared with service members who deployed elsewhere or did not deploy. In addition, there is good evidence that deployment to the Persian Gulf region during this period was associated with subsequent development of PTSD; other psychiatric disorders including generalized anxiety disorder, depression, and substance use disorders (Chaps. 445, 446, 447, 448); and functional gastrointestinal symptoms such as irritable bowel syndrome (Chap. 320); and chronic fatigue syndrome (Chap. 442).
Nuclear weapons, most specifically the atomic bombs used at the end of WWII, resulted in large-scale destruction both from the explosive effects as well as the residual radiation effects on the populations and environments involved. Military personnel stationed in these areas, as well as those involved in further testing of nuclear weapons in the subsequent decades, were at increased risk for numerous malignancies and radiation-related illnesses.
A prominent environmental exposure during the war in Vietnam (1962–1971) involved defoliants, including one that was referred to as “Agent Orange” (because it was transported in 55 gallon drums labeled with an orange painted stripe). The defoliant was contaminated with dioxin (2,3,7,8-tetracholordibenzo-p-dioxin or TCDD) which was subsequently found to potentially contribute to numerous health effects. Research results from various sources including VA, Center for Disease Control (CDC), and National Academy of Medicine examining the potential health impacts of dioxin exposure are published every 2 years. Conditions that have been identified as having potential associations with Agent Orange exposure include amyloidosis, chronic B-cell leukemia, chloracne, type 2 diabetes, Hodgkin’s disease, ischemic heart disease, multiple myeloma, non-Hodgkin’s lymphoma, Parkinson’s disease, peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, and soft tissue sarcomas. Services and benefits are available to all U.S. veterans with potential exposures to Agent Orange who are diagnosed with any of these conditions.
Prophylactic medications and vaccinations (often multiple and concurrent) associated with deployment also carry potential side effects and may be of concern to veterans. In recent conflicts in the Persian Gulf region, vaccinations for potential biological weapons such as anthrax and smallpox were common. During deployment to the 1990–1991 Gulf War, many military personnel took pyridostigmine bromide as a prophylactic against cholinesterase blocking nerve agents. Taking malaria prophylaxis is frequently required during deployments to malaria endemic regions; concerns about neuropsychiatric side effects of mefloquin in veterans with combat trauma and PTSD arose during the 1990–1991 Gulf War and has remained an ongoing concern.
In addition to exposures that may occur during deployment, there are occasional toxic chemical exposures that occur when military personnel are in garrison (based in military facilities in the United States). From the 1950s through the 1980s, people living or working at the U.S. Marine Corps Base Camp Lejeune, North Carolina, were potentially exposed to drinking water contaminated with industrial solvents (perchlorethelene and trichloroethylene), benzene, and other toxic chemicals. There have been similar concerns related to potential toxic chemical exposures at other military bases and facilities in the United States.
The Department of VA has created several Registry Programs to respond to the medical conditions and health concerns of Veterans exposed to Agent Orange, Ionizing Radiation, Gulf War exposures and other deployment-related toxic environmental exposures. These programs provide Veterans with information and access to services, resources, and other benefits available to them as a consequence of these exposures. The DoD and VA approaches to assessing and addressing such exposures have become much more proactive over the years, as is evidenced by the Airborne Hazard and Open Burn Pit Registry for military personnel and veterans involved in conflicts in the Gulf beginning in August 1990.