The Toxic Exposures Research Program supports research to improve detection of military-relevant toxic exposures and diagnosis of exposure-related illnesses and health outcomes for Service Members, Veterans and their Families.
More than 3.7 million Service Members who deployed to the Southwest Asia Theater of Military Operations and Afghanistan after 1990 experienced airborne hazards, such as burn pit emissions, oil-well fire smoke, vehicle exhaust and sand.
The U.S. Department of Veterans Affairs recognizes occupational hazards for military personnel and continues to identify new hazards as well as specific diseases and disorders as presumptive service-connected conditions. Of the over six million Veterans who completed the VA’s Toxic Exposure Screening, 47 percent identified at least one potential exposure to toxic substances. The VA health care service extended coverage to Veterans exposed to toxic substances through the Promise to Address Comprehensive Toxics Act of 2022.
Monitoring Service Members’ Environmental Exposures
In 2013, the Department of Defense and the VA created the Individual Longitudinal Exposure Record, an electronic platform and database to provide a history of a Service Member’s potential exposures during service. However, the ILER contains little individual exposure data; most data provides unit-level or location-wide exposures but exposures may vary based on a Warfighter’s specific role and workspace.
In fiscal year 2022, the TERP funded an Investigator-Initiated Research Award, led by Evgueni Kadossov, Ph.D., at XploSafe, LLC to improve Xcel+, a wearable “badge” comprised of porous TeflonTM tubes coated with a material designed to capture other chemical compounds. The badge previously demonstrated airborne detection of 11 specific chemicals that easily turn into gas at room temperature, such as benzene found in gasoline or acetone and isopropyl alcohol found in paint. Researchers can remove the tubes from the badge for analysis of chemicals in the environment, even determining the specific dose of exposure over time.
With the TERP award, Kadossov aims to expand the types of chemicals the Xcel+ can detect to include pesticides, organophosphates, toxic industrial chemicals and other classes of chemicals deemed high priority by the TERP. After determining the smallest detectable amounts for each chemical class and validating performance of the device in military environments, Kadossov and team will develop a data repository platform compatible with the ILER. Adding Xcel+ device data to the ILER could increase the ability to determine individual-level exposure data for Service Members.
“Deployment of the sampler technology will result in earlier and more timely diagnosis and prevention of illness due to toxic chemical exposure, thereby inherently increasing Service Member mission readiness and lethality,” Kadossov said. “Data mining of archived sampling data can lead to early illness diagnosis, help determine the cause of unexpected health effects in deployed or post-deployment military personnel, and lower overall morbidity as a result of service-related chemical exposure.”
With the additional individual-level data from the Xcel+ available in the ILER, doctors could use exposure information to help differentiate causes of symptoms and assist with developing treatment plans specific to Service Members or Veterans.
“As a result of this TERP project, a new standard for universal toxic chemical exposure sampling and quantification in austere environments has been made possible,” Kadossov said.
Non-Invasive Diagnostic Tests for Deployment-Related Respiratory Diseases
Among the currently identified presumptive conditions linked to military service, the VA describes more than 10 deployment-related respiratory diseases, including asthma, constrictive bronchiolitis, chronic obstructive pulmonary disease, commonly referred to as COPD, and other lung conditions. Following airborne exposures, Service Members and Veterans may present with a variety of symptoms and sometimes require invasive procedures, such as a lung biopsy, to confirm a diagnosis.
With a fiscal year 2016 Gulf War Illness Research Program New Investigator Award to the University of Michigan, John Osterholzer, M.D., evaluated an image-based, non-invasive method for detecting functional small airway disease in military personnel. Functional small airway disease, a precursor to various lung diseases, causes airflow limitation due to narrowing of small airway tubes in the lungs.
Osterholzer used a computational approach to analyze computed tomography lung scans of military personnel with constrictive bronchiolitis, which affects the small airways. Compared to scans of lungs from healthy subjects, lung scans from military members with constrictive bronchiolitis showed increased functional small airway disease that remained undetected during clinician-based lung function tests. The study’s results also suggested that military populations with constrictive bronchiolitis experience more airflow limitation than individuals living with mild or moderate COPD, which affects both small and large airways.
Osterholzer is expanding on these findings through a fiscal year 2022 Translational Research Award from the TERP. He and partnering investigator Craig Galban, Ph.D., also at the University of Michigan, are using the same non-invasive approach to evaluate lung images from Veterans who served in either Gulf War or post-9/11 conflicts, aiming to identify distinct criteria for different deployment-related respiratory disease subtypes.
By comparing lung images from Veterans with biopsy-proven deployment-related constrictive bronchiolitis to Veterans with undiagnosed respiratory symptoms, Osterholzer and Galban identified a subset of undiagnosed Veterans who would likely test positive by biopsy for deployment-related constrictive bronchiolitis, compared to other symptomatic Veterans with a different pattern of respiratory disease imaging features.
Through the TERP award and with additional funding support from other sources, Osterholzer and Galban continue to identify disease-specific imaging markers for differentiation and tracking of disease progression over time. Advancements in understanding deployment-related respiratory diseases and non-invasive detection methods show promise for rapid and accurate diagnoses for Service Members and Veterans as well as civilians.
Reducing the Effects of Toxic Exposures for Military Personnel
Since fiscal year 2022, the TERP received $105 million in congressional appropriations supporting research to prevent, minimize and mitigate the impact of military-related toxic exposures and improve the health and quality of life for affected Service Members, their Families, Veterans and the American public.
“I have welcomed home a new generation of Veterans and listened to their concerns about toxic exposures, including airborne hazards, open burn pits and other particulate matter exposures,” retired U.S. Air Force Tech. Sgt. Vera Roddy, a TERP Programmatic Panel member from fiscal years 2022 to 2025, said. “It is my hope that the Toxic Exposures Research Program will expand the knowledge of and discover interventions for the many conditions and health concerns that Veterans experience and that the outcomes of the program will contribute to a better quality of life.”
For more information about the Toxic Exposures Research Program, visit https://cdmrp.health.mil/terp/default.