Association of a Veterans Affairs toxic exposure medical evaluation with symptom-related care

Abstract: Rationale: Service members exposed to burn pit emissions may be at risk for adverse health outcomes. The Department of Veterans Affairs offers screening medical evaluations for these individuals, but the benefit of this strategy is unknown. Objectives: To determine the effect of a medical evaluation for Veterans participating in the Airborne Hazards and Open Burn Pit Registry (AHOBPR), the national registry program for service members exposed to burn pit emissions. Methods: We selected all Veterans who participated in the AHOBPR and requested a medical evaluation from 2016 to 2020. We identified cohorts of Veterans who self-reported symptoms on a registry questionnaire of possible cardiovascular, pulmonary, or sinus disease. Participants who completed the medical evaluation were matched by high-dimensional propensity score to those who instead completed a primary care visit. For each cohort, the primary outcome was the receipt of additional care consistent with that disease category, defined as the occurrence of a symptom-related diagnostic test or establishment of care in an associated specialty clinic. In an exploratory analysis, we also determined whether completing the AHOBPR medical evaluation was associated with a shorter time to diagnosis of new medical conditions. The relationship between completion of the medical evaluation and study outcomes was estimated via Cox proportional hazards regression. Results: We identified 27,192 Veterans who requested a medical evaluation, of whom 63% reported symptoms of possible cardiovascular disease, 25% of pulmonary disease, and 43% of sinus disease. After matching, the medical evaluation was associated with a higher hazard of receiving care for cardiovascular (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.23-1.51), pulmonary (HR, 1.58; 95% CI, 1.39-1.80), and sinus disease (HR, 1.33; 95% CI, 1.13-1.56). In a symptom-agnostic exploratory analysis, the medical evaluation was associated with a similar time to diagnosis of most medical conditions compared with the primary care visit. Conclusions: Among Veterans with symptoms suggestive of cardiovascular, pulmonary, or sinus disease, the AHOBPR medical evaluation was associated with a shorter time to receipt of symptom-related care compared with a primary care visit. A purpose-built toxic exposure medical evaluation appears to be an effective strategy to improve the identification of conditions that may be related to military exposures.