The Airborne Hazards and Open Burn Pit Registry (AHOBPR) allows Veterans who were deployed to Southwest Asia and/or Afghanistan to document their environmental exposures in an online questionnaire and then address any associated health concerns during a free, in-person exam with an Environmental Health Clinician at their local VA medical center.
The Golden VA Clinic began conducting AHOBPR exams in September 2018 and completed 687 exams as of February 1, 2020. Anisa Moore, MD, has personally conducted almost 300 of these exams since the clinic opened. She was the only AHOBPR examiner at the site until several others were hired in the summer of 2019.
Dr. Moore, who is Section Chief of the new Environmental Health Department at VA Eastern Colorado Health Care Services and Lead Environmental Health Clinician for Veterans Integrated Service Network (VISN) 19, is passionate about helping Veterans by conducting AHOBPR exams. VA’s Post Deployment Health Services talked to Dr. Moore about AHOBPR health exams and her experience conducting them.
How long does the average exam take for Veterans?
Moore: We schedule 90 minutes for most AHOBPR exams. Many of the Veterans who request these exams have done so because they have specific symptoms or concerns that they want to address, and we find that we need a full 90 minutes to address these concerns and perform a comprehensive history and physical. In addition to a 90-minute visit with the Environmental Health Clinician, we also schedule all AHOBPR Veterans for same-day, in-clinic spirometry (breathing tests) and labs.
What are some health concerns that Veterans have shared with you related to airborne hazards?
Moore: In my experience, the top four health concerns are:
- Breathing problems (e.g., shortness of breath, decreased exercise tolerance, or chronic cough
- Congestion (e.g., runny nose or post-nasal drip)
- Gastrointestinal problems (e.g., difficulty swallowing, diarrhea, constipation, or abdominal pain)
- Cancers (e.g., either an existing cancer diagnosis or concerns about developing cancer in the future)
About how many exams do you conduct per week?
Moore: I conduct three to four AHOBPR exams a day, and most of our other examiners perform two to three AHOBPR exams a day. To increase our productivity, we combine AHOBPR and Gulf War exams for Veterans who are eligible for both.
What do you like most about your role in conducting AHOBPR exams?
Moore: I absolutely LOVE doing AHOBPR exams—in fact, they are my very favorite registry exam to perform. Here’s why:
- AHOBPR exams contribute to our knowledge about the health impacts of inhalational exposures. My own husband was deployed to Kuwait and Saudi Arabia in 1990-1991 as a part of Desert Storm/Desert Shield, so you’d better believe I care about research that could identify the health impacts of deploymentrelated, inhalational exposures on him and other Veterans.
- AHOBPR exams yield a high return of individual diagnostic information. I have found all sorts of pathology (thyroiditis, eosinophilic esophagitis, Fanconi syndrome, various cancers, hypertrophic obstructive cardiomyopathy, etc.) just by listening to Veterans and doing a careful history and physical with a review of systems.
- Most importantly, the Veterans are deeply appreciative of AHOBPR exams. I frequently get hugs and thank you notes from Veterans after their exams. In fact, I had a retired lieutenant colonel tell me his AHOBPR exam was the most thorough medical exam he had ever had.
How does a Veteran go about scheduling an exam at your clinic?
Moore: Veterans contact our Environmental Health Coordinator via phoe or email.
Is there anything else you would like to tell me about your work with the AHOBPR?
Moore: AHOBPR exams are unique to the VA; these exams are simply not available in the community or private sector. Veterans who participate in AHOBPR exams should know that they are helping not only themselves, but all Veterans, by contributing to research on the health impacts of military environmental exposures.