New Presumptive VA Benefits

You may be eligible for newly enacted service-connected benefits.  

Over the course of the last six months, the Department of Veterans Affairs (VA) has begun processing service-connected disability claims for six new presumptive conditions related to environmental exposures during military service. We request your help in making more Veterans aware of these newly added presumptive conditions to help them file a claim and obtain any earned benefits. 

In May 2021, VA started implementing provisions of the William M. Thornberry National Defense Authorization Act for Fiscal Year 2021 (NDAA), adding bladder cancer, hypothyroidism and Parkinsonism to the list of medical conditions presumptively associated with exposure to Agent Orange. A few months later VA added asthma, rhinitis and sinusitis (to include rhinosinusitis) on a presumptive basis based on particulate matter exposures during military service in Southwest Asia and certain other areas.  

Any Veteran who was previously denied service-connection for any of these six conditions but had symptoms manifest within 10 years of military service would need to file a supplemental claim. Be sure to use VA Form 20-0995, Decision Review Request: Supplemental Claim when filing. The claim form should include the name of the condition and specify that the condition is being claimed due to in-service exposure to environmental hazards.  

I am committed to assisting Veterans who may have been exposed to Herbicide Agents.

Caregiver Support Program Extended Through 2022

The Department of Veterans Affairs Caregiver Support Program eligibility is exteded through Sept. 30, 2022, for veterans who are legacy participants, legacy applicants, and their family caregivers, participating in the Program of Comprehensive Assistance for Family Caregivers.

This extension helps veterans who were participating in PCAFC before Oct.1, 2020, those who applied for PCAFC before Oct.1, 2020, and those who were accepted into the program after Oct.1, 2020.

“During this one-year period, approximately 19,500 legacy participants, legacy applicants, and their family caregivers will be reassessed,” said VA Caregiver Support Program Executive Director Dr. Colleen M. Richardson.

VA , because of this extension, will have an additional year to conduct required reassessments of the group. This VA program offers enhanced clinical support for family caregivers of eligible Veterans who incurred or aggravated a serious injury in the line of duty and meet other eligibility criteria.

Veterans Pension Benefit

Eligibility for Veterans Pension

The Veterans Pension program provides monthly payments to wartime Veterans who meet certain age or disability requirements, and who have income and net worth within certain limits.

Are You eligible for Veterans Pension benefits?

You may be eligible for the Veterans Pension program if you meet the requirements listed below.

Both of these must be true:

  • You didn’t receive a dishonorable discharge, and
  • Your yearly family income and net worth meet certain limits set by Congress. Your net worth includes all personal property you own (except your house, your car, and most home furnishings), minus any debt you owe. Your net worth includes the net worth of your spouse.
    Find out about Veterans Pension rates SEE BELOW

And at least one of these must be true about your service. You:

  • Started on active duty before September 8, 1980, and you served at least 90 days on active duty with at least 1 day during wartime, or
  • Started on active duty as an enlisted person after September 7, 1980, and served at least 24 months or the full period for which you were called or ordered to active duty (with some exceptions) with at least 1 day during wartime, or
  • Were an officer and started on active duty after October 16, 1981, and you hadn’t previously served on active duty for at least 24 months

And at least one of these must be true. You:

  • Are at least 65 years old, or
  • Have a permanent and total disability, or
  • Are a patient in a nursing home for long-term care because of a disability, or
  • Are getting Social Security Disability Insurance or Supplemental Security Income

How do You know if  You served under an eligible wartime period?

Under current law, VA recognizes the following wartime periods to decide eligibility for VA pension benefits:

  • Mexican Border period (May 9, 1916, to April 5, 1917, for Veterans who served in Mexico, on its borders, or in adjacent waters)
  • World War I (April 6, 1917, to November 11, 1918)
  • World War II (December 7, 1941, to December 31, 1946)
  • Korean conflict (June 27, 1950, to January 31, 1955)
  • Vietnam War era (February 28, 1961, to May 7, 1975, for Veterans who served in the Republic of Vietnam during that period. August 5, 1964, to May 7, 1975, for Veterans who served outside the Republic of Vietnam.)
  • Gulf War (August 2, 1990, through a future date to be set by law or presidential proclamation)

2021 VA pension rates for Veterans

Current VA pension rates for Veterans, including VA Aid and Attendance rates.

If you qualify for these benefits, VA will base your payment amount on the difference between your countable income and a limit that Congress sets (called the Maximum Annual Pension Rate, or MAPR).

  • Your countable income is how much you earn, including your Social Security benefits, investment and retirement payments, and any income your dependents receive. Some expenses, like non-reimbursable medical expenses (medical expenses not covered by your insurance provider), may reduce your countable income.
  • Your MAPR amount is the maximum amount of pension payable. Your MAPR is based on how many dependents you have, if you are married to another Veteran who qualifies for a pension, and if your disabilities qualify you for Housebound or Aid and Attendance benefits. MAPRs are adjusted each year for cost-of-living increases. You can find your current MAPR amount using the tables below.

Example: You’re a qualified Veteran with a dependent, non-Veteran spouse and no children. You also qualify for Aid and Attendance benefits based on your disabilities. You and your spouse have a combined yearly income of $10,000.
Your MAPR amount = $27,549
Your yearly income = $10,000
Your VA pension = $17,549 for the year (or $1,462 paid each month)

What’s the net worth limit to be eligible for Veterans Pension benefits?

From December 1, 2020, to November 30, 2021, the net worth limit to be eligible for Veterans Pension benefits is $130,773.

On October 18, 2018, we changed the way we assess net worth to make the pension entitlement rules clearer. Net worth includes your and your spouse’s assets and annual income. When you apply for Veterans Pension benefits, you will need to report all of these assets and income.

Note: If your child’s net worth is more than the net worth limit, VA does not consider them to be a dependent when VA determines your pension.

Read VA definitions below:

Assets

Assets include the fair market value of all your real and personal property, minus the amount of any mortgages you may have. “Real property” means any land and buildings you may own. Your personal property assets include any of these items:

  • Investments (like stocks and bonds)
  • Furniture
  • Boats

Assets don’t include:

  • Your primary residence (the home where you live most or all of the time)
  • Your car
  • Basic home items like appliances that you wouldn’t take with you if you moved to a new house

Annual income

Annual income is the money earned in a year from a job or from retirement or annuity payments. It includes any of these:

  • Salary or hourly pay
  • Bonuses
  • Commissions
  • Overtime
  • Tips

VA subtracts certain expenses from your annual income when VA assesses net worth. VA calls these applicable deductible expenses. They include:

  • Educational expenses
  • Medical expenses you’re not reimbursed for

An example of net worth and eligibility

If you had $121,000 in assets and $14,000 in annual income, then your net worth would be $135,000. This is more than the net worth limit of $130,773. So you wouldn’t be eligible for Veterans Pension benefits.

What’s the 3-year look-back period for asset transfers?

When VA receives a pension claim, VA reviews the terms and conditions of any assets the Veteran may have transferred in the 3 years before filing the claim.

If you transfer assets for less than fair market value during the look-back period, and those assets would have pushed your net worth above the limit for a VA pension, you may be subject to a penalty period of up to 5 years. You won’t be eligible for pension benefits during this time.

Note: This new policy took effect on October 18, 2018. If you filed your claim before this date, the look-back period doesn’t apply. (A look-back period never includes a date before October 18, 2018.)

What is a penalty period?

A penalty period is a length of time when a Veteran isn’t eligible for pension benefits because they transferred assets for less than fair market value during the look-back period. VA will not pay pension benefits during a penalty period. The penalty period rate is $2,295.

Find your Maximum Annual Pension Rate (MAPR) amount

Date of cost-of-living increase: December 1, 2020
Increase factor: 1.3%
Standard Medicare deduction: Actual amount will be determined by SSA based on individual income.

For Veterans with no dependents:

If you have no dependents and…Your MAPR amount is (in U.S. $)
You don’t qualify for Housebound or Aid and Attendance benefits13,931
You qualify for Housebound benefits17,024
You qualify for Aid and Attendance benefits23,238

Note:
If you have medical expenses, you may deduct only the amount that’s above 5% of your MAPR amount ($696 for a Veteran with no spouse or child).

For Veterans with at least 1 dependent spouse or child:

If you have 1 dependent and…Your MAPR amount is (in U.S. $)
You don’t qualify for Housebound or Aid and Attendance benefits18,243
You qualify for Housebound benefits21,337
You qualify for Aid and Attendance benefits27,549

Note:

  • If you have more than one dependent, add $2,382 to your MAPR amount for each additional dependent.
  • If you have a child who works, you may exclude their wages up to $12,550.
  • If you have medical expenses, you may deduct only the amount that’s above 5% of your MAPR amount ($912 for a Veteran with 1 dependent).

For 2 Veterans who are married to each other:

If you’re 2 Veterans who are married to each other and…Your MAPR amount is (in U.S. $)
Neither of you qualifies for Housebound or Aid and Attendance benefits18,243
One of you qualifies for Housebound benefits21,337
Both of you qualify for Housebound benefits24,428
One of you qualifies for Aid and Attendance benefits27,549
One of you qualifies for Housebound benefits and one of you qualifies for Aid and Attendance benefits30,635
Both of you qualify for Aid and Attendance benefits36,861

Note:

  • If you have more than one dependent, add $2,382 to your MAPR amount for each additional child.
  • If you have a child who works, you may exclude their wages up to $12,550.
  • If you have medical expenses, you may deduct only the amount that’s above 5% of your MAPR amount ($912 for a Veteran with 1 dependent).

How to apply for a VA pension as a Veteran

Find out how to apply for tax-free VA pension benefits as a Veteran.

You can still file a claim and apply for benefits during the coronavirus pandemic

Get the latest information about in-person services, claim exams, extensions, paperwork, decision reviews and appeals, and how best to contact us during this time.
Go to our coronavirus FAQs

How do You prepare before starting my application?

You’ll need this information

  • Social Security number or VA file number (required)
  • Military history (required)
  • Your financial information and the financial information of your dependents (required)
  • Work history
  • Bank account direct deposit information
  • Medical information

Note: In 1973, a fire at the National Personnel Records Center (NPRC) in St. Louis destroyed records held for Veterans who were discharged from the Army and Air Force during certain periods of time. Your records may have been destroyed in the fire if you were discharged from the Army between November 1, 1912, and January 1, 1960, or if you were discharged from the Air Force between September 25, 1947, and January 1, 1964.

 

 

 


If You start Your pension application, does VA consider this “intent to file”?

No. Simply starting your VA pension application doesn’t show your intent to file. You will need to submit an intent to file form, which sets the effective date (the day you can start getting your benefits). Then you can focus on gathering supporting documents to turn in with your pension application. If you submit an intent to file before you file your claim, you may be able to get retroactive payments (money you’ll get starting from your effective date).

Note: If you apply online for pension benefits, you still need to separately submit an intent to file. 

How do I submit an intent to file?

You can submit your intent to file by phone or by written form. 

By phone

Call 800-827-1000, Monday through Friday, 8:00 a.m. to 9:00 p.m. ET.   

By submitting a form

Download, fill out, and submit an Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966).
Download VA Form 21-0966 (PDF)

Turn in your form in any of these ways:

VA Survivors Pension

A VA Survivors Pension offers monthly payments to qualified surviving spouses and unmarried dependent children of wartime Veterans who meet certain income and net worth limits set by Congress. Find out if you qualify and how to apply.

You can still file a claim and apply for benefits during the coronavirus pandemic

Get the latest information about in-person services, claim exams, extensions, paperwork, decision reviews and appeals, and how best to contact us during this time.
Go to our coronavirus FAQs

Are You eligible for a VA Survivors Pension as a surviving spouse?

You may be eligible for this benefit if you haven’t remarried after the Veteran’s death, and if the deceased Veteran didn’t receive a dishonorable discharge and their service meets at least one of the requirements listed below.

At least one of these must be true. The Veteran:

  • Entered active duty on or before September 7, 1980, and served at least 90 days on active military service, with at least 1 day during a covered wartime periodor
  • Entered active duty after September 7, 1980, and served at least 24 months or the full period for which they were called or ordered to active duty (with some exceptions), with at least 1 day during a covered wartime period or
  • Was an officer and started on active duty after October 16, 1981, and hadn’t previously served on active duty for at least 24 months

And this must be true for you:

Your yearly family income and net worth meet certain limits set by Congress. Your net worth equals the value of everything you own (except your house, your car, and most home furnishings), minus any debt you owe.

Am I eligible for a VA Survivors Pension as the child of a deceased wartime Veteran?

You may be eligible for this benefit if you are unmarried and you meet at least one of the requirements listed below.

At least one of these must be true:

  • You’re under age 18, or
  • You’re under age 23 and attending a VA-approved school, or
  • You’re unable to care for yourself due to a disability that happened before age 18

What wartime periods do you recognize for pension benefits?

Under current law, we recognize these wartime periods to decide eligibility for pension benefits:

  • Mexican Border period (May 9, 1916, to April 5, 1917, for Veterans who served in Mexico, on its borders, or in adjacent waters)
  • World War I (April 6, 1917, to November 11, 1918)
  • World War II (December 7, 1941, to December 31, 1946)
  • Korean conflict (June 27, 1950, to January 31, 1955)
  • Vietnam War era (February 28, 1961, to May 7, 1975, for Veterans who served in the Republic of Vietnam during that period. August 5, 1964, to May 7, 1975, for Veterans who served outside of the Republic of Vietnam.)
  • Gulf War (August 2, 1990, through a future date to be set by law or presidential proclamation)

How do I apply for a VA Survivors Pension?

You can apply in any of these ways:

Online

Use the direct upload tool through AccessVA to upload your form online.
Go to AccessVA to use direct upload

By mail

Fill out an Application for DIC, Death Pension, and/or Accrued Benefits (VA Form 21-534EZ).
Download VA Form 21-534EZ (PDF)

Mail your completed application to this address:

Department of Veterans Affairs
Pension Intake Center
PO Box 5365
Janesville, WI 53547-5365

In person

Bring your application to a VA regional office near you.
Find a VA regional office near you

2021 VA Survivors Pension benefit rates

Learn about VA Survivors Pension benefit rates. If you qualify for this benefit as a surviving spouse or dependent child, VA will base your payment amount on the difference between your countable income and a limit that Congress sets (called the Maximum Annual Pension Rate, or MAPR).

  • Your countable income is how much you earn, including your salary, investment and retirement payments, and any income you may have from your dependents. Some expenses, like non-reimbursable medical expenses (paid medical expenses not covered by your insurance provider), may reduce your countable income.
  • Your MAPR amount is the maximum amount of pension payable to a Veteran, surviving spouse, or child. Your MAPR is based on how many dependents you have and whether you qualify for Housebound or Aid and Attendance benefits. MAPRs are adjusted each year for cost-of-living increases. You can find your current MAPR amount using the tables below.

Example: You’re a qualified surviving spouse with one dependent child. You also qualify for Aid and Attendance benefits. Your yearly income is $10,000.

Your MAPR amount = $17,815
Your yearly income = $10,000
Your VA pension = $7,815 for the year (or $651 paid each month)

What’s the net worth limit to be eligible for Survivors Pension benefits?

From December 1, 2020, to November 30, 2021, the net worth limit to be eligible for Survivors Pension benefits is $130,773.

On October 18, 2018, we changed the way we assess net worth to make the pension entitlement rules clearer. Net worth includes your assets and annual income. When you apply for Survivors Pension benefits, you will need to report all of your assets and income.

Note: If your child’s net worth is more than the net worth limit, we don’t consider them to be a dependent when we determine your pension.

Read our definitions below:

Assets

Assets include the fair market value of all your real and personal property, minus the amount of any mortgages you may have. “Real property” means any land and buildings you may own. Your personal property assets include any of these items:

  • Investments (like stocks and bonds)
  • Furniture
  • Boats

Assets don’t include:

  • Your primary residence (the home where you live most or all of the time)
  • Your car
  • Basic home items like appliances that you wouldn’t take with you if you moved to a new house

Annual income

Annual income is the money earned in a year from a job or from retirement or annuity payments. It includes any of these:

  • Salary or hourly pay
  • Bonuses
  • Commissions
  • Overtime
  • Tips

We’ll subtract certain expenses from your annual income when we assess net worth. We call these applicable deductible expenses. They include:

  • Educational expenses
  • Medical expenses you’re not reimbursed for

An example of net worth and eligibility

If you had $121,000 in assets and $14,000 in annual income, then your net worth would be $135,000. This is more than the net worth limit of $130,773. So you wouldn’t be eligible for Survivors Pension benefits.

What’s the 3-year look-back period for asset transfers?

When VA receives a pension claim, VA will review the terms and conditions of any assets the survivor may have transferred in the 3 years before filing the claim.

If you transfer assets for less than fair market value during the look-back period, and those assets would’ve pushed your net worth above the limit for a VA Survivors Pension, you may be subject to a penalty period of up to 5 years. You will not be eligible for pension benefits during this time.

Note: This new policy took effect on October 18, 2018. If you filed your claim before this date, the look-back period doesn’t apply. (A look-back period never includes a date before October 18, 2018.)

What’s a penalty period?

A penalty period is a length of time when a survivor isn’t eligible for pension benefits, because they transferred assets for less than fair market value during the look-back period. This may apply if those transferred assets would’ve caused the survivor’s net worth to be over the limit mentioned above. However, not every asset transfer is subject to this penalty.

If we determine you’re subject to a pension penalty, we wouldn’t pay pension benefits during the penalty period.

Find your Maximum Annual Pension Rate (MAPR) amount

Date of cost-of-living increase: December 1, 2020
Increase factor: 1.3%
Standard Medicare deduction: Actual amount will be determined by SSA based on individual income.

For qualified surviving spouses with at least 1 dependent:

If you have 1 dependent child and…Your MAPR amount is (in U.S. $):
You don’t qualify for Housebound or Aid and Attendance benefits12,229
You qualify for Housebound benefits14,300
You qualify for Aid and Attendance benefits17,815
You qualify for Aid and Attendance benefits and you’re the surviving spouse of a Veteran who served in the Spanish-American War (SAW)18,355

Notes:

  • The Survivor Benefit Plan (SBP)/Minimum Income Annuity (MIW) limitation is $9,344.
  • If you have more than 1 child, add $2,382 to your MAPR amount for each additional child.
  • If you have a child who works, you may exclude their wages up to $12,550.
  • If you have medical expenses, you may deduct only the amount that’s above 5% of your MAPR amount ($611 for a surviving spouse with 1 dependent).

For qualified surviving spouses with no dependents:

If you have no dependents and…Your MAPR amount is (in U.S. $):
You don’t qualify for Housebound or Aid and Attendance benefits9,344
You qualify for Housebound benefits11,420
You qualify for Aid and Attendance benefits14,934
You qualify for Aid and Attendance benefits and you’re the surviving spouse of a Veteran who served in the Spanish-American War (SAW)15,539

Notes:

  • The Survivor Benefit Plan (SBP)/Minimum Income Annuity (MIW) limitation is $9,344.
  • If you have medical expenses, you may deduct only the amount that’s above 5% of your MAPR amount ($467 for a surviving spouse with no dependent child).

For qualified surviving children:

If you’re…Your MAPR amount is (in U.S. $):
A qualified surviving child2,382

VA Aid and Attendance benefits and Housebound allowance

VA Aid and Attendance or Housebound benefits provide monthly payments added to the amount of a monthly VA pension for qualified Veterans and survivors. If you need help with daily activities, or you are housebound, find out if you qualify.

You can still file a claim and apply for benefits during the coronavirus pandemic

Get the latest information about in-person services, claim exams, extensions, paperwork, decision reviews and appeals, and how best to contact us during this time.
Go to our coronavirus FAQs

Are You eligible for VA Aid and Attendance or Housebound benefits as a Veteran or survivor?

VA Aid and Attendance eligibility

You may be eligible for this benefit if you get a VA pension and you meet at least one of the requirements listed below.

At least one of these must be true:

  • You need another person to help you perform daily activities, like bathing, feeding, and dressing, or
  • You have to stay in bed—or spend a large portion of the day in bed—because of illness, or
  • You are a patient in a nursing home due to the loss of mental or physical abilities related to a disability, or
  • Your eyesight is limited (even with glasses or contact lenses you have only 5/200 or less in both eyes; or concentric contraction of the visual field to 5 degrees or less)

Housebound benefits eligibility

You may be eligible for this benefit if you get a VA pension and you spend most of your time in your home because of a permanent disability (a disability that doesn’t go away).

Note: You can’t get Aid and Attendance benefits and Housebound benefits at the same time.

How do You get this benefit?

You can apply for VA Aid and Attendance or Housebound benefits in one of these ways:

Send a completed VA form to your pension management center (PMC)

Fill out VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) and mail it to the PMC for your state. You can have your doctor fill out the examination information section. 

Download VA Form 21-2680 (PDF)
Find your PMC

You can also include with your VA form:

  • Other evidence, like a doctor’s report, that shows you need Aid and Attendance or Housebound care
  • Details about what you normally do during the day and how you get to places
  • Details that help show what kind of illness, injury, or mental or physical disability affects your ability to do things, like take a bath, on your own

If you’re in a nursing home, you’ll also need to fill out a Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779).
Download VA Form 21-0779 (PDF)

VA Proposes To Help Veterans Make Normal Loan Payments – COVID19

Today, the Department of Veterans Affairs (VA) proposed to establish the COVID–19 Veterans Assistance Partial Claim Payment program (COVID– VAPCP), a temporary program to help veterans return to making normal loan payments on a VA-guaranteed loan (guaranteed loan) after exiting a Coronavirus Aid, Relief, and Economic Security Act (CARES Act) forbearance period.

Under this proposed program, a servicer could consider a partial claim option after the servicer has evaluated all loss-mitigation options for feasibility. If the veteran qualifies and opts to move forward, VA would act as a mortgage investor of last resort by purchasing the amount of indebtedness necessary to bring the veteran’s guaranteed loan current. The veteran would have up to 60 months to defer repayment to VA and up 120 months to repay the loan in full, with the interest rate fixed at 1 percent per annum.

See:

VA Announces That Veterans Can Reschedule VA Healthcare Appointments that Were Cancelled Due to COVID19

VA announced today, that three tools are available to reschedule an appointment:

When actually going to a VA healthcare facility, instead of a virtual appointment, wear a mask that covers mouth and nose, and complete on-site the VA COVID-19 symptom screening questions.

Extension of Veterans’ Group Life Insurance (VGLI) Application Periods – – Response to the COVID–19 Public Health Emergency

This VA Final Rulemaking, that was effective October 7, 2020, extends by 90 days the deadlines for former members insured under Servicemembers’ Group Life Insurance (SGLI) to apply for Veterans’ Group Life Insurance (VGLI) coverage following separation from service in order to address the inability of former members directly or indirectly affected by the 2019 Novel Coronavirus (COVID–19) public health emergency to purchase VGLI. The final rule is in effect for one year from June 11, 2020, the date that the interim final rule was published in the Federal Register. [Until June 11, 2021].

See https://www.govinfo.gov/content/pkg/FR-2020-10-07/pdf/2020-19645.pdf

See also https://www.govinfo.gov/content/pkg/FR-2020-06-11/pdf/2020-12559.pdf, the Interim Final Rule that was published in the Federal Register on June 11, 2020.

Legislation To Help Veterans With Need for Mental Health Care and Resources Sent to the President

In early October 2020, the U.S. Senate sent a bi-partisan bill, known as the “Whole Veteran Act,” [H.R. 2359], to the President for signature – it is part of a government wide effort to prevent veteran suicides, and make holistic mental healthcare more available to service women and men. See https://www.va.gov/WHOLEHEALTH/index.asp

VA Caregiver Program Expanded – Eligible Vietnam, Korea and WWII Veterans

VA expanded on October 1, 2020 the Program of Comprehensive Assistance For Family Caregivers, which enhances 24/7 care from family and loved ones providers. VA announced in July 2020 that this program will cover veterans who served in the military on or before May 7, 1975. Veterans covered are required to have a single or combined service-connected disability rating of 70% or higher, and meet other general criteria. In part, geographic location with determine the actual provided dollar amounts.

See https://www.govinfo.gov/content/pkg/FR-2020-07-31/pdf/2020-15931.pdf

Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations

On September 11, 2020 the National Academies of Sciences, Engineering and Medicine, Committee on Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations, released the subject Report. In part, the Report said that:

“Southwest Asia theater veterans were exposed to a broad range of potentially hazardous airborne agents. These include such regional environmental exposures as air pollution from dusts; local point and area sources such as traffic, waste management, and local industries; and the aeroallergens and microbial agents present in the theater. Exposures related to military operations are also contributors, such as exhaust from heaters, military vehicles, and aircraft as well as smoke from structural fires, explosions, burning oil wells, or burn pits.” Continuing,

CONCLUSIONS REGARDING THE ASSOCIATION BETWEEN IN-THEATER AIRBORNE HAZARDS AND RESPIRATORY HEALTH OUTCOMES

The health effects of these airborne hazards were likely influenced by factors common to military operations in Southwest Asia. These effect modifiers include temperature extremes, psychosocial stress, sleep deprivation, and noise.

The committee formulated a list of 27 health outcomes for their literature review, delineated in Box S-2 [below]. The list included the conditions explicitly listed in the Statement of Task and those that the committee believed to be “of great concern to veterans.”

Of these outcomes, none met the criteria for sufficient evidence of an association. The evidence for respiratory symptoms—which included chronic persistent cough, shortness of breath (dyspnea), and wheezing—met the criteria for limited or suggestive evidence of an association for both veterans who served in the 1990–1991 Gulf War and those who served in the post-9/11 conflicts. Studies considered in previous National Academies reports were relatively consistent in reporting associations between deployment and more prevalent self-reported respiratory symptoms in theater veterans, and outcomes from more recent studies are largely in line with those findings. Importantly, a recent study that compared symptom reporting before, during, and after deployment found that the self-reported frequency of symptoms was increased both during and after deployment relative to pre-deployment. Many of the studies considered, however, were weakened by bias induced by the self-selection of their participants (which may have led to people being more likely to participate if they had respiratory symptoms than if they did not) and by the lack of control for cigarette smoking, which is known to exacerbate symptoms. These concerns, while serious, were consistent with a classification in the limited or suggestive category. Lastly, the committeepage21image1971788224

BOX S-2
Respiratory Health Outcomes Addressed

Non-Cancer Respiratory Disorders

Upper Airway Disorders

Rhinitis Sinusitis

Non-Infectious Lower Airway

Asthma
Chronic bronchitis
Chronic obstructive pulmonary disease

Interstitial Lung Diseases

Acute eosinophilic pneumonia Hypersensitivity pneumonitis Idiopathic interstitial pneumonia

Infectious Lower Airway

Acute bronchitis Pneumonia

Respiratory Symptoms

Chronic persistent cough Shortness of breath (dyspnea)

Respiratory Cancers

Esophageal cancer Laryngeal cancer

Other Outcomes

Sleep apnea
Vocal cord dysfunction

Constrictive bronchiolitis Emphysema

Idiopathic pulmonary fibrosis Pulmonary alveolar proteinosis Sarcoidosis

Tuberculosis

Wheeze

Lung cancer
Oral, nasal, and pharyngeal cancers

Changes in pulmonary function
Mortality due to diseases of the respiratory system

concluded that there is limited or suggestive evidence of no association between deployment to the 1990–1991 Gulf War and changes in lung function.

The committee found that there was inadequate or insufficient information to evaluate the association between service in the Southwest Asia theater and all of the remaining respiratory health outcomes it examined. While there are a variety of reasons for this that vary by the outcome under consideration, one prominent cause was the lack of good exposure characterization. Many studies used deployment to the theater as their only metric of exposure, and this undoubtedly led to people with widely different exposure experiences being grouped together for analysis purposes. Such grouping would be expected to diminish the possibility of observing an effect if one existed if there were large numbers of those with relatively low exposure compared with those with relatively high exposure.