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Publication Briefs

Study Examines Effect of Environmental Exposures on Non-Specific Physical Symptoms in OEF/OIF Veterans

Historically, environmental exposures in military personnel have been strongly associated with increases in physical symptoms (e.g., during the 1991 Persian Gulf War), and having many physical symptoms is frequently associated with poorer functional status, higher psychological distress, and greater disability. This study examined the prevalence of self-reported lifetime environmental exposures in a cohort of 768 Army National Guard and Reserve personnel who served in Iraq or Afghanistan — and the relationship of exposure reports to current physical symptoms. Using self-reports obtained before and immediately after return from deployment, investigators assessed exposures to a limited set of environmental agents (e.g., nerve agents/gas, biological warfare agents, herbicide or defoliants [Agent Orange]), as well as blast exposure, screening-based traumatic brain injury (TBI), and deployment experiences. Investigators also examined the relationship between these exposures and post-deployment physical symptoms after controlling for gender and pre-deployment physical symptoms. Of the original cohort, 508 soldiers (67%) completed some post-deployment measures.


  • Reporting of environmental exposures was relatively low in OEF/OIF Veterans, but reporting more environmental and other exposures, in particular screening positive for TBI, was related to greater non-specific physical symptom severity immediately after deployment.
  • Soldiers reported higher rates of exposure to blasts than to any other single exposure: 15% reported exposure to one blast, 9% to two blasts, 8% to three blasts, 2% to four blasts, and 29% to five or more blasts. Overall, nearly 22% of Veterans screened positive for TBI.
  • These data suggest that VA healthcare providers should ask Veterans about environmental exposures and address any concerns about exposures expressed by patients, especially when they co-occur with physical symptoms.


  • Although investigators asked Veterans to report lifetime environmental exposures, it is possible that they preferentially reported exposures that occurred recently, or only during deployment.
  • This study relied on self-report, with its potential for reporting biases.
  • There was considerable loss to follow-up in this sample due mostly to an inability to track some units after their deployment and return to the U.S.

This study was funded by HSR&D (IIR 02-296). Dr. Quigley is part of HSR&D's Center for Health Quality, Outcomes, and Economic Research in Bedford, MA. Drs. Quigley, McAndrew, D'Andrea, Ms. Almeida, Ms Hamtil, and Mr. Ackerman were part of VA's New Jersey War-Related Illness & Injury Center at the time the data were collected.

PubMed Logo Quigley K, McAndrew L, Almeida L, D’Andrea E, Engel C, Hamtil H, and Ackerman A. Prevalence of Environmental and Other Military Exposure Concerns in Operation Enduring Freedom and Operation Iraqi Freedom Veterans. Journal of Occupational and Environmental Medicine June 2012;54(6):659-64.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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