The PACT Act is sweeping legislation passed in 2022 that expands and strengthens health care and benefits for Veterans exposed to burn pits, Agent Orange, and other toxic substances. This law helps us provide generations of Veterans—and their survivors—with the care and benefits they have earned and deserve. The PACT Act grants health care eligibility to more than 5 million Veterans. It is the most significant expansion of benefits and services for toxic exposed Veterans in more than 30 years.

Through research and education, the AHBPCE furthers the goals of the PACT Act by informing the care that VA is required to provide. The work done at and through the Center also helps VA at large accurately diagnose and support Veterans with exposure concerns.

The AHBPCE has historically focused its research and clinical care efforts on respiratory conditions and concerns. The independent contributions of other investigators and programs have underscored the importance of broadening both the scope and the definition of deployment-related health concerns. Two federal funding bodies—the VA Office of Research & Development (ORD) and the Department of War (DoW) Congressionally Directed Medical Research Programs (CDMRP)—are providing researchers with opportunities for funding, attracting new investigators to the field, and broadening topic areas for research.

Publications distributed in the past year illustrate this broadening view toward health impacts of exposure to airborne hazards and burn pits:

• January 2026 issue of Medical Care
• March 2026 issue of the Journal of Occupational and Environmental Medicine
• CDMRP Toxic Exposures Research Program (TERP)
• VA ORD Military Exposures Research Program (MERP)

Additional topics studied in the past year in relation to airborne hazard exposure included:

• Irritable bowel syndrome
• Psychiatric and mental health conditions
• Sleep disordered breathing
• Insomnia
• Lymphoid malignancies
• Novel satellite-based exposure assessments
• Broader consideration of exposures - polycyclic aromatic hydrocarbons, jet fuel
• High-intensity interval training as a treatment
• Chronic rhinosinusitis
• Monocyte clusters
• Cardiovascular dysfunction
• Reproductive health

Beyond research and clinical care adjustments, efforts to address deployment-related health concerns have extended into public awareness, provider education, and policy development. Some of these efforts include:

• A historical recognition of airborne hazards with a feature on burn pits in Iraq through the History of VA in 100 Objects exhibit
• New mandatory training for military health system health care providers through the Burn Pit Exposure Training and Clinical Toolbox
• A new law in Maryland that requires doctors to ask their patients about military service

Together, these updates reflect a continued shift toward a broader and more comprehensive approach to deployment-related health concerns. By expanding research priorities, improving provider education, and increasing public awareness, AHBPCE is better positioned to understand and address the full spectrum of health concerns and outcomes affecting Veterans exposed to airborne hazards and burn pits.

Pilot Research Project Program

The Pilot Research Project Program supports VA-affiliated investigators in the pursuit of preliminary data and/or proof-of-concept feasibility studies to develop novel research questions across the spectrum of basic, clinical, and health services research. Applications with a strong rationale that clearly articulated both the potential impact on Veteran health as well as the near-term leveraging potential for future funding are given the highest priority. A two-tiered review system is used to evaluate each application, including external subject matter expert critique and internal programmatic review.

In the first year of the program, we received only five applicants. In the past year, interest surged to 17 applicants—and that interest continues to grow. AHBPCE is looking to support projects on all topics related to airborne hazards. For FY26, we were particularly interested in those projects designed to inform future treatments and therapeutics for Veterans with airborne hazards exposure. We were also interested in projects using machine learning approaches to identify Veterans with exposure-related disease(s) and/or condition(s).

FY26 Pilot Projects

Over the last year, several AHBPCE-supported pilot projects from previous years have published their works. Those studies include:

• Almekdash MH, Han J, Guffey D, Christie IC, Helmer DA, Wu TD. Association of a Veterans Affairs Toxic Exposure Medical Evaluation with Symptom-related Care. Ann Am Thorac Soc. 2025;22(8):1176-1182. doi:10.1513/AnnalsATS.202408-835OC
• Azarian M, Ramezani A, Sharafkhaneh A, et al. The Association between All-Cause Mortality and Obstructive Sleep Apnea in Adults: A U-Shaped Curve. Ann Am Thorac Soc. 2025;22(4):581-590. doi:10.1513/AnnalsATS.202407-755OC
• Cillay J, Sandrin B, Bull TM, et al. Pulmonary vascular response to high-intensity interval training in deployment-related respiratory disease: a pilot clinical trial. Ann Am Thorac Soc. 2026;23(3):453-457. doi:10.1093/annalsats/aaoaf037
• Forbes LM, Bauer N, Bhadra A, et al. Precision Medicine for Pulmonary Vascular Disease: The Future Is Now (2023 Grover Conference Series). Pulm Circ. 2025;15(1):e70027. Published 2025 Jan 2. doi:10.1002/pul2.70027
• Jones MB, Sharafkhaneh S, Glick DR, et al. Concordance Between Self-Report and Electronic Medical Record Diagnoses of Insomnia and Sleep Apnea: Lessons From the Airborne Hazards and Open Burn Pit Registry. Med Care. 2026;64(2S Suppl 2):S155-S160. doi:10.1097/MLR.0000000000002240
• Agrawal R, Razjouyan J, Glick DR, et al. Burn Pit Smoke Exposure and Sleep Apnea in US Veterans: A Retrospective Cohort Study. Med Care. 2026;64(2S Suppl 2):S161-S167. doi:10.1097/MLR.0000000000002237

Special Projects

The Oscar Auerbach Visiting Scholar Program Updates

The Oscar Auerbach Visiting Scholar Program supports VA investigators who are motivated to understand the incidence and prevalence of cancers (and/or other potential health conditions) among AHOBPR participants. This program provides multi-year support to highly accomplished VA investigators who are working to pursue research questions pertaining to long-term health outcomes (i.e., cancer or other noncommunicable diseases) among Veterans with military environmental exposure.

In 2024, AHBPCE selected its first two Visiting Scholars: Bhavika Kaul, MD, MAS, and Mohamed Ismail Seedahmed, MD, MPH.

Dr. Kaul's work integrates quantitative imaging and pragmatic clinical trial design to improve assessment and access to care for Veterans with pulmonary fibrosis (PF), particularly in rural populations.

• Applies quantitative CT analysis to Burn Pit Registry imaging to characterize lung disease burden and identify gaps in follow-up care, while revealing variability in CT acquisition quality across sites—especially in rural settings—where scans are more often unsuitable for advanced analysis.
• Uses these findings to highlight system-level needs for standardized imaging to support equitable implementation of AI-enabled diagnostics.
• Co-leads the Metformin to Attenuate Progressive Respiratory Decline in Idiopathic Pulmonary Fibrosis (MAVRIC-IPF) trial, the first pulmonary fibrosis study enrolling Veterans directly through VA Medical Centers, using a pragmatic design with remote visits to expand access for geographically dispersed and rural Veterans.

Dr. Seedahmed is leading research focused on sarcoidosis, a condition with disproportionate burden among Veterans and individuals in rural populations. His early work has been among the first to characterize the epidemiology of sarcoidosis within the VA, providing a critical foundation for ongoing studies and a forthcoming VA Career Development Award application. His recent publications further examine mortality trends and emerging clinical phenotypes, including pulmonary hypertension in IgG4-high sarcoidosis.

• Seedahmed MI, Albirair MT, Baugh AD, et al. Trends in All-Cause Mortality Among US Veterans with Sarcoidosis, 2004-2022. Chest. 2025;167(5):1416-1427. doi:10.1016/j.chest.2024.10.043
• Seedahmed MI, Okereke J, Al-Qadi MO. Pulmonary hypertension in a distinct IgG4-high phenotype of sarcoidosis: A case series. J Natl Med Assoc. 2026;118(2):276-283. doi:10.1016/j.jnma.2025.12.011

Department of War (DoW) Research

Using the Airborne Hazards and Open Burn Pit Registry (AHOBPR), AHBPCE researchers recruit eligible Veterans for ongoing research supported through the DoW. The purpose of the ongoing study (titled Cardiovascular Risk Profiling of Deployment-Related Respiratory Disease: A Translational Approach) is to help us learn whether air pollution exposure and combat during deployment to the Southwest Asia Theater of Military Operations increases the risk of cardiovascular problems.

Recruited Veterans have come from across the country:

Engaging Veterans in this research is helping them see the VA is committed to better understanding their ongoing health concerns. Feedback from Veterans has been positive:

Under Public Law 115-244, AHBPCE was directed to collaborate with institutions of higher education to establish a focused area of study on burn pit exposure and related research. Over the past seven years, AHBPCE has partnered with more than 15 academic institutions through research grants, contracts, and other agreements to advance its mission. The VA's Office of Research and Development has recognized AHBPCE as a leading example of VA-academic collaboration.

Air Pollution's Intergenerational Impact

Ohio State University

In partnership with The Ohio State University, AHBPCE is exploring the intergenerational health effects of exposure to particulate matter. At the OSU lab, researchers are studying how breathing polluted air before pregnancy can affect the health of future generations through the alteration of biological settings during the preconception period.

• Mears MJ, Mohler EJ, Bandaru P, Neczypor EW, Gorr MW, Wold LE. Cardiopulmonary and Immune Effects of Environmental Particulate Exposures. Physiology (Bethesda). Published online March 19, 2026. doi:10.1152/physiol.00064.2025

Multi-System Health Effects of Deployment Exposures

Rutgers, the State University of New Jersey

A new study in collaboration with Rutgers suggests that some Veterans with respiratory symptoms show persistent immune system activation. This includes specific patterns linked to early signs of cardiovascular dysfunction, indicating that deployment-related exposures may have broader, multi-system health effects beyond the respiratory system.

AHBPCE also has an ongoing academic partnership with Rutgers School of Engineering. Students work with a mentor at the AHBPCE and contribute to the design and construction of a custom open-circuit acetylene wash-in system for estimating cardiac output during exercise in Dr. Wilhite's Applied Pulmonary Physiology Laboratory.

State-of-the-Art Lung Imaging Analytics

University of Michigan

A formal partnership with the University of Michigan's quantitative CT group is advancing AHBPCE's role as the VA's leader in state-of-the-art lung imaging analytics for deployment-exposed Veterans. This partnership provides access to mature, rigorously validated image-based biomarkers and AI methods that are already in use in National Institutes of Health (NIH) multi-center lung disease trials. AHBPCE researchers can adapt these biomarkers and methods to VA deployment cohorts as well as leverage University of Michigan's high-performance computing infrastructure to enable scalable, timely analysis of large volumes of high-resolution computer tomography (HRCT) data across AHBPCE and affiliated VA sites.

• Bell AJ, Masotti M, Ram S, et al. Use of quantitative CT chest imaging to derive and assess a radiographic phenotype of deployment-related constrictive bronchiolitis. Respir Res. 2025;26(1):195. Published 2025 May 21. doi:10.1186/s12931-025-03269-8

The numbers below feature data from the legacy Registry.

Led by AHBPCE under the HOME program office, the Executive Committee (EC) serves Veterans with military environmental exposures through strategic guidance and oversight of the Registry.

Mission

The AHOBPR-EC is committed to ensuring the AHOBPR serves as a resource and facilitates collaborations among clinical and research experts to support the health and care of Veterans with military environmental exposure.

Purpose

1. Provide oversight and management of the AHOBPR and ensure its data integrity.
2. Advance knowledge on the health effects related to airborne hazard exposures.
3. Develop and disseminate reports for Veterans, families, health care providers, and policy makers.
4. Provide recommendations for guidelines, operational processes, and resource allocation to address airborne hazard concerns.

Membership

The AHOBPR-EC serves in a consultative capacity to the HOME Chief Consultant, who has ultimate responsibility for the management of the AHOBPR. Led by the AHBPCE, the AHOBPR-EC consists of members with representation from VA Program/Office Leads, key stakeholders, and technical leaders. Membership also includes representatives from the following offices and groups:

• Health Outcomes Military Exposure (HOME)
• VA Office of Research and Development (ORD)
• Veterans Benefits Administration (VBA)
• Veterans Experience Office (VEO)
• Office of Enterprise Integration (OEI)
• Office of Health Ethics (OHE)
• National Data Systems (NDS)
• Board of Veterans Appeals (BVA)

The AIMES Collaboration, a joint initiative between the AHBPCE and IQuEST, helps improve the health and care of Veterans with airborne hazards concerns. The AIMES team brings expertise in data management and analysis, implementation science, and quality improvement to the management and use of the Registry.

In the past year, we have been going through the full list of Veterans whose data were automatically added to the Registry when it was redesigned. Our priority is to make sure those records are accurate, so we have a strong foundation for research moving forward.

Featured Publication: Haltom TM, Zhou T, Vaclavik L, et al. Lessons Learned From a Nationwide Implementation of Airborne Hazards and Open Burn Pits Registry Clinical Examinations: A Qualitative Assessment. Mil Med. Published online January 31, 2026. doi:10.1093/milmed/usaf651

Redesigned Registry

The redesigned Registry was presented at the American Public Health Association (APHA) conference. There is also an upcoming submission to the American Thoracic Society (ATS) and we are preparing the Registry for sharing to investigators.

What is the Redesigned Airborne Hazards and Open Burn Pits Registry (AHOBPR)?

The Redesigned AHOBPR is an operational database that helps VA better understand, research, and ultimately treat the health challenges faced by Veterans exposed to airborne hazards and burn pits during their military service. Because of these studies, nationwide health care and benefits options for Veterans are improved.

Applications for Data Sharing

Before the Registry was redesigned, we received eight data applications from May 2024 to March 2025. Since redesigning, we now have 10 data applications: nine for research and one for operations. These applications came from VA Medical Centers and Health Care Systems across the country, including:

• Corporal Michael J. Crescenz VAMC
• DC WRIISC VA Medical Center
• VA Long Beach Healthcare System
• Robley Rex VA Medical Center
• San Francisco VA Health Care System
• VA Greater Los Angeles Healthcare System
• Washington DC VA Medical Center
• Center for Care Delivery and Outcomes Research, Minneapolis VAMC
• Salisbury VAMC
• Michael E. DeBakey VA Medical Center

The applications cover a wide range of research topics—investigators across the country are using Registry data to learn more about Veteran health outcomes. These topics include:

• Respiratory disease
• Lymphoid malignancies
• Liver disease
• Women's health - early menopause
• Prostate cancer
• Kidney and heart diseases
• Lung cancer
• Chronic kidney disease
• Male infertility

Data Sharing Process

We updated the data sharing process to include provisioning through the Data Access Request Tracker (DART). DART is a workflow application for requesting permission to access many data sources and tools for preparatory to research and Institutional Review Board (IRB)-approved research projects. DART manages data request submissions by gathering and retaining required information and documents submitted by those requesting data and makes them available to the appropriate reviewers.

Featured manuscripts using Registry data that were published in the past year:

• Agrawal R, Razjouyan J, Glick DR, et al. Burn Pit Smoke Exposure and Sleep Apnea in US Veterans: A Retrospective Cohort Study. Med Care. 2026;64(2S Suppl 2):S161-S167. doi:10.1097/MLR.0000000000002237
• Almekdash MH, Han J, Guffey D, Christie IC, Helmer DA, Wu TD. Association of a Veterans Affairs Toxic Exposure Medical Evaluation with Symptom-related Care. Ann Am Thorac Soc. 2025;22(8):1176-1182. doi:10.1513/AnnalsATS.202408-835OC
• Haltom TM, Zhou T, Vaclavik L, et al. Lessons Learned From a Nationwide Implementation of Airborne Hazards and Open Burn Pits Registry Clinical Examinations: A Qualitative Assessment. Mil Med. Published online January 31, 2026. doi:10.1093/milmed/usaf651
• Jones MB, Sharafkhaneh S, Glick DR, et al. Concordance Between Self-Report and Electronic Medical Record Diagnoses of Insomnia and Sleep Apnea: Lessons From the Airborne Hazards and Open Burn Pit Registry. Med Care. 2026;64(2S Suppl 2):S155-S160. doi:10.1097/MLR.0000000000002240
• Zeng S, Jani NC, Sotolongo AM, Luo G, Arjomandi M, Falvo MJ. Clinical Utility of Pulmonary Function Testing in Assessing Longitudinal Outcomes of Deployed Veterans with Preserved Spirometry. Ann Am Thorac Soc. 2025;22(11):1664-1673. doi:10.1513/AnnalsATS.202411-1205OC

Veteran Communication

We updated the Veteran communication system in coordination with the VET-HOME team to better communicate with Veterans about their status of inclusion in the Registry through opt-out indicators in the customer relations management (CRM) tool and the Power BI search inquiry tool. An update to the software now shows a Veteran's current status of inclusion in the Registry as well as the status of their opt-out request. This allows for VET-HOME and environmental health coordinators and clinicians to understand and more accurately communicate with Veterans.

We also updated our process and Data Use Agreement to better track recruitment and outreach to Veterans during research studies. This improved accountability will allow us to monitor and track contacts that Veterans may receive from researchers regarding the AHOBPR.

Infographics

Legacy infographics on minority Veterans and women in the Registry have been updated with the most recent data.

To best support provider education and knowledge, we develop educational products in a variety of formats on emerging science and clinical best practices for both VA providers and community providers. Using podcasts, webinars, on-demand education, and other channels allows us to reach as many providers as possible, giving them the information they need to provide the best care to their Veteran patients.

Presentations

"Dyspnea on Exertion and Airborne Hazards Exposure"

This training was put on by the War-Related Illness and Injury Study Center (WRIISC) within Health Outcomes Military Exposures (HOME). The primary aim of this presentation was to enhance clinical care by deepening the comprehensive understanding of airborne hazards exposure and dyspnea, particularly in relation to exercise.

"What does the future hold? Longitudinal evaluation of post-deployment respiratory symptoms."

This webinar, offered by the WRIISC within HOME, focuses on enhancing health care providers' ability to monitor and interpret pulmonary function trajectories in Veterans exposed to airborne hazards during deployment. The training highlights the importance of longitudinal pulmonary function testing (PFT) to support early identification, proactive monitoring, and timely intervention for at-risk Veterans. Designed for interprofessional health care teams, this session aims to improve provider competence in managing post-deployment respiratory health and ultimately enhance Veteran outcomes and quality of life.

Clinical Educational Tool to Predict VO2 Output

A recent study looked at how clinicians and researchers measure exercise capacity in Veterans using cardiopulmonary exercise testing. Researchers found that different commonly used formulas for estimating oxygen consumption (a key marker of cardiorespiratory fitness) can produce very different results for the same person. In fact, more than half of Veterans in the study were classified differently depending on which formula was used.

Tom Alexander, one of our PDCEN National Coordinators, created a web-based application to help providers better predict VO2 output. The tool allows individuals to input certain parameters, compare multiple formulas side by side, and better interpret results for Veterans and others.

Veterans remain the most important stakeholders within the Center. The Center continues to seek feedback and listen to Veteran concerns on airborne hazard and burn pit-related exposures and then develop information and education to respond to that feedback. The Center also develops educational resources and provides classes open to Veterans across the country to disseminate information. AHBPCE continues to maintain fact sheets on airborne hazards, available to Veterans and community members through the WRIISC's website.

Veteran Education Class

"Airborne Hazards and Burn Pits: What Veterans Need to Know"
804 Veterans attended this class on January 22, 2026. The class was a free, virtual education offering for Veterans that provided an overview of airborne hazard exposures, related presumptive conditions, the Airborne Hazards and Open Burn Pit Registry, and tips for managing common symptoms.

Veteran Toolkit

A toolkit co-designed by Veterans to address respiratory health concerns

For Army Veteran Freddy Allen, making sure Veterans know about airborne hazards and have the resources they need is top priority. Allen served overseas for 13 months with a field artillery unit. He understands why Veterans would be concerned about exposure to airborne hazards after experiencing environmental exposures himself and knowing how they can affect health.

It wasn't uncommon for soldiers to "burn everything to eliminate trash or waste of any kind" when serving overseas. His experience motivated him to help in the creation of a toolkit for Veterans about deployment-related respiratory disease (DRRD). This toolkit was developed through an innovative co-design process by Veterans and VA professionals.

DRRD is any long-term breathing problem related to exposure to airborne hazards during military service, and includes conditions such as asthma, sinusitis, and rhinitis.

"Veterans are rightfully concerned about how exposure to airborne hazards during their service can impact them," said Dr. Anays Sotolongo, AHBPCE co-director. "We had already created a toolkit for doctors to evaluate and treat DRRD. We knew it was important to create resources for Veterans. Veterans need to be able to understand what DRRD is and what they can expect from an evaluation."

The DRRD Toolkit for Veterans was commissioned by VA's AHBPCE. It was created by Veterans and VA professionals from VA's Exposure-Related Care Transformation (EXPRT) Center and VA's Center for Healthcare Organization and Implementation Research (CHOIR) led by Dr. Gemmae Fix.

A collaboration with Veterans

Seven Veterans, including Allen, worked with VA professionals to design the DRRD toolkit. They met for two hours each week for four months in fall 2024. They talked about what to include in the toolkit and shared ideas on content, copy, and design.

"As we develop resources to address Veterans' military exposure concerns, their perspectives must be integrated and at the center of everything we do," said Dr. Lisa McAndrew, director of VA's EXPRT Center.

"The co-design process ensures the end product resonates with other Veterans," explained Dr. Gemmae Fix, the team lead from CHOIR. "Working with Veterans makes our products better and demonstrates VA's commitment to learning from Veterans to improve their care."

Allen agreed that co-designing this product with Veterans makes the toolkit more credible.

"It's huge," he said, "because it's not just information coming from some scientists or someone who's never worn a uniform. It is coming from the opinions and experiences of those that survive and have had these things resonate through their households."

The toolkit

The toolkit has three parts: a webpage, a brochure, and a poster. It's available online and as a printed brochure on VA's website.

The toolkit includes:

• Information about airborne hazards
• How to identify breathing symptoms that may be related to airborne hazard exposure
• What to expect from a VA medical appointment for DRRD
• Recommended treatments for DRRD
• Latest research on airborne hazard-related conditions
• Checklists and worksheets for Veterans to fill out about their symptoms or to prepare for an appointment

The toolkit also lists other tools and resources for Veterans, like how to file a disability claim and information about other VA health programs.

Allen wants Veterans to know they're not alone in dealing with airborne hazard symptoms. He hopes knowing the toolkit was created by other Veterans "may lend some credence to… [understanding that] someone on the other side of this thing experienced the same things that I'm experiencing… and perhaps it's worth listening to or reading. Others need to know that they're not alone in their experiences, and there is help."

Access the Veteran toolkit here:

Addressing airborne hazard concerns of rural Veterans

Dr. Fix was able to leverage work on this project to support an application to the Office of Rural Health (ORH) to specific needs and care pathways of rural Veterans. This effort is entitled, "Tackling Rural Airborne Concerns for Exposed Veterans (TRACE)" and a notification of intent to fund was received in November 2025.

PDCEN Testing Videos for Veterans

This year, we started developing educational videos for Veterans who have been selected for testing at the PDCEN. This video series aims to:

Reduce anxiety through transparency

Walking Veterans through what they'll see, hear, and be asked to do makes the experience predictable, which can lower stress levels during the testing. Because many Veterans have lived experiences that can make certain parts of medical testing more distressing (e.g. sudden loud noises or feeling confined), we want to prepare patients in advance and minimize unexpected moments whenever possible, using a trauma-informed approach to care and health education.

Support informed decision-making

Demonstrating the process in advance of the test can encourage questions and help Veterans make informed decisions about their care.

Build trust

Showing and explaining the "why" behind the testing (e.g. what a high-resolution CT can detect; what each specific type of pulmonary function test looks for) can increase confidence in the testing process and in the medical team's recommendations. Improving informed consent can also help Veterans feel more in control of their care.

Improve preparedness and test result quality

A clear explanation of key steps (e.g. what to wear, fasting/medication instructions, how to perform certain requested maneuvers) helps Veterans arrive ready to follow directions to obtain a high-quality result.

In addition to all the listed benefits, these videos ultimately have the potential to reduce testing delays and prevent the need for repeat testing due to quality issues in the data.

Watch the first video in the series, "PDCEN Testing: What to Expect from your High Resolution CT Scan."

The AHBPCE is a leader in educating the medical and scientific community on new breakthroughs in research and treatment for deployment-related health issues.

Living Evidence Analysis Program

The Living Evidence Analysis Program (LEAP) is building a sustainable, AI-enabled evidence ecosystem that facilitates continuous identification, organization, and evaluation of emerging research on airborne hazards and related military environmental exposures. This allows the VA to efficiently evaluate scientific evidence for health care and policy decision-making. Some notable advancements during this reporting period include:

• Expanded and hosted the Veterans Affairs Data Repository - Rutgers (VADRR.org) to manage multiple concurrent living reviews and monthly search updates across key exposure-related conditions.
• Launched and tested an AI-scaffolded evidence extraction protocol, comparing large language model outputs with human extraction to improve speed and accuracy of epidemiologic data capture.
• Advanced high-priority manuscripts, including a methods paper on abductive weight of evidence synthesis for military exposures, an ILD synthesis, and an umbrella review of ILD in civilian populations.
• Strengthened Rutgers - VA HOME collaboration through expanded analyst capacity, embedded project management, and targeted training on VADRR workflows for VA partners.

Priorities for the year ahead include broadening our focus on respiratory symptoms and health to include cardiopulmonary symptoms and health, clarifying the relationship between cardiopulmonary diagnoses and airborne hazard exposures, and bringing Veterans back for repeat in-depth evaluations to generate longitudinal data that will better inform care and treatment for affected Veterans in the future.

Building on our recent findings showing a high burden of cardiac remodeling and other heart changes among deployed Veterans, AHBPCE is placing greater emphasis on cardiovascular outcomes in the coming year. These findings show the importance of looking beyond respiratory effects of airborne hazards alone to see additional, broader health effects in other areas.

In response, the Center is expanding its research portfolio to more systematically evaluate how deployment-related airborne hazard exposures contribute to cardiovascular structure, function, and exercise capacity over time. Our active DoW-funded study on cardiovascular risk profiling in deployment-related respiratory disease is providing detailed data on traditional and emerging cardiovascular risk factors in this population.

These efforts will shift AHBPCE's focus from primarily characterizing respiratory outcomes to a more integrated cardiopulmonary approach that includes early identification and management of cardiovascular risk and disease in exposed Veterans. This shift emphasizes not only the identification of respiratory conditions, but also the early detection, prevention, and management of cardiovascular risk and disease, ultimately supporting more holistic care for Veterans affected by deployment-related exposures.

The PDCEN advances AHBPCE's mission by delivering comprehensive, standardized cardiopulmonary evaluations to clarify diagnoses and their relationship to airborne hazard exposures. Interpreting these evaluations has been limited by the lack of an appropriate comparison group for post-deployment respiratory health.

In response, the PDCEN launched a phased effort to create comparison cohorts, with all participants completing the Core Clinical Evaluation and their data aggregated by AHBPCE.

Phase 1 just completed this past year, enrolling more than 220 asymptomatic civilians across three PDCEN-affiliated academic medical centers. Phase 2 just began with a target goal of enrolling a similar-sized sample, but the sample will be exclusive to previously deployed asymptomatic Veterans over the next three years.

AHBPCE launched a new longitudinal evaluation program that invites previously evaluated Veterans back to New Jersey for in-depth follow-up assessments. The Comprehensive Airborne Hazards Follow Up Program (CAP) focuses on a follow-up assessment of former patients who were evaluated for their pulmonary symptoms between 2014 and 2019. Current criteria include former patients who received a pulmonary function test (PFT), forced oscillation technique (FOT), cardiopulmonary exercise test (CPET), have a VA primary care provider, and are enrolled in the Airborne Hazards and Open Burn Pit Registry.

The first component of the program is a virtual assessment with the clinicians to document whether the patients were able to implement the initial WRIISC recommendations and any changes in their breathing symptoms since that time. Then, if appropriate, Veterans may be invited back for follow-up assessments to repeat comprehensive cardiopulmonary testing and imaging to track changes in symptoms, function, and diagnostic findings over time. Based on the assessment results, Veterans are provided with updated, individualized feedback on their health status and recommendations based on the latest evidence. For investigators, these repeat assessments generate longitudinal data that will help clarify the long-term health impacts of deployment-related airborne hazard exposures.