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Ask An Expert: How Medical Experts Look at Toxic Exposure Diagnoses

Ask An Expert: How Medical Experts Look at Toxic Exposure Diagnoses

We’ve partnered with experts in VA disability to answer your most pertinent questions.

This month, we spoke with Dr. Danielle Kelvas about Toxic Exposures.

It’s important to note that we sometimes enlist the expertise of professionals like Dr. Kelvas to rectify issues arising from VA examiners, including for conditions related to toxic exposures. If the expert supports our stance, they will directly address any adverse VA decisions and medical opinions present in your VA file. 

About Our Expert

Dr. Danielle Kelvas, MD, earned her medical degree from East Tennessee State University Quillen College of Medicine and initially specialized in Emergency Medicine. She later switched to primary care and became passionate about treating veterans from her inpatient and outpatient experience. She has traveled, lived, and volunteered medically in over 40 countries, giving her a unique perspective on how geographic and sociocultural determinants impact veterans. As the Founder and CEO of DKMD Consulting, Dr. Kelvas uses her medical background and writing experience to craft compelling narratives about veterans’ medical history. This assists our attorneys with tailoring the most substantial argument when advocating for disability benefits.


How are the health impacts of toxic exposures like Agent Orange, burn pits, or Gulf War Syndrome diagnosed and differentiated from other conditions?

The PACT Act simplified the diagnosis of many toxic exposure conditions by expanding the list of presumptive illnesses, presumptive exposure locations for Agent Orange (AO) and radiation, among other things. Conditions arising from toxic exposure have unique symptoms. Diagnosis typically requires documenting when and where exposure to toxins occurred, along with corresponding symptoms and disorders recognized by the Department of Veterans Affairs and other health organizations.

Agent Orange is associated with several diseases such as cancer, heart disease, and hypothyroidism, due to its contamination with dioxin. Common symptoms fatigue, shortness of breath, swelling of feet and legs, and tremors in muscles, but this is certainly not all-inclusive. Diagnosis for service connection involves documenting exposure to Agent Orange followed by the occurrence of illnesses or symptoms that the VA lists as presumptive to AO exposure. 

Burn pit exposure symptoms are varied because burn pits can release a variety of toxins. Diseases associated with exposure can range from respiratory disorders to certain types of cancer. Diagnosis is typically based on a combination of documented exposure and associated symptomatic complaints. 

Gulf War Syndrome, also referred to as a “chronic multi-symptom illness” and “undiagnosed illnesses,” is characterized by a group of medically unexplained chronic symptoms. It can include fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems. Precise diagnostic criteria differ but typically require a documented service in the Gulf War, along with the presence of a certain number of symptoms from the categories defined by the VA. 

These conditions, while having overlapping symptoms with other disorders, are generally diagnosed through a blend of exposure history and symptomatology aligning with recognized patterns.

Many veterans complain of respiratory problems, post toxic exposures. What tests and evaluations are used to determine the cause and connection to service?

Veterans experiencing respiratory problems post-toxic exposures undergo a battery of tests and evaluations to pinpoint the condition’s cause and correlation with their military service. The VA has established a protocol for conducting toxic exposure screenings. The screening is a comprehensive series of questions that typically take around 5-10 minutes and are part of a standard healthcare visit. It records a range of exposures during military service, enabling VA physicians to better ascertain the likely origin of health problems, including respiratory complications. 

Many veterans and servicemembers now participate in the VA’s Airborne Hazards and Open Burn Pit Registry, documenting their airborne hazard exposures and health conditions. If applicable, additional tests may include pulmonary function tests (PFTs), bronchoscopy, and imaging such as chest X-rays or CT scans. The choice of test will depend on the nature of the symptoms and the likely diseases being considered based on the veteran’s specific exposure history and clinical presentation. Always remember, if you are a veteran experiencing health problems believed to be associated with toxic exposures during military service, it’s crucial to seek medical attention promptly.

Is there anything you wish veterans knew or did during their medical exams to get them the most accurate diagnosis?

The military conditions soldiers to “grit and bear it,” but the truth is when you do suffer injury or illness while in service, it is absolutely critical that you seek medical care and have everything documented immediately. Do not postpone this.

The toughest part of my job when reviewing veteran cases is that sometimes, he/she believably suffered with symptoms for decades, but there’s no hardcopy record of it. Keep a record of your symptoms in a notebook and show that to the healthcare provider. Make sure it goes in your medical record. You may not think some things are important or be embarrassed to talk about it, but when trying to process disability claims, those sorts of details are crucial. Do not sugar-coat or make light of symptoms. If your joints ache, even if it’s just a 3/10 on the pain scale, mention it! And if there are things you can no longer do (sports, yard work, etc.) or activities in your life now that have to be modified secondary to pain/injury – then mention it! 

What are the things you look for when determining whether secondary illnesses are connected to the main illness?

  1. Direct Connection to Service: The essential criterion is establishing a direct connection between the veteran’s service and the primary illness. This involves proving that the primary illness occurred during active duty and that the current health issue is a result of that condition.
  2. Documented Medical Evidence: A crucial piece is medical evidence indicating a clear link between the primary illness and the secondary condition. Medical records, doctor’s notes, lab results, and other supporting documents are invaluable for providing this connection. I advise that veterans keep a personal notepad and write things down. It’s completely normal to forget things, but keeping a journal of symptoms, appointments, medications, etc., goes a long way in helping your healthcare team.
  3. Causation or Aggravation: The secondary illness can either be caused by the primary condition or a pre-existing condition that has been aggravated due to the primary service-connected condition. For instance, if a service-connected knee injury has led to arthritis, the arthritis could be considered a secondary condition.
  4. Continuity of Symptoms: Symptoms that have been persistent or recurrent since service and contribute to the secondary illness may help establish a connection. This involves assessing whether there are continuous symptoms or diagnoses from the time of service to the present day.
  5. Medical Opinions: Opinions from healthcare professionals can be valuable in connecting secondary illnesses to the primary service condition. They can identify and explain how the primary illness would have led to the secondary illness in the course of their medical practice.

Veterans who believe they have secondary conditions related to their service should seek out a VA-accredited attorney, Veteran Service Organization, or VA representative to aid them in navigating the complex process of disability compensation claims.

Toxic Exposure Resources for Veterans

Environmental Health Registry Evaluation for Veterans

VA’s health registry evaluation is a free, voluntary medical assessment for Veterans who may have been exposed to certain environmental hazards during military service. The evaluations alert Veterans to possible long-term health problems that may be related to exposure to specific environmental hazards during their military service:

Research Studies on Military Exposures

Veterans can find out more about ongoing studies and learn more about their own exposure risks by visiting the VA’s Public Health portal.

Are you getting the proper compensation?

Have you been denied benefits or wish to appeal your rating decision? Speak with an experienced VA attorney. Call (800) 861-7262 to schedule a free consultation, or fill out the contact form on our site.

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