Muscle Injury Tutorial

Regardless of an individual's age or skill level, engaging in strenuous physical activity can impose physical stress on the body, potentially resulting in pain or injury. Muscular injuries can arise through various mechanisms; each associated with distinct pathological processes. These training resources offer information on common muscle injuries and related structures, especially in physically demanding contexts. Included are discussions on sprains, strains, contusions, and shoulder conditions affecting the rotator cuff, with relevant considerations for personnel assessments.

Gulf War Syndrome/Illness

According to the Under Secretary for Health (Garthwaite, 2001), the care of Gulf War veterans has remained a complex and ongoing challenge. Veterans who served in the Gulf War were exposed to various environmental agents and are often affected by significant health issues. These health concerns have been collectively referred to as Gulf War syndrome or Gulf War illness. The Centers for Disease Control (CDC) defines a case of Gulf War syndrome/illness as experiencing one or more chronic syndromes (lasting longer than six months) from at least two of the following three categories: fatigue, mood and cognitive disturbances, and musculoskeletal symptoms. This tutorial will further elaborate on the definition of Gulf War syndrome/illness and provide information on its diagnosis, signs and symptoms, treatment options, and prognosis.

Agent Orange & Related Illnesses (including Diabetes)

Agent Orange, an herbicide blend, was used in Vietnam to kill unwanted plants and to remove leaves from trees which provided cover for the enemy. The name Agent Orange came from the orange stripe on the gallon drums. One of the chemicals in Agent Orange contained minute traces of the chemical TCDD or dioxin. Studies have suggested that this chemical may be related to a number of conditions and disorders. A registry for Vietnam veterans who were concerned about the possible health effects of exposure to Agent Orange was established. The components of the registry are described in the Agent Orange tutorial as well as body systems that are given particular attention during a health examination. Moreover, conditions or diseases that have been presumptively associated with exposure to the herbicide are presented.

Health Effects from Chemical, Biological, and Radiological Weapons

The tutorials on "Health Effects of Chemical, Biological, and Radiological Weapons" focus on the most commonly encountered substances within each category, highlighting their health impacts and potential clinical manifestations that reviewers may observe when reviewing veterans' medical records and case histories. The content has been developed by integrating information from the Veterans Health Initiative (VHI) website and other relevant sources to offer reviewers a thorough understanding of the health effects associated with military service. This resource is intended to assist reviewers in conducting efficient and accurate evaluations of veterans' health concerns.

Exposure to chemical agents can occur easily through environmental contact, personal use, or occupational settings. This tutorial on chemical weapons covers the classification of chemical agents and the three main types of agents most likely to be encountered in military operations and terrorist attacks. It also addresses the physiological processes that occur following exposure, as well as the acute and chronic effects that may result from such exposure.

The main categories of biological agents of concern to public health include those responsible for diseases such as anthrax, smallpox, plague, botulism, tularemia, and viral hemorrhagic fever. When utilized by malicious actors, anthrax and smallpox represent significant threats due to their ease of dissemination and transmission, their capacity to cause high mortality rates, and their potential to cause substantial social disruption.

Radiological Weapons

Historically, many veterans have been exposed to or contaminated by various forms of radiation during their military service. While the likelihood of terrorist use of nuclear weapons has decreased compared to the past, it remains a possibility due to the challenges associated with acquiring the essential components and technology needed to develop such devices. Conversely, radiological materials are more accessible and can be used to create simpler, more feasible weapons, thereby maintaining the risk of widespread radiological contamination.

Other Specific Environmental Hazards

Sulfur Fire

On June 24, 2003 roughly 42 million pounds of sulfur dioxide (SO2) per day as well as release of hydrogen sulfide (H2S) in Northern Iraq, and from late 2004 through February 2007 exposure to the Mishraq State Sulfur Mine Fire was reported.

• polycyclic aromatic hydrocarbons formed during the incomplete burning of coal, oil and gas, garbage, or other organic substances
• volatile organic compounds (VOCs) emitted as gases from certain solids or liquids, and
• toxic organic halogenated dioxins and furans to include those associated with tactical herbicide use in Vietnam.

Camp Lejeune, North Carolina- drinking water contaminated with VOCs. Contaminants included:

• tricholoroethylene (TCE)
• perchloroethylene (PCE)
• benzene
• vinyl chloride, and
• other VOCs.

Chromium VI in sodium dichromate is a lung carcinogen through inhalation and an acidic compound that can cause immediate irritation to the eyes, nose, sinuses, lungs, and skin. Particulate Matter is made up of a number of components to include:

• acids (such as nitrates and sulfates)
• organic chemicals
• metals, and
• soil or dust particles.

Shrapnel (Trauma) Wounds

In the evolving landscape of strategic operations in recent and ongoing conflicts, the increased deployment of improvised explosive devices (IEDs) and roadside bombs has heightened the risk of shrapnel-related injuries among military personnel. This tutorial examines the most common injury types, the physiological responses to such trauma, and the body systems most frequently affected by shrapnel penetration. Additionally, methods for assessing potential injury outcomes and the long-term consequences of these injuries are discussed.

POW Medical Issues

Former Prisoners of War (POWs) have been mistreated and killed since the beginning of recorded history. Studies indicated that life-long effects on health, social and vocational adjustment, and increased vulnerability to psychological stress results from endless fears faced by imprisoned American service members as a result of the physical hardships, and psychological abuse endured by POWs.

In addition, the length of captivity, the promptness of implementing treatment, and the duration of treatment may all have an impact on a former POWs ability to face additional obstacles once returned to their pre-war lives.

Infectious Diseases

Infectious diseases that afflicted the geographic areas of western Asia during the Gulf War pose the same risk of infecting military personnel in Iraq today. Prior experience with these various communicable diseases during the Gulf War has assisted in the implementation of greater countermeasure defenses against mass outbreaks within the military community in Iraq, thus decreasing the incapacitation of troops.

Regardless of preventive measures taken, such as vaccinations, a small percentage of veterans will return from overseas deployments with unusual illnesses. Some veterans will return from hazardous military deployments with serious symptoms difficult to diagnose. Historically, after every major military conflict some form of chronic symptoms have arisen.

Different types of infectious diseases to include those causing acute and chronic illnesses and those putting military personnel at risk in the Iraqi environment are included in this tutorial. Route of transmission and correlating diseases including symptomatology and complications are also discussed and links to additional resources are provided.

Heat Injuries

A discussion of heat-related conditions that are the result of a heat injury, heat illness, or exertional heat illness is presented. The discussion highlights the differences in heat-related conditions that are often referred to as classic or exertional heat injury or heat illness. Heat illness and heat injury are used synonymously to discuss the most frequently occurring heat-related conditions, heat exhaustion and heatstroke. It should be noted that not every person will present with all of the signs and symptoms for the suspected condition due to possible differences in pathophysiological responses to the same physiologic heat stress. Classifications, categories and or groupings of heat-related conditions may differ between health care facilities, and/or health care providers.

Post-Viral Syndrome

A condition classified by the World Health Organization (WHO) as a disease of the nervous system, Post-viral syndrome is a complex compilation of many named illnesses and symptoms, the most prevalent of which is muscle fatigability, characterized by three main categories.

This tutorial reveals specific diagnostic criteria, and symptomatology exemplified within three main categories. Also included are the association between this condition and US veterans returning from war, the insidious long-term effects on ones life, and current treatment measures that are available to alleviate symptoms and promote quality of life while living with this condition.

Post-Polio Syndrome

The Post-polio syndrome tutorial discusses the affects of the disorder on individuals long after one has succumbed to an initial poliovirus attack. Though this disorder may be marked by long periods of stability, it has a slow, progressive and unpredictable course that is difficult to diagnose, and leads to permanent lifestyle changes.

Silicosis and other conditions secondary to harmful inhalants

Of all the dust diseases, or pnuemoconioses, silicosis produces the largest number of victims. According to the World Health Organization (WHO), silicosis, one of the oldest occupational diseases, still kills thousands of people every year everywhere in the world. This tutorial provides important information on silicosis, asbestosis (another common respiratory disease caused by an inhalant) and pleural effusion a condition that commonly occurs secondary to silicosis and asbestosis.