The Veteran Military Occupational and Environmental Exposure Assessment Tool, Phase III Enhancements

Introduction: Service Members often face complex and potentially toxic exposures during their service. Currently, no comprehensive and validated tools exist to cover the full range of military environmental and occupational exposures. To address this gap, the Washington D.C. War Related Illness and Injury Study Center developed the Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT) through a 4-phase program, creating a robust survey for clinical use and research. Materials and Methods: Following the Phase II pilot VMOAT, Phase III improvements involved a panel of 17 experts in military occupational and environmental medicine. The team reviewed findings from the pilot VMOAT focus group, applied cognitive theory principles, and integrated extensive exposure literature to identify additional stressors. They also evaluated potential sources of survey bias to enhance reliability. Results: Enhancements in Phase III included improving readability and question clarity, optimizing the survey user interface, restructuring and integrating exposure stressors, refining exposure data capture elements, separating health concern questions from exposure reporting to minimize bias, and establishing data structuring to support robust exposure metrics and analyses. Conclusion: The VMOAT enhancements support Department of Defense and Veterans Administration efforts to better understand and improve care for Service Members and veterans by addressing military occupational and environmental exposures systematically. The VMOAT can be used as a self-reported evaluation tool, either independently or supplemented with additional clinical assessments and exposure information. It has significant potential to provide valuable data for occupational and environmental exposure clinical evaluations and research, contributing to improved health outcomes for veterans.