War Related Illness and Injury Study Center
Research
Complex Exposure Threats Center of Excellence (CETCE)
CETCE integrates existing clinical knowledge into a translational research framework focused on key domains aimed at understanding how complex and novel hazards impact Veteran health. If you are interested in learning more about CETCE research, please contact us at vhawascetceresearch@va.gov.
Active Clinical Research Recruitment
CETCE conducts clinical research through VA-led protocols and collaborations for Veterans and Service Members who are part of current CETCE Veteran exposure cohorts.
For Veterans - The Exposure Evaluation and Risk Stratification (Exposu-ERS) study aims to characterize complex military exposures and its impacts on Veteran health and well-being. The study will integrate medical histories and military records with monitoring of biobehavioral symptoms and cognitive assessments. Eligible CETCE Veterans can enroll in this remote VA study that involves neurocognitive testing, resting-state brain activity, autonomic physiological monitoring, sleep and activity assessments, exposure histories and health records reviews. If interested, please complete the online inquiry form.
For Veterans - The Testing Exercise Response Reflecting Allostatic Profile in VeteraNS (TERRAPINS) Study housed at the University of Maryland, College Park, School of Kinesiology is for CETCE Veterans in the Washington, DC, Maryland, and Virginia regions. TERRAPINS assesses body systems in deployed Veteran populations with complex exposures. The goal is to develop measures for identifying specific patterns of functional health associated with wear and tear on the body.
For Service Members - The Multi-modal observational study of Veterans with TBI and varying symptoms (TOS) Study focuses on improving understanding of military occupational exposures and various psychological and physiological assessments. The TOS Study is recruiting EOD Service Members to learn how military occupational exposures impact both Service Members' and Veterans' health by assessing wearable technologies in the EOD training environment. Veteran enrollment was completed in March 2025.
Research and Development for Exposure Assessment
CETCE research also focuses on new tools and collaborations to improve Veteran exposure-informed care.
New Clinical Tools for Veterans
The Veterans Military and Occupational Exposure Assessment Tool (VMOAT) integrates Veterans' exposure histories with their medical care, ensuring that providers have a comprehensive understanding of Veterans' exposures to environmental and occupational hazards. The clinical impact of this research aims to:
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Identify potential links between past exposures and current symptoms.
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Personalize treatment plans based on specific occupational and environmental hazards.
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Enhance diagnostic accuracy by incorporating exposure data into clinilca evaluations.
CETCE's Exposu-ERS Study and the PROject for Military Exposures and Toxin History Evaluation in U.S. Service members (PROMETHEUS) at the Uniformed Services University of the Health Sciences Murtha Cancer Center Research Program currently use a research version of the VMOAT for their studies.
VMOAT Citation for Collaborators*: War Related Illness and Injury Study Center, Washington DC. (2024). Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT): Comprehensive Structured Self-Report Military Exposure Questionnaire.
*The VMOAT is available to collaborators working with investigators at the WRIISC/CETCE. Please email vhawascetceresearch@va.gov if you are interested in using the VMOAT.
Collaborations to support Veteran Care
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Evaluating the use of DoD audiology measures as indicators of blast impact on Veterans' health (partnership with WRNMMC)
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Assessing VA clinical translational value of the Automated Neuropsychological Assessment Metrics (ANAM) tool used in DoD settings to detect and characterize cognitive deficits associated with blast (partnership with ARLIS)
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Review of civilian reports, primarily from U.S. government service personnel in Cuba (2016), of symptoms described as AHI/Havana Syndrome to improve the care of Veterans with potential AHI exposures (partnership with University of Pennsylvania)
Computational Modeling and Data Integration Research
CETCE scientists use computational tools and data aggregation techniques, and findings from our Health Surveillance efforts, to examine the nature of complex injuries and illnesses, establishing links between health outcomes and occupational and environmental exposure data. Collaborating with the DC-WRIISC's BRAIN Lab (Big-data Research, Artificial Intelligence, and Neuroscience Lab), CETCE has created a framework to consolidate military exposure records. Using common data elements from the EOD career pathway as a template, this CETCE research aims to develop clinical summaries of exposure health risks by integrating electronic health records, military service histories, and environmental exposure records.
