Ever wondered how military service shapes a career in healthcare? Join us for a captivating conversation with Dr. Matthew Reinhard, a leading figure in neuropsychology and the Director of the Complex Exposure Threat Center of Excellence at the VA in Washington, DC. Discover the personal journey that led him to champion veterans' health, inspired by his family's deep military roots. Dr. Reinhard offers an insider's look into the center's unique interdisciplinary approach, which brings together experts from a number of medical disciplines to research and tackle the pressing issues of environmental exposures affecting veterans.
We'll also address a poignant concern raised by a veteran who has fueled the Center's focused research on the health challenges of explosive ordnance disposal (EOD) professionals. Through their collaboration with the University of Maryland, they're breaking new ground in understanding the biological effects of military exposures using the concept of allostatic load (the cumulative "wear and tear" on the body caused by repeated or chronic stress). Dr. Reinhard shares his insights into the complex task of measuring these impacts and highlights the center's commitment to translating clinical insights into actionable research and education. This is a must-listen episode for anyone interested in the intricate world of veteran health research and the dedicated efforts to enhance care for those who have served.
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Episode Transcript
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Larry Zilliox (00:00):
Good morning.
I'm Larry Zilliox, Director ofCulinary Services here at the
Warrior Retreat at Bull Run, andthis week our guest is Dr
Matthew Reinhard.
He is the Director of theComplex Exposure Threat Center
of Excellence at the VA inWashington DC and I'm really
happy that he's able to join ustoday because I really want to
(00:24):
explore some of the researchthat the VA does.
Of course, our listeners arevery familiar with all the
health benefits and claims andgetting medical help from the VA
.
I'm not sure that many of themunderstand really how much
research the VA does or fundsthat goes into supporting our
(00:47):
veterans with medical healthissues.
So, dr Reinhardt, thank you forjoining us.
Dr. Matthew Reinhard (00:53):
Well, thanks for having me.
It's great.
I don't really usually get todo this kind of thing, so
hopefully I can Informationyou're looking for.
Larry Zilliox (01:03):
Yeah, I'm sure you'll be able to.
I've looked at your resumethere and I've been on the
webpage for the center and youseem like the guy who can handle
all my questions, that's forsure.
If we could start with, justtell us a little bit about your
background and how you becameinvolved with the VA and the
(01:25):
center.
Dr. Matthew Reinhard (01:26):
Wow, sure, I don't think anyone's ever
asked me that, but I've been thedirector for something called
the War-Related Illness andInjury Study Center, with the
acronym.
There is RISC, and now there'sa sub-center within that, the
Complex Exposure Threat Centerof Excellence, or .
I guess I'll refer to them asrisk and STETC from this point
forward.
Um, my training was as aneuropsychologist, um, and I
(01:53):
took a role coming out of agraduate school as a
neuropsychologist, uh, at therisk, and later, you know, after
a few short years, I ended uprunning that study center or
becoming director for it.
But I think you know how I gotto the VA originally.
You know my interest in the VA.
You know my dad is a veteran,my grandfather as well.
(02:16):
Relevant and important to me, Ithink you know our family
history is involved in serviceand my dad was, you know, during
the 1960s on the army, and soit was always.
It always was in my mindset to,you know, provide service in
some way.
I was not in the military myself, but I think being a civil
servant with the VA, whichreally has the greatest mission
(02:40):
that you could possibly have,which is, you know, to care for
veterans, is makes a lot ofsense to me, always made a lot
of sense to me, and I've beenfortunate, which is, you know,
to care for veterans.
Uh, is is makes a lot of senseto me, always made a lot of
sense to me, and, uh, I've beenfortunate enough to, you know,
have success and get intograduate schools and then do all
the studying and get to uh andget a positions and then, you
know, achieve through thosepositions some, some leadership
roles, uh, in a really kind ofdynamic center or centers that
(03:03):
we have now.
Larry Zilliox (03:04):
So tell us a little bit about the center and
what really distinguishes thecenter of excellence from your
just run-of-the-mill gardenvariety center.
Dr. Matthew Reinhard (03:18):
That's a good question, you know.
All right.
So I think I'll talk about theSETC, because that's what you
started with.
So a center of excellence, whatthat essentially means is
you've got a concentration ofexpertise and in our case it's
really an interdisciplinaryexpertise, specifically with
(03:42):
military exposures and veteranhealth, and that is not easy to
do.
You kind of have to hire andrecruit the right people and
we're a small center, we're nota big group, and really the risk
or the war-related illness andinjury study center is the major
(04:02):
support.
But, yeah, we've been able torecruit really some of the
finest occupational andenvironmental medicine
physicians that had longmilitary careers in medicine
throughout the military andleadership roles in the military
, who were also clinicalproviders, and so we've been
able to hire a few people thereand that allows us probably
(04:26):
because there's just not thatmany people like that that
allows us to have a probablythat's, you know, it's just a
few folks, it's probably thehighest concentration working
together towards, you know, someof the questions and issues
that we think are important forveterans, you know, president.
And then going forward into thefuture, I think I hope that
(04:47):
answers your question about whatI think a center of excellence
is different.
There.
You know there's some technicalstuff as well.
Like you know, you have tomaintain that excellence and
that's measured.
You know, every five yearsthere's sort of a you know a
look at how that's going andmeasuring success, and I think
that that's important as well.
Larry Zilliox (05:08):
And so is there elevated funding involved when
you kind of shift over to thecenter of excellence.
Dr. Matthew Reinhard (05:17):
That's a question that remains to be
determined.
I actually don't know.
That's probably above my paygrade.
I can don't know.
That's probably above my paygrade.
Larry Zilliox (05:26):
Well, I can't comment on that.
We'll keep our fingers crossed.
Yeah, that'd be great.
So, yeah, talk about the teamif you would.
So I think our listeners needto understand that it's not like
you're all in a little buildingdown in DC.
When you talk about the team, Ithink you're talking about
bringing people on board thatare part of other academic
(05:50):
institutions and things likethat that contribute and support
the center.
Is that kind of like what it is?
Dr. Matthew Reinhard (05:57):
Sort of.
Yeah, I mean, I think we, youknow we've got certainly some of
the occupational andenvironmental medicine
physicians which are kind ofwith military experience and
careers, and there's not thatmany of those We've got a few
there who are really premierpeople.
There's a multidisciplinaryteam Obviously.
(06:17):
I'm a neuropsychologist bytraining but now I'm more sort
of in a leadership role, but wehave neuropsychologists and
nurse practitioner and socialwork.
We also have, well, I shouldsay I should add, all these
people sort of have an expertisein environmental exposure
because that's something that'ssort of unique to, you know, to
military service and thenthereby you know, veteran care
(06:42):
so, and that's something sort ofunique to the VA.
I can go into a little bitabout that as well.
But we have multidisciplinarystaff.
We also have academic partnerswith.
You know it might be withgrants that we're writing or you
know we're working with that.
We're trying to because we docompete, or funding, you know,
(07:03):
like everybody else, to try tobring in additional studies and
grants.
And you know our area of focusis usually on environmental type
exposures or military typeexposures and health outcomes is
really because, again, sort ofgetting back to that center of
excellence concept, and sothat's kind of where we focus,
and so you need partners there.
We're never going to have allthe expertise in-house and I
(07:27):
don't think that that's the wayit should be right.
You have to partner and makefriends in academic institutions
, but also in other federalagencies actually, and so that's
something that isn't often done.
But spending the time andenergy to sort of partner with
other federal agencies I thinkis key, especially for the SETC,
(07:50):
because the role there is.
It's got a few key roles, butone of them know, as we talked
about, sort of thisenvironmental exposure concept,
you know.
So people who serve in themilitary are exposed to things
that we're not often going tosee like in a civilian context
(08:18):
airborne hazards or burn pitsmoke and things like that
depleted uranium or uniquesolvent exposures or weapons
systems or subconcussive blasts,repetitive subconcussive blasts
, all these.
And then of course there are newand emerging things as warfare
likely is changing as we cansort of see and observe, and VA
(08:42):
needs to be educated in someways and be prepared as a
healthcare organization forwhat's coming, not just
necessarily responding to thingsyou know many decades down the
line.
So that requires thoseconnections with other federal
agencies and one of the roles ofSEXI.
That I think is unique is it'sthinking about those emerging
(09:07):
issues, and so there's aneducation component.
You know, as we meet and talkwith other people and agencies
and find out things, you know,can we prepare education modules
for our own healthcare systemto be prepared?
Yes, that's something that onlythe VA can do, or typically, or
has done, I should say, becausethat's not really a civilian
(09:32):
healthcare system focus.
That's something, and I thinkthat's why veterans, many
veterans, are happy with theirVA care and because there really
is that emphasis on some of theunique military-related
exposures and I think VA isbecoming more and more aware of
that and I think sexy and therisks plays a role in uncovering
(09:55):
that stuff and also educatingour own system.
Yeah, because if you askveterans this is another thing
that you know probably wouldn'thappen in the civilian sector
but if you ask veterans abouttheir concerns and do you have
concerns about things that youmay have been exposed to when
(10:16):
you were deployed or in trainingor you know, or on this or that
base or wherever you might havebeen, they will tell you.
You know about their concerns.
Yes, you know I am, you know,you know these.
These alarms did go off and Iput on a mop suit and I'm
worried about you know, you know, or yes, I was exposed to, uh,
(10:38):
this, this solvent when we, youknow, when we um did this task
and people.
So as you start to ask and getpeople's stories, you will hear
that they have health concernsand sort of long-term.
What are the long-term effectsof these things?
And that's going to be a VAarea of interest, right?
Yeah, yeah, it's important.
Larry Zilliox (11:00):
So one of the things that jumped out at me
when I read sort of the pressrelease on the center a few
months ago is that it was soforward thinking that, as you
said, sometimes the VA is alittle slow to catch up with
things, and I get that.
It's always a funding issue.
You know it can't look atthings until it's a real problem
(11:24):
.
But this this sort of jumpedout at me because it seemed like
hey, somebody sitting down andsaying we've got all this stuff
going on and all of our servicemembers and maybe get ahead of
it and say this could be aproblem, so we need to handle it
(11:49):
this way.
I want to direct our listenersto a previous episode that we
did in season two back inFebruary of 2024.
It's episode six of season twoand that was an interview with
Dr James Stone, who's aresearcher at UVA and he is
researching the effects of lowlevel blasts on and TBI on EOD
(12:14):
instructors One of the kind ofthings that I see the center
funding or getting involved with, and I just can't get over the
fact that somebody at VA said weneed to take a look at these
things that are affecting ourmembers in the future.
(12:34):
I guess one of the questionsthat I have is that I know you
all are new.
Well, actually, the center hasbeen around since 2022, but as a
center of excellence, which I'massuming meant you brought more
people on and things like thatwhat is the process for
uncovering things that you mayneed to look at and then
(12:57):
deciding on what you should lookat?
Dr. Matthew Reinhard (13:01):
Wow, so that's a good question.
First of all, I got to listento the James Stone episode.
We do.
You know, you mentioned I thinkwhat you were talking about.
There was probablysubconcussive blast.
I think you said EOD, yeah, didyou say yeah?
So explosive ordnance disposal,we have a specialized focus in
(13:28):
EOD.
As an occupational group, oneof the things we're interested
in is and this is getting toyour question about processed
that is an example of a groupthat we identified as likely
high exposure.
(13:49):
So they're going to have highexposure to you know, whether it
be blasts, obviously it's anexplosive ordnance group
chemicals, stress, novel weaponssystems, all those things.
And so how do we identify thatgroup?
You know, believe it or not, Ireceived a written letter from a
veteran many years ago and itwas an EOD veteran and he was
(14:12):
concerned about the health andwellness of his colleagues and I
, you know, I called him back.
He had his phone number thereand I called him back and
started a conversation and a lotof you know, a lot of our
programs in some ways start withvery sort of with things you
wouldn't think of, you know.
But what I think it says is thatwe're kind of listening to the
(14:33):
you know, the veteransthemselves, and so we spend a
lot of time doing that.
We hear it's a little bit of asurveillance mode also because,
you know, we see patientsclinically.
So we bring in a few patients,sort of the higher exposure type
patients, and we listen to themand it's kind of a surveillance
mode.
It's in that way from aclinical surveillance sort of
(14:56):
model, where you're like, wow,this person is talking about
something that we hadn't thoughtof.
We need to look into thisfurther, like how many people
are there like this, what do weneed to do?
And so it kind of is veryorganic in that way.
There are times where it's notnecessarily organic.
From coming like I would callthat a grassroots process, which
(15:18):
you know, that was a goodexample of it say, like you know
, we need to check this out andI don't know, you know how those
things necessarily come to them.
but I can't say.
But you know there are.
There are cases where you knowthere are, let's say there are
(15:38):
cohorts of interest that we needto look at further, and
probably for very good reason.
There's lots of different waysand of course, we continue to be
out and about and talking toother investigators and
researchers and clinicians.
The center is like atranslational center, so it
means that we translate ourclinical experiences into, you
(16:01):
know, research, ideas as well aseducational, you know, products
and those things then serve thesystem back and influence
clinical care.
So it's like a big circle.
So I really, as part of whatI've done there, is to sort of
really reinforce thistranslational center, like you
know, to tell everybody this iswho we are, this is what we do.
(16:23):
This is why we need to hirepeople with clinical training
that also have interest instudying things a little bit
further.
But we also need this gets backto a previous question of yours
about our teeth we also need tohave people who really focus on
research, because that takes alot of time and effort, you know
, and we need people thatunderstand computational
modeling.
(16:43):
You know which isn't me, butyou know there are people that
know how to do that anepidemiologist and we need you
know, if we can't have all thatin-house, we have to partner
with others as well.
Hopefully that explains theprofit.
Larry Zilliox (17:01):
Yeah, I will send you a link to Dr Stone's
episode.
It was fascinating because theyhad started their research
looking at the effects of tierone door kicking operators
thinking well, they're exposedto these large blasts, and
constantly.
And then the EOD instructorsasked to be part of it and it
turned out that being subjectedto the lower level, the
(17:21):
sub-level explosions on a moreregular basis, seemed to have
more of an impact.
It was really interesting.
What is the center's focusright now?
What would you say is thenumber one thing that you're
looking at as a center forenvironmental exposures of what
(17:41):
our service members are goingthrough or may be exposed to
today?
Dr. Matthew Reinhard (17:45):
Well, it's interesting Right now.
You were right before me andsaid it's a new center.
We are, we're kind of young,there are cohorts of interest or
I would say, let me back upoccupations of interest, and so
ELD, as we just talked about, isa major interest of ours.
We've already learned a lot.
We have the only center in VAreally focused on that group.
(18:09):
I've seen a lot of the veteranpatients myself and with the
team and we've learned a lot.
And we're, you know, developing, you know, a research program.
We're seeing folks clinicallyright now and that's sort of
again gets back to thistranslational model like what
can we glean from the clinicalcare and what are questions that
(18:29):
need to be answered?
And so we're developing aresearch project with a partner
In this case it's the Universityof Maryland over here and
College Park over in Marylandhere and that's really to look
(18:55):
at the biological wear and tearof military exposures with that
group.
And I think we will addadditional occupations of
interest, I'd say, and kind ofwanting to understand probably
what Dr Stone was talking about,but how the cumulative military
exposures not just blast otherexposures that people often
aren't considering, whether itbe chemical, you know.
Obviously people consider sortof stress exposures and things
like that.
But there may be.
There may be toxin and chemicalexposures as well that often,
(19:19):
you know, researchers aren'tthinking about.
And so how those thingscumulatively may impact, you
know, health outcomes, and sowe're working with University of
Maryland on this concept ofallostatic load, which is
basically, you know, acumulative effect of stressors
on the body causingphysiological changes.
(19:41):
Because you know, a lot of thepatients I'm seeing really are,
you know, some of them arehaving a lot of difficulties and
it's hard for us to always, youknow, measure and conceptualize
, you know, with our instrumentsor you know, and I'm a
neuropsychologist so I think,sort of measuring cognition.
You know our measurements ofcognition don't always match up
(20:01):
with, you know, people'sself-report of what they're
saying, that the difficultiesare, and so trying to think
about different ways in whichthe cumulative effects of their
experiences lead to disease andyou know, and stress on the body
.
So that's an ongoing thing.
I'm kind of excited about itbecause we're sort of finishing
(20:22):
up, you know, some dry runs justwith our own staff to sort of,
you know, be able to enrollparticipants.
So I'm not really advertisingit yet, but we're getting there
with that, and so that's oneoccupational group.
There are other things I cantalk about as well, but that
would be one example right now.
Larry Zilliox (20:42):
Well, I will say that this kind of hits home for
me in my service.
I was Air and I was in from 77to 83.
The first duty station wasLoring Air Force in northern
Maine and I remember one night Iwas in a weapons storage area
(21:04):
and I was on a two-man patroljust sitting around and the
sergeant I was with was a realknucklehead and he said, hey,
come on over here.
I got to show you what I foundand we went over to this pipe
that was sticking out of theground and he said, look, the
top of it is loose.
And he swung the top of itaround.
I'm like, hmm, ok, and we werejust standing there and he
(21:27):
pushed the top back on and Isaid, yeah, maybe we should tell
somebody.
He said, no, no, well, probablywithin 20 minutes we were both
really sick, really sick, and wewent to the hospital and they
took us in, they kept usovernight and they said, well,
you seem to be okay.
And then they sent us home andwent back to the barracks and
(21:49):
that was the end of that.
And it wasn't.
My next duty assignment was Guamand I got to thinking, you know
, I wonder what made me sick andI actually stumbled upon the
environmental safety office thatthe Air Force had there in Guam
and I walked in and I said, hey, you know, this happened to me.
I can't figure out what it was,and the very nice officer I
(22:13):
think he was a captain at thetime, I don't remember his name
he said, well, let me look intoit.
And it took months and monthsand months to get an answer and
finally they came back and saidoh well, that was something that
led to some heavy water, whichI had never heard of, and they
said you probably inhaled thatand that's what made you sick.
And I, you know, I just think Iwas just an Air Force cop, you
(22:39):
know, sitting around on a patrolin a weapons storage area, and
it just makes me think that youcan be on duty just about
anywhere in the military and beexposed to all sorts of things.
I really appreciate the factthat the VA and you and your
staff and everyone there isthinking about this, when nobody
(23:03):
really no one else really was,and it's an amazing service that
you provide.
And I think it's also importantfor our listeners and folks to
know how much research the VAreally does.
It's not just a hospital,somewhere where they treat you
when you come in and you know,just treat your symptoms and
(23:24):
send you home.
There's a lot more that goesinto the VA and it's why it has
such a large budget.
It's also why you need moremoney, and I encourage all our
listeners to make a claim andsign up, and even if you get a
zero rating, that's one morebody that the VA has to deal
with and hopefully Congress willgive them more funding for not
(23:47):
only benefits but for researchlike this.
So, as we kind of wrap up here,I really appreciate everything
that you've told us about thecenter.
I do have one last question foryou, and it has to do with
artificial intelligence, and howdo you think AI will affect the
(24:08):
work that you do?
Dr. Matthew Reinhard (24:10):
That's interesting.
I guess I can answer that on acouple levels.
Larry Zilliox (24:14):
I don't.
Dr. Matthew Reinhard (24:16):
You know, I think AI right now is used for
like assisting writing.
You know I don't use it, but Ithink as it advances it probably
will help providers synthesizecomplex medical records.
And this is not in place yet,but I could see a not too
(24:38):
distant future where it reallysynthesizes for, let's say, a
physician in this case, althoughI'm not a physician let's say a
physician someone's medicalrecords from the DOD and the VA
over, you know many, overdecades, and it could maybe
distill down and capture, youknow many, many thousands of
pages of of information to thensort of um, suggest to the doc.
(25:05):
You know here's some point tomaybe ask about or look at and
here's, here's somerecommendations, not so much as
a, as you know, taking place ofof the physician, because they
have the.
You can't really replace that,I don't think um, but you know,
as an assistant, I could seethat happening.
I think that is happening insome places already.
I'm not sure about theassistant, I could see that
happening.
I think that is happening insome places already.
I'm not sure about the VA, but Icould see that being a real
(25:26):
benefit to patients.
You know, because there's no,we actually in the risk and
safety do very deep dives intopatients' medical records, but
that takes like human man hoursand woman hours, you know, and I
could see it, hours, you know,and I could see it.
If there were a tool that wasreally much better at that sort
(25:49):
of natural language processingand all this kind of stuff, that
could model some of thosethings and come up with
suggestions, I could see thatbeing a real help sort of in the
short term for healthcare.
Yeah, yeah, that's the firstthing that comes to mind.
Larry Zilliox (25:58):
Yeah, yeah, well, that's great.
Well, listen, doc.
Thanks so much for joining usand taking your time to tell our
listeners about the center andwish you all the luck and I've
got fingers crossed for muchmore funding for you.
All right, I'll do that.
Hopefully you'll see anincrease in that soon.
(26:22):
And listen, keep up the greatwork.
I really appreciate it.
Dr. Matthew Reinhard (26:26):
Well, thanks for this opportunity and
your interest.
Not often I get to be able totalk about the things that we're
doing, and it's really not.
You know I've talked about theteam and this group, but you
know it's really not me.
We have a very, very good groupof scientists and clinical
providers here as well, as ourleadership has been really,
(26:49):
really good.
So I feel very fortunate towork for VA and with the mission
that it has.
So, thank you.
Larry Zilliox (26:56):
Yeah, For our listeners.
If you have any questions orsuggestions, you can reach us at
podcast at willingwarriorsorg.
We'll have another episode nextMonday morning at 0500.
Until then, thanks forlistening.
Good morning.
I'm Larry Zilliox, Director ofCulinary Services here at the
Warrior Retreat at Bull Run, andthis week our guest is Dr
Matthew Reinhard.
He is the Director of theComplex Exposure Threat Center
of Excellence at the VA inWashington DC and I'm really
happy that he's able to join ustoday because I really want to
(00:24):
explore some of the researchthat the VA does.
Of course, our listeners arevery familiar with all the
health benefits and claims andgetting medical help from the VA
.
I'm not sure that many of themunderstand really how much
research the VA does or fundsthat goes into supporting our
(00:47):
veterans with medical healthissues.
So, dr Reinhardt, thank you forjoining us.
Dr. Matthew Reinhard (00:53):
Well, thanks for having me.
It's great.
I don't really usually get todo this kind of thing, so
hopefully I can Informationyou're looking for.
Larry Zilliox (01:03):
Yeah, I'm sure you'll be able to.
I've looked at your resumethere and I've been on the
webpage for the center and youseem like the guy who can handle
all my questions, that's forsure.
If we could start with, justtell us a little bit about your
background and how you becameinvolved with the VA and the
(01:25):
center.
Dr. Matthew Reinhard (01:26):
Wow, sure, I don't think anyone's ever
asked me that, but I've been thedirector for something called
the War-Related Illness andInjury Study Center, with the
acronym.
There is RISC, and now there'sa sub-center within that, the
Complex Exposure Threat Centerof Excellence, or .
I guess I'll refer to them asrisk and STETC from this point
forward.
Um, my training was as aneuropsychologist, um, and I
(01:53):
took a role coming out of agraduate school as a
neuropsychologist, uh, at therisk, and later, you know, after
a few short years, I ended uprunning that study center or
becoming director for it.
But I think you know how I gotto the VA originally.
You know my interest in the VA.
You know my dad is a veteran,my grandfather as well.
(02:16):
Relevant and important to me, Ithink you know our family
history is involved in serviceand my dad was, you know, during
the 1960s on the army, and soit was always.
It always was in my mindset to,you know, provide service in
some way.
I was not in the military myself, but I think being a civil
servant with the VA, whichreally has the greatest mission
(02:40):
that you could possibly have,which is, you know, to care for
veterans, is makes a lot ofsense to me, always made a lot
of sense to me, and I've beenfortunate, which is, you know,
to care for veterans.
Uh, is is makes a lot of senseto me, always made a lot of
sense to me, and, uh, I've beenfortunate enough to, you know,
have success and get intograduate schools and then do all
the studying and get to uh andget a positions and then, you
know, achieve through thosepositions some, some leadership
roles, uh, in a really kind ofdynamic center or centers that
(03:03):
we have now.
Larry Zilliox (03:04):
So tell us a little bit about the center and
what really distinguishes thecenter of excellence from your
just run-of-the-mill gardenvariety center.
Dr. Matthew Reinhard (03:18):
That's a good question, you know.
All right.
So I think I'll talk about theSETC, because that's what you
started with.
So a center of excellence, whatthat essentially means is
you've got a concentration ofexpertise and in our case it's
really an interdisciplinaryexpertise, specifically with
(03:42):
military exposures and veteranhealth, and that is not easy to
do.
You kind of have to hire andrecruit the right people and
we're a small center, we're nota big group, and really the risk
or the war-related illness andinjury study center is the major
(04:02):
support.
But, yeah, we've been able torecruit really some of the
finest occupational andenvironmental medicine
physicians that had longmilitary careers in medicine
throughout the military andleadership roles in the military
, who were also clinicalproviders, and so we've been
able to hire a few people thereand that allows us probably
(04:26):
because there's just not thatmany people like that that
allows us to have a probablythat's, you know, it's just a
few folks, it's probably thehighest concentration working
together towards, you know, someof the questions and issues
that we think are important forveterans, you know, president.
And then going forward into thefuture, I think I hope that
(04:47):
answers your question about whatI think a center of excellence
is different.
There.
You know there's some technicalstuff as well.
Like you know, you have tomaintain that excellence and
that's measured.
You know, every five yearsthere's sort of a you know a
look at how that's going andmeasuring success, and I think
that that's important as well.
Larry Zilliox (05:08):
And so is there elevated funding involved when
you kind of shift over to thecenter of excellence.
Dr. Matthew Reinhard (05:17):
That's a question that remains to be
determined.
I actually don't know.
That's probably above my paygrade.
I can don't know.
That's probably above my paygrade.
Larry Zilliox (05:26):
Well, I can't comment on that.
We'll keep our fingers crossed.
Yeah, that'd be great.
So, yeah, talk about the teamif you would.
So I think our listeners needto understand that it's not like
you're all in a little buildingdown in DC.
When you talk about the team, Ithink you're talking about
bringing people on board thatare part of other academic
(05:50):
institutions and things likethat that contribute and support
the center.
Is that kind of like what it is?
Dr. Matthew Reinhard (05:57):
Sort of.
Yeah, I mean, I think we, youknow we've got certainly some of
the occupational andenvironmental medicine
physicians which are kind ofwith military experience and
careers, and there's not thatmany of those We've got a few
there who are really premierpeople.
There's a multidisciplinaryteam Obviously.
(06:17):
I'm a neuropsychologist bytraining but now I'm more sort
of in a leadership role, but wehave neuropsychologists and
nurse practitioner and socialwork.
We also have, well, I shouldsay I should add, all these
people sort of have an expertisein environmental exposure
because that's something that'ssort of unique to, you know, to
military service and thenthereby you know, veteran care
(06:42):
so, and that's something sort ofunique to the VA.
I can go into a little bitabout that as well.
But we have multidisciplinarystaff.
We also have academic partnerswith.
You know it might be withgrants that we're writing or you
know we're working with that.
We're trying to because we docompete, or funding, you know,
(07:03):
like everybody else, to try tobring in additional studies and
grants.
And you know our area of focusis usually on environmental type
exposures or military typeexposures and health outcomes is
really because, again, sort ofgetting back to that center of
excellence concept, and sothat's kind of where we focus,
and so you need partners there.
We're never going to have allthe expertise in-house and I
(07:27):
don't think that that's the wayit should be right.
You have to partner and makefriends in academic institutions
, but also in other federalagencies actually, and so that's
something that isn't often done.
But spending the time andenergy to sort of partner with
other federal agencies I thinkis key, especially for the SETC,
(07:50):
because the role there is.
It's got a few key roles, butone of them know, as we talked
about, sort of thisenvironmental exposure concept,
you know.
So people who serve in themilitary are exposed to things
that we're not often going tosee like in a civilian context
(08:18):
airborne hazards or burn pitsmoke and things like that
depleted uranium or uniquesolvent exposures or weapons
systems or subconcussive blasts,repetitive subconcussive blasts
, all these.
And then of course there are newand emerging things as warfare
likely is changing as we cansort of see and observe, and VA
(08:42):
needs to be educated in someways and be prepared as a
healthcare organization forwhat's coming, not just
necessarily responding to thingsyou know many decades down the
line.
So that requires thoseconnections with other federal
agencies and one of the roles ofSEXI.
That I think is unique is it'sthinking about those emerging
(09:07):
issues, and so there's aneducation component.
You know, as we meet and talkwith other people and agencies
and find out things, you know,can we prepare education modules
for our own healthcare systemto be prepared?
Yes, that's something that onlythe VA can do, or typically, or
has done, I should say, becausethat's not really a civilian
(09:32):
healthcare system focus.
That's something, and I thinkthat's why veterans, many
veterans, are happy with theirVA care and because there really
is that emphasis on some of theunique military-related
exposures and I think VA isbecoming more and more aware of
that and I think sexy and therisks plays a role in uncovering
(09:55):
that stuff and also educatingour own system.
Yeah, because if you askveterans this is another thing
that you know probably wouldn'thappen in the civilian sector
but if you ask veterans abouttheir concerns and do you have
concerns about things that youmay have been exposed to when
(10:16):
you were deployed or in trainingor you know, or on this or that
base or wherever you might havebeen, they will tell you.
You know about their concerns.
Yes, you know I am, you know,you know these.
These alarms did go off and Iput on a mop suit and I'm
worried about you know, you know, or yes, I was exposed to, uh,
(10:38):
this, this solvent when we, youknow, when we um did this task
and people.
So as you start to ask and getpeople's stories, you will hear
that they have health concernsand sort of long-term.
What are the long-term effectsof these things?
And that's going to be a VAarea of interest, right?
Yeah, yeah, it's important.
Larry Zilliox (11:00):
So one of the things that jumped out at me
when I read sort of the pressrelease on the center a few
months ago is that it was soforward thinking that, as you
said, sometimes the VA is alittle slow to catch up with
things, and I get that.
It's always a funding issue.
You know it can't look atthings until it's a real problem
(11:24):
.
But this this sort of jumpedout at me because it seemed like
hey, somebody sitting down andsaying we've got all this stuff
going on and all of our servicemembers and maybe get ahead of
it and say this could be aproblem, so we need to handle it
(11:49):
this way.
I want to direct our listenersto a previous episode that we
did in season two back inFebruary of 2024.
It's episode six of season twoand that was an interview with
Dr James Stone, who's aresearcher at UVA and he is
researching the effects of lowlevel blasts on and TBI on EOD
(12:14):
instructors One of the kind ofthings that I see the center
funding or getting involved with, and I just can't get over the
fact that somebody at VA said weneed to take a look at these
things that are affecting ourmembers in the future.
(12:34):
I guess one of the questionsthat I have is that I know you
all are new.
Well, actually, the center hasbeen around since 2022, but as a
center of excellence, which I'massuming meant you brought more
people on and things like thatwhat is the process for
uncovering things that you mayneed to look at and then
(12:57):
deciding on what you should lookat?
Dr. Matthew Reinhard (13:01):
Wow, so that's a good question.
First of all, I got to listento the James Stone episode.
We do.
You know, you mentioned I thinkwhat you were talking about.
There was probablysubconcussive blast.
I think you said EOD, yeah, didyou say yeah?
So explosive ordnance disposal,we have a specialized focus in
(13:28):
EOD.
As an occupational group, oneof the things we're interested
in is and this is getting toyour question about processed
that is an example of a groupthat we identified as likely
high exposure.
(13:49):
So they're going to have highexposure to you know, whether it
be blasts, obviously it's anexplosive ordnance group
chemicals, stress, novel weaponssystems, all those things.
And so how do we identify thatgroup?
You know, believe it or not, Ireceived a written letter from a
veteran many years ago and itwas an EOD veteran and he was
(14:12):
concerned about the health andwellness of his colleagues and I
, you know, I called him back.
He had his phone number thereand I called him back and
started a conversation and a lotof you know, a lot of our
programs in some ways start withvery sort of with things you
wouldn't think of, you know.
But what I think it says is thatwe're kind of listening to the
(14:33):
you know, the veteransthemselves, and so we spend a
lot of time doing that.
We hear it's a little bit of asurveillance mode also because,
you know, we see patientsclinically.
So we bring in a few patients,sort of the higher exposure type
patients, and we listen to themand it's kind of a surveillance
mode.
It's in that way from aclinical surveillance sort of
(14:56):
model, where you're like, wow,this person is talking about
something that we hadn't thoughtof.
We need to look into thisfurther, like how many people
are there like this, what do weneed to do?
And so it kind of is veryorganic in that way.
There are times where it's notnecessarily organic.
From coming like I would callthat a grassroots process, which
(15:18):
you know, that was a goodexample of it say, like you know
, we need to check this out andI don't know, you know how those
things necessarily come to them.
but I can't say.
But you know there are.
There are cases where you knowthere are, let's say there are
(15:38):
cohorts of interest that we needto look at further, and
probably for very good reason.
There's lots of different waysand of course, we continue to be
out and about and talking toother investigators and
researchers and clinicians.
The center is like atranslational center, so it
means that we translate ourclinical experiences into, you
(16:01):
know, research, ideas as well aseducational, you know, products
and those things then serve thesystem back and influence
clinical care.
So it's like a big circle.
So I really, as part of whatI've done there, is to sort of
really reinforce thistranslational center, like you
know, to tell everybody this iswho we are, this is what we do.
(16:23):
This is why we need to hirepeople with clinical training
that also have interest instudying things a little bit
further.
But we also need this gets backto a previous question of yours
about our teeth we also need tohave people who really focus on
research, because that takes alot of time and effort, you know
, and we need people thatunderstand computational
modeling.
(16:43):
You know which isn't me, butyou know there are people that
know how to do that anepidemiologist and we need you
know, if we can't have all thatin-house, we have to partner
with others as well.
Hopefully that explains theprofit.
Larry Zilliox (17:01):
Yeah, I will send you a link to Dr Stone's
episode.
It was fascinating because theyhad started their research
looking at the effects of tierone door kicking operators
thinking well, they're exposedto these large blasts, and
constantly.
And then the EOD instructorsasked to be part of it and it
turned out that being subjectedto the lower level, the
(17:21):
sub-level explosions on a moreregular basis, seemed to have
more of an impact.
It was really interesting.
What is the center's focusright now?
What would you say is thenumber one thing that you're
looking at as a center forenvironmental exposures of what
(17:41):
our service members are goingthrough or may be exposed to
today?
Dr. Matthew Reinhard (17:45):
Well, it's interesting Right now.
You were right before me andsaid it's a new center.
We are, we're kind of young,there are cohorts of interest or
I would say, let me back upoccupations of interest, and so
ELD, as we just talked about, isa major interest of ours.
We've already learned a lot.
We have the only center in VAreally focused on that group.
(18:09):
I've seen a lot of the veteranpatients myself and with the
team and we've learned a lot.
And we're, you know, developing, you know, a research program.
We're seeing folks clinicallyright now and that's sort of
again gets back to thistranslational model like what
can we glean from the clinicalcare and what are questions that
(18:29):
need to be answered?
And so we're developing aresearch project with a partner
In this case it's the Universityof Maryland over here and
College Park over in Marylandhere and that's really to look
(18:55):
at the biological wear and tearof military exposures with that
group.
And I think we will addadditional occupations of
interest, I'd say, and kind ofwanting to understand probably
what Dr Stone was talking about,but how the cumulative military
exposures not just blast otherexposures that people often
aren't considering, whether itbe chemical, you know.
Obviously people consider sortof stress exposures and things
like that.
But there may be.
There may be toxin and chemicalexposures as well that often,
(19:19):
you know, researchers aren'tthinking about.
And so how those thingscumulatively may impact, you
know, health outcomes, and sowe're working with University of
Maryland on this concept ofallostatic load, which is
basically, you know, acumulative effect of stressors
on the body causingphysiological changes.
(19:41):
Because you know, a lot of thepatients I'm seeing really are,
you know, some of them arehaving a lot of difficulties and
it's hard for us to always, youknow, measure and conceptualize
, you know, with our instrumentsor you know, and I'm a
neuropsychologist so I think,sort of measuring cognition.
You know our measurements ofcognition don't always match up
(20:01):
with, you know, people'sself-report of what they're
saying, that the difficultiesare, and so trying to think
about different ways in whichthe cumulative effects of their
experiences lead to disease andyou know, and stress on the body
.
So that's an ongoing thing.
I'm kind of excited about itbecause we're sort of finishing
(20:22):
up, you know, some dry runs justwith our own staff to sort of,
you know, be able to enrollparticipants.
So I'm not really advertisingit yet, but we're getting there
with that, and so that's oneoccupational group.
There are other things I cantalk about as well, but that
would be one example right now.
Larry Zilliox (20:42):
Well, I will say that this kind of hits home for
me in my service.
I was Air and I was in from 77to 83.
The first duty station wasLoring Air Force in northern
Maine and I remember one night Iwas in a weapons storage area
(21:04):
and I was on a two-man patroljust sitting around and the
sergeant I was with was a realknucklehead and he said, hey,
come on over here.
I got to show you what I foundand we went over to this pipe
that was sticking out of theground and he said, look, the
top of it is loose.
And he swung the top of itaround.
I'm like, hmm, ok, and we werejust standing there and he
(21:27):
pushed the top back on and Isaid, yeah, maybe we should tell
somebody.
He said, no, no, well, probablywithin 20 minutes we were both
really sick, really sick, and wewent to the hospital and they
took us in, they kept usovernight and they said, well,
you seem to be okay.
And then they sent us home andwent back to the barracks and
(21:49):
that was the end of that.
And it wasn't.
My next duty assignment was Guamand I got to thinking, you know
, I wonder what made me sick andI actually stumbled upon the
environmental safety office thatthe Air Force had there in Guam
and I walked in and I said, hey, you know, this happened to me.
I can't figure out what it was,and the very nice officer I
(22:13):
think he was a captain at thetime, I don't remember his name
he said, well, let me look intoit.
And it took months and monthsand months to get an answer and
finally they came back and saidoh well, that was something that
led to some heavy water, whichI had never heard of, and they
said you probably inhaled thatand that's what made you sick.
And I, you know, I just think Iwas just an Air Force cop, you
(22:39):
know, sitting around on a patrolin a weapons storage area, and
it just makes me think that youcan be on duty just about
anywhere in the military and beexposed to all sorts of things.
I really appreciate the factthat the VA and you and your
staff and everyone there isthinking about this, when nobody
(23:03):
really no one else really was,and it's an amazing service that
you provide.
And I think it's also importantfor our listeners and folks to
know how much research the VAreally does.
It's not just a hospital,somewhere where they treat you
when you come in and you know,just treat your symptoms and
(23:24):
send you home.
There's a lot more that goesinto the VA and it's why it has
such a large budget.
It's also why you need moremoney, and I encourage all our
listeners to make a claim andsign up, and even if you get a
zero rating, that's one morebody that the VA has to deal
with and hopefully Congress willgive them more funding for not
(23:47):
only benefits but for researchlike this.
So, as we kind of wrap up here,I really appreciate everything
that you've told us about thecenter.
I do have one last question foryou, and it has to do with
artificial intelligence, and howdo you think AI will affect the
(24:08):
work that you do?
Dr. Matthew Reinhard (24:10):
That's interesting.
I guess I can answer that on acouple levels.
Larry Zilliox (24:14):
I don't.
Dr. Matthew Reinhard (24:16):
You know, I think AI right now is used for
like assisting writing.
You know I don't use it, but Ithink as it advances it probably
will help providers synthesizecomplex medical records.
And this is not in place yet,but I could see a not too
(24:38):
distant future where it reallysynthesizes for, let's say, a
physician in this case, althoughI'm not a physician let's say a
physician someone's medicalrecords from the DOD and the VA
over, you know many, overdecades, and it could maybe
distill down and capture, youknow many, many thousands of
pages of of information to thensort of um, suggest to the doc.
(25:05):
You know here's some point tomaybe ask about or look at and
here's, here's somerecommendations, not so much as
a, as you know, taking place ofof the physician, because they
have the.
You can't really replace that,I don't think um, but you know,
as an assistant, I could seethat happening.
I think that is happening insome places already.
I'm not sure about theassistant, I could see that
happening.
I think that is happening insome places already.
I'm not sure about the VA, but Icould see that being a real
(25:26):
benefit to patients.
You know, because there's no,we actually in the risk and
safety do very deep dives intopatients' medical records, but
that takes like human man hoursand woman hours, you know, and I
could see it, hours, you know,and I could see it.
If there were a tool that wasreally much better at that sort
(25:49):
of natural language processingand all this kind of stuff, that
could model some of thosethings and come up with
suggestions, I could see thatbeing a real help sort of in the
short term for healthcare.
Yeah, yeah, that's the firstthing that comes to mind.
Larry Zilliox (25:58):
Yeah, yeah, well, that's great.
Well, listen, doc.
Thanks so much for joining usand taking your time to tell our
listeners about the center andwish you all the luck and I've
got fingers crossed for muchmore funding for you.
All right, I'll do that.
Hopefully you'll see anincrease in that soon.
(26:22):
And listen, keep up the greatwork.
I really appreciate it.
Dr. Matthew Reinhard (26:26):
Well, thanks for this opportunity and
your interest.
Not often I get to be able totalk about the things that we're
doing, and it's really not.
You know I've talked about theteam and this group, but you
know it's really not me.
We have a very, very good groupof scientists and clinical
providers here as well, as ourleadership has been really,
(26:49):
really good.
So I feel very fortunate towork for VA and with the mission
that it has.
So, thank you.
Larry Zilliox (26:56):
Yeah, For our listeners.
If you have any questions orsuggestions, you can reach us at
podcast at willingwarriorsorg.
We'll have another episode nextMonday morning at 0500.
Until then, thanks forlistening.
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