Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
Welcome Home is a Willing Warriors and the Warrior Retreat at Bull Run project. The program highlights activities at the Warrior Retreat and issues impacting all Veterans. For questions or feedback, please email us at podcast@willingwarriors.org.
Welcome Home - A Podcast for Veterans, About Veterans, By Veterans
Championing Veteran Health: Dr. Matthew Reinhard on Interdisciplinary Approaches to Military Exposure Research
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.
Good morning. I'm Larry Zilliox, Director of Culinary Services here at the Warrior Retreat at Bull Run, and this week our guest is Dr Matthew Reinhard. He is the Director of the Complex Exposure Threat Center of Excellence at the VA in Washington DC and I'm really happy that he's able to join us today because I really want to explore some of the research that the VA does. Of course, our listeners are very familiar with all the health benefits and claims and getting medical help from the VA. I'm not sure that many of them understand really how much research the VA does or funds that goes into supporting our veterans with medical health issues. So, dr Reinhardt, thank you for joining us.
Dr. Matthew Reinhard:Well, thanks for having me. It's great. I don't really usually get to do this kind of thing, so hopefully I can Information you're looking for.
Larry Zilliox:Yeah, I'm sure you'll be able to. I've looked at your resume there and I've been on the webpage for the center and you seem like the guy who can handle all my questions, that's for sure. If we could start with, just tell us a little bit about your background and how you became involved with the VA and the center.
Dr. Matthew Reinhard:Wow, sure, I don't think anyone's ever asked me that, but I've been the director for something called the War-Related Illness and Injury Study Center, with the acronym. There is RISC, and now there's a sub-center within that, the Complex Exposure Threat Center of Excellence, or . I guess I'll refer to them as risk and STETC from this point forward. Um, my training was as a neuropsychologist, um, and I took a role coming out of a graduate school as a neuropsychologist, uh, at the risk, and later, you know, after a few short years, I ended up running that study center or becoming director for it.
Dr. Matthew Reinhard:But I think you know how I got to the VA originally. You know my interest in the VA. You know my dad is a veteran, my grandfather as well. Relevant and important to me, I think you know our family history is involved in service and my dad was, you know, during the 1960s on the army, and so it was always. It always was in my mindset to, you know, provide service in some way.
Dr. Matthew Reinhard:I was not in the military myself, but I think being a civil servant with the VA, which really has the greatest mission that you could possibly have, which is, you know, to care for veterans, is makes a lot of sense to me, always made a lot of sense to me, and I've been fortunate, which is, you know, to care for veterans. Uh, is is makes a lot of sense to me, always made a lot of sense to me, and, uh, I've been fortunate enough to, you know, have success and get into graduate schools and then do all the studying and get to uh and get a positions and then, you know, achieve through those positions some, some leadership roles, uh, in a really kind of dynamic center or centers that we have now.
Larry Zilliox:So tell us a little bit about the center and what really distinguishes the center of excellence from your just run-of-the-mill garden variety center.
Dr. Matthew Reinhard:That's a good question, you know. All right. So I think I'll talk about the SETC, because that's what you started with. So a center of excellence, what that essentially means is you've got a concentration of expertise and in our case it's really an interdisciplinary expertise, specifically with military exposures and veteran health, and that is not easy to do. You kind of have to hire and recruit the right people and we're a small center, we're not a big group, and really the risk or the war-related illness and injury study center is the major support.
Dr. Matthew Reinhard:But, yeah, we've been able to recruit really some of the finest occupational and environmental medicine physicians that had long military careers in medicine throughout the military and leadership roles in the military, who were also clinical providers, and so we've been able to hire a few people there and that allows us probably because there's just not that many people like that that allows us to have a probably that's, you know, it's just a few folks, it's probably the highest concentration working together towards, you know, some of the questions and issues that we think are important for veterans, you know, president. And then going forward into the future, I think I hope that answers your question about what I think a center of excellence is different. There. You know there's some technical stuff as well. Like you know, you have to maintain that excellence and that's measured. You know, every five years there's sort of a you know a look at how that's going and measuring success, and I think that that's important as well.
Larry Zilliox:And so is there elevated funding involved when you kind of shift over to the center of excellence.
Dr. Matthew Reinhard:That's a question that remains to be determined. I actually don't know. That's probably above my pay grade. I can don't know. That's probably above my pay grade.
Larry Zilliox:Well, I can't comment on that. We'll keep our fingers crossed. Yeah, that'd be great. So, yeah, talk about the team if you would. So I think our listeners need to understand that it's not like you're all in a little building down in DC. When you talk about the team, I think you're talking about bringing people on board that are part of other academic institutions and things like that that contribute and support the center. Is that kind of like what it is?
Dr. Matthew Reinhard:Sort of. Yeah, I mean, I think we, you know we've got certainly some of the occupational and environmental medicine physicians which are kind of with military experience and careers, and there's not that many of those We've got a few there who are really premier people. There's a multidisciplinary team Obviously. I'm a neuropsychologist by training but now I'm more sort of in a leadership role, but we have neuropsychologists and nurse practitioner and social work. We also have, well, I should say I should add, all these people sort of have an expertise in environmental exposure because that's something that's sort of unique to, you know, to military service and then thereby you know, veteran care so, and that's something sort of unique to the VA. I can go into a little bit about that as well. But we have multidisciplinary staff. We also have academic partners with. You know it might be with grants that we're writing or you know we're working with that. We're trying to because we do compete, or funding, you know, like everybody else, to try to bring in additional studies and grants. And you know our area of focus is usually on environmental type exposures or military type exposures and health outcomes is really because, again, sort of getting back to that center of excellence concept, and so that's kind of where we focus, and so you need partners there. We're never going to have all the expertise in-house and I don't think that that's the way it should be right. You have to partner and make friends in academic institutions, but also in other federal agencies actually, and so that's something that isn't often done. But spending the time and energy to sort of partner with other federal agencies I think is key, especially for the SETC, because the role there is. It's got a few key roles, but one of them know, as we talked about, sort of this environmental exposure concept, you know. So people who serve in the military are exposed to things that we're not often going to see like in a civilian context airborne hazards or burn pit smoke and things like that depleted uranium or unique solvent exposures or weapons systems or subconcussive blasts, repetitive subconcussive blasts, all these.
Dr. Matthew Reinhard:And then of course there are new and emerging things as warfare likely is changing as we can sort of see and observe, and VA needs to be educated in some ways and be prepared as a healthcare organization for what's coming, not just necessarily responding to things you know many decades down the line. So that requires those connections with other federal agencies and one of the roles of SEXI. That I think is unique is it's thinking about those emerging issues, and so there's an education component. You know, as we meet and talk with other people and agencies and find out things, you know, can we prepare education modules for our own healthcare system to be prepared? Yes, that's something that only the VA can do, or typically, or has done, I should say, because that's not really a civilian healthcare system focus. That's something, and I think that's why veterans, many veterans, are happy with their VA care and because there really is that emphasis on some of the unique military-related exposures and I think VA is becoming more and more aware of that and I think sexy and the risks plays a role in uncovering that stuff and also educating our own system.
Dr. Matthew Reinhard:Yeah, because if you ask veterans this is another thing that you know probably wouldn't happen in the civilian sector but if you ask veterans about their concerns and do you have concerns about things that you may have been exposed to when you were deployed or in training or you know, or on this or that base or wherever you might have been, 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 I put on a mop suit and I'm worried about you know, you know, or yes, I was exposed to, uh, this, this solvent when we, you know, when we um did this task and people. So as you start to ask and get people's stories, you will hear that they have health concerns and sort of long-term. What are the long-term effects of these things? And that's going to be a VA area of interest, right? Yeah, yeah, it's important.
Larry Zilliox:So one of the things that jumped out at me when I read sort of the press release on the center a few months ago is that it was so forward thinking that, as you said, sometimes the VA is a little slow to catch up with things, and I get that. It's always a funding issue. You know it can't look at things until it's a real problem. But this this sort of jumped out at me because it seemed like hey, somebody sitting down and saying we've got all this stuff going on and all of our service members and maybe get ahead of it and say this could be a problem, so we need to handle it this way. I want to direct our listeners to a previous episode that we did in season two back in February of 2024. It's episode six of season two and that was an interview with Dr James Stone, who's a researcher at UVA and he is researching the effects of low level blasts on and TBI on EOD instructors One of the kind of things that I see the center funding or getting involved with, and I just can't get over the fact that somebody at VA said we need to take a look at these things that are affecting our members in the future.
Larry Zilliox:I guess one of the questions that I have is that I know you all are new. Well, actually, the center has been around since 2022, but as a center of excellence, which I'm assuming meant you brought more people on and things like that what is the process for uncovering things that you may need to look at and then deciding on what you should look at?
Dr. Matthew Reinhard:Wow, so that's a good question. First of all, I got to listen to the James Stone episode. We do. You know, you mentioned I think what you were talking about. There was probably subconcussive blast. I think you said EOD, yeah, did you say yeah?
Dr. Matthew Reinhard:So explosive ordnance disposal, we have a specialized focus in EOD. As an occupational group, one of the things we're interested in is and this is getting to your question about processed that is an example of a group that we identified as likely high exposure. So they're going to have high exposure to you know, whether it be blasts, obviously it's an explosive ordnance group chemicals, stress, novel weapons systems, all those things. And so how do we identify that group? You know, believe it or not, I received a written letter from a veteran many years ago and it was an EOD veteran and he was concerned about the health and wellness of his colleagues and I, you know, I called him back. He had his phone number there and I called him back and started a conversation and a lot of you know, a lot of our programs in some ways start with very sort of with things you wouldn't think of, you know.
Dr. Matthew Reinhard:But what I think it says is that we're kind of listening to the you know, the veterans themselves, and so we spend a lot of time doing that. We hear it's a little bit of a surveillance mode also because, you know, we see patients clinically. So we bring in a few patients, sort of the higher exposure type patients, and we listen to them and it's kind of a surveillance mode. It's in that way from a clinical surveillance sort of model, where you're like, wow, this person is talking about something that we hadn't thought of. We need to look into this further, like how many people are there like this, what do we need to do? And so it kind of is very organic in that way. There are times where it's not necessarily organic. From coming like I would call that a grassroots process, which you know, that was a good example of it say, like you know, we need to check this out and I don't know, you know how those things necessarily come to them.
Dr. Matthew Reinhard:but I can't say. But you know there are. There are cases where you know there are, let's say there are cohorts of interest that we need to look at further, and probably for very good reason. There's lots of different ways and of course, we continue to be out and about and talking to other investigators and researchers and clinicians. The center is like a translational center, so it means that we translate our clinical experiences into, you know, research, ideas as well as educational, you know, products and those things then serve the system back and influence clinical care. So it's like a big circle.
Dr. Matthew Reinhard:So I really, as part of what I've done there, is to sort of really reinforce this translational center, like you know, to tell everybody this is who we are, this is what we do. This is why we need to hire people with clinical training that also have interest in studying things a little bit further. But we also need this gets back to a previous question of yours about our teeth we also need to have people who really focus on research, because that takes a lot of time and effort, you know, and we need people that understand computational modeling. You know which isn't me, but you know there are people that know how to do that an epidemiologist and we need you know, if we can't have all that in-house, we have to partner with others as well. Hopefully that explains the profit.
Larry Zilliox:Yeah, I will send you a link to Dr Stone's episode. It was fascinating because they had started their research looking at the effects of tier one door kicking operators thinking well, they're exposed to these large blasts, and constantly. And then the EOD instructors asked to be part of it and it turned out that being subjected to the lower level, the sub-level explosions on a more regular basis, seemed to have more of an impact. It was really interesting. What is the center's focus right now? What would you say is the number one thing that you're looking at as a center for environmental exposures of what our service members are going through or may be exposed to today?
Dr. Matthew Reinhard:Well, it's interesting Right now. You were right before me and said it's a new center. We are, we're kind of young, there are cohorts of interest or I would say, let me back up occupations of interest, and so ELD, as we just talked about, is a major interest of ours. We've already learned a lot. We have the only center in VA really focused on that group. I've seen a lot of the veteran patients 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 clinically right now and that's sort of again gets back to this translational model like what can we glean from the clinical care and what are questions that need to be answered? And so we're developing a research project with a partner In this case it's the University of Maryland over here and College Park over in Maryland here and that's really to look at the biological wear and tear of military exposures with that group. And I think we will add additional occupations of interest, I'd say, and kind of wanting to understand probably what Dr Stone was talking about, but how the cumulative military exposures not just blast other exposures that people often aren't considering, whether it be chemical, you know. Obviously people consider sort of stress exposures and things like that. But there may be. There may be toxin and chemical exposures as well that often, you know, researchers aren't thinking about. And so how those things cumulatively may impact, you know, health outcomes, and so we're working with University of Maryland on this concept of allostatic load, which is basically, you know, a cumulative effect of stressors on the body causing physiological changes.
Dr. Matthew Reinhard:Because you know, a lot of the patients I'm seeing really are, you know, some of them are having a lot of difficulties and it's hard for us to always, you know, measure and conceptualize, you know, with our instruments or you know, and I'm a neuropsychologist so I think, sort of measuring cognition. You know our measurements of cognition don't always match up with, you know, people's self-report of what they're saying, that the difficulties are, and so trying to think about different ways in which the cumulative effects of their experiences lead to disease and you know, and stress on the body. So that's an ongoing thing. I'm kind of excited about it because we're sort of finishing up, you know, some dry runs just with our own staff to sort of, you know, be able to enroll participants. So I'm not really advertising it yet, but we're getting there with that, and so that's one occupational group. There are other things I can talk about as well, but that would be one example right now.
Larry Zilliox:Well, I will say that this kind of hits home for me in my service. I was Air and I was in from 77 to 83. The first duty station was Loring Air Force in northern Maine and I remember one night I was in a weapons storage area and I was on a two-man patrol just sitting around and the sergeant I was with was a real knucklehead and he said, hey, come on over here. I got to show you what I found and we went over to this pipe that was sticking out of the ground and he said, look, the top of it is loose. And he swung the top of it around. I'm like, hmm, ok, and we were just standing there and he pushed the top back on and I said, yeah, maybe we should tell somebody. He said, no, no, well, probably within 20 minutes we were both really sick, really sick, and we went to the hospital and they took us in, they kept us overnight and they said, well, you seem to be okay. And then they sent us home and went back to the barracks and that was the end of that. And it wasn't.
Larry Zilliox:My next duty assignment was Guam and I got to thinking, you know, I wonder what made me sick and I actually stumbled upon the environmental safety office that the 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 think he was a captain at the time, I don't remember his name he said, well, let me look into it. And it took months and months and months to get an answer and finally they came back and said oh well, that was something that led to some heavy water, which I had never heard of, and they said you probably inhaled that and that's what made you sick. And I, you know, I just think I was just an Air Force cop, you know, sitting around on a patrol in a weapons storage area, and it just makes me think that you can be on duty just about anywhere in the military and be exposed to all sorts of things.
Larry Zilliox:I really appreciate the fact that the VA and you and your staff and everyone there is thinking about this, when nobody really no one else really was, and it's an amazing service that you provide.
Larry Zilliox:And I think it's also important for our listeners and folks to know how much research the VA really does. It's not just a hospital, somewhere where they treat you when you come in and you know, just treat your symptoms and send you home. There's a lot more that goes into the VA and it's why it has such a large budget. It's also why you need more money, and I encourage all our listeners to make a claim and sign up, and even if you get a zero rating, that's one more body that the VA has to deal with and hopefully Congress will give them more funding for not only benefits but for research like this. So, as we kind of wrap up here, I really appreciate everything that you've told us about the center. I do have one last question for you, and it has to do with artificial intelligence, and how do you think AI will affect the work that you do?
Dr. Matthew Reinhard:That's interesting. I guess I can answer that on a couple levels.
Larry Zilliox:I don't.
Dr. Matthew Reinhard:You know, I think AI right now is used for like assisting writing. You know I don't use it, but I think as it advances it probably will help providers synthesize complex medical records. And this is not in place yet, but I could see a not too distant future where it really synthesizes for, let's say, a physician in this case, although I'm not a physician let's say a physician someone's medical records from the DOD and the VA over, you know many, over decades, and it could maybe distill down and capture, you know many, many thousands of pages of of information to then sort of um, suggest to the doc. You know here's some point to maybe ask about or look at and here's, here's some recommendations, not so much as a, as you know, taking place of of 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 see that happening. I think that is happening in some places already. I'm not sure about the assistant, I could see that happening. I think that is happening in some places already.
Dr. Matthew Reinhard:I'm not sure about the VA, but I could see that being a real benefit to patients. You know, because there's no, we actually in the risk and safety do very deep dives into patients' medical records, but that takes like human man hours and woman hours, you know, and I could see it, hours, you know, and I could see it. If there were a tool that was really much better at that sort of natural language processing and all this kind of stuff, that could model some of those things and come up with suggestions, I could see that being a real help sort of in the short term for healthcare. Yeah, yeah, that's the first thing that comes to mind.
Larry Zilliox:Yeah, yeah, well, that's great. Well, listen, doc. Thanks so much for joining us and taking your time to tell our listeners about the center and wish you all the luck and I've got fingers crossed for much more funding for you. All right, I'll do that. Hopefully you'll see an increase in that soon. And listen, keep up the great work. I really appreciate it.
Dr. Matthew Reinhard:Well, thanks for this opportunity and your interest. Not often I get to be able to talk about the things that we're doing, and it's really not. You know I've talked about the team and this group, but you know it's really not me. We have a very, very good group of scientists and clinical providers here as well, as our leadership has been really, really good. So I feel very fortunate to work for VA and with the mission that it has. So, thank you.
Larry Zilliox:Yeah, For our listeners. If you have any questions or suggestions, you can reach us at podcast at willingwarriorsorg. We'll have another episode next Monday morning at 0500. Until then, thanks for listening.
