What is the increased risk of Amyotrophic Lateral Sclerosis (ALS) in military personnel?

From the Guidelines

The increased risk of ALS in military personnel is likely due to a combination of environmental toxins, physical exertion, traumatic brain injuries, and psychological stress, as well as potential genetic predispositions, as suggested by recent studies 1.

Key Factors Contributing to ALS Risk in Military Personnel

• Environmental toxins, such as lead from weapons, chemicals, pesticides, and air pollutants from burn pits, which have been linked to neurological damage
• Physical exertion and traumatic brain injuries, which are common in military service and may contribute to motor neuron degeneration
• Psychological stress and PTSD, which can trigger inflammatory responses that potentially damage motor neurons
• Deployment to certain regions, which may expose service members to specific environmental factors, such as those experienced by Gulf War veterans who show higher ALS rates
• Genetic factors, which may play a role in susceptibility to developing ALS when exposed to these environmental triggers

Reducing ALS Risk in Military Personnel

While no specific prevention measures exist, reducing exposure to known toxins and prompt treatment of traumatic brain injuries may help mitigate some risk factors. Additionally, investment in research and innovation, such as the creation of a network for ALS clinical care, education, research, and innovation within the Department of Veterans Affairs (VA), may lead to critical discoveries on ALS causality and improve access to high-quality ALS care for veterans 1. Prioritizing access to multidisciplinary care, including respiratory device access and support services, is also essential for improving quality of life and quantity of life for individuals with ALS 1.

From the Research

Increased Risk of ALS in Military Personnel

The relationship between military service and the increased risk of Amyotrophic Lateral Sclerosis (ALS) has been explored in various studies. Key findings include:

• A systematic review of 19 articles, including 1 meta-analysis and 18 original observational studies, suggested a possible association between military service and the subsequent development of ALS, although the evidence was limited 2.
• Exposure to certain chemicals, heavy metals, and head trauma appeared to increase the risk of ALS among military personnel 2.
• A case-control study of U.S. military veterans found higher odds of ALS for veterans whose longest deployment was World War II or the Korean War, and a positive trend with total years of all deployments 3.
• The study also found positive associations between ALS and exposure to herbicides, nasopharyngeal radium, personal pesticides, exhaust from heaters or generators, and other military-related factors 3.

Military-Related Factors and ALS Etiology

Several studies have investigated the relationship between military-related factors and ALS etiology, including:

• A review of 30 articles or abstracts published through 2013, which suggested a positive association between military service and ALS etiology, but found the evidence to be limited 4.
• A prospective study of a population-representative cohort of U.S. men and women, which found an increased adjusted ALS death rate among men who served in the military, particularly those who served during World War II 5.
• A population-based case-control study in Denmark, which found that employment in the military was associated with an increased risk of developing ALS, with a 10-year increase in years employed by the military associated with an odds ratio of 1.2 6.

Potential Exposures and Risk Factors

Potential exposures and risk factors for ALS among military personnel include:

• Exposure to pesticides, including Agent Orange 2, 3.
• Exposure to certain chemicals, such as exhaust from heaters or generators, and heavy metals 2, 3.
• Head trauma 2.
• Herbicides, nasopharyngeal radium, and personal pesticides 3.
• Burning agents, contaminated food, and explosions within one mile 3.