To enhance exposure-related care for service members, veterans and other beneficiaries, the Department of Defense and Department of Veterans Affairs created the Individual Longitudinal Exposure Record (ILER) in 2019.

ILER is a new information technology system that aggregates occupational, deployment, and assignments information with known exposures for specific jobs and specific locations. It provides an access point to search by individual, location, and exposure type across an individual's long-term military history.

Signed by President Joe Biden in 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act, otherwise known as the PACT Act, expands health care benefits for veterans who served at specific locations with exposures in the Vietnam War, Gulf Wars, and post-wartime 9/11 eras. Additionally, it adds presumptive conditions for burn pit and other toxic exposures that veterans do not need to prove are service connected. Today, ILER produces more than 6.3 million exposure summaries for veterans and service members. Full eligibility requirements and coverage is available through a VA fact sheet at VA.gov. 

DOD and VA track toxic exposures using multiple exposure registries such as the Agent Orange, Airborne Hazards and Open Burn Pit, Depleted Uranium Follow-up, Gulf War Ionizing Radiation, Toxic Embedded Fragments and Defense Occupational and Environmental Health Readiness System Industry Hygiene registries.

Veterans who voluntarily join the registries are monitored for health trends, assist research efforts linking exposure to long-term or latent health effects, and are contacted by VA to determine health care coverage and benefits. However, the reliability of self-reporting exposure registries is limited because veterans rely on their memories rather than historical records.

ILER provides DOD and VA clinicians, claims adjudicators, and benefits advisors the information needed to improve health care delivery. It also expedites benefits adjudication from an average of two years to under two weeks.

Additionally, ILER also gives health effects researchers, epidemiologists, and policymakers greater awareness of exposure events to assess and monitor exposure impacts.

Currently, via the Joint Longitudinal Viewer ("JLV"), ILER interacts with MHS GENESIS through the health care provider, and both the beneficiary and the provider can review exposures histories, explained Steven Jones, program director for Force Readiness and Health Assurance policy oversight at the Office of the Assistant Secretary of Defense, Health Affairs. "The beneficiary's diagnosis and treatment plan are better guided with relevant exposure information from ILER."

In October 2022, ILER hit one million active queries. On average, ILER is queried between 15,000 to 18,500 times per day, and that figure continues to grow.

The Federal Electronic Health Record Modernization office is now focusing on interfacing ILER with the federal electronic health record, enabling the exchange of exposure data as part of the federal EHR.

"Currently ILER is only accessible by DOD and VA health care providers, researchers, epidemiologists and claims adjudicators," said Jones. "There are current development efforts for DOD and VA beneficiaries to access their ILER exposure summary through DOD and VA Authentication interfaces using the Common Access Card ("CAC") and the Personal Identity Verification ("PIV") access platforms such as id.me and login.gov.

All service members and veterans who have a military record should have an entry within ILER. Beneficiaries do not need to register with ILER.

"Being able to exchange exposure data as part of the federal EHR equips our providers and researchers with critical information to inform patient care," said Bill Tinston, FEHRM director. "I cannot wait to see where this innovation takes us in enhancing care for our service members, veterans and other beneficiaries."

To learn more, check out the ILER Fact Sheet.