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Information on Depleted Uranium (DU)

A Resource for VA-NJHCS Health Care Providers

Be educated about Depleted Uranium! Prepare yourself to help your patients!

Some of our newest veterans are concerned about possible exposure to Depleted Uranium (DU). This fact sheet contains important information regarding:

  • Assessment of degree of exposure to DU
  • Possible health risks from DU exposure
  • Resources available to help address veterans' and service members' concerns

The web sites listed at the end are good sources of additional information and updates.

What is Depleted Uranium (DU)?

Depleted Uranium (DU) is a by-product of Uranium processing. Uranium is a weakly radioactive, naturally occurring metal mined from the earth's crust that is found in air, water, soil and food. DU has some of its radioactive component removed during processing- it is 40% less radioactive than natural uranium. DU primarily emits alpha particles, which do not penetrate intact skin.

What are the sources of DU exposure for Service Members?

Because of its density and relatively low cost, DU is used by the U.S. and other militaries to strengthen special armor on tanks and other equipment. DU is currently the most effective metal to use in armor to protect service members. It is also used to harden munitions so they penetrate targets better. The first time DU was used by the US military in large quantities was during the Persian Gulf War in the early 1990's.

How does Depleted Uranium get into the body?

DU is harmless as long as it remains outside the body. Therefore, just being in the vicinity of tanks or ammunition made with DU will not result in exposure. "Exposure" is often a difficult concept for veterans and service members to understand. It is important to explain that "exposure" to a hazardous substance requires that first there is a source of the material, and second, that the substance is able to get into the body. Veterans may be confused and think being near equipment made of DU means they were exposed. It is important to let them know that just being near equipment made of DU does not pose a health risk. Even when DU munitions are fired, or after "cooking off" the surrounding metal in fires or explosions, the exposed DU is not a health threat as long as the metal remains outside the body.

Exposure to DU only occurs if it gets into the body via metal fragments or dust-like particles that are inhaled into the lungs, are swallowed, contaminate open wounds or become embedded under the skin (shrapnel). The highest potential for exposure to DU is in service members who are involved in fires or explosions involving DU munitions or equipment. DU shrapnel can be embedded in the body and DU particles can be inhaled and ingested as part of the visible smoke from burning DU-armored vehicles or exploded DU munitions.

What happens to the DU once it's in the body?

Studies show that most of the DU that is swallowed is excreted in feces without ever being absorbed into the bloodstream. Inhaled DU particles may settle in the lung, but most are probably carried up by mucociliary action and swallowed. The DU shrapnel may be removed by surgery, or may need to remain in the body because of its location. How long the DU remains in the body depends on where it is located, the DU particle size, how much is present, and how easily the particles dissolve. DU that is retained anywhere in the body is gradually absorbed into the blood stream, circulated around the body, then processed by the kidney and excreted in the urine. This process of absorption and excretion can occur for years. While the absorbed DU is circulating, some of the DU particles settle in other parts of the body and may remain in the bones, kidneys and other soft tissues.

Possible health effects resulting from DU exposure.

Questions have been asked as to whether exposure to DU can cause any long term health effects and, in particular, whether there are effects from its radioactivity. DU is an extremely weak radioactive substance. The radioactivity of external DU does not pose a health concern and does not increase the risk of any illness, including cancer. The radioactivity of DU has been studied by many governmental and non-governmental bodies including the Veterans Affairs, Department of Defense, World Health Organization, and the United Kingdom Royal Society.

The potential for health effects from exposure to DU depends on the amount of DU that remains in the body, which depends on the type and duration of the exposure. Occupational epidemiology studies of uranium miners and processors, groups with very high occupational exposure over a very long time, show that any long term effect of high DU exposure would be on the kidneys. These studies have shown that the primary health effect of high doses of uranium is a heavy metal effect on the kidneys, causing kidney function to gradually worsen. Increases in lung cancer among uranium miners have been attributed to smoking and radon gas exposure, not the uranium.

Very few service members have enough DU remaining in their body to result in any health effects. There are ongoing studies of Veterans of Operation Desert Storm who have DU shrapnel embedded in their bodies compared to veterans who had no exposure to DU. These Veterans have the highest level of exposure to DU because of the metal embedded in their bodies. After almost 10 years of follow up, the DU shrapnel group has not had any health problems that can be linked to the DU, including cancer, birth defects and kidney problems, even though their measures of uranium on a urine test are elevated, as expected. Only minor differences have been detected. These differences did not persist from year to year and were not big enough to impact a person's daily life (Squibb & McDiarmid, 2006; McDiarmid et al, 2004; McDiarmid et al, 2001).

Talking about the risks of DU exposure with a patient.

The field of risk communication provides some guidance about how to discuss environmental health risks with people. Among the most critical components are TRUST and CREDIBILITY. These characteristics are often judged in the first moments of the initial interaction. Two strategies to increase trust and credibility are LISTENING and EMPATHIZING. These are both actions that must be demonstrated; you cannot assume that the patient knows you feel empathy or are actually listening unless you provide them with some visible sign that you are doing so. You can REFLECT what the patient is telling you- "It sounds like you're concerned about your exposure to depleted uranium." You can also ACKNOWLEDGE their fear and normalize it- "Other veterans are also concerned about depleted uranium. I see that you are concerned about having possible exposure to it."

Allow the patient to completely state what his or her concerns are before attempting to provide the factual information. This will allow you to tailor the information to that individual's need and allow you to gauge the extent of concern. After you have a sense of this, offer to read through the patient education sheet about DU with him or her. Together you can assess the probable level of exposure to DU and decide on a plan of action.

When should an individual be tested?

Even though research studies show that the majority of service men and women who work around DU will not experience harmful health effects, veterans are often concerned anyway. In part, this may be because it is often difficult to figure out the amount of exposure someone may have received. The following table provides some guidance to what the probable burden of DU is for an individual, given the different types of exposures.

The key questions to ask to determine a veterans' probable DU burden are:

Question about exposure Possible Exposure(s) Chance of DU in Body
Did you have contact with intact DU equipment? Handling DU munitions or sitting inside or near a vehicle with intact DU armor. Zero
Did you fire DU munitions? Loading and firing weapons that fire armor piercing ammunition made of DU. Some smoke/fumes may be present, especially in closed spaces (e.g., tanks). Very unlikely
Were you in close proximity to burning or exploded DU? Being in the smoke cloud of exploded DU munitions or burning DU armor, such as on an Abrams battle tank or a Bradley fighting vehicle Slight to moderate chance of inhalation and/or ingestion of DU particles
Do you have retained DU shrapnel in your body? Metal fragments from DU armor or DU munitions remain in the body after an attack or accident High chance of DU in the body; could be non-DU fragments, however

In general, most services members have not taken sufficient DU into their bodies to need testing.

What if the veteran has a probable exposure or feels it is very important to have a test?

If you and the veteran feel his or her exposure to DU may have been large, send the patient for an evaluation by the Environmental Health Clinician (Drew Helmer, MD, MS; East Orange x 2714) for the Depleted Uranium Evaluation Protocol. This will involve additional discussion of his or her deployment exposures and health concerns. It is part of the Persian Gulf War Registry Examination, which is an effort to standardize the evaluation of all veterans who serve in SW Asia to characterize their health concerns, symptoms and diagnoses. The hope is that patterns of illness can be detected early and possibly linked to specific exposures through the registry. The registry exam is a one hour evaluation by a physician with experience in deployment health concerns of veterans of conflict in SW Asia.

As an alternative, especially if the veteran has additional deployment-related health or exposure concerns or has any chronic symptoms that defy diagnosis after standard work up, consider sending him or her to the War-Related Illness and Injury Study Center for a comprehensive post-deployment health assessment. This multidisciplinary evaluation includes an environmental and occupational exposure assessment and can incorporate the DU urine testing.

If the veteran does not appear to have significant exposure to DU, but desires to have the DU testing anyway, this can be accommodated without a problem. However, it is important that you explain that a positive DU excretion rate is not evidence of a health effect (see below).

To refer the veteran for a Persian Gulf War Registry Examination call the Environmental Health Coordinator (Greg Ciencin; East Orange x 1298) to schedule an appointment. If the patient is unable to make the extra visit, it is possible for the primary care provider to order the 24 hour urine test for DU. The provider must complete the DU Evaluation Protocol (VA form 10-9009D, DU Questionnaire) and contact the Environmental Health Coordinator (Greg Ciencin) at East Orange x 1298 for further instructions. The form is available on the VA Forms website (http://www.va.gov/vaforms).

To refer a deployed veteran to the War-Related Illness and Injury Study Center (WRIISC), submit a consult through CPRS. It is listed as 'Wriisc- Local Evaluation'. OIF/OEF veterans do not need to have medically unexplained symptoms, but must have deployment-related health concerns.

What is the 'test' for DU and what does it show?

The test is a 24-hour urine collection that measures the total uranium that is excreted in the urine, the so-called excretion rate. If the level of uranium is high, additional testing of the same urine sample will examine how much of the total uranium is DU. This test is processed by the Baltimore VA Medical Center (for more details, call 800-815-7533). Results will indicate the individual's level of DU excreted in the urine relative to the normal range of DU excretion in the general population. While other tests are occasionally used, the 24-hour urinary excretion rate is considered the 'gold standard'.

The results of the 24-hour urine test for uranium will be communicated directly to the veteran by letter. A copy is sent to the referring VA provider, as well. It is important to know that the test does not measure any impact on kidney function or any health effect of the DU. If the result is elevated, the patient may be enrolled in an ongoing program to follow the uranium excretion rate over time. This determination will be made based on discussions among the veteran, the veteran's VA primary care provider and the staff at the Baltimore DU Follow-up Program. Annual measures of kidney function (BUN, creatinine, and urinalysis) would be prudent and likely reassuring to the veteran, as indicators of a possible health effect.

*The information contained in this sheet was obtained in part from the following sources. It was developed by a group of health care providers with special concern about deployment-related health concerns. For more information, see the following websites:

Additional References:

  • Squibb K & McDiarmid MA. "Depleted uranium exposure and health effects in Gulf War Veterans." Phil Trans R Soc 2006; 361:639-48.
  • McDiarmid MA, Engelhardt S, Oliver M, et al. "Health effects of depleted uranium on exposed Gulf War Veterans: A 10-year follow-up." J Tox Environ Health 2004;67:277-96.
  • McDiarmid MA, Squibb K, Engelhardt, et al. "Surveillance of depleted uranium exposed Gulf War Veterans: Health effects observed in an enlarged 'friendly fire' cohort." JOEM 2001;43(12):991-1000.

This document was developed by the War Related Illness and Injury Study Center (WRIISC)
VA-New Jersey Health Care System in East Orange, NJ
Last Updated December 16, 2005.