What Veterans Need to Know About Toxic Embedded Fragments

Medically Reviewed by Mahammad Juber, MD on May 09, 2022

Military members who serve during times of war are under the constant threat of not just severe injuries but also death. Armed forces veterans should also be aware of the long-term effects of the exposure to many toxic substances that they may have come across during active duty. Some of these toxic embedded fragments in veterans can cause symptoms right away, while others can go undetected for several years, which can lead to serious health concerns.

What Are Toxic Embedded Fragments?

An embedded fragment, also called shrapnel, is a piece of metal or any other material, like plastic, that remains inside the body after injury. These fragments may become toxic over time due to the potentially harmful material they're made up.

This usually happens in two ways. In the first scenario, these shrapnel wounds can cause inflammation where the fragments are lodged in the body. In the second, the material of the fragments themselves could be toxic, and when they dissolve, they could reach other parts of the body via the bloodstream and cause other complications.

Although there is no health condition that these shrapnel injuries can cause, the U.S. Department of Veterans Affairs (VA) monitors armed forces personnel with fragments regularly to detect any early onset of complications and provide timely care.

For example, military personnel who served in overseas operations in Iraq and Afghanistan sustained blast injuries in active combat through which toxic embedded fragments entered their bodies. 

At one point after the wars in Iraq and Afghanistan, it was estimated that over 40,000 service personnel had retained a toxic embedded fragment in their bodies after exposure to an improvised explosive device.

The Toxic Embedded Fragment Surveillance Center

VA created the Toxic Embedded Fragment Surveillance Center (TEFSC) to support military veterans in managing health complications due to their exposure to injuries. The TEFSC’s mission statement says that this includes injuries due to bullets, projectiles, blasts, and other detonations that have caused shrapnel injuries to veterans and led to retained fragments in their bodies.

The TEFSC was formed to provide medical care to veterans who served in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND).

The TEFSC maintains a list of veterans who have served in these operations and have either had toxic fragments embedded in their bodies or have had such fragments removed from their bodies. This helps arrive at a diagnosis at a later date. The TEFSC uses this list for multiple purposes:

  • To prepare medical guidelines to treat these veterans
  • To prepare and distribute guidelines to other VA healthcare providers across the country
  • To build infrastructure and test for specific toxic materials that may be discharged from such embedded fragments

You can contact a TEFSC location near you to get tested and learn the benefits that you may be eligible for. The TEFSC is also tasked with supporting veterans in the following ways:

Testing for toxic materials released from embedded fragments. The TEFSC offers a urine collection kit along with a form where you can include details about your injury.

Analyzing the urine sample. Your sample will be tested for exposure to harmful chemicals, and your creatinine levels will also be measured to understand how concentrated or dilute your sample is for effective analysis.

Provide a further course of action based on test results. Although most people have trace amounts of toxic substances in their urine samples due to the quality of the food or water, these tests will determine if there are any unusual levels of toxic substances. If so, the TEFSC will recommend doing the follow-up steps.

If an embedded fragment works its way out of your body naturally, the VA recommends approaching your health care provider and sending the material to the TEFSC for further testing. This will help detect any possible health concerns and address them on time.

What Can You Do?

If you think you may have toxic embedded fragments in your body or are concerned about the effects of such substances, the first step to receiving care from the VA is to register with the VA’s health care system. As a veteran, you can also enroll in health registry evaluations for treatments at the War Related Illness and Injury Study Center run by the VA.

The health registry evaluation is a free and voluntary service that the VA offers to veterans who have come in contact with environmental risks in the line of duty. The VA has created multiple registries that track the health of veterans who have served in specific operations around the world.

Check if You’re Eligible for Veteran Health Care

If you’ve served in the Army, Navy, or Air Force and have been honorably discharged, you may be eligible for VA health care benefits if you've served continuously for 24 months or the complete duration for which you were called to serve originally. You also need to have enlisted after September 7, 1980 or joined active service after October 16, 1981.

The above criteria don’t apply to you if any of the following are true:

  • You were honorably released from duty due to a disability that occurred or became worse during your active duty service.
  • You were honorably discharged for a hardship.
  • You served before September 7, 1980.

You may be placed on a high-priority list to get VA health care benefits if you meet at least one of the below criteria:

  • You were discharged due to a disability that occurred in the line of duty.
  • You were discharged due to a disability that became worse in the line of duty.
  • You’re already getting financial compensation from the VA due to a service-related disability.
  • You’re a former prisoner of war.
  • You’re currently getting a pension from the VA.
  • You’re a recipient of the Purple Heart or the Medal of Honor.
  • You either qualify or get Medicaid benefits.
  • You were on active duty in Vietnam anytime between January 9, 1962, and May 7, 1975.
  • You were on active duty during the Gulf War between August 2, 1990, and November 11, 1998.
  • You were on active duty for a minimum of 30 days at Camp Lejeune between August 1, 1953, and December 31, 1987.

Show Sources


Airborne Hazards Related to Deployment: “Toxic Embedded Fragments Registry: Lessons Learned.”

U.S. Department of Veterans Affairs: “Eligibility for VA health care,” “Health Care for Veterans,” “Military Toxic Exposures,” “Toxic Embedded Fragment Surveillance Center: Information For Veterans.”

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