Supporting Veterans and Congress by accelerating literature reviews

The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxins (PACT) Act of 2022 expanded healthcare benefits for veterans who’ve been exposed to hazardous materials, and required the Department of Veterans Health Affairs (VHA) to examine how exposures to jet fuels may have impacted the health of veterans. To comply with the law, the VHA Health Outcomes and Military Exposures (VHA HOME) had to quickly produce a report about the health effects of military and occupational jet fuel exposures.

Alongside VHA HOME and Titan Alpha, ICF leveraged its Litstream® program to conduct a rigorous, systematic, and defensible review of scientific evidence, completing this report—and a host of other deliverables—in just one year.

Challenge

To produce the robust and transparent report required by the PACT Act, VHA HOME faced the challenge of identifying and then synthesizing an expansive and complex body of scientific literature. The initial scope of this effort would take years when conducted with traditional, manual methods, but VHA HOME was required to deliver its report on the effects of jet fuel exposures to Congress within one year. VA HOME initially selected a narrow scope for the review, focusing specifically on the most relevant information: jet fuel exposures among military or workers. However, the initial review identified gaps in knowledge, prompting VA HOME to expand the scope to include additional environmental exposures, as well as toxicologic and mechanistic studies—significantly increasing the size and complexity of the review.

Solution

Achieving VHA HOME’s goals for this partnership required rapid scaling, efficient workflows, and high rigor—while ensuring the resulting content remained accessible to non‑scientific audiences.

We developed a tailored, fit-for-purpose systematic review protocol using ICF’s Litstream®. This customized workflow managed references from initial intake through screening, data extraction, and quality evaluation, ensuring consistency and transparency across the entire review process.

We used Litstream®️ to process 3,000+ references and 280+ full-text studies on occupational and military exposure to jet fuels to inform the report to Congress. Later, when VHA expanded the scope of the review to include additional study types, we seamlessly incorporated 1,000+ additional references and 300+ full-text documents into the workflow.

Results

With support from Litstream®, we helped VHA draft the full report to Congress—including an assessment of 14 outcome areas and methodology appendices—in just four months. For the expanded review, we also worked with VHA HOME and Titan Alpha to complete the larger review in a year. At the end of the efforts, ICF, Titan Alpha, and VA HOME collaboratively developed nine peer-reviewed manuscripts supported by interactive digital visualizations of all results.

Through this partnership, we delivered a defensible scientific foundation on an accelerated timeline—supporting VHA’s veterans health planning efforts while demonstrating an effective model for managing complex evidence reviews across varied scientific source types.