This article originally appeared on TheWarHorse.org, a nonprofit investigative news organization focused on covering the Departments of Defense and Veterans Affairs.
At a Senate Veterans Affairs Committee hearing on Sept. 25, Robert Miller, a pulmonologist at Vanderbilt University Medical Center, said chest X-rays and pulmonary function tests came back normal for a few hundred service members he'd recently evaluated. The soldiers had been struggling to run fast enough to pass their fitness tests, becoming tired with normal activity, and generally having difficulty breathing.
But Miller also biopsied the lungs of more than 50 101st Airborne soldiers and determined they had constrictive bronchiolitis, typically seen in lung-transplant patients or as a result of toxic fumes. He ended up diagnosing more than 100 service members with small airways disease.
The military no longer sends soldiers with breathing problems to Miller, saying the biopsies are too invasive. Meanwhile, hundreds of thousands of service members back from Iraq and Afghanistan are developing lung diseases and ailments that all link back to the same environmental hazard that soldiers came forward about 11 years ago: burn pits.
"It has been 10 years since I presented our preliminary data to this committee," Miller said during the hearing. "I hope that it is evident that this issue is not a transient one for our veterans and that too many of them with this disorder feel that they are not receiving proper health care or appropriate disability benefits."
When the burn pit story broke in October 2008, a litany of horrors were found, including service members who, while deployed, coughed up a black phlegm they called the "Iraqi crud"; including pilots who used the pits, which they could see from miles away to guide the way home.
But the details belied a much more insidious truth: As the military burned 250 tons of trash a day in an open pit at Joint Base Balad in Iraq, dioxin, the same Agent Orange chemical notorious for sickening service members during the Vietnam War, drifted through the air in a black plume to poison the air of troops living nearby.
Each base in Iraq and Afghanistan, no matter how small, had a pit where contractors or service members burned everything from human waste to Styrofoam plates to old computers to unexploded ordnance.
Here's the kicker: Experts say troops -- and contractors, foreign nationals, and journalists -- were exposed to the same contaminants as the first responders to the Sept. 11, 2001, attacks on the World Trade Center in New York City.
Researchers have seen respiratory symptoms and asthma rates go up in service members and veterans who deployed to Iraq and Afghanistan versus those who did not, and veterans who have joined Veterans Affairs' burn pit registry report high instances of hypertension and lung disease.
Because they haven't, until now, received the same national attention as have the first responders, advocates worry little will happen to help them address the diseases that have evolved from the wars in Iraq and Afghanistan.
It began in 2008, when Dan Clare, an airman stationed at Balad, sent a memo to Kerry Baker at Disabled American Veterans, who then sent it to me. It stated that a bioenvironmental flight commander there saw a "possibility for chronic health hazards associated with the smoke."
Clare, who has never before been named as the burn pit whistleblower and who now serves as chief communications and outreach director for Disabled American Veterans, said he needed the story told.
"We believed that if it caught on, we'd have a chance to get further ahead on this issue sooner than we could with herbicides in Vietnam," Clare said. "We knew it would take years to fully understand the health risks these exposures would cause -- but there was no doubt from the memo and what we were experiencing on the ground that it could be one generation's Agent Orange."
By speaking out, he risked his military career. At the time, he served as the senior enlisted member of the team that handled media relations for the base.
"It was not an issue where commanders were intentionally poisoning their troops," said Clare. They couldn't get incinerators installed because of the bureaucracy, and they were focused on the war, he said.
Management of the burn pits had been contracted out to KBR Inc., an engineering, aerospace, defense, and construction company, even though the military's own rules prohibited long-term use of burn pits. In January, the Supreme Court refused to hear an appeal filed by veterans against KBR, which said it wasn't liable for any injuries caused by the pits because it was working under the direction of the Defense Department.
After my burn pit story appeared, hundreds of service members sent emails to me about their asthma, chronic coughs, and slow run times. As the stories came in, Baker began maintaining a data base at DAV keeping track of the numbers of people who said they had cancers, breathing problems, and neurological issues they believed were associated with the burn pits.
Meanwhile, Miller said soldiers can't get service connection for their lung injuries, even if they are medically discharged for not being able to meet military standards.
Because their chest X-rays and pulmonary function tests come up normal.
"There's an unwillingness to take it to the next level," Miller said at last month's hearing, adding that the military won't perform the more invasive procedure, but also will not associate lung diseases with the burn pits. "They say, 'We're sorry that you're short of breath. Your X-rays and pulmonary function tests are normal."
In 2017, Miller's research found long-term lung damage in mice and humans exposed to airborne toxins.
Then, Anthony Szema, a doctor who worked for the Northport VA Medical Center, found that services members who deployed to Iraq and Afghanistan had higher rates of asthma than troops who didn't deploy, and about 15% of service members had respiratory symptoms.
Often, the trash was burned with a jet fuel that releases benzene, a carcinogen, Szema said. The pits also released fine particulate matter, which service members breathed in and increased their risk of lung injury, he said. And hundreds of thousands of plastic water bottles were burned, releasing n-hexane, a neurotoxin. He compared the chemicals and particulate to what first responders breathed in when they worked at the World Trade Center.
Both Szema and Miller have seen another surprise in their analyses of lung tissue: bits of dust embedded deep in the lungs.
A new Center of Excellence
Veterans Affairs announced on July 26 a new Center of Excellence for airborne hazards located in New Jersey. The center was created to conduct research, determine proper treatments for those exposed to airborne hazards, train clinicians to work with affected veterans, and monitor the VA's burn pit registry, said Terrence Hayes, a VA spokesperson.
But some argue that progress has been slow on the burn pit issue, and the center follows years of denials from both VA and the Defense Department of ill health effects from the burn pits. Additionally, the registry is hard to join, the data is inaccessible, and there's continued use of burn pits in places like Egypt and Syria.
"DoD and VA had the open burn pits symposium this year," said Rosie Torres, whose husband, retired Army Captain Le Roy Torres, was medically discharged after serving at Balad Air Base. "I was really disappointed to see that almost a decade letter, after we formed our organization, the topic of conversation with VSOs was how to conduct outreach, not about the number of deaths or about research or about benefits."
Torres and her husband formed Burn Pits 360 after a lung biopsy showed he had constrictive bronchiolitis.
"I was a VA employee for 23 years," Torres said. "I was angry. I was like, 'No, we're not going to stand back and let this happen.'"
Their group has issued press releases highlighting the similarities between the dioxins emitted by both the burn pits and the burning wreckage of the World Trade Center, and aggressively pushed the Defense Department and Veterans Affairs to shut down the pits, acknowledge the illnesses, and provide compensation for those suffering from the effects of the toxins.
A first-responder blueprint
Rosie Torres sees a simple solution: She wants compensation similar to that of the World Trade Center first responders that the president signed at the end of July -- after former Daily Show host Jon Stewart appeared on Capitol Hill to goad Congress into action. And she wants a registry similar to that of the first responders, which allows doctors, researchers, and people affected to see collected data -- unlike the VA's registry.
"They have the ultimate blueprint," she said of the first responders. "They have a very effective health monitoring, as well as legislation establishing the connection between exposure and illness."
VA has created Airborne Hazards and Open Burn Pit Registry, but veterans reported not being able to gain access going back to when it first launched in 2014.
Torres sat with a veteran this summer as he tried to sign up for the registry, but after 45 minutes, he had made it only 9% through the registry process, she said.
According to a 2017 report from the National Academies of Sciences, Engineering and Medicine, 40% of people who begin registration quit before they complete it. And the report states that the registry's structure and operation, as well as the registry's questions and method of asking them, is flawed.
As of Aug. 1 of this year, 181,000 people have joined the registry, Hayes said. About 2.77 million people have deployed to Iraq and Afghanistan since 2001. But Hayes did not respond to questions about whether veterans still encountered problems while trying to sign up for the registry.
Training for benefits claims
Kerry Baker, a Marine Corps veteran who while working as a policy and legislation chief at the Veterans Benefits Administration helped write the VA's original 2010 burn pit training letter, which lays out instructions for adjudicating claims related to the pits, said that he's also frustrated by the lack of forward motion on the issue.
"Nothing's changed," he said. "People still aren't following the policy letter. They haven't issued any additional policy letters."
Worse, Baker said he's not seeing good training for the case managers who help veterans file their claims, so many aren't.
"From June 2007 through June 2019, burn-pit related claims accounted for less than one-tenth of a percent of all VA claims processed," Hayes said by email. That's 12,880 of 14,254,956 claims, he explained.
But at the Sept. 25 hearing, when asked why 80% of burn pit claims were denied, Dr. Patricia Hastings, VA's deputy chief consultant for Post-Deployment Health Services, said she was unsure about the number, but it's "harder to connect things that weren't associated with the respiratory system."
Veterans who file claims for migraines and irritable bowel disease related to service connection for the burn pits are often denied, she said.
Baker's not surprised.
Because there's no automatic presumption of burn pit exposure or a presumption of service connection once exposed, as there is with exposure to Agent Orange for Vietnam War veterans, Baker said some VA examiners won't grant it.
"If there's no presumption, it's not there -- it's like they're on robot mode," he said. "If VA doesn't tell them A is related to B, then it can't be related."
And, if a) veterans don't know about the burn pits, b) their case managers assume they can't file for burn pit related compensation, c) doctors don't document burn pit exposure and d) no one knows how to file a burn pit related claim, there are going to be small numbers of claims, he said.
Hayes said some burn pit cases have been approved, however.
"VA has granted service connection for various ailments associated with burn pits and does so on an individual, case-by-case basis after review of a veteran's case," Hayes said.
But Baker said that's not enough.
"The biggest problem as I see with the burn pits now are the examiners," he said, referring to the people who examine veterans and record medical opinions about veterans' injuries and ailments that are then used to determine if those injuries are service connected.
Baker also said that even if doctors suspect a veteran's illness was caused by the burn pits, it's not ending up in the record.
"I'm hearing anecdotally that a lot of treating physicians are supportive of the subject," he said. "But they're afraid to write it down."
Officially, VA says, "research does not show evidence of long-term health problems from exposure to burn pits." Baker said medical professionals fear going against the official VA talking points -- and that even if they do, the compensation and pension examiner, a medical professional, generally a nurse practitioner or physician assistant, often says the lung injury is not service connected regardless of what other medical experts may think. This normally results in benefits being denied.
However, Baker said if burn pit exposure were to be presumptively connected to respiratory illnesses, processing times would likely go down for claims -- and VA could save money in the long run. For now, the results of the claims are all over the place.
"We see people all the time who aren't getting any benefits," Szema said. "Other patients I have seen have been granted 10% disability despite a lung biopsy showing constrictive bronchiolitis. Often soldiers may wait years before a determination that their lung disease is a result of burn pit exposure and qualifies for compensation."
A bit of hope
Both Jon Stewart and former veteran news anchor Ted Koppel have cued up public service announcements to bring publicity to the burn pits issue at a national level, push lawmakers to provide benefits and treatment for exposed veterans, and encourage veterans to get themselves checked.
Koppel, whose wife, Grace Anne Dorney Koppel, was diagnosed with chronic obstructive pulmonary disease in 2001, said he wants to encourage veterans to immediately seek diagnosis, as well as treatment, to ensure they can live longer, healthier lives, as his wife has done, 18 years after her diagnosis.
"I think it's important to include the veterans because somehow veterans are a little bit harder to dismiss, as are the first responders," Koppel said. "Some of them smoked, but most of them got the COPD from the chemicals and smoke they breathed."
Stewart has worked with Burn Pits 360, a burn pit advocacy group, to tell veterans they are eligible for a free exam through Veterans Affairs, as well as to sign up for the VA's burn pit registry.
While people have a better understanding after Stewart's emotional testimony in Congress and PSA about the medical issues New York's first responders face, most don't understand about the "invisible" wounds from burn pits in Iraq and Afghanistan.
"Despite everybody's effort to get the information out, I'd say the general public still doesn't know anything about this," said Szema. While it's almost impossible to see microscopic damage from metals such as iron and titanium without biopsies and special equipment, there are some telltale signs of lung injury, including chronic bronchiolitis, he said. This is different from asthma, though some service members develop asthma. First, an inhaler prescribed for asthma often doesn't work. And second, skin tests for allergens are often negative. The biggest sign is new shortness of breath in someone who previously was a great distance runner, he said.
Doctors can also use oscillometry to see if veterans' airways have narrowed, Szema said.
"A majority of the cases are asthmatic-like, but they're otherwise healthy and have a healthy heart," he said. "Make them go on a treadmill. We're seeing police who served who can't chase down perpetrators."
For that reason, Szema said the security community might be a good place to start a publicity campaign.
And, he added, he and others are working toward a cure.
He believes he has a lock on an effective treatment, and he's working on getting funding for research to get the drug to the FDA.
"We've got the model," he said. "We've shown the drug works. And right now, there's a lot of room for improvement with these lung injuries."