October 30, 2019 – by Dr. Kiersten Downs, Research Director, ScoutInsight and Céilí Peake, Research and Marketing Intern, ScoutInsight
ScoutInsight, the market research division of ScoutComms, recently conducted a survey for Warrior Centric Health (WCH), a veteran-owned company focused on educating medical practitioners in the private sector about the healthcare needs of military veterans. The survey explored veterans’ experiences seeking medical care in the private sector. When respondents were asked what they felt medical practitioners should be knowledgeable about with regards to treating veterans, findings revealed that medical practitioners ought to ask patients if they have a history of military service. If the patient answers in the affirmative, inquiry should be made into possible exposures the veteran might have encountered during their military service. Known and unknown exposures that service members are currently being or have been subjected to during military service pose real threats to their health both during and after service. Public awareness and advocacy on the issue are critical to our healthcare journeys. This month’s ScoutInsight Spotlight examines the issue area of toxic exposures and military service.
Analysis by Dr. Kiersten Downs, Research Director, ScoutComms
Drawing a lot of press over the past week due to the release of his new book is Dr. David Shulkin, the former Secretary of the Department of Veterans Affairs. Dr. Shulkin served under President Obama and was later unanimously confirmed to serve as a member of President Trump’s cabinet. Amidst a slew of VA scandals Trump quickly dismissed Shulkin via one of his infamous tweets because, as stated by Trump, Shulkin didn’t agree with the White House’s efforts to expand care for veterans in the private sector. While Washington continues to play its game of power politics, veterans subjected to vile contaminates during their military service are suffering from debilitating illnesses en masse from Agent Orange exposure in Vietnam, burn pit exposure across the Middle East, and biological warfare agents, among other contaminants. Regardless of personal opinions of Shulkin and the drama surrounding in his dismissal, credit needs to be given for his dedicated advocacy for granting veterans with Agent Orange exposure needed VA benefits. Shulkin was a proponent of including bladder cancer, Parkinson’s-like symptoms, and hypothyroidism to the growing list of presumptive diseases eligible for Agent Orange service-connected benefits. Unfortunately, he faced intense scrutiny from White House officials derailing the approval effort using claims of a lack of supporting evidence linking these illnesses to the toxin. The challenge is that exposures can be difficult to prove epidemiologically, especially when a population such as military veterans are exposed to so much in the span of our military careers. I understand the argument of needing supporting scientific evidence to link exposures to certain illnesses. Yet too often, politics take center stage and impacted people live at the periphery. The end result is the denial of military-connected people accessing the healthcare they need, leaving them economically disenfranchised, ill, aggravated, and isolated by systems that are supposed to help them.
A “toxic exposure” is considered by the VA to be an umbrella term that includes exposure to “hazardous chemicals and materials”. Exposures can take forms including airborne exposures, illnesses due to toxic drinking water, and occupational hazards such as toxic chemicals used during military service, and medications issued during military service. Examples of exposures include burn pits, Agent Orange, asbestos, mustard gas, contaminated drinking water, and radiation exposure. Biological warfare agents given to deployed troops administered under the intent of protection can produce side effects resulting in debilitating illness. Examples of biological warfare agents include anthrax and botulinum toxoid; pyridostigmine bromide, used during the Gulf War to protect against nerve agent attacks; the smallpox vaccine; and Mefloquine, used to prevent malaria. This list is certainly not exhaustive.
The VA website acknowledges that veterans who served as long ago as WWII may have been victims of toxic exposure, and goes on to document an alarming laundry list of potential contaminants which suggests that toxic exposure has always been a significant risk for service members. Multiple operations during the Vietnam War exposed troops to defoliation sprays, most often Agent Orange. Despite exposure-connected diseases and symptoms never being labeled a “syndrome,” the struggle for recognition of illnesses these combat veterans face was similar to the experiences of future generations struggling to access healthcare for combat-related diseases.
As stated by Marine veteran and applied anthropologist Dr. Jodie Sweezey in her dissertation on Gulf War Syndrome, despite decades-long focus by the media and medical research the Department of Veterans Affairs Research Advisory Committee (RAC) on Gulf War Veterans’ Illnesses did not acknowledge a Gulf War-era syndrome until its 2008 report (RAC 2008:4). Immediately following Operation Desert Shield/Desert Storm in 1991, stories emerged of unexplained symptoms plaguing veterans, not only in the United States but also from partner nations including Great Britain, Australia, Canada, the Czech Republic, and France (Carnall 1996, Emmerova 2004, Gwini et al.2016, Kerr 2015, McKenzie et al.2015, Nettleman 2015, Reid et al.2001, Richter et al.2015, and Schumm 2004). Because there was no overarching diagnosis for these symptoms, an umbrella term was used for reference–Gulf War Syndrome. By the late 1990s, the new moniker of Gulf War Illness was adopted in relevant research. More recently, the VA referred to it as “chronic multi-symptom illness,” or “undiagnosed illness” due to the varied symptoms (Department of Veterans Affairs Public Health 2015). However, they now refer to it as “medically unexplained illnesses (popularly known as Gulf War Syndrome).”
The Department of Veterans Affairs estimates that 3.7 million veterans and service members were exposed to the toxic fumes from burn pits. The total number of veterans exposed to burn pit contaminants remains elusive because burn pit sites and their debris have either not been made readily available or such information was not recorded accurately. Burn pits resulted from the construction of Forward Operating Bases (FOBs), populated by thousands of US service members, contractors, and workers from other countries. According to Dr. Kenneth MacLeash and Dr. Zoë Wool, these FOBs generated hundreds of tons of waste per day, and all of it—from plastic water bottles and Styrofoam food trays, to vehicles parts, batteries, ammunition, and medical waste—was dumped into shallow open-air pits, some of them hundreds of feet long. During my own deployment to Balad Airbase in Iraq between 2006 and 2007, I remember a putrid smell in the air when I woke up early in the morning to exercise. When the wind blew towards our sleeping quarters, the soot was visible on my skin. Just outside the wire of the bustling base city was the biggest burn pit I had ever seen, with visible remnants of vehicles, refrigerators, and trucks that would dump loads of plastic bottles that were delivered on thousands of pallets for us to drink. Wool and MacLeash continue to study burn pits and their research elaborate on how the waste was doused in jet fuel and set ablaze, often burning around the clock for years on end. This model of waste management, they state, was replicated on smaller bases and outposts, and even tiny, platoon-sized observation and command posts burned their trash in improvised pits.
Legislative efforts to spur research into toxic exposure and compensate affected service members have had limited success. Vietnam Veterans of America’s successful push to pass the Agent Orange Act of 1991 laid the groundwork for Congress to not only recognize the dangers of toxic exposure, but also research how military personnel have been impaired by chemical contaminants such as Agent Orange. Unfortunately, few effective steps have been taken to further compensate victims of toxic exposure, or even further research into the matter. In 2016 Congress passed the Veterans Health Care and Benefits Improvement Act which directed the VA to facilitate toxic exposure research, but little progress has been made on this front.
The ‘Blue Water’ Veterans Bill will restore the presumptive disability status for veterans who had served in the seas around Vietnam and therefore allows greater access to VA disability benefits. Sen. Kirsten Gillibrand (D-NY), one of the bill’s sponsors, argued that the VA’s policy of “only treating those who stepped on Vietnam’s soil or served on boats on inland waters…is arbitrary and capricious.” The bill, which is expected to be signed into law, will go into effect on January 1, 2020, but the VA has announced a stay on “blue water” veterans’ claims decisions until that date. This year, more than a dozen advocacy groups will join forces to track and highlight toxic exposure illnesses among former military members in an attempt to push for quicker action. Some groups involved include Wounded Warrior Project, Vietnam Veterans of America, Iraq and Afghanistan Veterans of America, Veteran Warriors Inc., and the Tragedy Assistance Program for Survivors. This coalition is forming after Justice officials announced they will not appeal a federal court ruling which awarded presumptive disability benefit status to about 90,000 “blue water” Vietnam veterans who served in ships at sea during the war there. The Blue Water veterans case has been dragged through the courts for years as veterans’ claims were denied by VA officials under the precedent that a clear lack of evidence exists linking their illnesses to cancer-causing defoliants. A lack of evidence is often cited as the primary reason for denial to exposure claims. We are seeing a similar fight with modern exposure to burn pits for veterans who developed health problems after serving in Iraq and Afghanistan.
While VA Secretary Robert Wilkie said it is necessary to “minimize the impact on all veterans filing for disability compensation,” retired Navy Cmdr. John Wells of the Military-Veterans Advocacy noted that “time is of the essence in this matter” as many veterans affected by Agent Orange exposure may pass away during the stay. Individual members of Congress have introduced bills to address issues that fall under the umbrella of toxic exposure–for example, Congressman Dennis Ross (R-FL) championed a bill extending disability benefits to service members exposed to Agent Orange in Guam, and Sen. Burr’s Janey Ensminger Act was intended to protect veterans exposed to chemical contaminants at Camp Lejeune. Wells writes that “VA intransigence appears to be the prohibitive factor” in passing these bills.
The Protection for Veterans’ Burn Pit Exposure Act of 2018 remains in subcommittee; it would direct the VA to presume service connection for veterans with illnesses related to open burn pit exposure. On June 7, 2018 the House Committee on Veterans Affairs held the first ever hearingon the health effects of the US military’s overseas burn pits. In recent years, much of the focus in Congress on burn pits has centered on improving research to inform future benefits decisions. This past January, the U.S. Supreme Court rejected an appeal in which veterans sought to hold private companies responsible for their use of open-air burn pits. The decision was based on the statement that burn pits are an issue that Congress, rather than the courts, needs to prioritize.
The Burn Pit Registry Enhancement Act (HR 1381) proposed by Rep. Raul Ruiz (D-CA), a former emergency room doctor and medical school administrator, would allow any veterans who can show burn pit exposure to receive “priority group 6” status for VA care. His motivation for the legislation was due to his personal research that he believes proves a clear link between burn pit exposure and physical ramifications including pulmonary issues, lung diseases, and cancers. Passage of this legislation would prioritize veterans exposed to burn pits ahead of veterans without any service-connected problems when seeking appointments in the department’s health system. It would also lessen the standard of proof to receive disability benefits for burn pit veterans with lung diseases. Additionally, the legislation would allow family members to submit information into VA’s Burn Pit Registry, giving the department information on veterans who passed away from suspected toxic exposure illnesses or who are too sick to access the list themselves.
No matter what era of military service an individual participated in, the list of possible exposures is vast. We need to be as proactive with our healthcare as possible. Part of this requires identifying possible exposures veterans may have been subjected to and breaching discussions about these exposures with our healthcare providers whether in the private sector, community care clinics, or the Department of Veterans Affairs. It’s important to note that family members of veterans can be affected by toxic exposures too, whether through drinking water or unsafe living conditions on military bases, or via genetic exposure from their biological parents who may have participated in military service. One step veterans and family members can take is to ensure that veterans are signed up for healthcare benefits through the Department of Veterans Affairs. Another productive step is to review medical records for correct dates of service and deployment history. I served from 2001 to 2009 and after a review of my personal records two years ago, I realized that the wrong deployment history was included in my records. I quickly took steps to correct this as memories of burn pit exposure while on my deployment to Iraq, exposure to chemicals like jet fuel and hydro fluid, and the experiences of many sick friends who are veterans, are always on my mind.
A good place to begin the exploration of toxic exposures is the VA’s A-Z list of exposure topics. The VA also provides a breakdown of exposures by conflict and health concern to help guide conversations with healthcare providers. At the end of this article we have provided a list of resources for veterans, family members, and caregivers relating to toxic exposures and military service. The list is likely not exhaustive but we hope it will provide valuable information and organizations to contact that are focused on this issue.
Kiersten Downs, PhD, Research Director and Program Lead for ScoutInsight, the market research division of ScoutComms.
Dr. Downs is an Air Force Veteran and Applied Anthropologist with over a decade of experience in research and managing projects that focus on Veteran policy, transition and reintegration, suicide prevention, military sexual trauma, and employment needs.
Céilí Peake, Research and Marketing Intern supporting ScoutInsight, the market research division of ScoutComms. Céilí is pursuing a Bachelor’s Degree in Statistics at George Mason University.
Resource List for More Information on Toxic Exposure and Military-Connected Populations
Veterans and Servicemembers who have deployed to the Southwest Asia theater of operations on or after August 2, 1990 as well as those who have deployed to Afghanistan or Djibouti after September 11, 2001 can use the registry questionnaire to report exposures to airborne hazards (such as smoke from burn pits, oil-well fires, or pollution during deployment), as well as other exposures and health concerns.
DAV has been a leading advocate for veterans who have suffered illnesses believed to be caused by toxic exposures. For example, the organization’s representatives in Washington, D.C., have long fought for Blue Water Navy Vietnam veterans to be granted the same presumption of exposure to Agent Orange as other so-called “boots on the ground,” finally seeing significant victories for these veterans in 2019. See Vietnam War veterans: health concerns and benefits for more information.)
VVA’s goals are to promote and support the full range of issues important to Vietnam veterans, create a new identity for this generation of veterans, and change public perception of Vietnam veterans. VVA is at the forefront of advocacy in making sure that Vietnam veterans get benefits for toxic exposures.
Military personnel who served at the Marine Corps Base Camp Lejeune or Marine Corps Air Station (MCAS) New River in North Carolina may have had contact with contaminants in the drinking water there. If you have qualifying service at Camp Lejeune and a current diagnosis of certain conditions, you may be eligible for disability benefits.
NAAV was founded in August, 1979 by the late Orville E. Kelly (of Burlington, Iowa) for the purposes of allowing the U. S. Atomic Veteran Community to speak with a single voice, to their inability to get a fair hearing related to their developing (radiogenic) health issues that may have been precipitated by their exposure to “ionizing” radiation while participating in a nuclear weapon test detonation, or a “post-test” event.
The VA presumes that any veteran who served in Vietnam between January 9, 1962 and May 7, 1975 was exposed to Agent Orange. However, other military-connected populations, including other veterans working around the planes who carried the chemical as well as veterans stationed at the Navy’s Camp Garcia in Puerto Rico, may also have been exposed to Agent Orange in the 1970s. This resource details the service members who may be eligible for Agent Orange-connected disability benefits, lists health issues associated with Agent Orange exposure, and guides veterans through the process of applying for associated VA benefits.
Vets4Warriors is a one-of-a-kind 24/7 peer support network that complements official government resources available to service members and veterans. We are committed to ensuring that all veterans, service members, their families, and caregivers always have direct and immediate access to a peer who understands their life experiences and the challenges they face, and can provide support whenever they confront an issue, wherever they are in the world. We serve veterans of all generations and the entire military community.