Editor’s note: This is one in a series of reports about the potential health hazards to military personnel who had been deployed to areas with airborne toxins from burn pits, oil fires and desert sandstorms.
Combined with heat sometimes in excess of 120 degrees, the smell lingered — sometimes faint, sometimes overwhelmingly pungent. Always, the smell meant the fires of the burn pits were destroying everything from human waste to batteries.
Depending on a service member’s proximity to the pit, the smell was accompanied by smoke: Sometimes a haze in the air, seemingly a mirage, other times a thick fog.
Millions of service members fighting in areas of Iraq and Afghanistan were subjected to these conditions, because they were ordered to burn everything so it would not fall into enemy hands or impact the environment.
In the three counties surrounding Fort Hood, nearly 60,000 veterans could have been exposed to the health-altering chemicals contained in smoke from those burn pits during deployments to Southwest Asia since the beginning of the Gulf War Era conflict in 1990, according to the Texas Veterans Commission. That does not include the thousands of active duty troops currently stationed at Fort Hood who have been exposed.
Sources of toxins
Burn pits toxins were not the only airborne hazards in the Southwest Asia theater of operations. Heavy black smoke from burning oil fields and the brown-out conditions of frequent sandstorms carried hazards capable of bringing long-term health problems to those exposed.
Yet, of those nearly 60,000 veterans from the Fort Hood area potentially exposed to these toxins, barely 4,500 veterans living within 50 miles of the Temple VA hospital have signed up for the Department of Veterans Affairs’ Airborne Hazards and Open Burn Pit Registry, said Vincent Mitchell, program analyst and registry manager for the VA.
The registry, mandated by Congress, became available to veterans of the Gulf War Era in June 2014, said Dr. Patricia Hastings, deputy chief consultant for the VA’s Post Deployment Health Services in Washington, D.C. The Gulf War Era encompasses all operations in the Southwest Asia theater since August 1990, which includes the wars in Afghanistan and Iraq after Sept. 11, 2001.
Signing up for the registry gives veterans and service members who might have been exposed to toxic chemicals information on what research is being done and the opportunity to get an exam.
“The registry allows us to have a mailing list of sorts to encourage people to have the optional airborne hazards medical exam. It also will allow us in the future to build cohorts to look at studies for health outcomes with regard to their service and proximity to a burn pit, if that occurred,” said Hastings, a retired Army colonel.
Nationally, approximately 3.7 million veterans have been impacted by exposure to burn pits, oil well fires and sandstorms during deployments to places that include Iraq, Afghanistan, Kuwait and Djibouti in the Horn of Africa, Hastings said. This includes current conflicts as well as Operations Desert Shield and Desert Storm.
The U.S. military had 250 burn pit sites in Iraq and Afghanistan alone since the beginning of the War on Terror, according to www.vetshq.com.
“The goal of the registry is three-fold — one is information to the veterans. Like I said, it’s sort of a mailing list if there is something we want to notify a large number of people, we can do mailings to people in our registry,” she said. “We also use it to get them to take the optional medical exam. And then we are looking at it for research that can be done and being able to tie the registry and exposures with health outcomes.”
So far, no illnesses have been linked to exposure to airborne hazards and burn pits, the doctor added. But the VA and the National Academy of Medicine continue to research possible links.
A June 2015 report on the registry done by the VA has found commonalities among participants seen by a medical provider after deployments. They included reported diagnoses of chronic obstructive pulmonary disease (COPD), chronic bronchitism, emphysema and asthma. A small percentage reported constrictive bronchiolitis. Other illnesses reported included cardiovascular issues, insomnia, neurological problems and immune system problems.
A 2011 study by the Institute of Medicine of the National Academies found that between 100 and 200 tons of waste was disposed of each day just at Joint Base Balad in Iraq, according to www.vetshq.com. The study at Joint Base Balad found that five or more chemicals contained within the smoke from the burn pits were associated with health effects such as liver and kidney problems; stomach, respiratory and skin cancers; and reproductive issues.
With many of those health issues, people afflicted require a heavy regimen of medication and frequent medical procedures such as dialysis, seriously affecting their quality of life.
Health hazards have been tied to other conflicts and the VA has registries for them also.
“For example, the Vietnam conflict — there are some health outcomes that are tied with exposure to Agent Orange,” Hastings said. “We haven’t found that (with the burn pits) yet, but we are looking at it continuously because the health of the service members and health of veterans is exceedingly important.
“(The airborne hazards and open burn pit registry is) really a long-term study. There is a latency for a lot of diseases. For example, we would not know of any cancers associated for 10, 20, 30 or more years because there is a latency for some disease processes.”
Nationally, more than 141,000 veterans and active service members have signed up for this particular Gulf War Era registry, but only 5.2 percent who register have opted to take the exam, Hastings said.
“I think in a lot of cases the reason for this is, if they do not have an illness and are feeling OK, then they don’t feel compelled to come in for the burn pit exam,” she said. “But we are trying to encourage (taking the exam).”
The health exam can be done multiple times over the years, she added. “And they are doing it for other veterans — we’ll be tying this to health outcomes over the course of decades, similar to what we’ve done with Agent Orange. Their volunteering to do this helps other soldiers, and it helps other veterans.”
The use of burn pits was a common waste disposal practice at military sites outside of the U.S. such as in Iraq and Afghanistan, according to a fact sheet put out by the VA. Smoke and other emissions from these pits contained an unknown mixture of substances that may have short and long-term health effects, especially for individuals who were exposed for longer periods or those with pre-existing conditions such as asthma or other lung or heart conditions.
“The things burned that are concerning are batteries, other things that could be recycled. There is also the issue of the burning oil wells,” Hastings said. “We also have the issue of some of the different munitions that were burned. It’s a very different environment with regards to the arid, desert environment and the many things that were there, as well as the dust and sand.”
According to a September 2016 report by the Government Accountability Office to Congress, DOD established guidance to meet applicable legislative requirements through the issuance of DOD Instruction 4715.19, which covers how and when the use of open burn pits may be used during overseas contingency operations. However, DOD has not fully assessed the health risks associated with burn pits. DOD officials told GAO that there are short-term effects from being exposed to toxins, but DOD does not have enough data to confirm whether direct exposure to burn pits causes long-term health issues.
The VA’s registry will help DOD gather that data, Hastings said. The registry includes a rather long questionnaire and will take between 40 and 50 minutes to complete, depending on the number of deployments. Part of that is due to asking questions on hobbies, jobs and places the veteran has lived.
“Our over-riding priority is burn pits, but say you decided you were a shooting enthusiast and you make your own bullets — there is exposure to lead,” Hastings said. “So we do ask about hobbies, we ask about jobs.”
Signing up for the registry does not sign a veteran into the VA health care system, however, she said.
Veterans are encouraged to register for VA healthcare for treatment.
While the exams will be free and will help veterans possibly exposed to monitor their personal health, any illnesses they may develop tied to the airborne hazards and open burn pits cannot be treated by the VA unless the veterans sign up separately for VA health care.
“The (registry) exam is not meant for ongoing care — it is an exam to determine health status, so if they want to get care they have to register with the VA,” said Hastings, who served 30 years on active duty in the Army. “I don’t think it’s that onerous — the just have to prove they served, were discharged honorably. I mean, many of us do that.”
Michelle Sivak, a spokesperson for the Department of VA headquarters, said that one of the benefits of signing into the VA health care system is that while most care for veterans can be taken care of at the local VA, if they have an unusual case — something that is hard to diagnose or put together a treatment plan for — there is another level of care offered by the VA to put together an exam and a treatment plan.
After a veteran has exhausted the appropriate specialty consults and the diagnostic capabilities at the local VA facility, a referral for an evaluation at the War Related Illness and Injury Study Center may be appropriate, according to a VA fact sheet. That center provides clinical evaluations for veterans with the most complex, difficult-to-diagnose or medically unexplained health concerns related to airborne hazards or other deployment-related exposures.
“This is an important subject, something the VA is working on very diligently,” Hastings said. “I encourage people to come into the registry and get the optional health exam; the things this registry will provide for research are important.”
For more information on the registry, visit www.publichealth.va.gov/exposures/burnpits/registry.asp.
Reporter David A. Bryant is an Army veteran who had been deployed to Iraq, Kuwait and Djibouti.
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