A bipartisan measure to expand medical coverage for millions of Iraq and Afghanistan veterans exposed to toxic fire pits stalled Thursday after 25 Republican senators who supported the bill last month changed their minds.
The move prevented the legislation from reaching President Biden’s office. The bill has already been passed in the House of Representatives, and an earlier version was passed in the Senate last month, before some changes were made. Proponents of the measure were surprised that the current version did not sail again.
It’s about the way military bases in Iraq and Afghanistan disposed of waste from around 2010 to 2015: by dumping it in a pit and setting it on fire in the open.
Many veterans attribute later-onset health problems, such as cancer and respiratory diseases, to exposure to chemicals released into the air from these fires. The smoke contained a range of harmful substances, including lead, mercury, benzene, hydrocarbons, dioxins and volatile organic compounds.
“Those deployed to bases where fire pits were used were clearly exposed to agents known to be harmful,” said David Savitz, a professor of epidemiology at Brown University School of Public Health.
The legislation would have expanded access to health care to more than 3.5 million veterans who were exposed to toxins while serving in the military after September 11, 2001. It would also have added 23 diseases, including various cancers, to the list. of conditions eligible for federal health care coverage.
Sergeant First Class Heath Robinson fulfilling our promise to address the Comprehensive Toxics Act of 2022 — or PACT Act, as it’s known — was named after an American veteran who attributed his lung cancer to burn exposure. Robinson died of his illness in 2020.
Savitz and other experts said that burning waste like the military did could certainly increase the risk of disease, but more research is needed to know whether the ailments veterans report were directly caused by fire pits. Regardless, they believe that veterans should be able to receive the care they seek.
“The legislation was very important to provide health benefits to veterans who receive and care for these types of lung diseases and a suspected diagnosis of rare cancer,” said Steven Coughlin, a professor of epidemiology at Augusta University. “Hopefully they’ll bounce back.”
Why did fire pits turn out to be so toxic?
Savitz said fire pits were gradually being replaced by incinerators around 2010. But before that, the military set fire to all kinds of waste in the open air.
“They burned everything they had — everything from the garbage, the food waste, the medical waste, water bottles,” he said.
Coughlin said the list included plastics, cardboard, heavy metals and vehicle parts.
“They poured jet fuel on it to ignite it, and they burned these piles of garbage day and night,” he said.
Fire pits were often located near barracks, so combatants “often breathed this crud daily with significant exposure,” Coughlin said.
Exposure to fire pits during military service has since been linked to a number of respiratory and cardiovascular diseases, including asthma, bronchitis and chronic obstructive pulmonary disease. A small 2011 study also identified cases of constrictive bronchiolitis — a rare but potentially fatal lung condition — in previously healthy soldiers serving in Iraq and Afghanistan.
A possible association with cancer is weaker, both experts said, as veterans from Iraq and Afghanistan have been exposed to fire pits in the past two decades and some cancers are only diagnosed longer after exposure to a carcinogen.
“There are widespread reports of veterans getting rare cancers,” Coughlin said. But “it can take decades — 30, 40, 50 years — for some chronic diseases to manifest.”
The PACT Act proposes adding lung, brain, kidney, gastrointestinal and other cancers to the list of diseases eligible for more comprehensive health coverage.
Veterans Affairs Secretary Denis McDonough expressed support for the PACT bill in May.
“The bipartisan bill will help us advance one of the department’s top priorities: getting more veterans into VA care,” McDonough said in a statement. “President Biden has also been clear about his commitment to getting more VA health care for veterans affected by toxic exposure, which is why we need Congress to send the PACT bill to his office.”
Biden’s son Beau died of a brain tumor in 2015 while serving in Iraq on military bases that used fire pits.
Coughlin said that of the several compounds soldiers were exposed to, dioxins are of particular concern because of a link with respiratory cancer.
“Humans are not designed to deal with exposure to dioxins,” he said. “There is no safe exposure limit.”
However, it can be challenging to make a casual link between burns and illness, Savitz said, because exposures weren’t well documented by the military. He is currently investigating whether people with respiratory or cardiovascular disease were previously stationed at fire pit bases.
For now, Savitz said, “it has not been directly shown that those exposed to fire pits during their military service actually have long-term elevated rates of illness.”
But he and Coughlin said the government shouldn’t wait to provide health care to veterans until scientists fully understand all the risks of burn exposure.
“It’s important to make sure these veterans get the right care and not wait for epidemiology to catch up,” Coughlin said.