Burn pits—where trash and other waste are disposed of through burning in large, uncovered pits, often with an accelerant like jet fuel—were once commonly used by the U.S. military, particularly in Iraq, Afghanistan, and other areas of the Southwest Asia theater of military operations. In recent years, the Department of Defense has largely phased out their use, with plans to close all remaining active sites. While not much was known about the long-term implications of burn pits when they were first introduced, recent studies have shown the clear detrimental effects of exposure to burn pits on the health of tens of thousands of veterans and servicemembers. Among the waste products incinerated in burn pits are paint, chemicals, medical and human waste, and other toxins that can cause serious harm to the skin, eyes, respiratory and cardiovascular systems, as well as internal organs.
Unfortunately, instead of receiving care and treatment for the injuries and illnesses resulting from exposure to burn pits, veterans continue to face challenges because in far too many cases VA refuses to acknowledge that these injuries are service-connected. Many are struggling to get adequate care and compensation despite years of effort and clear evidence of ill health. Disabled American Veterans (DAV) is among several veteran service organizations advocating for long-delayed reform in VA’s response to the harms caused by burn pits. DAV and other advocacy groups are lobbying for legislation that would add presumptive conditions for service-connection, removing bureaucratic barriers for veterans with injuries related to burn pit exposure.
The 2022 DAV Distinguished Speakers Series at Harvard Law School put a spotlight on the toxic health effects of burn pits, and featured a keynote address by U.S. Senator Kirsten Gillibrand (D-NY). The event was especially timely, given VA’s recent announcement of its intention to add, as of March 1, nine rare respiratory cancers to the list of presumed service-connected disabilities that stem from exposure to toxic chemicals. The event underscored that this was just a small first step in responding to this crisis.
Senator Gillibrand was joined for a panel discussion by Shane Liermann, Deputy National Legislative Director at DAV and Marine Corps veteran; Anthony M. Szema, M.D., a leading expert on the health impacts of burn pit exposures and Clinical Associate Professor of Occupational Medicine, Epidemiology, and Prevention, and Clinical Associate Professor of Medicine (Divisions of Pulmonary/Critical Care and Allergy/Immunology) at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; and Rosie Torres and Le Roy Torres, co-founders of Burn Pits 360. Rosie is the organization’s executive director and Le Roy is a veteran of the Iraq War.
A Significant and Timely Issue
Senator Gillibrand opened the discussion by noting that while many veterans face difficulties in navigating the claims process, there are hurdles unique to veterans dealing with the effects of exposure to burn pits. The type of injuries that afflict veterans exposed to burn pits can be unusual and their course not well known, given the relative recency of exposure and limited research on the issue. Consequently, when veterans seek treatment, they are often told that they are the first of a certain type of injury the doctor has seen, prompting referrals to other doctors. Veterans ill from exposure to burn pits often have to see multiple specialists to find definitive answers on their condition, as many in the medical field may be unaware of the types of injuries and illness caused by burn pits.
We sent these brave servicemembers on tours of duty that exposed them to dangerous conditions on the battlefield and off. We asked them to live in places around the world where burn pits were used to destroy everything from plastics and electronics to human waste, creating toxic, poisonous air and we asked them to breathe it in every day. Just because these toxic wounds are hidden, it doesn’t mean that we can ignore them. We have the responsibility and obligation to help. This healthcare is the cost of war. And we have to pay it.
Senator Kirsten Gillibrand
VA estimates that over 3.5 million service members were exposed to burn pits. Over 290,000 of those have added themselves to the national burn pit registry, which DAV was instrumental in launching. The Airborne Hazards and Open Burn Pit Registry, created in 2014 and run by VA, is a voluntary database of information about veterans and servicemembers that seeks to make participants more aware about their own health, track trends in illnesses, and help researchers study the long-term health effects of exposure to burn pits.
Despite the registry and existing evidence on the harm caused by burn pits, VA denies the majority of disability claims related to this toxic exposure. Having started to recognize some of the detrimental health effects of burn pits, in 2010 Congress banned the use of these pits except where there are not feasible alternatives. Similar health problems were present among Vietnam veterans exposed to Agent Orange and among 9/11 first responders. Senator Gillibrand remarked that this is one instance in which history should not repeat itself, stating “to deny [veterans] the care they have earned is a dereliction of our duty.”
Senator Gillibrand has met with many constituents exposed to burn pits during their military service. Some of these service members have lost military colleagues and fellow veterans to lung disease in their thirties and others have described in horrifying detail what it was like to live and work near burn pits, with black smoke and soot hanging in the air and sticking to clothes and tents.
This is why our slogan at Burn Pits 360 is the war that followed us home. We thought it was over when we came home. And here we are years or a decade later still in the fight.
Le Roy Torres, Army veteran and Co-founder of Burn Pits 360
Collecting and Analyzing New Information
Dr. Szema explained that research into the burn pits is constantly evolving, with new evidence of burn pits’ lasting health effects regularly coming to light. He described biopsies that show burn particles in the lungs of soldiers, similar to what has been found in the biopsies of those who had inhaled burning jet fuel at Ground Zero. According to Dr. Szema, the fact that he has treated many veterans with damaged lungs who were nonsmokers serves as further proof that their deteriorating health is linked to burn pits. Despite growing evidence of causal links, Dr. Szema observed that resistance remains, saying that “there’s no question the VA would be evasive in denying that there is a link here.”
To his senior position at DAV, Liermann brings more than 20 years’ experience as benefits advocate and policy expert. Besides receiving VA disability compensation, Liermann said that the reason service connection for these injuries is important is that it often serves as a gateway to other benefits, especially health care. Thus, receiving a denial for a burn pit claim compounds the stressors veterans are already facing. Liermann explained that this is why presumptive symptoms are so important in establishing a link between toxic exposure and illness, noting parallels between the effects of burn pit exposure to those of exposure to Agent Orange. Given that this is not the first instance of servicemembers suffering significant health effects from exposure to toxic chemicals, efforts to establish presumptive service connection are essential, “so that the next generation doesn’t have to wait 30 years” to access benefits and health care, he said.
Part of the problem with the whole process is there isn’t one specific design [that is] applicable for all exposures, all disabilities… from 2007 until now, the VA has received over 13,000 claims just on burn pit conditions and they denied roughly 77% of them.
Shane Liermann, Marine Corps Veteran and Deputy National Legislative Director at DAV
When veterans first started coming forward with complaints of injuries from burn pits, Le Roy Torres said there were gaps in information about what was truly making them sick, and their doctors didn’t make a clear connection between the veterans’ time in service and their health conditions. Many veterans were also unaware that there were others like them, facing the same injuries from having served in similar areas around the same time. He explained that is why collecting tests and data for scientific research are critically important in establishing that this is a widespread and ongoing problem for the thousands who served in Iraq, Afghanistan, and other locations where burn pits were used. As Torres made clear, “this is the war that followed us home,” noting that providers who were aware of his injuries had no idea that these were recurring issues and were common among those returning home from deployment.
Rosie Torres stated that, as a military spouse, she had a first-hand view of how the stressors affected her husband. Burn Pits 360, which she co-founded with her husband, started as a community of military spouses meeting online, but soon the scope of the problem, and the need for concerted action, became undeniable. “We can’t sit back and become the next Agent Orange,” she said. Soon they were advocating for veterans’ rights at the Congressional level.
Navigating the VA Claims Process
Sen. Gillibrand underscored that one of the most important things to do to begin to address burn pit exposure is to bring veterans, advocates, and medical experts together, just as the DAV Speaker Series has done. Getting the word out about people’s stories is vital, according to Senator Gillibrand, as many are still unaware of the toxic consequences burn pits have had, and continue to have, for thousands of veterans. Broad lack of awareness of the issue contributes to the number of veterans who are denied benefits and the number who might not even seek benefits in the first place.
The Torreses echoed this sentiment, stating that Le Roy was told he faced additional hurdles because he had been activated as a reservist and not an active-duty member during the period in which he faced exposure to burn pits. He was also barred from certain medical studies for similar reasons. Liermann explained that one obstacle is that there is not one specific presumptive process applicable to all exposures and that the high rate of denial is proof that the direct service route simply is not working.
Unless you understand the claims process and the policies behind lung injury and things of that nature, it is really tough. We did finally receive the constrictive bronchiolitis diagnosis, [but] even then it was a challenge for Le Roy to receive compensable rate for that specific disease because it was not listed in the code of federal regulations.
Rosie Torres, Co-founder and Executive Director of Burn Pits 360
Dr. Szema drew a parallel to the effort to implement monitoring for 9/11 first responders after certain diagnoses became common, allowing those conditions to be caught earlier for other first responders. Similar monitoring should be started sooner for illnesses stemming from burn pit exposures. More specifically, said Dr. Szema, academic centers of excellence, which report to Congress annually and produce peer-reviewed research, are well positioned to research emerging and ongoing health issues among veterans exposed to burn pits.
The Torreses stressed that outreach starting on the local level is key to taking note of systemic injuries like this in the future. Their circle of outreach started small, with just a few people discussing their situations via an online chat, but when their numbers grew, they realized that the problems they were facing were not rare at all, and that many other veterans were suffering from similar injuries.
In communicating with others, the Torreses found that many had given up on the VA claims process, citing how it had affected other aspects of their life, and that they lacked the resources and energy to continue challenging claim denials. Their nonprofit, Burn Pits 360, seeks to educate as much as it advocates, providing template letters and information to those just starting the claims process for these injuries. DAV has a national program of service officers who represent veterans in the claims process.
On How To Make Change and Ease Burdens of Proof
Senator Gillibrand described her fight for passage of the Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act. The bill, which was co-sponsored by Senator Marco Rubio and has bipartisan support in both the House and Senate, would remove the burden of proof from veterans to establish a causal link between certain medical conditions and their military service. A veteran would only have to submit proof that they received a Gulf War Medal or a campaign medal linked to the Global War on Terror to receive benefits for injuries caused by burn pits and other toxins.
Looking Ahead, Legislative Fixes
Overall, the panelists agreed that much progress has been made as more veterans come forward with their injuries, and a coalition is working urgently to address the the harms caused by burn pit exposure among veterans. But panelists emphasized the need for continued advocacy and more action to spur reform. On March 1, President Biden made burn pits a key talking point during his State of the Union address, calling on Congress to do more for those exposed to burn pits, saying we have a “sacred obligation” to care for veterans after they return home and ensure that they can access benefits and health care. Critically, President Biden also announced expanded eligibility for benefits for veterans suffering from a group of respiratory cancers believed to be caused by exposure to burn pits.
The VA is asking too much and providing too little. The longer we wait for more studies to prove the causation that we already know, the more veterans will suffer and die.
Senator Kirsten Gillibrand
On March 3, 2022 the House of Representatives passed its own version of a burn pit bill, similar to the legislation introduced by Senator Gillibrand, called the Honoring our PACT Act. It was passed on a bipartisan basis, and while the language of the House and Senate bills will need to be reconciled, the passage of such legislation would serve to further streamline the process for establishing service-connection for veterans who have been exposed to burn pits. Many lawmakers have recently made the same point Liermann raised during the panel discussion —any costs associated with this legislation should be thought of as another cost of war, and should not be subject to the restrictions of the PAYGO budget rule, which stipulates that new legislative spending must be offset by cuts to some other program. For many service members, the relief is long overdue.
View a recording of the event and read more about our panelists at: legalservicescenter.org/dav-speaker-series-2022/
***
Previous speakers in the DAV Speaker Series have included Hon. Robert Davis, Chief Judge of the U.S. Court of Appeals for Veterans Claims; Dr. David Shulkin, Secretary of VA; Ray Mabus, Secretary of the Navy; Robert McDonald, Secretary of VA; Hon. Robert Russell, founder of the nation’s first veterans treatment court; Lieutenant Colonel Shannon McLaughlin, the lead plaintiff in a federal lawsuit demanding that partners and family members of LGBTQ military service members and veterans receive the same benefits as those of heterosexual service members; Delphine Metcalf-Foster, National Commander of the Disabled American Veterans, and the first woman to hold that position at DAV, a one-million-member veterans services organization; Barbara Ward, former Director of VA Center for Minority Veterans; Christopher Parker, a Navy veteran and Professor of Political Science at the University of Washington; and Will Gunn, HLS ’86, the former general counsel for the US Department of Veterans Affairs and first-ever chief defense counsel in the Department of Defense Office of Military Commissions, which was charged with representing prisoners at Guantanamo Bay. Read more about the work the Veterans Legal Clinic here.