An Institute of Medicine panel this week began its investigation into possible links between illnesses being reported by Iraq and Afghanistan war veterans and contractors and their exposure to burn pits there.
Working on behalf of the Veterans Affairs Department, the panel over the next 18 months plans to scour existing data on burn pits and then recommend whether service members should be provided disability benefits. The committee will not conduct any new health surveys as part of the $1 million investigation.
The VA is empowered to establish a "presumption" that an illness was caused by exposure to an environmental hazard -- even when specific proof is absent -- Victoria Cassano, the VA's acting director of environmental agents service, told the committee at its meeting Tuesday. Establishing this presumption would relieve veterans of having to prove either exposure to the burn pits or causation, she said.
For example, she said, the VA has the "legal authority to presume that all Vietnam veterans were exposed to Agent Orange," a poisonous defoliant used in the war, and cover them for disabilities.
Open-air pits are used to burn garbage and other wastes at bases in Iraq and Afghanistan that lack incinerators. The pits have been cited as the cause of maladies ranging from respiratory problems to cancers in veterans and former contractors who worked at bases. The most commonly discussed burn pit was the now-shuttered 10-acre pit at Joint Base Balad in Iraq.
The largest obstacle to studying a causation between exposure to the open-air burn pits and illnesses has been a lack of individual exposure data, said Craig Postlewaite, acting director of DOD's force health protection and readiness programs.
"We can't assume everybody located at Balad was exposed to the same concentrations of emissions," he said. "Winds blow in different directions ... even if they were on the installation, there is potential for misclassification for different levels of exposure."
He added, "We now have a database that has been populated over the last three years with a once-daily location recording for all of our service members in theater. But there are some limitations to that. We know that not every change in location is reported for every individual," he said. "There's potential for a great amount of misclassification just in terms of who was there."
The VA plans to use the committee's evaluation of the potential long-term health risks from burn pit exposure to help inform its decision on disability coverage.
"You tell us what the science is. You tell us what the evidence is," Cassano told the panel.
The Institute of Medicine, which assembled the committee, is an independent, nonprofit organization that aims to provide unbiased and authoritative advice to decisionmakers. Established in 1970, the institute is the health arm of the National Academy of Sciences.
Controversial DOD study
The Defense Department has held that there are no long-term health effects from living and working close to the pits at bases in Iraq and Afghanistan.
To back its claim, the Pentagon has routinely cited a controversial 2007 study conducted by the Army Center for Health Promotion and Preventive Medicine at Joint Base Balad. That study was criticized last year for failing to measure extremely fine airborne particles, which pose the greatest health risks, and for being conducted during Iraq's rainy season, which would tend to depress levels of airborne soot (Greenwire, Nov. 11, 2009).
The committee on Tuesday also questioned aspects of other DOD studies that examined air quality and respiratory illnesses in Iraq and Afghanistan and pressed for answers on why the Pentagon had not conducted air-dispersion studies to explore how smoke travels at Joint Base Balad.
At the meeting, DOD's Postlewaite reiterated comments he made last year, saying it's "plausible" that "a smaller number of service members may be affected by long-term health effects" from burn-pit exposure, but that other risk factors -- smoking, high levels of airborne particulate matter in Iraq and Afghanistan, and pre-existing health conditions -- make it difficult to pinpoint the exact cause of illnesses in these veterans.
"People that come forward [claiming causation are] all over the map," he said, "there's not a central diagnosis that we can zero on -- this makes it very difficult to determine if there's an association," he said.
The VA's Cassano asked the committee not to be deterred from giving the department as much insight into the matter as it can, even if it is difficult to parse other potential pollutants.
"Where it is significant and appropriate, if you cannot tease out the different variables, then please give me an aggregate understand of what's going on," she said. "Our purpose here is to look for things that may have caused harm to veterans so that we can care for them."
Seventy-three percent of service members redeployed from Joint Base Balad expressed health concerns about burning trash and human waste, Postlewaite said.
Where it is possible, commanders in Iraq and Afghanistan are trying to switch over to using incinerators to dispose of waste, he said. "But there's also been widespread acknowledgment in some cases that won't be possible."
'Important step forward'
The committee is chaired by David Tollerud, the head of environmental and occupational health services at the University of Louisville's School of Public Health. The panel plans to examine the effects of Balad's burn pit on service members and air quality because DOD says it was its largest pit in Iraq or Afghanistan. The scientists will also examine available data from the health effects of burn pits in other conflicts.
In addition, the committee expects to examine data slated to be released this spring comparing air samples taken at Balad last year -- when the base's last burn pit was still in use -- and air samples expected to be taken next month at the base, which now uses four incinerators instead of open-air burning. The committee will also have access to data that have not been formally published.
The final report to the VA will spell out the feasibility of conducting an epidemiology study of veterans exposed to burn pits and make a recommendation on the presumptive coverage question.
Rep. Tim Bishop (D-N.Y.) attended the committee meeting and applauded the VA for taking "an important step forward."
"This is an issue that should be definitive in terms of the science," Bishop said. "I don't think this is mysterious. I think that a careful, methodical study will yield the results that anecdotal evidence has already shown, and that will allow us to act."
Bishop and six other lawmakers had written to VA Secretary Eric Shinseki last February to request a VA investigation into "the combined effect of sand, burn pits, dioxins, benzene and volatile organic compounds on returning veterans" from Iraq and Afghanistan.
Bishop and Rep. Carol Shea-Porter (D-N.H.) introduced legislation last month that would create an official registry documenting the "tens of thousands of troops" exposed to burn pits in hopes of removing obstacles to VA disability benefits and ban open-air burning of large quantities of plastics.