A new report from a scientific advisory panel finds some evidence that chronic respiratory symptoms, such as coughing and wheezing, are linked to service in the 1990-91 Persian Gulf War and post-9/11 combat environments such as Iraq and Afghanistan.
But the research, published Friday by the National Academies of Sciences, Engineering and Medicine, found there was not enough evidence or data to conclude a link between combat deployments to the Middle East and Afghanistan and many serious pulmonary diseases -- a finding likely to disappoint thousands of service members who believe their poor health was caused by open-air burn pits used by the U.S. military for waste disposal or by the dust or emissions inhaled while they served overseas.
The Department of Veterans Affairs asked the National Academies in 2018 to review existing scientific and medical research to determine whether such deployments contributed to the development of respiratory illnesses in U.S. service members.
An 11-member panel led by Dr. Mark Utell, professor of medicine and environmental medicine at the University of Rochester Medical Center, could not definitively prove any association between deployment and more than 20 health conditions, including non-cancerous respiratory disorders such as sinusitis, sleep apnea, constrictive bronchiolitis and chronic obstructive pulmonary disease, as well as cancers of the lungs, esophagus, mouth and nasal passages.
Panel members said their conclusions did not mean there was no link, but simply that research or data does not exist to draw a connection.
"The committee experienced a general sense of frustration, given the testimonials that we heard and obvious interest in outcomes. For example, asthma in theater -- the data did not support it, and it was a frustrating aspect of our work on the committee," said panel member Dr. Svere Vedal, professor emeritus in the department of environmental and occupational health sciences at the University of Washington School of Public Health.
The panel was able to determine that "limited or suggestive evidence" existed of an association between deployment for veterans who served in the first Gulf War and those who served in military operations after Sept. 11, 2001, and chronic cough, shortness of breath and wheezing.
The "limited or suggested evidence" characterization might make it easier for thousands of Gulf veterans with such symptoms to receive VA disability compensation, but the VA would have to accept the ruling and add the symptoms to a list of illnesses presumed to be connected to overseas service in the Persian Gulf and post-9/11.
The VA historically has listed conditions with the same designation for exposures such as Agent Orange but, since 2016, has not listed any new conditions recommended by the National Academies as having "limited or suggested evidence" as service-related.
More than 3.7 million service members have deployed to the areas studied since 1990, beginning with the Persian Gulf War. During these operations, troops were exposed to smoke from oil well fires; burn pits; operational airborne hazards such as exhaust and industrial emissions; and airborne dust stirred up during combat and storms.
Service members in Iraq and Afghanistan reported that they were exposed to various hazardous materials as a result of what was burned in the pits, including garbage, plastics, batteries and other waste, and some have respiratory diseases, rare cancers and neurological disorders their doctors attribute to environmental exposures.
According to the report, the panelists found that the research done to date on airborne exposures in the region since 1990 has not been adequate or the studies lacked the scientific rigor required to confirm association.
For example, they noted, many of the studies they reviewed assumed that deployed veterans all had the same exposure, which ignores the fact that service members were assigned across locations and time and did not have the same exposure.
They also found that studies failed to account for cigarette smoking, and the mortality research they examined often did not specify the cause of death, making it impossible to determine how many veterans have died from respiratory diseases.
"We know that there were hazardous exposures, but we have limited information on who was actually exposed, what they were exposed to where, and what concentration they were exposed to over what time and how frequently exposure occurred," Utell said. "In light of that, the committee recommended some things need to be done, and rather than just throwing up our hands and saying 'more needs to be done,' we made constructive recommendations."
The committee recommended specific studies be done on veterans who may have been exposed, using biomarkers to provide more information on exposure effects and susceptibility.
Advanced technology could be used to analyze satellite data taken during operations in the past 30 years, and the Defense Department could improve its understanding of battlefield pollutants by equipping service members with wearable devices to monitor exposures and health conditions, panel members noted.
And they also recommended that the VA conduct an analysis of mortality among this cohort of veterans -- something it hasn't done since 2011. The VA should continue identifying subpopulations to study and follow across time to fully understand the effects of exposures, the panel suggested.
A number of bills have been introduced in Congress this year to improve the lives of veterans whose health has been affected by exposure to airborne pollutants. On Tuesday, comedian Jon Stewart and activist John Feal will join Sen. Kirsten Gillibrand, D-N.Y.; Rep. Raul Ruiz, D-Calif.; and veterans to call attention to the issue and introduce new legislation.
Stewart, who pressed Congress to continue funding a compensation fund for the families of 9/11 victims, has said that the issue is "about the way we go to war as a country."
"We always have money to make war. We need to always have money to take care of what happens to people who are selfless enough, patriotic enough, to wage those wars on our behalf," Stewart said earlier this year.