WASHINGTON, DC—Legislators are concerned that a lack of detailed knowledge about the environmental hazards that troops are exposed to during deployment will result in health consequences further down the line. Specifically, they are concerned as to whether DoD is collecting enough data and whether that information, if it exists, is being transferred in a swift and detailed manner to the Department of Veterans Affairs, where it will be useful in the treatment of sick veterans.

Exposure at Home and Abroad

At a Senate Veterans Affairs Committee hearing last month, legislators heard about cases—both confirmed and unconfirmed—where troops were exposed to environmental contaminants that impacted their health and that of their families. The cases ranged from contaminated drinking water at Camp Lejeune Marine base in North Carolina in the 1980s, to burn pits still being used to dispose of waste in Iraq and Afghanistan.

The Camp Lejeune incident was of particular concern to North Carolina Sen Richard Burr, ranking Republican on the committee. “The residents of Camp Lejeune didn’t know it at the time, but the water they were drinking, cooking with, and bathing in contained harmful chemicals—including TCE, PCE, benzene, and vinyl chloride—that are known or probable human carcinogens,” Sen Burr said.

As many as 40 adult men who were either stationed there or who were children of parents stationed there have been diagnosed with rare male breast cancer linked to exposure to the contaminated tap water. Burr has introduced legislation that would allow veterans stationed at Camp Lejeune while the water was contaminated to get medical care from the VA, and would also allow the VA to treat their families for any conditions associated with exposure to the contaminated water.

The environmental contaminants at Camp Lejeune have been extensively documented, as have the health effects. Information on other possible and probable environmental hazard areas is far spottier. Exposure to sodium dichromate and hexavalent chromium at the Qarmat Ali water treatment plant in Basra, Iraq has likely resulted in acute conditions like skin burns and bleeding, and long-term lung cancer risk for soldiers stationed there. But blood tests taken from soldiers during their time there might not be sufficient to determine the severity of exposure.

Exposure in June 2003 to a fire at the Mishraq Sulfur Mine—the largest sulfur mine in the world, located in northern Iraq—has resulted in many soldiers presenting with constrictive bronchiolitis upon returning home. Linking such symptoms to toxic exposure is difficult without a biopsy. Also, the type and extent of the toxins created by the fire are still unknown.

And an incinerator facility adjacent to the US Naval Air Facility at Atsugi Japan, southwest of Tokyo, has been identified as a possible environmental hazard, causing increased cancer risk in children, and possibly adults, stationed at the facility. However, an analysis of the plant failed to determine the extent of the environmental hazard and the potential danger to service members and their families.

Knowledge Needed Before and After Deployment

Two common themes in these cases were a general lack of information about environmental hazards during deployment, and a similar lack of information about links to health consequences following deployment. It was pointed out by legislators that similar ignorance led to the fallout from Agent Orange used in Vietnam and environmental links to Gulf War illnesses. However, Department of Defense officials stated that the military has significantly improved its ability to determine possible dangers to service-members.

According to Craig Postlewaite, DVM, MPH, acting director of Force Health Protection and Readiness Programs, DoD applies a rigorous risk management program to prevent or limit hazardous exposures both in peacetime and in deployed settings. “We are dedicated to protecting and preserving the health of our personnel by identifying hazards, ascertaining the significance of any health or safety risks associated with the hazards, determining appropriate options to control the hazards, and communicating risk information to commanders and affected personnel,” Dr Postlewaite declared.

Since 2001, DoD has collected more than 17,500 environmental samples throughout its theater of operations, including 10,000 in Iraq, more than 3,500 in Kuwait, and more than 3,300 in Afghanistan. “In the vast majority of cases, these data indicate US personnel are not experiencing any exposures that would put their long-term health at risk.”

He admitted, though, that with current technology, it is not possible in a wartime environment to monitor all locations that a service member may be exposed to. And that effort becomes more difficult for those who operate outside of base camps. “While our focus continues to remain on exposure prevention and control, we realize what some exposures can do, and that they will occur despite our best efforts,” Dr Postlewaite said.

To ensure that VA is aware of all individual hazardous exposures DoD has record of, exposure-related information is entered into each individual’s medical record so it will be available at the time of treatment or claims adjudication, Dr Postlewaite said. That process will be significantly improved by the creation of the DoD electronic individual exposure records. That database is expected to become a reality in the next few years, he added, and will be made available to VA.

Exposure Epidemiology

On the VA side, a new study currently underway will help VA assess environmental exposure risks for the latest generation of veterans. The study begins with examining 30,000 veterans deployed to OIF/OEF and 30,000 comparison veterans who were not deployed. It includes veterans in each branch of service, including Reserve and Guard members. Female veterans are being oversampled to provide a large enough comparison population.

“The study compares them for chronic medical conditions, TBI, PTSD, and other psychological conditions. It also looks at general health perceptions, reproductive health, pregnancy outcomes, behavioral risk factors, and VA disability compensations,” explained Michael Peterson, DVM, VA’s environmental health chief. “It will help us see what conditions are disproportionately identified in the deployed population. And that will provide an evidence base for health care treatment and possibly service presumption for benefits.”

“One of the many lessons VA has learned from experiences with Agent Orange and Gulf War illnesses is that information regarding possible exposure to toxicants both within the combat theatre and other areas in which our troops operate must be received and acted upon by VA as early as possible,” Dr Peterson said.

This requires as much up-to-date information on environmental hazards as it is possible to collect, so that VA physicians can better evaluate a servicemember’s individual risk of exposure and mitigate any health effects that may have occurred as a result. And epidemiological studies on troops are better than retrospective studies conducted after a contaminant and adverse health effect has been determined, Dr Peterson noted.

Burn Pits

Legislators focused much of their attention on ongoing environmental hazards, like the burn pits being utilized throughout the combat theater. Used in a number of camps in Iraq and Afghanistan, they are considered an expedient means of disposing of the waste generated by those camps so that the waste itself does not become a health hazard. The general desire by commanders is to locate the burn pit as far away from the camps as possible.

“Unfortunately, some of these burn pits were located quite close to the camps, in some cases upwind of the camps,” Dr Postlewaite admitted. “Some of that was due to hostilities in the area, and commanders didn’t feel that they could locate them very far away from the installations without putting their people at risk.” Occasionally burn pits were located on a camp’s periphery, but as the camps grew they encroached on and sometimes incorporated the burn pits.

The burn pit at the Balad Air Base in northern Iraq is the largest currently in operation and frequently cited as one of the worst environmental sites in theater. Being the largest, and in a relatively safe area, it is also the burn pit DoD has been able to study the most. Over 400 air samples were taken at Balad in 2007. Analysis of those samples did not indicate a health risk, Dr Postlewaite said.

“We do feel like some people probably have suffered some untoward health effects because of it, but we don’t feel the numbers are large,” he noted. “We aren’t seeing significant elevations of the kinds of conditions that we would expect as a result of exposure to [toxic] smoke.”

DoD is still examining the site and currently conducting a site-specific study on people deployed at Balad to see if their health results differ in any way from those not deployed there. The mixed message of recommending burn pits be placed as far from camps as possible, but saying there are no adverse health effects, did not please legislators. “If exposure to burn pits has some potential downstream effect, I want a VA doctor to know exactly where that person was so they can see them and treat them based upon what their exposure might be,” Sen Burr declared.

“This problem is far worse than the delays in sharing the electronic medical record,” Sen. Burr said. “It’s much worse, because even where we identify things that potentially could cause long-term health conditions to our active duty, Reserve and Guard, there’s not an attempt to download that information to where we know these individuals will be at some point receiving their health care.”

He places blame equally on VA’s shoulders, he added, “for not screaming about the need to get this information.”

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