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Iraq and Afghan war vets exposed to toxic air struggle for breath — and a diagnosis

Among the more than 2.5 million men and women who have served in the wars in Iraq and Afghanistan, there are many veterans -- exposed to sandstorms, burn pits and other hazards -- who suffer from a mysterious pulmonary illness, as well as the confusion and doubt that surrounds their condition. The NewsHour's Dan Sagalyn reports, with narration from Nick Schifrin.

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  • Judy Woodruff:

    But first, more than 2.5 million men and women have served in the wars in Iraq and Afghanistan.

    The health challenges many veterans face when they return home, such as post-traumatic stress disorder or traumatic brain injury, are well-documented.

    But there’s another illness many military personnel suffer from that’s led to a fight among doctors over how to diagnose the condition. Some doubt it even exists.

    Nick Schifrin returns now with this story, produced and reported by the “NewsHour”‘s Dan Sagalyn.

  • Nick Schifrin:

    On the edge of a U.S. base in Kuwait, the entire horizon has become a cloud of dust.

  • Man:

    That is just insane.

  • Nick Schifrin:

    It’s 2011. U.S. service members have been stationed in the desert for eight years. And in a matter of seconds, what was once a blue sky becomes thick yellow dust, and then red, and then darkness.

  • Man:

    Now we can’t see anything.

  • Nick Schifrin:

    Sandstorms like this were routine, not only in Kuwait, but theater-wide, in Iraq and Afghanistan. So were thick black clouds of smoke.

  • Man:

    Luckily, the wind is not blowing our way.

  • Nick Schifrin:

    The military used burn pits to dispose of pretty much everything, from tires to batteries to styrofoam, all burned near where soldiers lived and where soldiers worked.

    The horror of car bombs produced combat dust and debris. Soldiers inhaled all that dust, all that smoke, and it may have afflicted them with higher-than-average rates of asthma, bronchitis, and other pulmonary disorders.

  • Cynthia Aman:

    I find myself struggling, when I pull into a parking lot, even at the grocery store, because I know what’s going to happen. If I have to park in the back of the parking lot, by the time I get inside, I’m so winded that it’s miserable for me to even do my grocery shopping.

  • Nick Schifrin:

    Former Army Sergeant Cynthia Aman is one of more than 360,000 Iraq and Afghan war veterans diagnosed with lung disease and seen by Department of Veteran Affairs.

    Aman’s Missouri National Guard police company deployed to Kuwait and Iraq in 2003. She says, in her yearlong deployment, she suffered dozens of sand storms.

  • Cynthia Aman:

    The only thing we had were like scarves or things to cover our faces. So, when we were out doing these missions in these small camps, a sandstorm would come up so quickly that you — the only thing you can do is try to cover your face. And I joke now, but it was almost like we were eating it.

  • Nick Schifrin:

    Aman lives in Delaware with her husband and daughter. She leaned on her family for support while she struggled to figure out what was wrong.

  • Cynthia Aman:

    It’s been a year-and-a-half, almost two years of nonstop jumping through hoops and fighting trying to get answers and get a definitive diagnosis.

  • Nick Schifrin:

    Aman travels from her home in Delaware to Washington to advocate for veterans. She says, at first, doctors said the problem was in her mind.

  • Cynthia Aman:

    When I first starting going to the VA and explaining my symptoms, automatically, they were telling me it was anxiety. I was just hyperventilating. They tried to put me on antipsychotic medications, different mood stabilizers and things of that nature.

    And I was telling them, no. My shortness of breath, it’s something physical. I know it is. It’s not psychological. I’m not depressed. I’m not anxious. You know, I want to find an answer.

  • Nick Schifrin:

    After dozens of medical tests, Aman got a surgical procedure like the one seen here, a lung biopsy, where doctors remove a sample of her lung.

    When they examined it, they realized she had constrictive bronchiolitis, a lung disease where the small airways are destroyed. It’s rare among civilians, and there’s no treatment or cure.

    The first time U.S. troops came down with constrictive bronchiolitis, it’s believed they’d breathed in the black haze caused by a sulfur fire like this one. It spewed toxic fumes for almost a month. But the unit’s doctors couldn’t figure out the source of the soldiers’ lung problems, so they sought out Dr. Robert Miller of Vanderbilt University.

  • Dr. Robert Miller:

    When we started seeing service members with unexplained shortness of breath, they had already had a number of noninvasive studies, chest X-rays, C.T. scans, pulmonary function tests, exercise tests. None of these tests seemed to explain their exercise limitation.

  • Nick Schifrin:

    The patients were undiagnosable without lung biopsies that are expensive and invasive and carry some risk. He published his findings in “The New England Journal of Medicine.”

  • Dr. Robert Miller:

    Small airways disease is known to be a stealth-like disease. It is difficult to diagnose it without a lung biopsy.

  • Dr. Allyn Harris:

    Constrictive bronchiolitis is the most common, far and away the most common thing that I see, which is a disease of the small airways.

  • Nick Schifrin:

    Doctor Allyn Harris is a pulmonologist at the Jackson, Mississippi, VA Medical Center. We met her at a conference attended by veterans with lung disease, including Cynthia Aman.

  • Dr. Allyn Harris:

    I think it’s underdiagnosed, for sure, nationwide.

  • Nick Schifrin:

    Dr. Harris says she has around 200 patients who have constrictive bronchiolitis.

  • Dr. Allyn Harris:

    My feeling is that constrictive bronchiolitis is very prevalent, and probably second only to PTSD.

  • Nick Schifrin:

    The VA has diagnosed more than 390,000 Iraq and Afghanistan veterans with PTSD, or post-traumatic stress disorder.

    And they argue patients with constrictive bronchiolitis is nowhere near that number. The VA told the “NewsHour” they have diagnosed only 128 veterans with the condition, and that shortness of breath can be caused by other factors.

    That skepticism is shared by retired Army Colonel and pulmonologist Dr. Michael Morris, at the Brooke Army Medical Center in San Antonio.

  • Dr. Michael Morris:

    If you are a little bit heavier, you haven’t exercised as much, if you have some sleep issues, if you have reflux — reflux affecting the lungs is very hard to diagnose. All those things may play a role in your symptoms.

  • Nick Schifrin:

    Morris researches soldiers’ respiratory health. He believes that, unless noninvasive tests show problems, doctors should avoid invasive and what he calls risky lung biopsies.

  • Dr. Michael Morris:

    There is a risk. They have to go general anesthesia. There is a risk to that. There is a risk to the procedure itself. And our thought is that we should do everything noninvasively first before we proceed to a biopsy.

  • Nick Schifrin:

    And he says, since there’s no treatment plan for constrictive bronchiolitis, biopsies serve little purpose.

    But Cynthia Aman says her lung biopsy eliminated so many doubts that had been plaguing her.

  • Cynthia Aman:

    The biopsy has given me a definitive diagnosis and just some answers. It was funny, because when I got the results, the first words out of Dr Szema’s mouth — wait, stop. I’m sorry.

    Literally, the first words out of his mouth were, “Cindy, you’re not crazy,” because for so long, after you’re getting a normal pulmonary function test, and you have lung specialists or doctors saying, your tests are normal, we don’t think anything’s wrong, to hear those words of there’s definitely something wrong with your lungs was just such a relief.

  • Nick Schifrin:

    But for these veterans, getting a proper diagnosis from the inhalation of dust, debris and smoke is only a first step. The next step is to qualify for disability compensation. And doing that turns out to be a second major challenge.

    When Aman applied, she says the VA ignored her diagnosis and assigned her its lowest benefit rating.

  • Cynthia Aman:

    They gave me a zero percent, because they said my pulmonary functioning is normal, and I’m not using inhalers or corticosteroids every day.

  • Nick Schifrin:

    Aman appealed and ultimately won. The VA rated her 100 percent disabled. She now gets disability compensation.

  • Kerry Baker:

    If I had to guess how many people were getting denied benefits because of this, I would say probably 80 to 90 percent

  • Nick Schifrin:

    Attorney Kerry Baker represents veterans struggling to obtain VA coverage. He used to lead the VA’s legislative and policy staff.

  • Kerry Baker:

    Veterans are pushed through the claims process so fast. VA examiners might do an exam for orthopedic disabilities, the next one may be hearing loss. The next one may be some other type of disability.

    And when you’re a physician’s assistant doing that for a living, the odds of you having any real knowledge of complicated exposures, such as burn pits, it’s not likely.

  • Nick Schifrin:

    Dr. Miller thinks vets who lived under those dusty conditions and exhibit the symptoms of constrictive bronchitis should qualify for compensation.

  • Dr. Robert Miller:

    A soldier that presents with unexplained shortness of breath, with the appropriate exposures, and no other complicating factors, such as heart disease or asthma, and has a clear history of exercise limitation, may be a candidate for that presumptive diagnosis.

  • Nick Schifrin:

    The VA disagrees.

    In response to the “NewsHour”‘s questions, the agency said, “The evidence simply doesn’t exist to support the presumption of service connection for constrictive bronchiolitis.”

    And the VA also denied any problems with how it determines disability compensation.

    Out in Denver, researchers are trying to figure out if they can diagnose constrictive bronchiolitis without biopsies. This lung clearance index test at National Jewish Health could discover the same problems a biopsy does, without the invasive procedure. But their research will take years.

    In the meantime, countless veterans exposed to airborne hazards struggle with every breath more than 15 years after many of them deployed.

    For the “PBS NewsHour,” I’m Nick Schifrin.

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