Veterans who were exposed to particulate matter while serving in Southwest Asia beginning in 1990 are now able to receive compensation, according to an announcement by the Department of Veterans Affairs this week.
Over the past three decades, veterans who served in Southwest Asia that later suffered from chronic asthma, rhinitis and sinusitis, among other conditions, have had to prove that their illnesses were caused by their military service in order to receive disability compensation or medical care — proof that more often than not was impossible to provide.
This new guidance “will ease the evidentiary burden of … Veterans who file claims with VA for these three conditions, which are among the most commonly claimed respiratory conditions,” according to the interim final rule published in the Federal Register.
More than 3.7 million people have served in the Persian Gulf and Afghanistan since 1990. Almost all of them were exposed to smoke from burning garbage on U.S. military bases in burn pits, as well as dust storms and man-made pollution.
“I think it is very exciting for those veterans who have served since the beginning of the first Persian Gulf War and I think it’s long overdue,” Dr. Victoria Cassano told the PBS NewsHour.
The VA’s decision to grant presumptive service connection is “a good start. And it affects probably hundreds of thousands of veterans because most of these guys and gals come back with some form of upper respiratory discomfort and disability,” said Cassano, an occupational and environmental physician who served as a Navy physician from 1984 to 2004 and now works as a consultant.
According to the VA, 212,805 veterans who served in Southwest Asia filed a claim for asthma between 1990 and March of this year. Overall, 51 percent of these claims were granted. But there were hundreds of thousands that were not. Fifty-five percent of the 322,000 veterans who filed a claim for sinusitis during that time were rejected. And 29 percent of the 410,000 veterans who filed a claim for rhinitis also during that time were rejected. These veterans can now file a new claim for those same illnesses.
The VA’s new policy is effective as of August 5, 2021 — which means if a veteran filed a claim in the past that was rejected, new benefits will only become available once a new claim is filed.
Former VA Secretary Dr. David Shulkin believes the department’s new ruling is a good first step, but says it still falls short.
“I’m very pleased that the VA has taken a proactive position to finally grant veterans who have been waiting sometimes now for decades to get the benefits that they deserve. But I’m concerned that they didn’t go far enough,” Shulkin said.
Shulkin believes there are other medical conditions that also should have been included in the VA’s ruling.
“What the VA has announced is that they are going to grant benefits to veterans who can show that they have conditions like … a runny nose and asthma. Those are generally pretty common conditions. But what they have excluded from the list are those veterans who are suffering from very severe and sometimes life-threatening illnesses like cancers or conditions such as constrictive bronchiolitis, which have been shown to be present in the biopsies of lungs of veterans who have come back from exposure to burn pits.”
According to documents obtained by the PBS NewsHour, 42,686 veterans who served in the Global War on Terror filed a claim for cancer between September 11, 2001 and earlier this year. Sixty-three percent, or 26,867 of these veterans had their claim rejected. The rejection rate for cancer claims among veterans who served in the Persian Gulf war of 1990-1991 is even higher. Seventy-four percent or 12,410 of these veterans had their cancer claims rejected.
The Southwest Asia theater of operations refers to Iraq, Kuwait, Saudi Arabia,Bahrain, Qatar, the United Arab Emirates, Oman, the Gulfs of Aden and Oman, the Persian Gulf, the Arabian Sea, the Red Sea and the air space above those locations. The VA’s new rule also applies to veterans who served in Afghanistan, Uzbekistan, Syria and Djibouti.
Besides veterans with cancer, there is another large group of veterans who will also not be covered by the VA’s new ruling.
“Asthma explains shortness of breath and exercise limitation for many post 9/11 service members, but 40 percent of deployers with exercise limitation have unexplained symptoms. They are short of breath but do not meet criteria for asthma,” according to Dr. Robert Miller of Vanderbilt University School of Medicine.
Miller was the lead author of a groundbreaking study that discovered that some veterans had constrictive bronchiolitis, a rare and hard-to-diagnose lung condition. Veterans with constrictive bronchiolitis have severe shortness of breath when exercising or exerting themselves, yet this condition cannot be detected by diagnostic testing, such as by pulmonary function tests, x-rays or computed tomography (CT scans). Constrictive bronchiolitis can only be diagnosed by performing invasive biopsies.
Miller said “it is imperative that the VA now address the group of deployers with unexplained exercise limitations and add them to the group qualifying for presumptive disability benefits.”
Cassano is hopeful that the VA will also grant presumptive service connection for cancer. “I would hope there would be a logical progression at least to lung cancer.” She said particulates from soot have been the “primary malefactors in burn pits and in Gulf Coast Gulf War in general. And I think if you look at the spectrum of diseases that are caused by soots and by particulate matter, that you will eventually get to lung cancer.”
It would have been easier for veterans if the department had looked at all past claims that had been rejected for chronic asthma, rhinitis and sinusitis and reversed previously denied claims, said Kerry Baker who served as a senior official in the VA and is now a veteran advocate. “If you have been denied you should be able to have your claim re-adjudicated to when you originally filed,” saying it would make it fair and “more efficient for everybody.”
Congress is now formulating legislation that would require the VA to provide presumptive service connection for a wide range of illnesses including cancer, constrictive bronchiolitis, and a number of autoimmune disorders.
“I don’t think that this ends the need to have legislation. I think that while this is a very positive step the VA has taken, it’s not far enough,” Shulkin reiterated. “They’re going to be thousands of veterans who are still remaining in need of help and having to wait. And that’s the role of Congress to step in and to create a law that allows VA and actually forces VA to do the job of honoring our commitment to these veterans.”
The VA’s Interim final rule issued this week is effective as of August 5, 2021. But the VA will consider and address comments that are received within 60 days.
Correction: The original version of this story said Dr. Victoria Cassano was a toxicologist. This story has been updated to reflect that she is an occupational and environmental physician. The NewsHour regrets the error.