By Annette M. Boyle
EAST ORANGE, NJ—For years, multiple veterans’ groups have contended that burn-pit exposure in Iraq and Afghanistan increased the risk of long-term health problems. The Institute of Medicine found insufficient evidence to support that claim, and a study by the Armed Forces Health Surveillance Center suggested that servicemembers deployed to bases with burn pits were no more likely to develop respiratory and cardiovascular conditions than their colleagues who served stateside.
A new study, with some significant caveats, now indicates that the veterans’ groups might have been right all along.
The study, published this summer in the Journal of Occupational and Environmental Medicine, found an association between the number of hours of burn pit emissions exposure and higher rates of self-reported emphysema, chronic bronchitis, chronic obstructive pulmonary disease (COPD) and hypertension.1
The findings come with significant qualifiers and questions, however. “There is evidence of an association between higher levels of exposure to burn pit smoke as measured in this analysis and greater risk of self-reported pulmonary conditions, but no evidence of association between higher levels of exposure and pulmonary conditions documented in Veterans Health Administration (VHA) medical records,” said study co-author Drew A. Helmer, MD, MS, director of the VA’s War Related Illness and Injury Study Center at the VA New Jersey Health Care System. The same dichotomy was seen with hypertension.
The researchers found no correlation between burn pit smoke exposure and risk of self-reported or VHA-documented cardiovascular disease.
Co-author Sybil Morley, MPH, of the VA’s Office of Suicide Prevention, noted that the discrepancies between self-reports and VHA documented conditions could be attributed to multiple causes. “This may indicate that participants received care for these conditions outside of VHA or are inaccurately recalling diagnosis history,” she told U.S. Medicine.
The researchers drew on the records and reports of 4,343 veterans who completed the Airborne Hazards and Open Burn Pit (AH&OBP) Registry questionnaire and for whom information on where and when they were stationed at military bases with and without burn pits could be retrieved from the Armed Forces Health Surveillance Center (AFHSC) and Defense Manpower Data Center records. All veterans who participated in the Southwest Asia theater of operations after Aug. 2, 1990, or in Afghanistan or Djibouti after Sept. 11, 2001, are encouraged to participate in the registry. The questionnaire provides a view of participants’ exposures during service and their health.
Analysis of the records revealed that 2,663 registry participants had been deployed for 30 or more days within 2 miles of burn pits at Joint Base Balad (JBB) or Camp Taji in Iraq between Jan. 1, 2003, and June 30, 2007. Another 1,680 participants spent at least 30 days in Kuwait during that time frame and were not deployed to JBB or Camp Taji.
Kuwait had no burn pits during the time period studied but did have meteorological conditions similar to those in Iraq. The researchers noted that servicemembers deployed to Kuwait provided a better control than servicemembers who stayed in the United States, as some of those not deployed might have been retained stateside because of illness or impairment. The AFHSC study compared veterans who had been deployed to those who had domestic postings.
The IoM report found high particulate matter concentrations at JBB and attributed a large portion of the pollutants to dust, industrial and transportation activities rather than burn pits. The researchers involved in the JEOM study noted that the air-monitoring assessment relied on for the IOM report did not measure the concentrations of ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide or hydrogen cyanide or other pollutants which could affect health.
“The analysis supports the possibility of the association between burn pit smoke exposure and greater risk of pulmonary conditions, but it is just one study with several limitations,” Morley said. The limitations include the retrospective nature of the exposure assessment, which could lead to inaccurate recollection. Using time deployed as a proxy measure of exposure may over or underestimate actual exposure and the researchers had no individual measure of the specific elements to which an individual was exposed. In addition, VHA diagnosis coding may be inaccurate or incomplete and veterans may have received treatment outside of the VA.
The study’s strengths included extended follow-up, use of recent incidence information from the registry, use of both self-report and VA medical records and comprehensive adjustment for possible demographic, lifestyle and military service-related confounders.
“The combination of possible inaccuracy and bias toward over-reporting of exposures require the results of this analysis to be taken as supportive, but not definitive evidence of an association between burn pit smoke exposure and respiratory conditions,” Morley added.
Still, the results suggest more of a link than previous studies and Helmer encouraged healthcare providers and veterans to take the possible connection into consideration. “We want all healthcare providers caring for veterans—whether in the VHA, Department of Defense or the private sector—to recognize and acknowledge the possibility of harm from airborne hazards and burn pit smoke exposure,” he said. “If exposed veterans have respiratory symptoms, they should discuss the symptoms and their exposure concerns with their healthcare provider.”
The advocacy group Burn Pits 360 recently wrote a letter to President Barack Obama, stating, “Many of us went to war able to run marathons, but now our health has deteriorated so much that we cannot hold down steady jobs. We are misdiagnosed. We are not getting the medical care we urgently need.”
Veterans have reported long-term health problems that they believe are linked to exposure to the burn pits, which were used to get rid of waste products including chemicals, paint, medical and human waste, metal/aluminum cans, munitions and other unexploded ordnance, petroleum and lubricant products, plastics, rubber, wood and discarded food.
Concerns about the health impact of burn pits led Congress to pass legislation in 2013 requiring VA to set up the National Airborne Hazards Open Burn Pit Registry to monitor health conditions affecting veterans and troops.
While VA maintains that research does not show evidence of long-term health problems from exposure to burn pits, affected veterans continue to press the government on the issue.
In the letter, the advocacy group called the burn pit issue “this generation’s Agent Orange” and asked Obama to take a number of actions, including commissioning “an independent research study to better understand health conditions and deaths related to the effects of combustion burning.”
1 Liu J, Lezama N, Gasper J, Kawata J, Morley S, Helmer D, Ciminera P. Burn Pit Emissions Exposure and Respiratory and Cardiovascular Conditions Among Airborne Hazards and Open Burn Pit Registry Participants. J Occup Environ Med. 2016 Jul;58(7):e249-55. doi: 10.1097/JOM.0000000000000776.