A bipartisan measure to expand medical coverage for millions of Iraq and Afghanistan veterans exposed to toxic burn pits stalled on Wednesday, after 25 Republican senators who supported the bill last month reversed their stance.
The move prevented the legislation from reaching President Biden's desk. The bill has already passed in the House, and a previous version passed in the Senate last month, before a few changes were made. Proponents of the measure were surprised that the current version did not sail through again.
At issue is the way military bases in Iraq and Afghanistan disposed of waste from around 2010 to 2015: by dumping it in a pit and setting it on fire in the open air.
Many veterans attribute health problems that arose later, such as cancer and respiratory illness, to exposure to chemicals released into the air via these fires. The smoke carried a range of harmful substances, including lead, mercury, benzene, hydrocarbons, dioxins and volatile organic compounds.
"Those who were deployed at bases where burn pits were used clearly had exposure to agents that are known to be harmful," said David Savitz, an epidemiology professor at the Brown University School of Public Health.
The legislation would have expanded health care access to more than 3.5 million veterans who were exposed to toxins while serving in the military after Sept. 11, 2001. It also would have added 23 illnesses, including several cancers, to the list of conditions eligible for federal health care coverage.
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 — or PACT Act, as it’s known — was named after a U.S. veteran who attributed his lung cancer to burn pit exposure. Robinson died of his illness in 2020.
Savitz and other experts said burning waste the way the military did could certainly raise the risk of disease, but more research is needed to know if the conditions veterans are reporting were directly caused by burn pits. Regardless, they think veterans should be able to get the care they seek.
"The legislation was very important for providing health benefits for veterans who are coming down with these types of pulmonary diseases and a presumptive diagnosis of rare cancer and providing care for them," said Steven Coughlin, an epidemiology professor at Augusta University. "Hopefully, they’ll get back on track."
Why burn pits proved so toxic
Savitz said burn pits started gradually getting replaced by incinerators around 2010. But before that, the military set fire to all manner of waste in the open air.
"They were burning everything they had — everything from the garbage, the food waste, the medical waste, water bottles," he said.
Coughlin said the list included plastics, cardboard, heavy metals and vehicle parts.
"They poured jet fuel on it to ignite it, and they burned these piles of refuse night and day," he said.
Burn pits were frequently located near barracks, so combatants "were often breathing this crud daily with substantial exposure," Coughlin said.
Exposure to burn pits during military service has since been linked with some respiratory and cardiovascular conditions, including asthma, bronchitis and chronic obstructive pulmonary disease. A small 2011 study also identified cases of constrictive bronchiolitis — a rare but potentially fatal lung condition — among previously healthy soldiers who served in Iraq and Afghanistan.
A potential association with cancer is more tenuous, both experts said, since Iraq and Afghanistan veterans were exposed to burn pits within the last two decades or so, and some cancers aren't diagnosed until longer after exposure to a carcinogen.
"There have been widespread reports of veterans coming down with rare cancers," Coughlin said. But "it may take decades — 30, 40, 50 years — before some chronic diseases manifest themselves."
The PACT Act proposes adding lung, brain, kidney, gastrointestinal and other cancers to the list of illnesses eligible for expanded health care coverage.
Department of Veterans Affairs Secretary Denis McDonough expressed support for the PACT Act in May.
"The bipartisan bill will help us advance one of the department’s top priorities: getting more veterans into VA care," McDonough said in a statement. "President Biden has also been clear about his commitment to getting more VA health care to veterans impacted by toxic exposures, which is why we need Congress to send the PACT Act to his desk."
Biden's son, Beau, died of a brain tumor in 2015 and served in Iraq at military bases that used burn pits.
Coughlin said that of the various compounds soldiers were exposed to, dioxins are a particular concern because of a link to respiratory cancer.
"Humans were not designed to deal with exposure to dioxins," he said. "There’s no safe exposure limit."
However, establishing a casual link between burn pits and disease can be challenging, Savitz said, because exposures weren't well documented by the military. He is currently studying whether people with respiratory or cardiovascular diseases were previously stationed at bases that used burn pits.
For now, Savitz said, "it’s not been shown directly that those who have been exposed to burn pits through their military service in fact have long-term elevated rates of disease."
But he and Coughlin said the government should not wait to offer veterans health care until scientists fully understand all risks of burn pit exposure.
"It’s important to ensure that these veterans have appropriate care and not wait until the epidemiology catches up," Coughlin said.
CORRECTION (August 1, 2022, 10:00 a.m. ET): A previous version of this article misstated when the PACT Act vote was held. It was Wednesday, not Thursday.