During Marine veteran Scott Evans' two tours in Afghanistan, his work on a specialized team that used dogs to sniff out explosives led him to spend large chunks of time around open-air pits where trash was burned.
In August, Evans, 33, of North Carolina, received devastating news: he had terminal pancreatic cancer. The diagnosis placed him among a growing number of military veterans who say they have developed serious and sometimes fatal diseases after facing prolonged exposure to burn pits at overseas bases.
The pits were a common feature at military bases during the wars in Iraq and Afghanistan, a crude answer to the basic logistics problem of how to deal with piles and piles of trash. Everything from electronics and vehicles to human waste was regularly doused in jet fuel and set ablaze, spewing toxic fumes and carcinogens into the air.
The Department of Defense estimates that roughly 3.5 million service members could have been exposed to burn pits. The Department of Veterans Affairs has denied about 75 percent of veterans' burn pit claims, including Evans’, because it does not acknowledge a connection between conditions like asthma and cancer to exposure to the flaming garbage piles.
Veterans say that at the same time they face resistance while seeking treatment from the VA, they have also been let down by civilian medical providers who often lack an understanding of the existence and dangers of burn pits.
“Over the next decades, I'd be shocked if we didn't see spikes in disease in these patients,” said Dr. Tom Abrams, an oncologist at the Dana-Farber Cancer Institute who has treated two veterans affected by burn pits.
“Whether it's cancer, respiratory illness or some other disease that has yet to make itself known, I think we have to be on the lookout and really be aware that these veterans are at very high risk.”
Abrams and other medical experts acknowledge that it’s exceedingly difficult to draw a definitive link between burn pits and the conditions veterans are reporting, but they note that ample evidence already exists showing that long-term exposure to toxic smoke can lead to serious health issues.
A VA spokesperson said it “follows the science on questions of health outcomes of military exposures” and is conducting a review of the hazards of burn pits.
The spokesperson referenced a 2020 report by the National Academies of Sciences, Engineering and Medicine that found none of the 27 respiratory health outcomes it reviewed met the criteria for “sufficient evidence of an association.” The evidence for respiratory symptoms such as chronic persistent cough and wheezing met the criteria for “limited or suggestive evidence of an association,” the spokesperson added.
A Pentagon spokesperson said the Defense Department and VA are "continuing to fund studies to provide more evidence on the potential long-term effects of burn pit exposure."
Lawmakers in Washington have taken up the cause, introducing multiple bills aiming to change the way the VA deals with veterans who think they’re suffering from a burn pit-related illness.
On Tuesday, advocates and legislators led by Sen. Kirsten Gillibrand, D-N.Y., Sen. Marco Rubio, R-Fla., and the comedian Jon Stewart will take to Capitol Hill to rally in support of a measure, which would force the VA to expand care and benefits to veterans affected by certain burn pit-related illnesses.
In an interview with NBC Nightly News' Lester Holt, Stewart said the situation echoes the aftermath of the terror attacks of Sept. 11, 2001, when first-responders were coming down with serious illnesses and health officials were slow to recognize them as being caused by toxins swirling in the air at ground zero.
“What the first responders were standing on top of was essentially a burn pit,” he said. “The jet fuel from the planes ignited it, but it was all those materials from the World Trade Center.”
Stewart got involved in the effort after being approached by Rosie Torres, the founder of the nonprofit Burn Pits 360. Torres started advocating for veterans suffering from toxic exposure-related illnesses after her husband, an Army veteran, was diagnosed with constrictive bronchiolitis.
“I would challenge any congressperson who says, ‘Well, we're going to wait for the science to be settled,’ to dig a hundred-yard pit in the middle of a town where your constituents live, and burn everything in that town with jet fuel,” Stewart said. “And then come and tell me that, ‘Yeah, they're cool with it, because there's a lot of confusion about whether or not the science is settled that this is harmful to your health.’”
For most veterans who think they are suffering from a burn pit or other toxic exposure-related illness, getting the VA to acknowledge their condition and treat them has been a losing battle. Veterans must prove to the VA that they were exposed to a burn pit during their service, and that the exposure caused their condition.
Further complicating matters, veterans affected by toxic exposure often find themselves against the clock when it comes to gaining access to health care through the VA. If veterans don’t seek treatment during an initial five-year period in which the VA offers combat veterans free health care — and experts say many of the diseases that stem from toxic exposure typically manifest slowly — they have to wait for their claim to be approved before getting care at a VA facility.
Even if they do meet the burden of proof and have their claim approved, veterans say the approval process can take months to years, wasting precious time for those with terminal illnesses.
Gina Cancelino, whose husband, Joseph, died of an aggressive form of testicular cancer in 2019, said they only learned about the possible link between burn pits and the disease months before he passed away.
“I said, ‘Hon, burn pits, burn pits in Iraq,” she recalls telling the former Marine Corps gunnery sergeant. “‘Look, I'm reading about this. Were you near these?’ And he's like, ‘Yeah, I'm pretty sure I was.’”
Joseph Cancelino, who worked as a New York City Police Department sergeant, had deployed to Iraq in 2003 during the first wave of Operation Iraqi Freedom.
Now, his wife has made it her mission to piece together his exposure to burn pits.
“Had we known earlier that this was an issue, maybe he goes annually and gets checked,” Gina Cancelino said. “Maybe we find it earlier, and we don't give it a chance to harbor in there, and fester in there. So I'm disappointed. I'm disappointed in the lack of communication.”
Gen. Michael Heston was one of the rare few whose claims were approved. He served three tours in Afghanistan with the Vermont Army National Guard, and died in 2018 after a battle with pancreatic cancer. He was 58 years old.
Heston’s wife, June, said she remembers her husband questioning the safety of the burn pits while he was still deployed. At one of the bases where Heston was stationed, she said, the burn pit was initially near the airfield, but the smoke and soot were interfering with the jet engines, so it was moved to another area of the base, closer to where troops lived and worked.
“He just couldn't understand,” she said. “If it's doing that to a jet engine, well, why would you think it would be OK to be moving [it] closer to human beings that are breathing that in?”
When Heston started complaining of back pain and rapidly losing weight in 2016, it took doctors 10 months to deliver a diagnosis.
By that time, the cancer had metastasized to other parts of his body.
Abrams, the Dana-Farber oncologist, had never heard of burn pits before treating Heston. When Heston first explained them, Abrams said, he was shocked.
“I was just horrified because I thought that was probably one of the most toxic kinds of things you could possibly have,” Abrams, who is also a faculty member at the Harvard Medical School, said. “It's extremely unhealthy to be exposed to the products of massive combustion for years on end.”
Abrams ultimately came to the conclusion that Heston’s cancer was likely caused by his exposure to toxic substances in Afghanistan, and wrote a letter spelling that out to bolster his application for VA benefits.
"Most patients are diagnosed [with pancreatic cancer] in their mid- to late-60s or early 70s,” Abrams said. “He had no risk factors, he was not a diabetic, he was in excellent shape. And he had this long term, very significant toxic exposure that was certainly not something that was common at the time.”
The VA ultimately acknowledged that Heston’s cancer was due to his toxic exposures during service, due in large part, June Heston thinks, to Abrams’ letter. But a letter like that is not easy to come by, experts say, because doctors are tasked with treating an illness, not investigating its cause.
"It's very difficult to definitively say that X causes Y,” Abrams said. “But on some level, I think it's important to at least acknowledge that exposure to high levels of toxic smoke is a contributor to lots of diseases in general. And I don't think you need to necessarily pore through the data for years to make at least that kind of general claim.”
Andrew Myatt deployed to Iraq in 2004 as a combat engineer with the Army National Guard, disarming improvised explosive devices, or IEDs. He believes the acute lymphocytic leukemia he was diagnosed with in 2019 is connected to his exposure to burn pits in Iraq, but when he applied for health care and benefits, the VA denied his claim.
Myatt, 53, said he’d be lost without the help of Anita Ritchie, the senior national service officer at the nonprofit Wounded Warrior Project, who is helping him gather evidence for an appeal.
“Toxic exposure is one of the few instances where there's not a lot of people in the civilian world who know anything about this stuff,” Ritchie said.
Myatt said he is happy with his current private health care, but getting the VA to accept that his cancer was related to his service would ensure he has access to medical care in the future.
“If this [cancer] shows up 20 years from now, when I'm retired and living someplace, then I can go to them for help,” he said.
In 2014, the VA created a burn pit registry to start tracking the long term health effects for service members who were exposed to burn pits and other airborne hazards. Since then, nearly 240,000 current and former service members have joined.
But the practice hasn’t stopped. In an April 2019 memo to Congress, the Defense Department acknowledged that it had nine active burn pits at bases throughout the Middle East.
Legislators and advocates are hopeful that this will be the year that burn pit reform makes its way through Congress in part because of a unique connection to President Joe Biden.
In the past, Biden has suggested that his son Beau’s deployment to Balad Air Base in Iraq may have had something to do with his brain cancer diagnosis.
Balad Air Base had one of the largest burn pits, spanning more than 10 acres. "Because of exposure to burn pits — in my view, I can't prove it yet — he came back with stage 4 glioblastoma," Biden told a Service Employees International Union convention in 2019.
But for veterans like Scott Evans, who said he was told he had between six months and a year to live, legislation may not come soon enough.
Evans first contacted the VA medical center closest to his home last April after his weight began to plummet and the whites of his eyes had turned yellow. But he said he was told he was ineligible because there was no evidence his condition was connected to his service and he didn’t qualify for financial need.
He was eventually able to start receiving care at the VA in July due to a different condition. The following month, he was diagnosed with pancreatic cancer at age 32.
Evans said he tries not to dwell on how things may have been different if he had been able to access VA care last April.
“Would [the tumor] have been operable? What would the outcome have been of it?” he said. “For me, it's done and over with, we can't change that. But the big thing that I would like to see happen is that if somebody comes in and they need help, and they're a veteran, be able to get that help right away. And let's ask questions later.”
Still, Evans said he has no regrets over his military service.
“Even knowing what I know now, and knowing the consequences, I'd still do exactly the same thing, because it was about the guys you're with,” he said, pausing to collect himself. “The thing I'm most proud of is everybody who walked behind me has all their limbs, and came back safe. And if the cost of it was getting cancer, that's fine.”