At first, doctors thought the constant wheezing meant Veronica Landry had asthma.
Then, she developed bronchitis and started having more and more trouble breathing, before ending up in the hospital with what doctors thought was pneumonia. After months of testing, in January 2016, she had a lung biopsy, and the results came back showing what Landry told the Daily Beast she’d suspected all along: She had inflammation and lung disease linked to the time she’d spent on military bases in Iraq, surrounded by burn pits — open dumps that were set aflame to dispose of garbage.
Landry is a veteran, but worked in Iraq as a contractor in 2004 and 2005 with the company KBR (formerly Kellogg Brown & Root). In January 2018, her diagnosis of deployment-related lung disease helped her successfully sue the company for benefits—the first legal decision recognizing a link between lung disease and exposures during deployment.
But veterans—thousands of whom have already come forward with lung disease—have a much more difficult pathway to receiving recognition and compensation for their deployment-related illness, and are still fighting for the Department of Veterans Affairs (VA) to recognize the problem.
Living and working around bases in the Middle East is associated with lung conditions range from asthma to constrictive bronchiolitis, a disease that causes inflammation in the lungs and is rare in young, healthy adults. After returning from deployment, people have a higher rate of new respiratory symptoms than people who did not deploy.
As a contractor in Iraq, Landry helped provide logistical support to the military: building and running bases, cooking, doing laundry. She started out working in a gym and cafe on a military base before moving into a role that tracked ongoing projects. “I was out running around the camp all the time,” she told The Daily Beast. “I was out in the elements, right by the burn pits. We lived very close to them.”
Landry filed a claim against KBR under the Defense Base Act, which provides workman's compensation to civilians injured working with the U.S. Army as contractors. Cases are adjudicated by administrative law judges at the U.S. Department of Labor. Landry’s diagnosis of deployment-related lung disease, and her lung biopsy, which linked the disease to burn pits, was enough for the judge to rule in her favor.
In Defense Base Act cases, Landry and her attorneys only had to show that the work environment she was in could “conceivably cause the harm alleged”—the burden of proof was on her employer to show that it did not. The judge determined that they did not produce enough evidence to refute the claim, and they were instructed to pay the cost of her medical treatment.
Landry was able to take that approach because she was exposed to burn pits while working as a contractor. Veterans, however, can’t file claims in the same way, even though they were living and working in the same camps as the contractors, and exposed to the same environments. To get compensation for the illness they believe resulted from breathing in the air around the camps in Iraq and Iran, the VA has to agree that their lung disease was, in fact, directly connected to their time serving overseas, and provide coverage for their care. That’s difficult to prove, especially years after their return.
Defense Base Act cases are each tried individually, with benefits only doled out to the person who filed the claim. The burden is on each individual contractor to prove the link between their particular disease and their burn pit exposure, and proving that relationship requires that someone has the resources to see a doctor and get a diagnosis. But it also allows the process to move forward more quickly, Gary Pitts, Landry’s attorney and partner in a firm specialising in Defense Base Act cases, told The Daily Beast.
“With the VA, it’s sort of like moving an aircraft carrier,” he said. “If they come around to saying lung problems come from being deployed, thousands of people are going to be able to file claims at once. It won’t be litigated individually.”
The VA’s current position, according to their website, is that there is not enough evidence yet to conclusively link lung disease to burn pits. They opened a registry for service members and veterans in 2014 to track reported exposures and health concerns, and the Department of Defense is funding research into burn pits and related respiratory problems.
Cecile Rose, an occupational pulmonologist at National Jewish Health in Colorado, got involved in research around deployment related lung disease in 2010, and receives some of the Department of Defense Funding.
From a scientific perspective, she told The Daily Beast, there’s still no conclusive link between inhalation exposures to burn pits and lung disease.
“While it seems likely in some cases that burn pits probably did play a role, I cannot say was the most important thing or the only thing [to cause the lung disease],” Rose said.
In particular, desert dust, chemicals from paint fumes, diesel exhaust, and other airborne exposures can also contribute to the lung problems in veterans, as well. “One of the biggest challenges in occupational lung disease is understanding the mixtures of exposures, and the synergistic relationship between them,” she said.
There are a few major questions researchers still need to answer before they can pinpoint exactly what’s causing the uptick in lung disease rates, Rose said. First, they need to understand how the specific biological mechanisms that the dust and fumes from burn pits might affect lung tissue. “Hopefully, if we can understand the disease mechanisms, then we can develop treatment strategies based on the mechanisms of lung injury that will, long-term be very vital for deployers,” she said. Researchers also need to develop a better way to diagnose deployment-related lung problems, and do more robust epidemiological studies to understand the scope of the problem.
It’s difficult to make public health policy decisions when the science still isn’t black and white, Rose said. “In the face of scientific uncertainty and complicated exposures, how do we protect people?”
The VA, Pitts said, likely will wait to get more conclusive, broadly applicable scientific evidence before they set anything in motion. It’s the same procedure that they went through for when veterans were reporting illnesses related to Agent Orange after the Vietnam War and Gulf War Syndrome.
“They were contested for a long time, and they funded a bunch of research after pressure from the public and journalists reporting on them, and eventually said that they’d cover the symptoms,” Pitts said. “I’m sympathetic to them wanting to take their time. But I’m also sympathetic to these soldiers who want to get care.”
The success of cases under the Defense Base Act, though, might help move the needle at the VA, even if only by increasing public attention to the issue, Pitts said. But as research and debate moves forward incrementally, veterans are left unable to get funding to treat their illnesses.
“When you’re talking about public policy and people, particularly those who have put their lives on the line, there ought to be a different standard,” he said. “Not science beyond reasonable doubt — if this is high possibility, lets give these guys the benefit of the doubt and help them.”