Military burn pit exposures and the ‘mystery illness’ the VA still ignores

Thanks in large part to celebrity Jon Stewart and his coalition of Sept. 11 first responders, the “mystery illness” long affecting Middle East war veterans has triggered at least a shred of the attention it deserves. Finally, the U.S. Department of Veterans Affairs reversed its long-standing position that had rejected the link between chronic illness — at least those that are respiratory — and exposures to burn pit emissions.

In a New York Times article published last month, the scientists who first uncovered the issue shared disheartening stories of their work being stymied and even “censored” for years by the VA. Veterans who themselves pleaded with the VA described being met with “stonewalling” and bureaucratic sluggishness. For the ill, each rejected plea means the loss of a precious commodity — time. 

The origin of this saga can be traced to the Persian Gulf War and the more recent Iraq war, when veterans reported a variety of unexplainable symptoms that didn’t fit into the ordinary box of medical symptomology. Many complaints took the form of respiratory ailments, including difficulty breathing and exercising despite normal-looking X-ray exams and pulmonary tests.

It wasn’t until lung biopsies were conducted in 2004 that direct physical evidence of toxic lung injury finally emerged, corroborating the complaints veterans described for years. Yet, while the recent extension of government health benefits to these veterans marks a major victory, a condition suffered by other vets still remains outside the VA’s sphere of accountability.

For some, chronic illness has taken the form of chemical intolerance, a condition in which a wide variety of previously tolerated substances (e.g., certain foods and medications, nail polish, cleaning solvents, tobacco smoke, etc.) now trigger debilitating multi-system symptoms that include fatigue, headache, weakness, mood changes, “brain fog,” as well as respiratory and skin problems. In certain accounts, a lifting of brain fog was described when patients vacated to relatively pristine areas (e.g., upper Colorado mountains) only to reappear when returning home in heavy traffic.

Prior to military deployment, these “normal” exposures were just that — normal. Post-deployment, however, it’s an entirely different story. Although often perceived as a chemical “allergy,” these intolerances are different in that the antibodies involved in “allergic sensitization” are largely absent. Consequently, the condition doesn’t show up on allergy tests, leaving most diagnoses overlooked by physicians. With the absence of an accepted lab test, patients are often left in the dark and ineligible for government health coverage. For war vets, the story is the same.

According to a national survey of Gulf War-era veterans conducted by the VA, about 30 percent of the roughly 700,000 deployed military personnel met the Centers for Disease Control and Prevention

(CDC) case definition of the enigmatic “multi-symptom illness.” That this was twice the rate reported among non-deployed veterans should have been an early red flag that illness was related to environmental exposures incurred while overseas. Importantly, rates of post-traumatic stress disorder were not systematically higher among Gulf War vets compared to soldiers deployed elsewhere, thus ruling out psychological factors for the majority.

Evidence suggests a key culprit to be military burn pits where medical waste, tires and other plastic-laden trash are set aflame and toxic air pollutants released. President Joe Biden himself implicated such pollution as possibly causing his son’s death.

Although receiving less attention, however, other important implicated exposures include those sustained by over 100,000 troops when U.S. forces blew up the Iraqi weapons depot at Khamisiyah in 1991, releasing the neurotoxic agents sarin and cyclosarin into the air, or those incurred by the 250,000 U.S. soldiers who received pyridostigmine bromide (PB) pills as a pre-treatment drug to protect against chemical warfare, or, still, the 40,000 troops who were exposed to the organophosphate (OP) pesticides used to combat vector-borne disease among U.S. troops. Although a seemingly diverse range of chemicals, they share one key characteristic — namely, interaction with the central nervous system through an enzyme called acetylcholinesterase (AChE).

Dr. Claudia Miller, a physician and research scientist with over three decades of experience studying the health effects of OPs, served as environmental consultant to the VA Regional Referral Center in Houston, Texas, shortly after the war where she evaluated about 60 Gulf War vets with what was then “unexplained” illness and found a striking similarity between their symptoms and those described by 37 individuals who became chemically intolerant following OP pesticide extermination. Miller was the first to point to OPs as probable initiators of Gulf War illnesses and coined the term “Toxicant-Induced Loss of Tolerance,” or TILT, back in 1997 based on her observations.

TILT describes the two-stage physiological process that characterizes chemical intolerance — namely, the onset of disease (“initiation”) that arises after a major chemical exposure event (or repeated low-level exposures), followed by a second stage (“triggering”) in which these people react adversely to certain chemicals, foods and medications that never previously bothered them, including fragrances, cleaning products, nail polish and vehicle exhaust. Oftentimes, it’s intolerances to favorite foods such as barbecue, caffeine, beer and red wine that are first noticed.

In a recent study, my colleagues and I examined eight of the most well-documented cases of chemical intolerance acquired in different cohorts including: employees at the U.S. Environmental Protection Agency headquarters after new carpeting was installed; Gulf War veterans; casino workers exposed to pesticides; airplane staff exposed to fume events; Sept. 11 first responders; surgical implant patients; those exposed to moldy buildings; and tunnel workers exposed to solvents.

Indeed, a mysterious illness becomes all-the-more visible when its occurrence is compared across cohorts. The study found burn emissions and volatile organic compounds (including pesticides) to be the most commonly reported exposures preceding chemical intolerance. Patterns of exposure and symptoms, including new-onset intolerances to foods and drugs, were strikingly similar.

In the last decade, TILT has become increasingly well documented and researched around the world by doctors and scientists. A validated questionnaire called the Quick Environmental Exposure and Sensitivity Inventory (QEESI) exists to help patients and doctors identify this otherwise elusive condition. The QEESI is being used in over a dozen countries and remains the most reliable tool for screening and helping patients, including military vets, who are seeking a diagnosis and wish to better understand their condition. Despite increased science, diagnostic tools and awareness, a grassroots effort similar to that ignited by John Stewart which   ultimately address respiratory illnesses and burn pits will likely be necessary before the VA extends essential health coverage to the war heroes who remain left behind. Whether such leadership will take the form of another celebrity, a lawmaker in Congress, or the president himself remains to be seen.

Shahir Masri, Sc.D., is the author of “Beyond Debate: Answers to 50 Misconceptions on Climate Change.” He is an air pollution scientist at the University of California at Irvine, and also teaches at the Schmid College of Science and Technology at Chapman University. Follow him on Twitter: @ShahirMasri