Sick soldiers: Symptoms exist but the diagnosis unclear

by Kelly Gustafsonand Kristen KellarMarch 08, 2012


Benjamin Kesling/MEDILL

Burn pits in Iraq and Afghanistan burn 24 hours a day, seven days a week.

Dust storms may also be to blame for health ailments.

Courtesy of Octal/Flickr

Produced by Kristen Kellar and Kelly Gustafson

Data from the New England Journal of Medicine

Doctors who examined troops from Fort Campbell, KY found that they were exposed to a number of potential hazards.

Produced by Kristen Kellar and Kelly Gustafson

Data from the U.S. Army Public Health Command, the Environmental Protection Agency and the Center for Disease Control and Prevention

Returning from Iraq, Leroy Torres thought he had left the battle overseas. But he would soon become one of hundreds of troops fighting two more battles on our soil: a battle for recognition of a mysterious ailment and a bureaucratic one. “When he first got back, he immediately had several ER visits for respiratory issues. We’re all scrambling. We’re all broke. We’re trying to make something happen, trying to prevent another Agent Orange,” said his wife, Rosie.

Torres was deployed to Iraq in 2007 and again in 2008, but since his return to Texas in 2008, he’s been in and out, in and out, in and out of hospitals.

Torres is not alone.

For veterans returning from Iraq and Afghanistan this is increasingly common. Many veterans are blaming the dust storms and burn pits — giant pits where trash in burned – for their respiratory and other symptoms.

So for these vets, what might have started as shortness of breath, or a headache, or a cough has spiraled into myriad illnesses, from lung diseases to digestive problems to brain tumors.

Mystery Symptoms

“The common thread to all of the stories is that ‘I got back from service and I can’t climb up a flight of stairs or complete my two-mile run,’” said Dr. Robert Miller, a pulmonologist at the Vanderbilt University Medical Center.

Miller has examined troops from Fort Campbell, KY for respiratory symptoms. In a study published last year. He and his fellow researchers concluded that 38 of the 80 troops they saw had constrictive bronchiolitis, a rare condition in a healthy population.

Constrictive bronchiolitis in an inflammation of the small airways of the lung where scar tissues and fibrosis could block the airways. After doing surgical biopsies, Miller noticed small black dots in the airway. He doesn’t know what causes them. “I don’t think I’ve ever seen this in a civilian population.”

Even when troops see a doctor for their symptoms, it’s difficult to get an exact diagnosis. Doctors may not know what to look for or have the right equipment, said Dr. Anthony Szema, assistant professor of medicine and surgery at Stony Brook University Hospital.

“Your lungs are delicate little air sacks. Even if you have a normal breathing test, you may have an abnormal biopsy. But, they may not know how to see it,” he said, he said.

Another problem is that in order to diagnose conditions such as constrictive bronchiolitis, a surgical biopsy is required, resulting in as long as six weeks to recuperate. Szema said, “You can’t pick this up on a X-ray and you can’t take everyone to the operating room.”

Ben Krause, founder of, said that many veterans are coming forward with breathing problems, constrictive bronchiolitis and otherwise. Another disease that worries troops is chronic obstructive pulmonary disease, a lung disease that worsens with time.

“I don’t think there’s enough awareness. Now we have this COPD and breathing issue and people don’t know what’s causing it,” Krause said.

Because doctors have been unable to determine the cause, there are no treatments. “Sometimes we give them inhalers because it makes them feel better, not because it helps,” Miller said.

He added that most of the patients he’s seen haven’t progressed past their initial diagnosis. So, he said it probably doesn’t make a difference if doctors see troops right away or not.

Inside the Pits

The Army hired an outside contractor, an American engineering and construction company called KBR, to take care of waste disposal overseas. Rick Lamberth, a former KBR employee testified to a Senate Democratic Policy Committee in 2009 about his stints in Kuwait, Iraq and Afghanistan.

“I witnessed KBR employees dump nuclear, biological, chemical decontamination materials and bio-medical waste, plastics, oil and tires into burn pits in direct violation of military regulations,” Lamberth said.

Army regulations say that waste management outside the U.S. must comply with the National Environmental Policy Act and allows for the use of burn pits “only in emergency situations until approved incinerators can be obtained.”

When he tried to report violations, he was told by his superiors to “shut up” and keep it to himself.

The pits burned 24 hours a day, seven days a week. “You could see mile-high clouds of smoke coming from the pits,” Lamberth said. “The ash that came from the pits looked like burned notebook paper and fell like a black, sooty snowfall.”

But some, like Krause, think the burn pits aren’t the only reason people are having health problems. He served in U. S. Air Force from 1996 to 2001 and wasn’t exposed to burn pits, but has developed breathing problems as well.

“It probably has something to do with the dust particles combined with the burning pits,” Krause said.

Dust and sand in northern Iraq, where many troops are stationed, is hollow and tends to be coarser, said Szema. “You can stick anything in that nanosphere and it’s small enough to inhale. If something is burning and a sandstorm comes by, then it could get in.”

Legal Battle for Recognition

When Torres lost both of his jobs – he was a captain in the Army Reserve and a Texas state trooper – because of his ailments, his wife made the march to Washington. There, she fought to create a national registry that could link long-term health problems with burn pits in the future.

“We need to make every legislator aware of our cause. These soldiers are from every state,” Torres said. “I think what people fail to realize is invisible wounds aren’t just PTSD, it’s toxic exposure, too.”

Torres rallied congressional support from Rep. Todd Akin (R-Mo.) and Sen. Tom Udall (D-N.M.). While the bill sits in front of the Committee of Veterans Affairs, Torres has started an online registry that is tracking more than 500 soldiers.

“We’re not ever going to get any help if we don’t get any numbers,” Torres said. Krause said that in the past receiving benefits from the VA wasn’t too difficult, but receiving benefits in a timely manner is a challenge veterans are now facing. When he left the Air Force, it was easier to claim VA benefits. Now, he said, there’s a lot of red tape.

“In a lot of instances they consider it a pre-existing condition. So you’ll have a hard time getting healthcare. Veterans are having to wait for a year or more to get coverage,” Krause said. recently launched a survey to document service by the VA. “Majority of the veterans were unhappy about the way they were treated by the VA Around 70 percent was unsatisfied,” Krause said.

Last year, Veterans for Common Sense filed a lawsuit against the VA to get better treatment for mental health issues and faster claim processing. The case is currently at the Ninth Circuit Court of Appeals.

What Comes Next?

Some are now calling the health fallbacks the next Agent Orange. Hopefully, said Krause, it doesn’t take 30 or 40 years for people to realize what’s going on. He is currently pursuing his law degree from the University of Minnesota Law School. “I’m currently going to go after and protect veterans benefits and make sure that politicians are aware that it is a nonpartisan effort,” Krause said.

Derek Giffin, a 31-year-old Army veteran who is a service officer at the VA, said most of his job entails helping veterans affected by Agent Orange.

“It is my concern that burn pits can be the Agent Orange of my generation,” Giffin said. “The effects of the exposure will probably be latent.” He said he “obviously has concerns” about his own health after serving in Iraq in 2004, but doesn’t know what the later effects will be.

On the other hand, Miller doesn’t think there is a relation to Agent Orange. He said that over the years, the VA had linked Agent Orange to many things, but in the case of bronchiolitis, “we’ve clearly seen something under the microscope. We’re not sure what it is, but there’s something there.”

Miller does want people to be aware and that’s one reason why he and others have pushed for biopsies. By performing them, the soldiers coming in with breathing problems have more credibility.

“As of right now, it’s hard to file a claim (a VA claim) because you need to have a doctor say there’s a causal link between exposure and illness. That’s tough to do because a doctor won’t know what’s in a burn pit in Iraq,” Giffin said.

A report released in October by the Institute of Medicine said there was not enough evidence to draw a firm conclusion linking burn pits to long- term health effects. The report recommended a tiered approach to gathering data about returning troops, which is similar to the registry currently awaiting approval.

Giffin said: “We’re at the mercy of these investigations by the NIH.”

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