Limitations in existing studies and lack of quality data mean there's "insufficient evidence" to prove veterans' respiratory illnesses are caused by burn pit and other airborne hazard exposure in Afghanistan and Persian Gulf countries and a new approach is needed, experts said in a report released this week.
A committee of National Academies of Sciences, Engineering and Medicine researchers said better, more thorough studies are necessary to definitively link respiratory illnesses in troops and veterans to their exposure to burn pits and airborne hazards while deployed in the Southwest Asia Theater.
That doesn't mean there's no evidence suggesting exposures cause illnesses, though.
There was "limited or suggestive evidence" of a link between service in the Gulf War from 1990 to 1991 and for those who served in operations after Sept. 11, 2001, who experience "chronic persistent cough, shortness of breath and wheezing," according to existing data.
But it's not enough to definitively prove a connection without better studies, experts said.
“New approaches are needed to better answer whether respiratory health issues are associated with deployment. The current uncertainty should not be interpreted as meaning that there is no association – rather, the issue is that the available data are of insufficient quality to draw definitive conclusions,” said Mark Utell, a doctor and professor of medicine and environmental medicine at the University of Rochester Medical Center, and chair of the committee that wrote the report. “However, the committee believes it is possible – today – to conduct well-designed studies that will provide more clarity to veterans who are seeking to understand the respiratory problems they are experiencing.”
National Academies’ experts were tasked with sifting through existing research to determine if any had gathered sufficient evidence to prove that exposures caused respiratory illnesses and to identify gaps in knowledge about those exposures and how they affect troops and veterans deployed to those areas.
So far, VA only recognizes temporary health effects related to burn pits, including respiratory, skin, eye and gastrointestinal tract irritation.
Sverre Vedal, professor emeritus for the Department of Environmental and Occupational Health Sciences at the University of Washington School of Public Health, said the committee "experienced a general sense of frustration" during their work, as they heard testimonials from veterans and service members who said they experienced ill effects after their exposures.
"But the data did not support it," Vedal said, explaining again the limits of previous studies. "That was a frustrating aspect of our work on this committee. The data were not strong enough for us to conclude that there were associations."
Data on veterans and troops who experienced toxic exposures is frequently limited, since many veterans go undiagnosed, misdiagnosed or don't report their exposure, said Chelsey Poisson, National Guard medic, ER nurse and toxic exposure researcher at the Hunter Seven Foundation.
"If approximately 50% of Afghanistan veterans go to civilian providers and never use VA Medical Center services, how can the VA clinically account for a representative sample of the post-9/11 VA population?"
In limiting the scope of the review to respiratory illnesses, VA may miss other illnesses linked to exposures, Poisson said.
"We have to look beyond the respiratory diseases," she said. "If they looked at glioblastoma rates or prostate (issues), they’d probably see the seriousness of toxins on other organ systems."