With a reputation for denying veterans' claims for harm caused by military toxic exposures and faced with mounting Congressional pressure, the Department of Veterans Affairs pledged to turn over a new leaf to help ill vets on Wednesday.
Lawmakers and veterans advocates didn't appear wholly convinced it would be enough.
Ronald Burke, deputy undersecretary for policy and oversight for the Veterans Benefits Administration, told Senate Veterans Affairs Committee members VA recognizes that toxic exposure "is a critical congressional interest item" and it's "not surprising" that most of the veteran service organizations that shared their priorities with lawmakers last month made addressing exposures a top goal.
"Their message was clear -- it is time to act now," Burke said Wednesday. "We acknowledge that VA must continuously evaluate how we approach researching and granting claims for disabilities related to toxic and environmental exposures."
That will include changes within the department, and a new push to encourage veterans to file toxic exposure-related claims.
The Senate Veterans Affairs Committee on Wednesday weighed nearly two dozen bills, including several that would require sweeping change at VA and grant new benefits and rights to veterans who were exposed to toxicants during service -- from Agent Orange and Vietnam-era veterans to harmful levels of radiation, chemical warfare agents, burn pits and more for later generations.
Rather than weigh in on those toxic exposure bills individually, Burke and other VA officials instead outlined changes they say leaders are making at the department to help veterans now.
But Burke and other VA leaders stopped short of saying VA supported or approved of any of the pending bills. They argued it was "too early to legislate" and called some measures "premature" while lawmakers again insisted that veterans had waited long enough, and many have died without seeing care and benefits expanded.
Though VA has already provided care and benefits to tens of thousands of veterans ill from exposures, "we have more work to do," Burke acknowledged. "Secretary McDonough is committed to taking immediate and deliberate steps to ensure the department leans forward in its approach to getting answers to key environmental exposure questions."
An executive board of senior leaders has been re-established within VA to consider matters including toxic exposures and the department is developing a new decision-making model for determining presumptions based on environmental exposures, Burke said.
VA's current process for deciding what health conditions it will consider presumed to be caused by veterans' military service is an often slow, opaque and incomplete practice -- advocates and lawmakers have urged change for years. While the VA secretary has the authority to add presumptive conditions, different administrations have seemingly required differing levels of evidence and research linking health conditions to military service. Congress has legislated some additional presumptives, but those also often take time and face significant political hurdles.
"Every year, Congress considers numbers exposure-related bills, each focusing on a specific generation of veterans or one particular disease or condition," Senate VA Committee Chairman Jon Tester, D-Montana, said Wednesday. "What has emerged is a broken process and disjointed coverage for veterans ... Not everyone who needs help is getting it. And most of those folks are getting it late."
Burke promised a change with VA's new strategy: an "end-to-end review" of how the department handles exposures, improved science and surveillance, better use of department benefit claims data, expanded training for healthcare providers and "consideration of other factors." He said VA hopes to present its new model for making these decisions in the next six months. VA also plans to encourage veterans to file claims related to their exposures, including urging them to get compensation and pension (C&P) exams.
One in three veterans report a possible military environmental hazard exposure and one in four report health concerns because of deployment exposures.
"We are moving with a sense of urgency," Burke told lawmakers. "VA must take decisive action."
Meanwhile, veterans continue to languish with illnesses they, their families and in many cases their doctors, link to exposure to toxic herbicides, chemical warefare agents and football-field sized landfills burning for years at a time -- among others.
Tester and other lawmakers on the committee did not appear satisfied with VA's plans. Tester said he believes the path forward will require legislation in Congress to overhaul VA's processes and policies on toxic exposures.
"In my opinion, that step must be legislation that is veteran-focused, consist, and science-based. And that is my top policy priority this Congress," Tester said. "We must provide health care and benefits to all veterans suffering from the effects of toxic exposure: past, present and future. It is the cost of war. That is pure and simple."
Several bipartisan legislative efforts were introduced last year, and reintroduced this year, to create a path to VA care or benefits for veterans sick from toxic exposures, or even create presumptives for veterans who served in specific areas. Tester and other lawmakers recommitted to passing such legislation this Congress. Tester said his goal was to craft a collective package of the bills by Memorial Day, but it remains to be seen if such an effort will gain wide enough support to pass both chambers and head to the president's desk to become law.
Millions of veterans have been exposed to toxic hazards just since 2001, along with generations of troops who came before. But after nearly two decades of war, the Department of Veterans Affairs still denies the majority of claims for burn pits, one of the most common exposures troops experience.
As of April 28, 241,034 veterans and service members have added themselves to the VA Airborne Hazards and Open Burn Pit Registry, open to those who have served since 1990. VA has previously estimated as many as 3.5 million veterans and troops have been affected by burn pits alone.
Surveys from veteran service organizations including Iraq and Afghanistan Veterans of America and Wounded Warrior Project show a majority of respondents report toxic exposures of some kind, and most said they were not receiving care for those exposures at VA. Veteran service organizations have made multiple presentations to Congress in recent years arguing that toxic exposures should be a top legislative priority. Veterans have testified before lawmakers again and again about the rare cancers and other severe, and often fatal, conditions they believe have been caused by toxic exposures they suffered, or lost friends to.
VA has received more than 15,000 claims from veterans of conditions specifically related to burn pits. The most common issues claimed are respiratory conditions. VA has denied nearly 75% of those claims, according to VA data provided to Connecting Vets.
On Wednesday, Burke told lawmakers that VA research indicates "an overly cumbersome process and an assumption of denial discourages veterans from filing toxic and environmental exposure-related claims." Veterans advocates fired back at VA, however, arguing that the statistics show VA does deny the majority of toxic exposure claims.
A lack of evidence and documentation is consistently cited as a reason for the Departments of Defense and Veterans Affairs to deny veterans' exposures to environmental hazards. Defense Department data collected to determine health risks from airborne particulate matter, or the location of burn pits or troop movements, is largely incomplete and unreliable, and both massive federal agencies place the burden on veterans and their families to prove they were exposed, when and where with documents that often don't exist.
Burke told lawmakers that "while science is the best way to ensure veterans are cared for properly, VA will not wait for perfect science before deciding" on whether to provide care and benefits for vets. That message seems a departure from the previous administration. Then-VA Secretary Robert Wilkie repeatedly delayed expanding care and benefits to Vietnam-era veterans over pending VA studies -- results of which have still not been released -- and arguing he could not make changes to help other veterans suffering from exposures without an act of Congress.
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 in September 2020. 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.
But there is some evidence suggesting exposures can cause illnesses, the experts acknowledged. 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.
Veterans, advocates and lawmakers are still struggling to ensure Vietnam-era veterans exposed to toxic hazards such as Agent Orange receive the care and benefits they need, with thousands still waiting. Congress, as part of the 2021 National Defense Authorization Act, passed measures to force VA to cover bladder cancer, hypothyroidism and Parkinson's-like symptoms for veterans exposed to Agent Orange, but it could be years before those veterans see those benefits. An effort to also include hypertension among those conditions fell short, and lawmakers and Congressional staff have said they believe it was because some members of Congress balked at the potential cost. VA Secretary Denis McDonough earlier this year pledged to work to expedite the process, as well as consider extending benefits to those with hypertension.
For information on how to add yourself to VA's burn pit and airborne hazard registry, click here.
Need help with toxic exposure? Click here for a list of resources and information on VA and Defense Department registries.
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