In March 2016 – a full seven years after burn pits were discontinued in Iraq and Afghanistan – the Department of Veterans Affairs published a guide for VA doctors meant to inform them of the potential health effects of exposure to burn pits. But the “Clinician’s Guide to Airborne Hazards” which conveniently leaves the phrase “burn pits” out of the title and fails to give doctors the information that might actually help them evaluate patients with burn pit-related illnesses.
Want to see for yourself? Check out the VA’s “Clinician’s Guide to Airborne Hazards” here.
Want our take? Below we’ll discuss the five reasons this four-page packet just doesn’t cut it when it comes to the information doctors really need to help veterans exposed to burn pits.
1. The Clinician’s Guide does not say what a burn pit is.
That’s right. The guide to airborne hazards and open burn pits does not even describe what burn pits looked like, how large they were, or the wide variety of items burned in the pits. The VA’s only ‘explanation’ of the burn pits is as follows:
The use of burn pits was a common waste disposal practice at military sites overseas, exposing thousands of service members to potentially harmful substances, including elevated levels of particulate matter (PM).
Without an idea of the sheer size of burn pits and the way they were tended, doctors would not be able to appreciate the extent of Iraq and Afghanistan veterans’ exposure. Ten pounds of trash burnt in an open barrel produces as much smoke pollution as a modern incinerator burning 400,000 pounds of trash per day. So the amount of smoke produced by a football field-sized open pit burning several hundred tons of unregulated waste per day certainly warrants at least a sentence in a guide meant to help doctors evaluate the significance of potentially toxic exposure.
Additionally, the guide does not mention any of the items burned in the pits. Listing (or simply mentioning) these items – which include plastics, metals, ion batteries, human feces, and much more – would give doctors information about the types of chemicals to which veterans may have been exposed. This brings us to our next point…
2. Besides particulate matter (PM), the Guide does not list any chemicals or toxins detected in burn pit smoke.
The Department of Defense (DoD) measured levels of particulate matter (PM) that exceeded limits set by U.S. agencies. The VA Clinician’s Guide acknowledges this and briefly notes that toxicology research has already linked high PM levels to cardiopulmonary effects.
However, the VA neglects to mention any of the hundreds of chemicals detected in burn pit smoke. The chemicals – many of them known carcinogens – include dioxins, the same potent toxin found in Agent Orange. These chemicals are scientifically known to be hazardous on their own, but likely have even greater, “synergistic” effects when burned together.
3. The Guide does not include important aspects of particulate matter (PM) and its toxicity.
Even on the subject of particulate matter, the Guide provides little helpful information. The size of the PM – which is not included – is important information for doctors because the smaller the PM, the deeper the particles are able to travel into the lungs.
Additionally, the particles act as carriers of harmful chemicals in the air, so the toxicity depends on the composition of the particulate matter itself. Without information about the chemicals carried by the PM, doctors’ ability to gauge the severity of the exposure is diminished.
4. The Clinician’s Guide does not provide any specific information about the rare conditions (such as constrictive bronchiolitis) that are occurring at higher rates in veterans exposed to burn pits.
Illnesses such as constrictive bronchiolitis and eosinophilic pneumonia are mentioned only as examples of the self-reported “unexpected conditions.” Though the Guide devotes a whole page to conducting an initial evaluation and deciding if a specialty consultation is warranted, neither section mentions these conditions by name.
This is a dangerous omission given that constrictive bronchiolitis can be fatal and often goes undetected until it has progressed too far. Constrictive bronchiolitis can only be diagnosed with a lung biopsy. So the spirometry and bronchodilator tests, which the Guide recommends to assess pulmonary function, may not indicate a problem when there is a very serious one.
5. Directions on how doctors can view a veteran’s Burn Pit Registry self-assessment and how to document an evaluation using the Registry are buried in an unrelated section of the Guide.
The Clinician’s Guide spends almost the entire first page talking about the purpose of the Airborne Hazards and Open Burn Pit Registry and how medical support staff will explain it to veterans. Intuitively, it doesn’t make much sense for this information about the Registry and the role of Medical Support Assistants and Environmental Health Coordinators to take up such a large and prominent space in the packet. Especially while the two-paragraph section about research on the health effects of burn pit exposures is the very last section and takes up about a third of the page.
But most perplexing is the fact that the Registry information actually relevant to clinicians is hidden on the last page (which otherwise does not discuss the Registry). At the bottom of an unrelated box called “Talking to Veterans about Exposure Concerns,” there is a small note.
The note tells doctors how to access a veteran’s self-assessment from the Burn Pit Registry. Such information can be used by doctors to get a more complete understanding of a veteran’s proximity to the burn pit, their health concerns during deployment, and other important information that might not be covered in-person.
The note also tells doctors how to document a burn pit-related medical evaluation. This information is critical because burn pit exposure is such a new phenomenon. If VA doctors do not track the symptoms and illnesses their patients are experiencing, there is no way to see if trends are emerging or if certain treatments are more effective than others.
The Guide instructs clinicians to “rely on their own evidence based knowledge, expertise, and skills.” But without the facts – the size and scope of burn pits, the items burned, the chemicals released, how to diagnose the related illnesses – doctors are simply unable to apply even the most basic knowledge or skills to the issues their patients are experiencing. Given the very serious medical conditions at play and the need for more detailed information about the effects of exposure, the VA’s Clinician’s Guide to Airborne Hazards is, frankly, irresponsible.