Congressional Briefing Regarding Exposure to Burn Pits
Most VA Medical Centers are not equipped to diagnose veterans who have suffered small airway injuries from Deployment Related Lung Disease (DRLD). And when it comes to VA’s disability rating guidelines for these conditions, things get even messier. But one lawmaker’s response to the recent Congressional briefing hosted by Burn Pits 360 and Amnesty International could help veterans exposed to burn pits with both of these issues.
On July 27, 2017, members of Congress, congressional aides, and veterans and families affected by exposure to burn pits piled into a room in the Capitol Building for the bipartisan briefing. Nearly 12,000 Facebook users joined them online. A panel of experts and a DRLD survivor discussed the health issues associated with burn pit exposure, and the obstacles that affected veterans face in acquiring the specialized health care and benefits they need.
After hearing about the research and experiences of the panel, Representative Mike Coffman of Colorado – one of three congressional co-sponsors of the event – was moved to take things a step further. Working with two of the expert panelists – Dr. Richard Meehan and Kerry Baker — Rep. Coffman wrote a compelling letter addressed directly to Secretary of Veterans Affairs David Shulkin. Dr. Meehan researched burn pits as a Marines medic in Iraq and now co-directs the Deployment-Related Lung Disease Center at National Jewish Hospital. Kerry Baker is a leader in the fields of toxic exposure and veterans’ benefits and represents disabled veterans at the law firm of Chisholm Chisholm and Kilpatrick.
Congressional Inquiry to VA Secretary Shulkin
The letter, known as a congressional inquiry, requires a response signed by Secretary Shulkin. Typically, such letters are sent to subject matter experts within the appropriate branch of the VA and then sent back up the chain of command for approval. This letter will likely be sent to officials in both the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA) because it involves the VA’s healthcare capabilities as well as the rating guidelines for disability benefits.
While there are many conditions believed to be associated with burn pit exposure, Rep. Coffman, Dr. Meehan, and Mr. Baker focused in on small airway injuries due to Deployment Related Lung Disease. Rep. Coffman described the many causes of air pollution in Southwest Asia, highlighting the wide range of medical, plastic, metal, and chemical waste disposed of in on-base burn pits. He then addressed two critical concerns for veterans affected by DRLD. First, the lack of necessary diagnostic capabilities at VA medical centers and, second, the total lack of disability rating guidelines for diseases like constrictive bronchiolitis.
Having diagnosed and treated over 150 veterans at the DRLD Center at Jewish National, Dr. Meehan knows full well that such conditions are tricky to diagnose. Non-invasive tests that measure lung function – such as pulmonary function testing (PFTs) or cardiopulmonary exercise testing (CPET) – are often not enough to diagnose DRLD, showing negative results for the condition when a veteran does in fact have DRLD. So, for many veterans the only reliable diagnostic is a much more invasive surgical lung biopsy. Unfortunately, most VA medical centers do not have the capabilities to perform such a procedure.
Having represented thousands of veterans with conditions related to burn pit and other military exposures, Mr. Baker is intimately familiar with the flaws in the VA’s disability guidelines for deployment related respiratory issues. Despite sending out a Training Letter seven years ago indicating many VBA adjudicators were having trouble rating these conditions, officials at the VBA still have not created separate rating categories for small airway injury (such as constrictive bronchiolitis). This means VA rates the disease as ‘analogous’ to conditions like asthma or chronic pulmonary disease (COPD) and thus relies on inadequate pulmonary function testing which fails to recognize the real severity of small airway injury. As a result, veterans may receive very low or even non-compensable ratings even though they experience severe functional limitation.
Though it can take quite a while for congressional inquiries to make their way through the VA system, congressional inquiries carry significant weight. In the long run, the letter could result in a congressional hearing, legislation, or potentially internal VA policy change. And in the short term, the letter will keep these issues on the radars of important policy-makers and will make it clear that members of Congress and the public care deeply about the changes Rep. Coffman proposed.