Constrictive Bronchiolitis (CB) is a small airway fibrotic respiratory disease characterized by the inflammation of small airways. Sufferers of CB often have persistent cough and dyspnea.
CB is very difficult to diagnose and extremely uncommon. Patients with CB can have shortness of breath when they exert themselves, but also have normal chest X-rays and pulmonary functioning test results. CB is often diagnosed as chronic pulmonary obstructive disease (COPD). To correctly diagnose CB, patients must undergo a surgical lung biopsy, an invasive procedure that can confirm their diagnosis. Since CB is uncommon and difficult to diagnose, unfortunately, VA frequently rates veterans with this condition incorrectly.
What Can Cause Constrictive Bronchiolitis in Veterans?
One of the generally accepted causes of CB in all patients, veteran or not, includes inhalation of toxic fumes. In veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), these fumes can include those emitted from open air burn pits and sulfur fires.
Burn pits were used as a means of waste disposal in Iraq, Afghanistan and Djibouti after September 11, 2001. Military personnel burned hazardous materials such as human and medical waste, ammunition, aluminum and plastics, and fuel. One of the most well-known of these pits was located at Joint Base Balad and spanned more than 10 acres.
In addition to toxic fumes, burn pits emitted particulate matter into the air in the surrounding area. Particulate matter is a mixture of very small particles and liquid droplets that can be harmful when inhaled or ingested. Service members in Southwest Asia could have been exposed to particulate matter which can have respiratory and cardiopulmonary health effects. Long-term exposure to ultrafine particulate matter has been associated with small airway diseases such as constrictive bronchiolitis. In addition to the particulate matter emitted from burn pits, service members were also exposed to dust and sand storms in Iraq and Afghanistan, another significant source of particulate matter.
Another known military cause of CB is sulfur dioxide and hydrogen sulfide gases. On June 24, 2003, Mishraq State Sulfur Mine Plant in Northern Iraq set fire and burned for approximately three weeks. The toxic fumes emitted from the fire impacted many troops who were located near the plant. Both sulfur dioxide and hydrogen sulfide gases can produce coughing, and irritation of the eyes, nose, and throat. At high levels, sulfur dioxide can cause significant airway obstruction.
VA Training Letter 10-03 acknowledges that some military personnel who were involved in the sulfur fire were found “to have long-term respiratory conditions such as ‘constrictive bronchiolitis.’”
What is Training Letter 10-03?
In general, training letters are used by VA to instruct raters and those who work on veterans’ claims on specific issues. Training Letter 10-03 was published April 26, 2010. It intended to advise VA employees how to approach and adjudicate claims related to environmental hazards in Iraq, Afghanistan, and other military installations, such as claims for service connection for CB.
The Training Letter acknowledges that CB is difficult to rate for VA disability purposes. The VA uses pulmonary function tests to assess the severity of conditions such as Asthma and COPD for rating purposes. However, those with CB can often have normal pulmonary function test, making it difficult for VA personnel to apply the correct rating.
How Do I Get Service Connected for CB?
The Training Letter notes that veteran’s “lay statement of exposure to the [Mishraq] sulfur fire is sufficient if his or her service records shows service in Iraq at Mosul Airfield or Qayyarah Airfield West” during the four week period that the sulfur fire burned.
If you are not sure if you were exposed to the sulfur fire, you can still file a claim. In the Training Letter, VA personnel are instructed to actively review claims for potential exposures. This means they should always consider whether a veteran was potentially exposed to environmental hazards during their service. They do this by looking at where veterans were stationed as well as consulting their service records. However, if you think you were exposed to the sulfur fire or burn pits, it is helpful to include lay statements with your claim detailing your exposure.
Additionally, the Training Letter instructs VA personnel to request Compensation and Pension Examinations (C&P) for environmental-hazard claims for veterans who have: 1.) a current diagnosed disability or persistent or recurrent symptoms of disability, 2.) evidence of exposure to an in-service exposure event, and 3.) evidence that the claimed condition may be associated with the in-service exposure.
How is CB Rated?
Once you show that your CB is related to your time in service, the VA will rate the severity of your CB to compensate you appropriately. As mentioned above, CB can be very difficult to rate and it does not have its own rating criteria. This means that the VA list of conditions for rating does not include CB, so it has to be rated “analogous” to another condition.
The Training Letter instructs VA personnel to rate CB as analogous to the rating codes 6600-6604. These rating codes include the criteria for bronchitis, bronchiectasis, asthma, emphysema, and COPD. The training letter also instructs personnel to consider what is called “extra-schedular ratings” when the veteran’s condition impacts their employment. This means that VA personnel are supposed to look into how CB impacts the veteran’s ability to work and award compensation for their loss in earning capacity.
If you are an OEF or OEIF veteran and have developed a severe respiratory condition, we may be able to help. Contact our office for a free consultation.