Earlier this month, the Senate Veterans’ Affairs Committee approved legislation that would improve access to healthcare for post-9/11 combat veterans exposed to burn pits and other toxic substances in the course of their military service.
The “Health Care for Burn Pit Veterans Act” passed the 18-member committee unanimously, hailed by both Democrats and Republicans as landmark legislation, and in the words of Republican Sen. Jerry Moran of Kansas, the bill’s co-sponsor, it’s “an important first step to make certain our veterans receive the care they need.”
But one prominent Republican senator, who’s not on the committee, is less than thrilled with the “first step,” which he argues is far too tentative.
“Veterans who are suffering from debilitating illnesses and dying because they cannot get care deserve better than half measures,” Florida Republican Sen. Marco Rubio said. “Specifically, the bill fails to provide a presumption of service connection for key ailments afflicting many veterans who were exposed to toxic burn pits.”
“Even if the bill were to become law, the burden would still be on veterans to prove their illness is a direct result of their deployment to receive critical benefits,” Rubio said in a statement.
Rubio and New York Democratic Sen. Kirsten Gillibrand introduced a competing bill last year, the “Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act,” which also has bipartisan co-sponsors in the House and goes much farther in removing bureaucratic barriers to care.
The measure would establish an automatic presumption that any of more than 20 categories of cancers, lung diseases, and breathing problems are related to military service — even if medical science has yet to establish a definitive causal link between the exposure and the ailment.
“More than 3 million service members could have been exposed to toxic burn pits, yet the [Department of Veterans Affairs] continues to deny them care by placing the burden of proof on veterans suffering from rare cancers, lung diseases, and respiratory illnesses,” Gillibrand said. “The bottom line is that our veterans served our country, they are sick, and they need healthcare — period.”
One of the critical lessons learned from the years dealing with the so-called Gulf War illnesses in the 1990s is that policymakers can’t afford to wait for science to establish a clear link between exposure and any specific disease.
Science is slow, methodical, can take wrong turns, and even hit dead ends before eventually landing on an accepted truth — as the shifting advice on COVID-19 has illustrated.
What’s particularly difficult to prove is that low-level exposure to something toxic, which produced no symptoms or ill effects at the time, can cause serious disease years or even decades later.
Take the case of Marine Maj. Randy Hebert, who testified before Congress in 1996.
Hebert, suffering from amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, could barely talk and struggled to stand for his swearing-in ceremony before the House committee.
Hebert told lawmakers he believed his exposure in 1991 to an exploding chemical mine in Iraq triggered the onset of his ALS and that the government was covering it up.
“My view is the Pentagon knew from day one,” he said.
Scientists caution that “correlation is not causation,” saying that just because one thing happened after another, it doesn’t mean the first caused the second.
But it’s human nature to think so.
How else to explain why a young, perfectly healthy Marine would return from Iraq only to be told by doctors a few years later he had Lou Gehrig’s disease and three years at most to live?
Except that young, perfectly healthy people get Lou Gehrig’s disease all the time. Like Lou Gehrig, for instance.
For epidemiologists, the first step in establishing a probable cause and effect is to determine if exposure victims are sicker at a higher rate than the general population or a comparable demographic.
For ALS, it would be 10 years before a major study by the VA would show a clear correlation.
Among the nearly 700,000 U.S. troops who served in the Gulf War from August 1990 to July 1991, the rate of ALS turned out to be twice that of the 1.8 million troops who did not deploy.
When the study was published in 2001, the VA had identified 40 Gulf War veterans with ALS, almost half of whom had since died.
And even that study did not determine why.
That’s why senators Rubio and Gillibrand aren’t satisfied with the go-slow approach in the Veterans’ Affairs Committee bill, which would allow the VA to continue to decide which diseases qualify as presumptive causes.
“We don’t have time for studies,” Rubio said. “People who are being impacted by this don’t have the benefit of a several-year study where some expert will eventually conclude whatever they conclude. It’ll be too late by then. This is happening now, and for too many, it’s already too late.”
But Moran, one of the bill’s 18 co-sponsors, said the legislation is only “the first step on a continuum” of measures to ensure exposure victims get the medical care they need.
“We will continue to work with the Department of Veterans Affairs to make certain in the next phase, the next step, that presumptions for benefits are addressed,” Moran said at a news conference this month.
Last year, the VA added asthma, rhinitis, and sinusitis to the list of conditions that are presumed to have been caused by burn pit exposure, and Moran noted that the agency has “a pilot program that is testing the process by which presumptions come into existence.”
With some 250,000 veterans now on a national registry, the problem Moran sees is that presumptively qualifying them all at once would overwhelm the system and disadvantage veterans already in line for care.
“We want to make sure we do this right in a way that the VA has the capability of caring for every veteran and not disadvantage any other veteran in the process,” Moran said.
That argument just doesn’t cut it with Gillibrand and Rubio.
“We are in an urgent crisis, with people who are dying of cancer not getting coverage by the VA,” Gillibrand said at a session with reporters last summer. “And as a consequence, they have to use their own money and are going into bankruptcy and losing their homes and going into other financial ruin.”
“We can’t trust the VA bureaucracy to get this right, and we don’t need any more excuses,” Rubio said, announcing his opposition to the committee’s approach. “What we need to do is pass a bill with presumptive benefits.”
As for Hebert, the Marine who was told in 1995 that he would likely die from ALS in three years, at last report, he was beating the odds.
According to local media reports, Hebert is approaching 60 and lives in Emerald Isle, North Carolina, with his family, and thanks to the efforts of his wife, Kim, his community built a wheelchair-friendly walkway to the beach and named it “Randy’s Way.”
Jamie McIntyre is the Washington Examiner’s senior writer on defense and national security. His morning newsletter, “Jamie McIntyre’s Daily on Defense,” is free and available by email subscription at dailyondefense.com.
