HSR&D Adds to the Knowledge about Veterans’ Risk Related to Burn Pit Exposure
June 2, 2023
Takeaway: HSR&D investigator Dr. Amal Trivedi and colleagues developed a study that assigned burn pit exposure based on deployment to specific military bases in Iraq and Afghanistan, noting the length of time served on each base. They found that 86% of the Veterans in this study, nearly 475,000, had been deployed at some time to bases with burn pits. With this information and follow-up, it is possible to assess health outcomes over an extended length of time following deployment. This will offer a better understanding of potentially long-term health effects of burn pit exposure so appropriate care can be provided for affected Veterans.
Following the attacks of September 11, 2001, Operation Enduring Freedom was initiated in Afghanistan in October of 2001 and Operation Iraqi Freedom in Iraq in March 2003. The war in Iraq continued until December 2011, while in Afghanistan, the war concluded in September 2021. During these military operations, soldiers were housed in temporary bases that often used open burn pits to dispose of waste materials (i.e., food and human waste, packaging, and electronic equipment). Depending on the size of the base, the use of burn pits also varied. For example, some bases had a burn pit operating one day a week, others 24/7, depending on base activities and the size of its population.1
Thus, thousands of military personnel may have been exposed to “airborne hazards” from open burn pits while serving in these countries. Depending on a variety of factors, Veterans may experience health effects related to this exposure. Some health conditions related to this exposure can be serious, including several types of cancer.2 Factors that could indicate whether they have a greater or lesser risk of short or long-term health effects include:
- Types of waste that were burned;
- Proximity, amount of time, and frequency of exposure;
- Wind direction and other weather-related factors of exposure; and
- Presence of other airborne or environmental hazards in the area.
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 expands VA healthcare eligibility for Veterans who were exposed to toxins during the Vietnam War, Gulf War, and post-9/11 wars, by adding eligibility for more than 20 burn pit and other toxic exposure conditions. 3 Researchers, including VA experts, are actively studying airborne hazards like burn pits and other military environmental exposures, which will help us to better understand potential long-term health effects and to provide better care and services.
According to Denis McDonough, Secretary of Veterans Affairs, approximately four million Veterans deployed over the last 30 years were exposed to burn pits.
We’ve got a long way to go, and we won’t rest here in this building until we’ve reached every one of those Vets, made sure they know what they qualify for, we get them signed up and we get that process going. —Denis McDonough, VA Secretary4
As of January 2023, nearly 260,000 claims had been filed and 66,000 benefits issued since the PACT legislation was signed into law.4
Understanding the Short- and Long-term Effects of Open Burn Pit Exposure
In a study led by Drs. Amal Trivedi, part of HSR&D’s Center of Innovation in Long-term Services and Supports for Vulnerable Veterans (LTSS), David Savitz, Professor of Epidemiology, Brown University School of Public Health, and Susan Woskie, Professor Emeritus, University of Massachusetts, Lowell, investigators developed an exposure assessment method that determines the presence of a burn pit, an incinerator and waste segregation methods for specific military bases in Iraq and Afghanistan. Investigators then obtained deployment histories of nearly 475,000 Veterans who served in Afghanistan and Iraq – and were enrolled in VA care in order to study long-term health impact from exposure to open burn pits. They then totaled the number of days each Veteran was assigned to a base with a burn pit and linked it to each Veteran’s VA healthcare data.
- In the final cohort of 475,326 Veterans, the exposure assessment of 109 Iraq and Afghanistan bases found that 86% of these Veterans had been deployed at some time to bases with burn pits.
- For the 406,191 soldiers with burn pit exposure, the median number of days deployed at bases with burn pits was longer than one year (370 days).
- Despite a 2010 DoD directive prohibiting burn pits without a formal determination by the base commander that no other method was feasible, more than 54-67% of the bases in Iraq and 59-71% of the bases in Afghanistan had burn pits from 2011 to 2013.
- 2009 DoD regulations on burn pits did produce changes in waste segregation, as well as adding incineration and local disposal of waste.
Investigators also plan to determine the effects of burn pits separately from any other health effects associated with deployment more generally. By using information from deployment records to more accurately estimate an individual’s exposures to burn pits, investigators will be able to link refined exposure estimates to data on health outcomes from medical records over multiple years following military service to see if there were health problems that continue over time.
Dr. Amal Trivedi and colleagues developed an exposure assessment method that assigns burn pit exposure to specific military bases by time period and links that to the Veteran’s deployment history—this, in turn, is linked to VA healthcare data. With this information, it is possible to observe health outcomes over an extended length of time following deployment. This will offer a better understanding of any potentially long-term health effects of exposure to burn pits so the appropriate care can be provided for affected Veterans.
- National Academies. Institute of Medicine. Long-term health consequences of exposure to burn pits in Iraq and Afghanistan. 2011.
- U.S. Department of Veterans Health. Public Health. Airborne hazards and burn pit exposures.
- U.S. Department of Veterans Health. Disability Benefits. Exposure to burn pits and other specific environmental hazards.
- O’Donnell N and Hastey A. CBS Evening News. After years of denial, VA urges millions of Veterans exposed to burn pits to file claims. January 26, 2023.
Woskie S, Bello A, Rennix C, Jiang L, Trivedi A, and Savitz D. Burn pit exposure assessment to support a cohort study of U.S. Veterans of the wars in Iraq and Afghanistan. Journal of Occupational and Environmental Medicine. January 11, 2023;65(6):449–57.