[Senate Hearing 117-093]
[From the U.S. Government Publishing Office]
S. Hrg. 117-093
MILITARY TOXIC EXPOSURES: THE HUMAN CONSEQUENCES OF WAR
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
MARCH 10, 2021
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
46-012 PDF WASHINGTON : 2022
COMMITTEE ON VETERANS' AFFAIRS
Jon Tester, Montana, Chairman
Patty Murray, Washington Jerry Moran,Kansas, Ranking Member
Bernard Sanders, Vermont John Boozman, Arkansas
Sherrod Brown, Ohio Bill Cassidy, Louisiana
Richard Blumenthal, Connecticut Mike Rounds, South Dakota
Mazie K. Hirono, Hawaii Thom Tillis, North Carolina
Joe Manchin III, West Virginia Dan Sullivan, Alaska
Kyrsten Sinema, Arizona Marsha Blackburn, Tennessee
Margaret Wood Hassan New Hampshire Kevin Cramer, North Dakota
Tommy Tuberville, Alabama
Tony McClain, Staff Director
Jon Towers, Republican Staff Director
C O N T E N T S
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Wednesday, March 10, 2021
SENATORS
Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............ 1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas...... 2
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire...... 14
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 18
Brown, Sherrod, U.S. Senator from Ohio........................... 19
Blackburn Hon. Marsha, U.S. Senator from Tennessee............... 21
Tuberville, Hon. Tommy, U.S. Senator from Alabama................ 22
Manchin III, Hon. Joe, U.S. Senator from West Virginia........... 24
Sinema, Hon. Kyrsten, U.S. Senator from Arizona.................. 26
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 27
WITNESSES
Anthony Szema, MD, Director, International Center of Excellence
in Deployment Health and Medical Geosciences; Clinical
Associate Professor of Occupational Medicine, Epidemiology and
Prevention, Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell.............................................. 3
William Thompson, SSG, U.S. Army (Ret.), testifying in regard to
burn pit exposure.............................................. 5
Karl Kelsey, MD, MOH, Professor of Epidemiology, Pathology and
Laboratory Medicine, Brown University School of Public Health.. 7
Jeffrey O'Malley, Veteran, United States Army, testifying in
regard to Agent Orange and hypertension........................ 8
Shane Liermann, Deputy National Legislative Director, Disabled
American Veterans.............................................. 10
Aleks Morosky, Government Affairs Specialist, Wounded Warrior
Project........................................................ 12
APPENDIX
Witnesses Prepared Statements
Anthony Szema, MD, Director, International Center of Excellence
in Deployment Health and Medical Geosciences; Clinical
Associate Professor of Occupational Medicine, Epidemiology and
Prevention, Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell.............................................. 32
William Thompson, SSG, U.S. Army (Ret.).......................... 33
Karl Kelsey, MD, MOH, Professor of Epidemiology, Pathology and
Laboratory Medicine, Brown University School of Public Health.. 37
Reports from the National Academies of Sciences, Engineering,
and Medicine that Assess Exposure to Herbicides or Health
Outcomes Among Vietnam Veterans.............................. 44
(Table 42) Results of Epidemiologic Studies of Circulatory
Disorders Reviewed in Veterans and Agent Orange Series.pdf... 47
(Table S-1) Summary of Outcomes Included in Veterans and Agent
Orange 11.pdf................................................ 68
Veterans and Agent Orange Update 11, Consensus Study Report
highlights.pdf............................................... 74
Jeffrey O'Malley, United States Army............................. 78
Shane Liermann, Deputy National Legislative Director, Disabled
American Veterans.............................................. 82
Aleks Morosky, Government Affairs Specialist, Wounded Warrior
Project........................................................ 96
Statement for the Record
Tragedy Assistance Program for Survivors (TAPS).................. 106
MILITARY TOXIC EXPOSURES: THE HUMAN CONSEQUENCES OF WAR
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WEDNESDAY, MARCH 10, 2021
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:08 p.m., in
room SD-G50, Dirksen Senate Office Building, Hon. Jon Tester,
Chairman of the Committee, presiding.
Present: Senators Tester, Brown, Blumenthal, Manchin,
Sinema, Hassan, Moran, Boozman, Rounds, Tillis, Blackburn, and
Tuberville
OPENING STATEMENT OF CHAIRMAN TESTER
Chairman Tester. I call this meeting of the Senate
Veterans' Affairs Committee to order. Good afternoon and thank
you for joining us today, to hear from veterans, medical
experts, and veteran services organizations about the long-term
health consequences of war.
When we promise to train and equip our servicemembers so
that they are ready for war we also promised to care for them
as veterans after they return home. We now know that not all
injuries are visible, not all reveal themselves immediately,
and not all are due entirely to enemy action. Some conditions
can take years to manifest, and too often they are the results
of our own government's actions, whether it is spraying the
battlefield with Agent Orange to remove hiding spots from an
enemy, or using burn pits to dispose of waste. No matter the
cause, our promise remains the same--fight for us and we will
fight for you.
In the last Congress we made tremendous strides in keeping
that promise. We are bringing relief to Vietnam-era veterans
dealing with hypothyroidism, bladder cancer, and Parkinsonism.
But this fight is not over. Current science shows even greater
evidence of an association between Agent Orange and other
conditions like hypertension and MGUS.
So here we are again. Relief for these conditions is long
overdue. We have wasted literally decades deliberating over
science and wrestling with bureaucratic red tape. We should not
delay any longer.
Even as Vietnam-era veterans struggled with the decades-
long effects of Agent Orange, the next generation of brave men
and women were fighting new wars in Iraq, Afghanistan, and
Syria. There, many servicemembers were exposed to open burn
pits to dispose of waste. Many returned with obviously damaged
lungs while others continue to fall ill today, in some
instances, a decade or more after coming home.
As a government, we did not learn our lesson after Vietnam.
Our veterans are still fighting red tape to get health care and
benefits that they have earned and are needed. Because of the
VA's inaction on behalf of Agent Orange-exposed veterans,
Congress has acted to provide benefits for Blue Water Navy
Vietnam veterans and Korean War veterans who served on the DMZ.
And most recently, we worked to add three presumptive
conditions in keeping with the scientific evidence provided by
the National Academies.
But that is not an ideal solution. We must develop a
comprehensive system that is able to quickly deliver care and
benefits to veterans as science develops around currently known
and newly discovered exposures, without congressional action.
This system must prioritize serving veterans' urgent needs
and delivering life-saving care. Only then will we begin to
fulfill the promises we have made to care for those who have
sacrificed so much on our behalf. Otherwise, we will continue
to hear from vets like Jeff O'Malley, a Vietnam War veteran,
and William Thompson, Iraq War veteran, about how their
government is failing to address the cost of war associated
with their services to this Nation. And I ask my colleagues,
listen closely today to their testimony.
I also want to thank our other witnesses for joining us
today to help us better grasp the scientific evidence that
should inform our decisionmaking, and the impact of these
exposures on the veteran community at large.
With that I turn it over to you, Senator Moran.
OPENING STATEMENT OF SENATOR MORAN
Senator Moran. Chairman, thank you. Thank you for the
things you said in your opening Statement and thank you for
organizing this hearing.
Good afternoon, everyone. Thank you to all of our witnesses
for joining us today. I certainly appreciate what Senator
Tester had to say and I look forward to learning more from this
hearing about how we can do our jobs, as a committee, better.
In modern history, we have tragically seen that exposure to
toxic substances have become an increasingly common component
of armed conflicts and warfare. Such exposure is not always
known or considered at the time, and too often the long-term
health effects are not understood. For too long, veterans have
been exposed to toxic substances during the course of their
military service, and they have faced overwhelming barriers to
get the VA care and services that they deserve. The burden of
proof is a challenge for veterans, and we must find ways to
bridge that gap.
I was encouraged by bipartisan legislation passed by this
Committee last Congress to address these issues. As a result of
our work, we have seen several new laws on the books directing
research and covering more of our veterans from Vietnam and
Korean War, but our work, of course, is far from done.
Over the years, Congress has responded to multiple cohorts
of veterans affected by exposure to mustard gas, lewisite
during the 1940's, iodizing radiation from nuclear test sites
during the cold war, Agent Orange during the Vietnam War, Gulf
War illnesses during Desert Storm, and now burn pits and other
toxins during the global war on terror. The varied approaches
to addressing these different exposures in the past
demonstrates the need to establish a fair, transparent, and
sustainable process going forward. Decades of patchwork fixes
show a clear need for significant improvement.
As we consider ways to improve how our country cares for
those who became ill through exposure to these substances
during their military service, we must and should listen to
those who have suffered the negative health outcomes. I think
all of my Committee colleagues would agree when I say that the
voices of veterans are always those we want to hear, the ones
we listen to most. Theirs are the voices we hold in highest
regard in helping us do our jobs.
It is also crucial that we hear from the scientific and
medical communities. Care works best when there is a reliable
system in place for the VA to first be provided with necessary
scientific research on which to inform timely decision on
whether to establish presumptions of service connection for
certain conditions. Veterans deserve an enduring framework to
identify, research, and address cases of toxic exposure in a
timely manner. The need for reform has existed far too long,
and veterans cannot be forced to wait decades for care any
longer.
In our last hearing, I remember hearing one of the VSO
representatives indicate that he had been working on his case,
his own case, really for his lifetime, since he departed from
the service, with still no satisfaction.
I am interested to hear from our witnesses today on how
best we, on this Committee, can achieve the outcomes that we
all want for veterans. I look forward to hearing from each of
you today and to continue to work to make certain that all
veterans suffering negative health consequences from their
service receive the care they deserve.
And I yield back to the Chairman.
Chairman Tester. Thank you, Senator Moran. Thank you for
your comments. I certainly appreciate them very much.
We are going to have six witnesses today. The first four
are going to give their testimony virtually. And so we will
start out with Anthony Szema, who is an MD, a Clinical
Associate Professor of Medicine in Pulmonary and Critical Care,
Zucker School of Medicine at Hofstra/Northwell. You have the
floor, Dr. Szema.
STATEMENT OF ANTHONY SZEMA
Dr. Szema. Can you hear me?
Chairman Tester. We can.
Dr. Szema. The 2003 invasion of Iraq, and resulting
conflicts in the Middle East, have led to the longest,
prolonged military deployment in U.S. history. One million
troops have served in Iraq and Afghanistan during the eighteen-
year conflict. Now, 26 percent of the 150,000 military
personnel in the U.S. VA Burn Pits Registry self-report new
onset respiratory symptoms, beginning in military theater. We
noted 14.5 percent of New York-based soldiers developed new
onset asthma post deployment.
Airborne hazards may account for new onset lung diseases.
Soldiers inhale dust storms, pollen, mold, and improvised
explosive devices leading to shock waves in the lung with metal
deposition. Blast overpressure from shock waves induces
traumatic brain injury and post-traumatic stress disorder,
PTSD, which, by itself, is linked to asthma.
Most importantly, these troops are also exposed to burning
trash in open air ``burn pits.'' Uniformly, trash was lit on
fire with jet fuel, JP-8, which contains benzene, a carcinogen.
Burn pits are in open air without an incinerator, and burn at
low heat. This generates more particles than incinerators. More
particles are associated with increased risk of all-cause
mortality, or death, cardiovascular diseases such as heart
attacks and strokes, and lung diseases, including asthma, COPD,
and among these soldiers we have seen, as you will hear from
Will today, constrictive bronchiolitis and lung scarring, or
fibrosis. In fact, we can detect burned particles in the lungs
of these troops.
Military personnel often do not have pre-deployment lung
testing other than a two-mile run time. If a soldier returns
with a cardiopulmonary exercise test that is 80 percent
predicted post-deployment, which would be considered otherwise
within normal limits, if in fact pre-deployment that soldier
was 120 percent predicted, then this is a significant decrease.
We propose NIH-or NIOSH-funded monitoring centers of
excellence for affected patients, analogous to World Trade
Center Monitoring Programs, since in the greater New York area,
for instance, most veterans are not seen in the VA since they
exceed income limits, are young with full-time civilian jobs,
and have commercial health insurance. We envision centers
studying basic animal models, investigating therapeutic agents,
clinically monitoring patients longitudinally, like the World
Trade Center Monitoring Programs, and conducting clinical
trials.
The consultative National VA War-Related Illness injury
centers are few and excellent, but neither monitor patients nor
perform biopsies. We conceptually agree with 2020 bipartisan
bill H.R.8261 in the House and S. 4572 in the Senate which
proposed to grant presumption of medical claims for all troops
who were deployed to Iraq and Afghanistan since 2003. We agree
with the concept that President Biden should propose for
consideration in his first 100 days, presumption of care for
war fighters with subsets of lung diseases post-deployment.
Even in 2020, 77 percent of veterans requesting
compensation and pension medical exams for maladies beginning
in Iraq and Afghanistan are denied benefits. The American
Thoracic Society, in 2019, argued for more research. The
National Academy of Medicine, in addition, argued for
investigation of biomarkers and pre-deployment pulmonary
diagnostic monitoring. So we urge further research on returning
soldiers.
Not only should we honor the dead who have made the
ultimate sacrifice in war, but we also should provide care for
the living: brave women and men who sacrificed their health for
freedom.
Senator Moran. [Presiding.] Doctor, thank you very much. I
am now going to recognize one of your patients, William
Thompson, who is an Iraq War veteran, who served in the Army,
who has had both lungs transplanted twice due to his exposure
in Iraq. Mr. Thompson?
STATEMENT OF WILLIAM THOMPSON
Mr. Thompson. Yes, sir. Can you hear me?
Chairman Tester. Yes, sir.
Mr. Thompson. Thank you for hearing us today and thank you
for having us. My name is retired Staff Sergeant William
Thompson. I served 23 years, 3 months and 11 days in the United
States Army and the West Virginia Army National Guard. I have
deployed twice with the West Virginia Army National Guard to
Iraq. During my last deployment, I was stationed at Camp
Stryker at the Victory complex.
My symptoms of frequent coughing started around September
2009, while in Iraq, in which my doctors and physician
assistants treated me for what they thought were allergies. I
returned to Fort Stewart, Georgia, and after I mentioned to the
doctors I was having frequent cough, they did a chest x-ray
that revealed bilateral pneumonia. They treated me with
antibiotics and sent me home to West Virginia to followup with
my PCP in 1 week.
After a week, I followed up with my doctor, Dr. Remines,
and he discovered, after more testing, that I had pulmonary
fibrosis with nodules, and Stated that my lungs looked like an
``80-year-old coal miner's lungs.'' He referred me to Walter
Reed Army Medical Center pulmonary department where I was
treated by Dr. Jacob Collins for 6 months. He admitted me to
the Warrior Transition Unit at Walter Reed and after 6 months
of testing, which included an open lung biopsy, I was informed
that I had titanium, magnesium, and iron, in addition to
silica, in my lungs. They diagnosed me with hypersensitivity
pneumonitis and pulmonary fibrosis.
I gained 60 pounds from the high amounts of steroids I was
on daily. Because my lung disease was chronic, I was referred
to Inova Fairfax Hospital by Walter Reed and was told I would
most likely need a lung transplant in the future. I have been
seen by Inova Fairfax Hospital Lung Transplant Clinic from
February 2011 to the present time. During that time, I have
been on oxygen levels as high as 10 liters continuously. On
June 6, 2012, I received a double lung transplant. After 2
months of followups, I was able to return home and start
pulmonary rehab.
The first year was a good year. I took all precautions and
followed all the orders that were instructed by my doctors.
Despite this, over the next 3 years, I went through periods of
lung rejection and infections and decreased oxygen levels. I
was back on oxygen again, and on March 9, 2016, I underwent
another double lung transplant. Unfortunately, they are more
susceptible to complications than other organ transplants since
the lungs are exposed to everything from the environment.
My life and my family's life have changed since I returned
home in 2010. I have to wear a mask in highly populated areas.
I know wearing a mask is typical these days, but I have been
wearing one since 2012. It is hard to hang out with my kids
only to tell them ``I cannot do that.''
``Daddy, let's go skiing.'' Sorry, kids, I cannot do that.
``Daddy, let's go swimming.'' Sorry, kids, I cannot do
that.
``Daddy, can you give me a piggyback ride?'' Sorry, Ava, I
cannot do that.
``Daddy, let's go fishing.'' Sorry, Ethan, I cannot do that
because of the bacteria on the fish.
``Dad let's go to the beach.'' Sorry, kids, I cannot do
that because of the bacteria in the water and the sun with my
transplant medications makes me more prone to skin cancers.
Speaking of skin cancers, I am currently battling
trigeminal neuralgia after having a skin cancer removed from my
left cheek that aggravated my trigeminal nerve. This is a very
painful and debilitating condition that is also known as the
``suicide disease'' and is known to be one of the most painful
disorders known to medicine. It causes sudden shock-like pain
in my face that lasts from minutes to hours at a time. Because
of this disorder, I have added numerous medications to my
previously very large daily pill regimen.
I do not feel like a man anymore because my wife has had to
take many roles from me. There are so many things that I can no
longer do.
I am a warrior of the United States of America. I gave my
lungs for my country. The toxins in the air from the burn pits
and the dust in Iraq has changed my life. I am glad to be alive
and home when so many did not make it home. My illness and
injuries are different. I have heard so many times from the VA
``We do not know how to treat you,'' or ``You do not qualify or
fit the parameters for benefits.'' I have been denied TSGLI
because the Army does not think having a lung transplant is a
``traumatic event.'' Burn pits should be recognized and
acknowledged as an incident of war.
Luckily, we found the group, Semper Fi of America Fund, who
works with veterans and provided the funds to make my bathroom
ADA accessible. Since then, the VA has helped me with one
housing HISA grant, but only after being denied several times.
My injuries and illnesses are different from other more
common injuries from Iraq and because of that it took the VA 3
years to provide me with an air purifier in my home to keep my
home free of allergens and dust. They also denied help in
removing carpet from my home that was instructed by my doctors,
so we had to pay for this ourselves. We have also taken out a
loan to build a workout area in my home where I can work out
and continue my pulmonary rehab during times of my illness or
times when cold or flu season is at its peak. Although I was
100 percent service connected through the Army and VA, I do not
qualify to receive my retirement until age 60 because my
injuries were not ``combat related.'' I may not live to be age
60--I turn 50 this year.
Every day for me is a battle I continue to fight. I still
have to battle infections and try to keep my body healthy from
lung rejection. I still have to fight secondary problems
related to my transplant. Hopefully, after hearing my story, it
will bring awareness for not only me but others who are
battling the same or similar injuries related to burn pit
exposures from Iraq or Afghanistan.
Thank you allowing me to share my story.
Senator Moran. Mr. Thompson, thank you for your compelling
story, your testimony. Senator Tester, Chairman Tester, has
turned and I now turn the gavel back to him.
Chairman Tester. [Presiding.] Thank you, Ranking Member
Moran. Next up, virtually again, is Karl Kelsey, who is an MD,
Professor of Epidemiology, Pathology and Laboratory Medicine at
Brown University. Dr. Kelsey, you have the floor.
STATEMENT OF KARL KELSEY
Dr. Kelsey. Good afternoon, Chairman Tester, Ranking Member
Moran, members of the Committee. My name is Karl Kelsey. I am a
professor at Brown University and a physician. I am here today
in my capacity as a member of a committee formed by the
National Academy of Sciences, Engineering, and Medicine to
assess the evidence of an association between exposure to Agent
Orange and other herbicides used in the Vietnam War and adverse
health effects.
As many of you know, the National Academies have a long
history of advising the Federal Government on the health
effects of military services. I have served on committees that
produced 4 of the 12 reports in the Veterans and Agent Orange
series. Today I will discuss Update 11, which was released in
2018, and I will focus my testimony on the epidemiologic
evidence of an association between exposure to herbicides and
hypertension.
From 1962 to 1971, the U.S. military sprayed herbicides
over Vietnam for tactical purposes. The most used chemical
mixture sprayed was Agent Orange, which, as you know, is
contaminated with TCDD, which is the most toxic form of dioxin.
The National Academies committees classified a strength of
evidence regarding the association between exposure to the
chemicals of interest and health outcomes into four categories:
sufficient, limited or suggested, inadequate or insufficient,
and no association. As mandated by the Agent Orange Act, the
distinction among the categories are based on statistical
association, not strictly on causality.
Our Update 11 committee concluded that the available
medical and scientific information constitutes significantly
sufficient evidence of an association between exposure to at
least one of the chemicals of interest and hypertension. The
strongest conclusion regarding a potential increase in the
incidence of hypertension came from studies that controlled for
many risk factors associated with hypertension.
Our committee reviewed six new studies of exposure to
chemicals of interest and hypertension that have been published
since the previous update. Five of these had one or more
significant study design deficiencies that would not be
considered adequate to change the level of association
individually.
Our decision to change the classification from ``limited or
suggested'' to ``sufficient evidence'' of an association was
really motivated by a 2016 paper, authored by VA researchers,
Yasmin Cypel and colleagues. These investigators conducted a
study of Vietnam veterans in the Army Chemical Corps, the ACC.
The study was characterized by a large sample size, appropriate
controls, and validated health endpoints. The statistical
analysis was robust, they used State-of-the-art methods, they
adjusted for relevant confounders, and included several levels
of exposure, herbicide sprayers and non-sprayers, and Vietnam-
deployed and non-deployed veterans.
The study clearly showed that self-reported hypertension
rates were the highest among the military personnel with the
greatest opportunity for exposure to the chemicals of interest.
Among the Vietnam-deployed veterans, there was a statistically
significant elevated association between the odds of
hypertension through sprayers versus non-sprayers, and this
remained after adjusting for potential confounders.
Similarly, for the veterans who did not deploy to Vietnam,
self-reported hypertension was significantly elevated among the
sprayers compared with the non-sprayers.
Among those with serum TCCD levels available, self-reported
herbicide spray status had high agreement with the measured
levels. The highest mean TCCD level was observed among the
sprayers deployed to Vietnam, and the lowest level was found
for the non-Vietnam non-sprayers. This would be expected with a
significant dose response association.
Likewise, there was high agreement between self-reported
hypertension and in-person blood pressure measurements in
medical records review that was done for a subsample of the
participants. As I said, the analysis controlled for the
important risk factors for hypertension.
So a major strength of this analysis was also using non-
Vietnam-deployed ACC veterans as a comparison group, because
they are really quite similar to the members of the study
group. Although it is important to note the exact types and
quantities of the various chemicals that these ACC veterans
were possibly exposed to during the Vietnam War are unknown,
and may include chemicals other than herbicides, there is a
statistically significant support for an association between
herbicide exposure and self-reported, physician-diagnosed
hypertension.
I should also mention recent biological mechanistic
research was reviewed by the committee and it also showed
evidence for dioxin's impact on hypertension via effects on
gene expression, vascular function, lipid glucose metabolism,
and so on. When the totality of evidence was considered, our
committee found that this body of literature constituted
sufficient evidence of an association.
I thank you for the opportunity to testify, and I am happy
to answer any questions that you may have.
Chairman Tester. Thank you, Dr. Kelsey. I appreciate your
testimony also, and there will be questions here as soon as we
hear from all the witnesses.
Next we have Jeffrey O'Malley. Jeffrey is a Vietnam veteran
who served in the Army, currently living with drug-resistant
hypertension and kidney cancer. Jeff, the floor is yours.
STATEMENT OF JEFFREY O'MALLEY
Mr. O'Malley. Chairman Tester, Ranking Member Moran,
honorable members of the Committee, my name is Jeff O'Malley,
and I am honored to be asked to participate in today's hearing
of the Committee. I would like to note the date as having
special significance for me, as it is exactly 50 years from the
date that I boarded the plane for Vietnam, March 10, 1971. The
experiences I had during my tour, and those of all my comrades,
have stayed with us for all these years.
I signed a 4-year enlistment in June 1969, committing to
assignment with the Army Security Agency, and with the
expectation that I would probably be sent to language school. I
completed basic and was sent to the Defense Language Institute,
Southwest at Biggs Field, Ft. Bliss for the 47-week Vietnamese
language course. After graduation, we were sent to an
electronics courses and then Vietnam. During language school
and the electronics course, our top secret security clearances
were completed.
I served from March 1971 to late February 1972, as a voice
intercept linguist for the Army Security Agency. Except for a
few day trips, I worked at the 8th Radio Research Field Station
south of Hue. The work was important, and, at times, stressful,
but the unit was well run and efficient, earning two unit
citations during my tour.
I returned to the United States in late 1972, pending my
discharge, and received my discharge and I returned to Houston,
and re-entered civilian life.
Over the years, I used the GI Bill to go to college, and
worked in various positions in retail, including a career of
about 15 years as a loss prevention executive in Texas and
Louisiana. After that career, I had various jobs, and many of
them were of a contract nature and did not have benefits,
including health insurance, but I was in generally good health.
In the summer of 2008, I was offered a permanent position
with an alternative school in the area, with a raise and full
benefits. It was due to begin on September 1, 2008, and I
accepted. As is fairly common in southeast Texas in late
summer, a hurricane arose in the Gulf, knocking out power for a
2-week period, and I was not able to start at the beginning of
the school year. I took the time, during my downtime, to try to
find a primary care physician with my new Blue Cross Blue
Shield insurance, and I found one that was open and had power,
and went to meet the doctor.
Since the nurse had not been scheduled to be there that
day, the doctor did the normal nurse things for me--height,
weight, and took my blood pressure and history. When she took
my blood pressure she got very quiet, and then she said, ``I
think I am going to take it again,'' and she did, and she said,
``Mr. O'Malley, I am your primary care physician now. I am
going to give you a pill and you are going to sit in the lobby
for an hour, and we are going to see if we can get it to come
down, because it is really high.''
I went and sat in the lobby. I think I had a Klonopin pill.
And in an hour she took it again and she said, ``I am going to
give you another pill and we are going to wait another hour.''
During that time she scheduled me for blood work and a chest x-
ray, and various other tests, and it was determined that my
blood pressure, at that point, when she first read it, was 210/
140. She had indicated that she had never seen blood pressure
that high in the office. She had seen it in the emergency room
when someone was having a stroke.
She needed to find out why I had that high blood pressure,
but she gave me a prescription and I started work. The
prescription did not work for me. I regularly had my blood
pressure taken and was sent home because it was too high.
Eventually I went to a cardiologist who got my prescription
right, but he still needed to find out why, so he was going to
send me for a CT scan. Sometimes the kidney arteries can cause
high blood pressure.
After the CT scan it was determined that I also had kidney
cancer. It was stage I, because I had no symptoms of anything
when I went to the doctor. I did lose my kidney at that point,
but I have not ever had radiation or chemo.
After about 6 months I tried to figure out why was it,
since I lost my kidney, why was I still taking blood pressure
medicine? And the doctor had to tell me, ``Mr. O'Malley, we
found your kidney cancer but we still do not know why you have
high blood pressure.''
So I take four medications for my high blood pressure, and
it is under control when I take my medication but it causes me
a great deal of fatigue. It took me a while to recover, and in
the long run I lost the job that I had, I lost the Blue Cross
insurance that I had, and that is when I came to the VA.
A fellow veteran of mine, who trained and served with me,
Dan Ferguson, from Toledo, Ohio, asked me, on a trip to Toledo,
what kind of cancer I had and whether it was an Agent Orange
presumptive disease. It was not. We went to his VSO to try to
determine if there was anything that could be done, and he
indicated to me that I should start watching the research on
hypertension, and I did so.
When Dr. Shulkin, in 2017, in November, announced that he
had made a decision about the pending presumptives, I tried to
figure out what that decision actually was, and I could not. I
did everything that the VA asked me to do. I called the White
House Veterans Hotline; they could not give me an answer. Four
times I called them and they never did anything, were able to
tell me.
Eventually, I filed a FOIA and was denied, and then
appealed, and then I won, and then I started getting documents
from the VA. I, over a period of time, grew frustrated with the
process, and provided those documents to the press and to
Congress, which indicated some of the flaws in the way
presumptives are decided.
My health, when my blood pressure is controlled, has been
pretty good, but my stamina has meant that I, at my age, I was
not able to find meaningful employment after that.
The opportunity to testify about this before the Committee
and to support the effort to understand the ongoing problems
resulting from the use of Agent Orange is greatly appreciated,
and I look forward to any questions you may have.
Chairman Tester. Thank you, Mr. O'Malley, and I want to
thank Mr. Thompson and Drs. Kelsey and Szema for their
testimony. Now we will hear from Shane Liermann, Deputy
National Legislative Director for the DAV. Shane, you are up.
STATEMENT OF SHANE LIERMANN
Mr. Liermann. Thank you. Chairman Tester, Ranking Member
Moran, and members of the Committee, on behalf of DAV's more
than 1 million members who have wartime service-related wounds,
injuries, diseases, and illnesses, we thank you for the
opportunity to appear before you today to discuss the human
costs of toxic exposure.
When our service men and women are subjected to toxins and
environmental hazard, our sense of duty to them must be
heightened, as many of the illnesses and diseases due to these
exposures may not be identified for years, even decades, after
they have completed their service. As noted in our written
testimony, this is compounded by the time it takes for VA to
concede these exposures and to scientifically associate
presumptive diseases. In many instances, it has taken decades
to provide these veterans access to benefits and health care
they have earned.
Although Congress established a presumptive process and
diseases for Vietnam veterans exposed to Agent Orange in 1991,
it is now over 40 years--excuse me, over 50 years since the end
of that conflict and they are still fighting for inclusion of
presumptive diseases. We thank you, Chairman Tester and Ranking
Member Moran, and the whole committee for getting bladder
cancer, hypothyroidism, and Parkinsonism added to the
presumptive list.
However, Vietnam veterans are still facing obstacles. For
example, Theodore Kalagian, my wife's uncle, honorably served
the United States Army in Vietnam and is still fighting VA for
his benefits. He was diagnosed with bladder cancer in 2005, and
was denied VA benefits in 2007. Subsequently, he developed
ischemic heart disease, diabetes, and prostate cancer, all
presumptive to his Agent Orange exposure. Last, he also has
hypertension, which VA died and has refused to add as a
presumptive disease, despite, as noted, the National Academies
determined there is a significant, positive, scientific
association to Agent Orange exposure.
There are millions of other veterans exposed to toxins that
VA has not conceded or established presumptions for, such as
burn pits. Ms. Ashley McNorrill was deployed to Iraq as an Army
JAG officer stationed at Camp Victory in Baghdad in 2005. She
was exposed to toxins emitted from burn pits that she noted
were only a few feet from their chow hall. After service, Ms.
McNorrill and her husband tried to start a family but were
unable to conceive due to what they were told was
endometriosis, which required a hysterectomy. After they
adopted two small twin boys, she decided to have the
hysterectomy, and during the surgery was discovered that she
had stage IV appendiceal cancer, a rare form of the disease
occurring only in one or two cases out of a million.
After years of VA claims and appeals, with the assistance
of a DAV service officer in South Carolina, she was awarded
total and permanent VA disability benefits. The grant of
benefits was based on her private medical opinion, linking her
burn pit exposure to the development of her rare disease.
Shortly after this victory, she succumbed to her burn pit-
related cancer and left her husband and two young sons behind.
This is why S.437, the Veterans Burn Pit Exposure
Recognition Act, is so important. The bill would concede
exposure to burn pits for anyone who served in a recognized
country and concede their exposure to the specific list of
toxins already accepted by VA. It would also guarantee a VA
exam and medical opinion, if required, to grant the claim. This
bill would not provide presumptive diseases. Instead, it will
remove barriers for direct service connection.
We thank Senator Sullivan and Senator Manchin for
introducing this legislation, and it could have granted Ms.
McNorrill benefits much sooner and allowed her to enjoy more
time with her family in her final years, instead of fighting
the VA.
Mr. Chairman, we are at a critical crossroads of the
horrific cost of toxic exposures and a presumptive process that
is wildly inconsistent and lacking flexibility moving forward.
It is clear that veterans need a way of establishing service
connection for diseases related to toxins now, and not wait for
the scientific community or VA's bureaucratic processes. We
recommend reforms and a new framework which should include
access to VA health care, a concession of exposure, and time-
required actions by the VA.
This concludes my testimony, and I am pleased to answer any
questions you may have.
Chairman Tester. Thank you, Mr. Liermann. I appreciate your
testimony. Next up we have Aleks Morosky, Government Affairs
Specialist for the Wounded Warrior Project. Aleks?
STATEMENT OF ALEKS MOROSKY
Mr. Morosky. Chairman Tester, Ranking Member Moran, and
members of the Committee, thank you for the opportunity to
testify on Wounded Warrior Project's efforts to assist veterans
who have been exposed to toxic substances during their military
service.
For nearly 20 years, a significant number of post-9/11
veterans have been exposed to contaminants such as burn pits,
toxic fragments, radiation, and other hazardous materials found
on deployments to countries like Iraq, Afghanistan, and
elsewhere. As an organization dedicated to connect, serve, and
empower our Nation's post-9/11 wounded ill and injured
veterans, we are firmly committed to addressing their toxic
wounds with the same urgency that we address the physical and
invisible wounds of war.
Results from our 2020 Annual Warrior Survey confirm the
scope of the issue, but the warrior story cannot be told with
data alone. To better illustrate the challenges that exposed
warriors face, both with their illnesses and with access to VA
health care and benefits, I would like to tell you about a
warrior named Scott Evans.
Scott was a Marine. He deployed twice to Afghanistan as a
combat engineer and as a dog handler. He served at the Battle
of Marjah, and like so many, he also suffered exposure to open-
air burn pits during his deployments. He says burn pits were
sometimes even used as a training area where they taught
military dogs to sniff out munitions among burning waste.
In 2012, Scott was honorably discharged and immediately
began working a full-time civilian job. Like many hard-charging
veterans, since he felt he suffered no significant disabilities
from his service, he never filed a claim or enrolled in VA
medical care.
Then suddenly, in the spring of 2020, at the age of 32,
Scott started experiencing severe abdominal pain and rapid
weight loss. At that point, he attempted to enroll for care at
his local VA, but learned that he was not eligible since he
never filed a disability claim and was beyond the 5-year
enhanced eligibility period for combat veterans.
In July 2020, a friend who had served with Scott reached
out to Wounded Warrior Project to see if we could help, and by
this time Scott had incurred about $20,000 in medical bills,
seeking a diagnosis and treatment for his condition. It was
obvious at that time that Scott was critically ill.
Our Wounded Warrior Project teammate convinced Scott to
return with him to the VA hospital. When he got there, the
emergency room doctors immediately recognized the seriousness
of the situation but needed Scott to visit Eligibility before
they could provide further care. Eligibility told him once
again that he was ineligible to until he was service connected.
After Scott and his wife left the room a teammate told the
clerk that Scott was an uninsured, terminal cancer patient with
multiple combat tours and an honorable discharge. After looking
again at Scott's combat service record, the clerk relented and
Scott was enrolled at VA.
Since then, Scott has received compassionate, life-
prolonging care for his illness, eventually diagnosed as
terminal pancreatic cancer. Scott has since been granted
service connection, but we are immensely grateful that our
teammate was able to obtain care for him when he did. Sadly, a
veteran without such an advocate may have been turned away
indefinitely.
I spoke to Scott and his wife on the phone yesterday. They
told me that while the care has been good at VA since he has
been enrolled, it is a terrible feeling to wonder whether the
mass on his pancreas may have been operable if it was caught a
few months sooner, when he first tried to seek care. They also
told me that they know that there are other veterans who are in
the same situation as them, and they only hope that sharing
their story will lead to improvements in the system for others,
even though Scott does not know how much time he has left.
Wounded Warrior Project thinks that no veteran should have
to go through what Scott went through. This is why we believe
that access to care for all veterans who suffered toxic
exposures is an urgent priority, and we think that any veteran
who has served in an area of known exposure should be eligible
for permanent enrollment in Priority Group 6, regardless of the
location or timeframe in which they served, now and in the
future.
And while we see health care as an urgent need, we also
recognize that benefits, including disability compensation and
DIC eligibility, are critically important. That is why we
support the establishment of a permanent framework that
requires VA to respond to scientific data and create
presumptive service connection whenever there is a positive
association between an illness and an exposure, in a timely and
transparent manner. Once again, we feel this should apply to
all toxic exposures, regardless of era or location of service.
Finally, we believe there are several ways to improve the
process for direct service connection, and these include
concession of exposure to burn pits and other toxic substances
for all current-era veterans who served in areas of known
exposure.
Senators, the Wounded Warrior Project believes that we owe
it to veterans like Scott to get this right, and we look
forward to continuing to work with the Committee to address
this urgent issue in the 117th Congress.
Chairman Tester, Ranking Member Moran, this concludes my
Statement and I look forward to your questions.
Chairman Tester. Thank you for your testimony, Aleks. We
are going to start with questions. These will be 5-minute
rounds. I would ask the Senators to try to stay as close to
that as you possibly can.
I will yield my time to Senator Hassan from New Hampshire,
because she has a conflict at the top of the hour. Senator
Hassan.
SENATOR MAGARET WOOD HASSAN
Senator Hassan. Thank you so much, Mr. Chairman, and thank
you for your courtesy in yielding the time. To Ranking Member
Moran, thank you as well for holding this hearing. To all of
the witnesses, thank you for your testimony today. To the
veterans, thank you so much for your service and sacrifices,
and I particularly want to thank Mr. Thompson and Mr. O'Malley
for your testimony. It is not easy to talk about these things
in front of an audience but it makes such a difference for your
fellow veterans and your fellow Americans to hear what you have
to say, so thank you.
I am going to, I think, just stick to one question, because
I have to go preside at the top of the hour, which the Chairman
referenced, and I want to talk to Mr. Liermann and Mr. Morosky,
because as we examine these issue we have to recognize that
unfortunately servicemembers, veterans, and their families may
have been exposed to toxic environments not only while serving
overseas but also while they are right here at home.
In my State of New Hampshire, members of the military who
serve at the Pease Air Force Base, their families, and people
living in the surrounding community, were exposed to drinking
water contaminated by high levels of PFAS, pollutants that are
known as, quote, ``forever chemicals.'' I know that the Biden
administration is currently considering implementing better
PFAS safeguards, and I strongly support these efforts.
Unfortunately, toxic exposure at domestic sites is not
unique to New Hampshire. For example, decades ago, Camp Lejeune
in North Carolina experienced dangerous water contamination,
and the VA has since appropriately created a presumption of
service connection for certain diseases for veterans and their
families who were exposed at Camp Lejeune.
So, Mr. Liermann and Mr. Morosky, can you speak to some of
the issues facing veterans and their families who were exposed
to toxic environments within the United States, and any lessons
learned from Camp Lejeune that can be applied to other
situations such as the PFAS one?
Mr. Liermann. Thank you, Senator. I believe if you take a
look at the types of toxic exposures, just domestically, within
the U.S., outside of Camp Lejeune and the PFAS there then is
also Ft. McClellen, Alabama. So there is a history of toxic
exposures throughout the country, even domestically. So finding
a way to establish something, as you mentioned, like Camp
Lejeune, is what we are all striving for, especially the PFAS
issue. They are now indicating over 600 military installations
have been known to have high levels of PFAS.
So there are several different things that can be done,
like setting up a presumptive like Camp Lejeune, or like the
idea of the concession of exposure as noted in S.437. If we
could conceded their exposure to those chemicals now, instead
of waiting for studies and science, we can provide a quicker,
direct path for service connection for diseases related
thereto.
Senator Hassan. Great. Thank you. Mr. Liermann?
Mr. Morosky. Senator, I will just add that in the past we
have often dealt with toxic exposures on sort of a conflict-by-
conflict basis. What we envision would be offering access to
health care and benefits for all eras on the same basis, and
toxic exposures now and in the future, and that would also
include domestic as well as overseas. We think that those who
were exposed on a domestic basis should be offered care and
benefits on the same basis as those overseas.
Senator Hassan. Thank you very much. I look forward to
working with you all on that. To all the witnesses, thank you,
and to those advocating and researching on these issues we are
really grateful for your work too.
Thank you, Mr. Chair. I yield back.
Chairman Tester. Senator Moran.
Senator Moran. Chairman Tester, thank you.
Chairman Tester. Sherrod, you have got to mute.
Senator Moran. Thank you very much, Mr. Chairman. I was
waiting to see if Senator Brown had any other comments before I
began my remarks. Let me start with Mr. Morosky. Can you opine
on what you believe to be Congress' role in adding additional
presumptions to the list versus the Executive branch, the
Department, and others exercising its authority? And can you
comment on any concerns that the precedent being set, if it
continues to be left to Congress to add to that presumptive
list.
Mr. Morosky. Thank you, Senator Moran. You know, in the
past we have seen presumptive service connections that are
established by Congress, with bills in Congress, and we have
seen cases where the VA acted based on scientific evidence. We
believe it is ideal when the VA acts based on scientific
evidence, which is why we support a framework that would
require them to respond to the scientific data in a timely and
transparent manner. We believe that veterans deserve that.
While we will continue to support bills introduced in Congress
that establish presumptive service connection by statute in
that way, we also think that it should not always take an act
of Congress for veterans to have their claims granted, and it
should ideally be the VA that is responding to the scientific
data and giving that.
Senator Moran. I guess that is a good point, because often
the expression is it will take an act of Congress, as if that
is something nearly impossible, but we generally respond when
something is not being done, less than we are able to do. So
thank you for that analysis.
Mr. Liermann, in your testimony you noted the barriers to
veterans' claims for benefits related to burn pit exposure.
Noting the history of toxic exposures that have face multiple
subsequent generations of veterans and future uncertain combat
environments, what actions can Congress take to most
immediately--most immediately--make an impact for veterans
suffering from toxic exposure today? In other words, I think my
question is, what can we do now that would make a difference
now?
Mr. Liermann. Thank you, Senator. Two things. I believe,
one, if we take this idea of the concession of exposure and
implement it now--it does not require science, it does not
require anything additional--it is a quicker path for direct
service connection for veterans. Two, we need to establish a
framework, as Aleks has mentioned and several other people
mentioned, that has a lot of these built in so we are not
spending time squabbling over the science each and every time
there is a new presumptive or a new exposure. We have something
in place so immediate action can be taken, so veterans do not
have to continue to wait decades for access to health care and
benefits.
Senator Moran. Thank you for that answer. Let me turn again
to Mr. Morosky and ask, any comments that you have about
expedited health care for veterans for toxic exposure? I think
your testimony indicates how important it is for a quick
answer. Is there something specific that we should know why
that is important, or is that just self-evident?
Mr. Morosky. We think it is self-evident, and we think it
is an urgent need that is not being met for veterans like
Scott, that I spoke about in my opening Statement, Mr. Ranking
Member. Access to care is something that is provided to Vietnam
veterans on a priority group 6 basis, without the need to
establish a presumptive service connection. It is provided to
post-9/11 combat veterans but only for a period of 5 years.
Once that 5-year window runs out, veterans like Scott, who have
serious illnesses seven or 8 years later, are turned away,
unfortunately.
Senator Moran. So it may be true, if I had time to ask the
medical doctors that are our witnesses today, and maybe I will
have that chance later, that there may be specific nature of
these conditions that so much better result can occur if
treatment begins quickly. I would guess that is true in most
instances, but maybe there is something unique about these
circumstances that our service men and women face.
I would conclude, Mr. Chairman, by saying that a number of
years ago, certainly during my time in the Senate, a group of
veterans met in Wichita, Kansas, and it was family members, and
I would highlight what has stuck with me since then, probably
for a decade now. And that is that these veterans and their
family members were there because they were concerned about
their own children and grandchildren. And the consequences that
occur from these exposures, those consequences are appearing
their children and grandchildren. It has always stayed with me
that I know service men and women are willing to accept risks
for their service, but I cannot imagine one of them thought
they were doing anything that might harm a family member, or
somebody who may not even be born yet.
And so we will continue. Senator Blumenthal and I have
worked to try to make certain that we get the scientific and
medical evidence necessary to determine what role the
Department of Veterans Affairs, what we as Congress should do
for another generation of service men and women's family
members.
Mr. Chairman, thank you.
Chairman Tester. Thank you, Senator Moran. Mr. Thompson, I
am going to start with you. First of all, thank you for your
testimony. Thank you for your service.
Your health problems started to manifest toward the end of
your second deployment in Iraq in 2009. Could you tell me, how
long from when you started to experience symptoms did it take
before a doctor concluded that burn pits played a role?
Mr. Thompson. Yes, sir. It was September 2009 is when I
started feeling the effects, and I would say it was the summer
of 2010 that the doctor from Walter Reed had listed that the
burn pits and environmental agents caused the effect.
Chairman Tester. I appreciate that. Has either the DoD or
the VA conceded that your health conditions were caused
directly by your exposures in Iraq?
Mr. Thompson. No, sir. Not to my knowledge.
Chairman Tester. And what has that meant for you on a day-
by-day basis? What has that meant?
Mr. Thompson. Well, I was denied my Army retirement because
if it was not a combat action then I do not receive that
retirement.
I am sorry for being slow. I am going on 3 days without any
sleep.
Chairman Tester. Well, you are doing just fine. Do not
apologize for that. We appreciate your testimony.
Dr. Szema, you have done some pretty amazing research on
lung injury in Iraq and Afghanistan veterans. I want you to
walk us through some of the conditions that your research has
found to be associated with burn pit exposures.
Dr. Szema. So the most common ones would be asthma,
bronchitis, and COPD, chronic obstructive pulmonary disease,
even in the absence of smoking. But we see a rare form of lung
disease called constrictive bronchiolitis, which have been
duplicated by Dr. Robert Miller of Vanderbilt. And the most
severe patients are like Will, who have had lung scarring with
the constrictive bronchiolitis, and actually Will was gracious
enough to give his native lungs to us. We actually determined
that there were burned particles in his lungs. They were
polycyclic aromatic hydrocarbons, which are products of
incomplete combustion. So he has got burn pit stuff in his
lungs.
And we can duplicate it. He was at Camp Victory. We, at the
surface, grabbed samples from Camp Victory, Iraq, taken in that
timeframe, and we found those same particles as well, burn
particles in the actual dust, that the U.S. Geological Survey
connected for us.
Chairman Tester. I appreciate that. Mr. O'Malley, by the
way, you have the same name as my elementary principal so I
feel like I am talking to him. But I want to thank you for your
service. I want to thank you for your testimony. You talked
about not having health insurance until you learned you were
eligible for VA health care, from a fellow Vietnam veteran. Can
you tell us about your experience with VA health care?
Mr. O'Malley. Thank you, Chairman. For those of you not
familiar with Houston area, I get my primary care and my
special care at the Michael DeBakey Veterans Affairs Medical
Center in Houston. It is located in basically the heart of the
Texas Medical Center, which is one of the finest research areas
for medicine in the United States and in the world. Many of the
doctors who do specialty care for me when I need it are wearing
also Baylor College of Medicine tags and are receiving their
training under the supervision of Baylor and the VA.
I have had, in my 11 or so years of treatment at the VA,
exemplary care, and it is by far the longest relationship with
a primary care physician I have had in my life. I recently, for
the first time, experienced a new primary care physician after
mine retired. The hearing aids I am wearing, the treatments I
have received for conditions that have arisen have been top
notch. And in my experience talking to other veterans that I
know, they may be frustrated with bureaucratic things with the
VA, but I do not know anybody in the Houston area that is upset
with their medical care.
Chairman Tester. That is good news and that is news we
always like to hear on this Committee.
Senator Tillis, you are up.
SENATOR THOM TILLIS
Senator Tillis. Thank you, Mr. Chairman, and thank you to
the witnesses for testifying. Mr. Chairman, I want to thank
you, in the time that we have worked together, since I have
been on this Committee and particularly with your vocal support
for trying to move forward with the TEAM Act. I want to thank
former Chair and Ranking Member Moran for having a vote where
the TEAM Act was passed unanimously out of the Committee.
I know that one of the witnesses referred to the process
that they go through with the VA, when dealing with exposures
and presumptions as--Shane, I think it was you, actually, that
said it was complex and uncaring, exposure and presumptive
process. I think it is. And that is why I think the TEAM Act,
and actually the Burn Pit Exposure Act that was co-sponsored by
Senators Sullivan and Manchin, are so important for us to get
before this Committee.
We have a coalition of some 30 veteran service
organizations. I think every one that is not even on the
coalition supports the bill. And I believe that it moves
forward with getting rid of some of that frustration and not
putting the weight on veteran, but having an independent
review, and maybe let the tie go to the veteran. And I look
forward to working with you and the other members to get that
to the floor and ultimately to the President's desk.
I am sorry for not being here earlier. We have got another
committee that I have to speak at shortly. But the other thing
that I hope we start thinking, I think we are going to make
progress on the TEAM Act. I think that we can figure out a way
to resolve some minor differences with some of our colleagues
on the House side and move forward with the bill in this
Congress, and hopefully the first half of this Congress.
But also, as I was looking at some of the provisions in the
TEAM Act, something as simple as an exposure questionnaire when
a veteran comes into a VA facility, I think we have got to
start looking further upstream. And I think I have made note
for my staff that I would like to have that exposure
questionnaire as a part of a TAP program, before they ever
transition into veteran status.
And I would even like to go further. I would like to be
able to provide information in the electronic health record for
a servicemember to where we are capturing information that we
can predict--it may have been an event that they can no longer
remember, but with increased situational awareness on the
ground there should be some way to be able to capture that
information over the life of a servicemember so that we could
even predict someone who may fill out that form and just blow
through it because, you know, when you go through TAP what you
are really wanting to do is make the transition.
I want to get to a TAP program of one. I want to know
everything that we need to know about that servicemember, up to
and including potential health risk exposures, so that we can
actually vector them immediately, before they ever have any
sign or a symptom, and then have the weight of their service
history, the medical and exposure dimensions of their service
history, as being the weight that they carry to that process,
along with a fairer process with respect to outside
consultation on exposures.
So, Mr. Chairman, this is a group of people that my office
has spent a lot of time with, and we are going to spend a lot
more time because we are going to do everything we can to get
the TEAM Act and some great ideas from other members embodied
in the same bill, and we are going to need your support to make
sure that in this Congress we can all have a celebration,
hopefully without masks and not virtually, of what I think is a
major step forward. We have made great progress.
I got exposed to this when I first came to the Senate 6
years ago, with the Camp Lejeune situation. We fought and I
dealt with administrations, Democrat and Republican
administrations, where the presumptions were almost maddening,
and, you know, as a U.S. Senator I found it maddening. I cannot
imagine what it would be like for a veteran who has encountered
an illness, that is going through this process.
So, Mr. Chairman, I am not going to ask any other questions
except to say, in my remaining minute, I really do hope that
you all will not only think about those veterans but think
about that servicemember, that active servicemember, and what
more we can do to better integrate and better identify these
problems before that servicemember or that veteran may ever
know that they have an exposure or a problem.
Chairman Tester. Thank you, Senator Tillis, and it is fair
to say that you and your predecessor, Senator Burr, on this
Committee have been on this issue for a long, long time now, so
we appreciate your leadership.
Next we have Senator Brown.
SENATOR SHERROD BROWN
Senator Brown. Thank you, Mr. Chairman, and I apologize for
my talking when I was not muted before. I was just asking if
Mr. Hamilton was actually here, because I could not see on the
screen, so thank you. I know he is remote, so thank you. And I
appreciate the comments of Senator Tillis a moment ago.
Thanks for the hearing, first. Thanks for the witnesses'
testimonies. I really am heartened the way that all of your
talking about toxic exposures. I appreciate Senator Tester's
leadership on Agent Orange. We have still got to work on
hypertension, but the success of last year of presumptive
eligibility were really important to so many veterans who I
have met in Ohio and I know across the country.
I want to talk about burn pits a little bit. I appreciate
comments earlier. Mr. Hamilton, I will start with you--Mr.
Thompson, I am sorry. Mr. Thompson, let me start with you.
Thanks for your testimony today. I heard part of it and then I
heard your answer to a couple other questions. I am sorry, I
was on another meeting. Nobody should have to go through what
you have gone through, still, what your family has been
through.
Mr. Thompson, what should servicemembers who are currently
overseas and exposed to burn pits do? What steps do you think
the Army and DoD should take? So answer that, and then what
steps the Army and DoD should take to prevent this exposure in
the first place, to burn pits.
Mr. Thompson. Well, first and foremost, they have already
improved incinerators back when--I think back when I was still
in country. And the only thing they need to do is just
implement it and get them up, get them running.
And then, it comes back to my memory. When I was there,
there were some of the foreign workers that we had at Camp
Stryker, every day I saw them wearing masks, and now I wish I
had took their lead and wore one every day. I do not know if it
would have helped but at least it would have been something.
Senator Brown. Yes, Okay. Thank you, Mr. Thompson, and
thanks again for serving, and I hope you are seeking out
results and getting better support from others and from the VA,
especially.
Dr. Szema, Dr. Miller was before our Committee a year, 18
months ago maybe, and I will ask similar questions to what I
asked him. You have treated servicemembers exposed to burn
pits. You have treated other environmental exposures. Do DoD
and VA have the protocols in place to correctly diagnose these
respiratory illnesses, and I think you mentioned constrictive
bronchiolitis? Are we doing that right? Do we have the
protocols in place?
Dr. Szema. The problem with diagnosing constrictive
bronchiolitis is that it is going to require a lung biopsy. Now
what we are working on at my hospitals, Norwell Health, with my
colleague, Dr. Agarwal, is transbronchial cryobiopsy. So that
is a way of getting a piece of lung without taking patients to
the operating room. So that is in the formative stages, but we
have a robust interventional pulmonary program. So that will be
a game-changer in terms of diagnosing without going for a
surgical biopsy, which was one of the criticisms in the past of
taking everybody to the operating room.
The other problem is there is noninvasive testing that I
use that is not widely available in the VA, and among the
things we do are something called impulse oscillometry, and it
is a $15,000 machine, and it takes 2 minutes. You put your
mouth on it and it determines if your distal areas are
narrowed. And if you do not reverse with an inhaler, it
suggests that your distal airways are narrowed and fixed,
consistent with constrictive bronchiolitis, in the absence of
other disease. So some of the tools are not available widely in
the VA.
Senator Brown. Thank you. My last question, Mr. Chairman,
Senator Portman and I have introduced a bill named after Heath
Robinson, an Ohioan who served in Iraq who was exposed to burn
pits and later died, far too young, of cancer. I hope that our
bill will help connect the dots between veterans' health
outcomes and burn pit exposure so that veterans get the
benefits that they have surely earned.
This is for Mr. Liermann, or maybe anybody else. Do you
happen to know at what rate burn pit victims' disability claims
are approved?
Mr. Liermann. Thank you, Senator. I believe the report the
VA put out last year was roughly 78 percent of the claims are
being denied when they are specific to burn pits, so roughly 22
to 24 percent are being granted, or 30 percent. I am a Marine;
math is not my strong suit.
Senator Brown. Why do you think, representing veterans, why
do you think that is the case, that that many are denied?
Mr. Liermann. Well, I think part of the problem is VA is
not recognizing that exposure as being toxic exposures, plus
there are no presumptive diseases. Fifty percent, or over 50
percent of those cases being denied are because they do not
have a medical link or a nexus between that exposure and that
disease, and that is why S. 437 would definitely remove some of
those barriers and make it easier to get direct service
connection in those cases.
Senator Brown. Mr. Chairman, if I could do one more real
quick question. Mr. Liermann, do you see a time when we have
presumptive eligibility for burn pits like we did, many years
too late, for Agent Orange?
Mr. Liermann. I would love to see that. Yes, absolutely,
and I hope we get to that point. The problem is, it has already
been, since the first Persian Gulf we are talking 30 years
since burn pits were again active, since 2001. We are way
behind the curve here. So I hope we do get to that point. I
just hope we find a way, in the intermediate, to establish a
way to get them health care, as Aleks was referring to, and
service-connected benefits now, so they do not keep suffering
and waiting another 10, 20, or 30 years.
Senator Brown. Thank you. Thank you, Mr. Chairman.
Chairman Tester. Yes, make no mistake about it, Senator
Brown. We hold these hearings for two reasons: to gather
information for the Committee members and to help educate the
VA that they might take action before Congress does.
Senator Blackburn, you are up.
SENATOR MARSHA BLACKBURN
Senator Blackburn. Thank you, Mr. Chairman, and thank you
to each of you for being with us today.
Just a couple of quick questions. I have done a good bit of
work on the K2 veterans issue. We have folks in Tennessee that
were part of the 5th Special Forces Group, the 160th SOAR, and,
of course, they spent time there at K2. And we have worked
diligently. The NDAA has a study, a 180-day study, that we are
going to look at some of these veterans and getting to them
what they need.
It is of concern to us that we have the number of denied
veterans that we have, and the hope there is that the TEAM Act
would help with removing some of those barriers, by getting the
K2 veterans included in the Burn Pit Registry, getting that
exposure there. That is something that we think is going to be
vital.
Dr. Szema, I do have a question I wanted to ask you,
because we have got the MISSION Act that allows veterans to go
now outside of the VA system and seek care when they need it.
So what I would like to hear from you is what ways could DoD
proactively, or the VA proactively, pursue measures that would
adequately capture a servicemember's long-term respiratory
health, and then for issues like those that are suffered by our
K2 veterans, seek that care there in their communities?
Dr. Szema. So as I mentioned earlier, we are advocating for
centers of excellence, sponsored by the NIH or NIOSH, analogous
to the World Trade Center Monitoring Programs, because in order
to capture the veterans, you really need a center of excellence
that is impartial and academically based, and has the resources
and the specialized diagnostic testing available that is
largely not available at community veteran hospitals.
Senator Blackburn. And I would add to that, timely, because
that is part of the problem. They do not have that timely
access.
Dr. Szema. Right. I agree. And for example, I am in New
York State. As part of Northwell Health, you know, we are the
largest employer in New York State and we have 22 hospitals. So
we were able to respond to the COVID pandemic very rapidly in
New York, and it is one of those things where, you know,
resources and expertise do matter. And I think, yes, you have
to share with the VA, but you also have to rely on where the
expertise is.
For example, 4DMedical is a company that just got FDA
approval last year to do a noninvasive test and use software to
stack all the CT scans and fluoroscopy to do a 3D image and
make a movie and tell me where the ventilation is abnormal, and
it is color coded. So that is brand new. You have to be able to
respond and be agile, and I think the problem with bureaucracy
is, you know, these soldiers are not getting the care because
of the existing framework of the benefit system.
Senator Blackburn. Thank you. I appreciate that. Mr.
Chairman, I yield back.
Chairman Tester. Thank you, Senator Blackburn. Senator
Manchin.
[No response.]
Chairman Tester. Senator Manchin? Senator Tuberville.
SENATOR TOMMY TUBERVILLE
Senator Tuberville. Thank you, Mr. Chairman. Thank you for
testifying today. This is kind of alarming, a little bit. You
know, I grew up in Vietnam era. I lost a lot of my buddies,
older buddies, to Agent Orange. It seems like it takes us
forever, you know, to come up with any kind of answer to
something like this, and now we have the burn pits. And, you
know, sooner or later the type of country we have, you would
think we would come up with some kind of idea of what affects
people. We knew smoke affects people, and we have all these
burn pits.
But, Chairman Tester, I want to thank you. One of your top
priorities is adding hypertension to, you know, this list,
Agent Orange. My dad was in the military. He landed at Normandy
at age 18, and fought all the way across Europe, and 30 years
later died of a heart attack, of hypertension. And it is there.
It is proven. Stress is a huge part of it, and you cannot
imagine the stress that you have going through some kind of
battle or war in the theater, especially in the type of areas
that we fight in. You know, now we are in the mountains and the
hills and deserts, a few years before that, and then the
jungles back in my era. It is just amazing. But we have got to
come up with advances in equipment.
That is one thing I want to ask the doctors is, you know,
once we go into an area, is there any way that we--preventive
medicine is the best, you know, for all of us. I mean, if you
go get a physical you tend to be able to find out things a lot
quicker than just sitting around. And we could do the same
thing when we are going to go to the theater, and we are going
to fight these wars. We ought to be able to understand what we
are getting into.
And I want to ask the doctors about, you know, equipment
and preventive measures. You know, for instance, this toxic
exposure in the theater, do we have anything now that we give
our troops that are out in the field, that are around--even if
we have got these containers that we are burning it in, you are
still going to have some exposure. Any doctor.
Chairman Tester. Either Dr. Szema or Dr. Kelsey, you get
that question.
Senator Tuberville. Yes.
Dr. Kelsey. Senator, I am not military personnel but my
expertise is really in the area of the effects of exposures. I
would say that I agree with you, prevention is the primary way
to go here, and I would echo what Senator Tillis said, in the
sense that we have got trouble trying to figure out what is
exposure related if you do not measure it. And I think his
comment was really quite insightful in the sense that I think
the military does not do a great job of assessing exposure, and
certainly they do not keep track of it.
So in terms of going forward, one of the best things in the
prevention world, that I can think of, is to act on Senator
Tillis' observation that they can do a better job assessing and
storing information on what active service encounters in terms
of exposures.
Senator Tuberville. Exactly. Thank you. You know, we send
these young men and women to war. We pay them $38,000, and I
get more calls on veterans than anything, and I have been doing
this for 2 months. And it is amazing that they cannot get an
appointment, they cannot get in. I know I have got something
wrong with me because of the toxic I have got in my lungs. They
tell me I have got to have more proof. We have got to do a
better job of taking care of our young people. If we are going
to go to war, we have got to understand, we have got to pay the
price for it, on both ends.
And so I want to thank you guys for your help, the Wounded
Warriors and Disabled Veterans. It is so important, because
what have we been fighting now, 20 years? Twenty years in these
two wars we have been fighting, and we have got a lot of young
people coming back, they have got bad problems, and PTSD--I am
waiting every day. I will get a call from my best friend,
wondering whether his wife is going to tell me whether he has
committed suicide, because he cannot sleep. And he gets very
little help at the VA, because it takes him a while to get in
there.
So thank you for your help. I know we have got huge
problems. We look forward to working with you and I look
forward to working hard on this Committee. Thanks for your
help, and Doctors, thank you for your help, and you veterans,
thanks for your service. Thanks for everything that you have
done for our country, and hopefully we can do a lot better job
taking care of you.
Thank you, Mr. Chairman.
Chairman Tester. I understand that Senator Manchin is on
the phone? Speak to me, Senator Manchin.
SENATOR JOE MANCHIN
Senator Manchin. I am on video for you, Mr. Chairman, just
for you. I found a video that worked, and I came to make sure I
could see you in person.
Thank you, Mr. Chairman. I appreciate it very much. Mr.
Thompson, I wanted to take a moment to thank you for your over
23 years of service in the United States Army and the West
Virginia National Guard. I am honored to have the opportunity
to meet you, and I am proud to be a West Virginia because of
veterans like you who have made unimaginable sacrifices for our
country.
Your testimony sheds light on so many problems veterans are
facing when it comes to toxic exposure. But one in particular
grabbed my attention. You wrote that you do not qualify to
receive your retirement until age 60 because your injuries were
not combat related. To me, this is just one part of a larger
issue when it comes to toxic exposure. We are not providing
parity between active-duty and reserve component service.
So my question would be, what can Congress and VA do to
ensure that veteran families are taken care of and receiving
the benefits they are entitled to after our veterans are gone?
Mr. Thompson?
Mr. Thompson. Yes, sir. I want to say just make sure that
the benefits that are there are the same across the board,
because the way I felt after I was told that is that it is
cheaper to send a National Guard soldier over to get injured or
killed than it is an active duty soldier.
Senator Manchin. Oh, my God. That is hard to believe.
Mr. Thompson. That is exactly how I felt. I am not asking
for, you know, anything special. None of us are. It is just,
you know, if we do this, when I put on that uniform I gave 150
percent. And when I take off that uniform I expect 150 percent.
Senator Manchin. Right. Mr. Thompson, let me just tell you
this. There is not a member on the Veterans Committee, Democrat
and Republican, and sure not our Chairman or our Ranking
Member, that does not believe that the fairness should be
across the board, and we have all the respect, because all of
us have National Guards that we basically love and support. So
you making this testimony, hopefully it will make the changes
that need to be made.
My followup question to you would be, I would like to say
to you, and all West Virginians who are servicemembers or
veterans, that I am going to keep fighting for your access to
health care and benefits in both my role on the Senate
Veterans' Affairs Committee and the Armed Services Committee.
So I just thank you for your service. I will say that I am
proud to represent one of the most patriotic States in the
Nation. As you know, we have a lot of veterans, on a per capita
basis, one of the highest in the country.
So, Mr. Thompson, thank you so much, sir. I just cannot
thank you enough, and your testimony, I think, is going to make
a big difference in what we are going to do and how we can make
the changes. Thank you, sir.
Mr. Thompson. Thank you very much.
Senator Manchin. You are welcome, sir.
I would like to address this to Mr. Shane Liermann. Mr.
Liermann, first I want to thank you personally for all you have
done and been doing to help us with the Veterans Burn Pits
Exposure Recognition Act. I know you have been working
tirelessly behind the scenes with my staff and Senator
Sullivan's. I know you agree that we need to pass this
legislation as soon as possible to ensure our veterans have the
access to care that they desperately need.
So my question would be, can you outline some of the
consequences in the short and long term if we do not pass this
bill and VA does not concede veterans' exposure to the specific
toxins of burn pits?
Mr. Liermann. Thank you, Senator. Unfortunately, if we do
not pass this we are going to continue on the path we have been
on for 20 years, and that means numerous veterans exposed to
burn pits will continue to suffer from those illnesses, they
will still continue to be denied health care, and we will not
get any closer to establishing presumptive diseases.
So if we do not do anything right now, while we wait for
presumptives or find other science that we need to establish,
millions of veterans exposed to burn pits will continue to
suffer, without VA health care, without the peace of mind for
benefits for their families, when they pass, due to those
diseases.
Senator Manchin. Let me just thank you, and, Mr. Chairman,
let me just finish up by saying to you and Ranking Member
Moran, that part of the reason I have enjoyed working in the
Senate Veterans' Affairs Committee is because regardless of our
party we always find a way to come together to support our
veterans, in the most bipartisan way.
I am proud that has been the case with the Veterans Burn
Pits Exposure Recognition Act that Senator Sullivan and I re-
introduced. We have 18 co-sponsors and almost half of the
Committee signed on. However, of those 18, only 6 are
Democrats. We must do better. I am calling on my Democratic
colleagues on the Committee to make joining the important piece
of legislation a priority. And I know you can lead the charge,
Mr. Chairman, as you always do for the right cause. Thank you.
Chairman Tester. Thank you, Senator Manchin. Senator
Sinema, I understand you are on.
SENATOR KYRSTEN SINEMA
Senator Sinema. That is right. Thank you so much, Mr.
Chairman. I appreciate it. I want to start by thanking everyone
for appearing today, and thank you for sharing your personal
experiences and helping the Committee consider this important
topic.
As some of you have already alluded to, toxic exposure is
an issue that requires this committee to take a retrospective
and prospective view. We need to look back on our military
operations and make amends where our veterans have been harmed
by toxic exposures. And we also need to look at the current
practices, the way the military uses these chemicals in burn
pots and then do better to protect future generations of
veterans from the terrible health impacts of these toxic
exposures.
In Arizona, we were recently notified of PFAS contamination
outside of Luke Air Force Base. Mr. Liermann, you highlighted
that DoD found evidence of over 600 installations with
contaminated ground or drinking water. The Department of
Defense has established a task force to address PFAS
contamination. Do you feel that is enough, and what other steps
need to be taken to ensure a national strategy to address PFAS
use and the health risks associated with that use?
Mr. Liermann. Thank you, Senator. I do not think it is
enough. I think what we need to do is we need to start looking
at are these exposures causing long-term diseases within those
exposed to that PFAS-contaminated water. That is one. Two, we
need to get established a presumptive process to make sure the
men and women exposed have that access.
So we need to be doing more, quicker, and I think that is
the thing we are all talking about, is we are not moving fast
enough in reference to how quickly we are learning of how
severe some of these exposures really are.
Senator Sinema. Thank you. My next question is for Mr.
Morosky. You highlighted in your written testimony that the
Wounded Warrior Project has been using DoD Individual
Longitudinal Exposure Record, ILER, to help identify a link
between a person's service and their exposures. I have
repeatedly asked DoD and VA officials why is it that
servicemembers or veterans are left to prove that they were
exposed to toxic substances during their service, and DoD has
answered that the ISER will enable DoD and VA to proactively
identify exposures, taking the burden off of the servicemember
or veteran.
Is the ILER being used by the VA and DoD to proactively
identify exposures?
Mr. Morosky. Senator, we do not find that VA is using the
ILER consistently. It is a relatively new tool. Our service
officers request ILER reports and submit them as evidence for
veterans' claims, and we have seen some success with that.
However, we think that there should be better standards for
when VBA claims personnel look into the ILER themselves in
order to better develop the claim and help the veteran
establish concession of exposure.
Senator Sinema. So do you think the ILER could be developed
to the point where it could be useful to help proactively
address these claims and remove the burden from the veteran or
servicemember, him or herself?
Mr. Morosky. We think it is effective now. It will never be
100 percent effective because there are gaps in it, and the
further back it goes, the more gaps that there are. So we think
that the improvement that really needs to be made is for VA
claims personnel to be instructed how to use it, for there to
be standards on that, but also for them to understand that a
lack of evidence in ILER should never be grounds alone for a
denial of claim.
Senator Sinema. That is an important point. So ILER could
be used to supplement or help prove, but the lack of
information in ILER should not be used as dispositive to say
that there is no injury or no exposure. Thank you. I appreciate
that.
My next question is for Drs. Szema and Kelsey. I hear from
researchers and those gathering data on toxic exposure that
though the VA and DoD are collecting information on toxic
exposure through the various environmental health registries,
this information is not available to researchers outside of DoD
and the VA. If that is true, what would the advantages be to
opening up the data to researchers outside DoD and VA if done
in a way that protects the privacy rights of individuals?
Dr. Szema. I think it is important to open up the data, but
it depends on what is in the data base, otherwise it is garbage
in, garbage out. For example, you know, one of my premed
students is now graduating from medical school, Guadalupe
Jimenez. When she was in the Marines she burned her trash on
the side of the road in Iraq. She did not dig a pit. So in the
questionnaire for the open-air burn pits registry she was not
exposed to a burn pit, even though she definitely did it for a
year.
If you shoot a gun and you are lying on your stomach you
are going to be exposed to the dust in the sandstorms that are
there, and we know that the dust and the particulate matter in
the sandstorms are frequent, they can rise as high as a mile or
two up in the air, and they contain particles that include
burning trash.
So the questionnaire is key, and, you know, locations of
military bases are often top secret. They are not on the map.
So often the soldiers would say, ``I served here, here, and
here,'' but that is not indicated in their record, as well. So
I think there are some gaps that are going to be there, just on
the basis of the current questionnaire.
Chairman Tester. Thank you, Senator Sinema.
Senator Sinema. Thank you.
Chairman Tester. Senator Blumenthal.
SENATOR RICHARD BLUMENTHAL
Senator Blumenthal. Thanks, Mr. Chairman. Thank you so much
for holding this hearing, which is so vitally important to all
of our veterans, and to all of the witnesses for being here
today. And I want to thank Mr. O'Malley and Mr. Thompson,
particularly, for sharing your stories.
I was proud to support efforts led by Chairman Tester to
grant a presumption of service connected for Parkinson's
disease, bladder cancer, hypertension, and hyperthyroidism for
veterans exposed to certain herbicide agents while serving in
Vietnam, and I was proud, as well, to see the presumption for
three of those conditions included in the recent National
Defense Authorization Act, and we are going to continue to
fight to have hypertension included on this presumption list as
well.
I am really concerned that we are repeating our past
mistakes with more recently discovered toxic exposures like the
ones associated with the burn pits at Karshi-Khanabad, also
known as K2, the air base there. We must ensure that justice
for these veterans is achieved now, and no longer delayed, the
way it was for Blue Water Navy veterans exposed to Agent
Orange.
I appreciate your organizations, Mr. Liermann and Mr.
Morosky, supporting my K2 Veterans Care Act. I understand that
the DAV and the WWP assist veterans in pursuing veterans'
benefits claims, and I am grateful for all of your work, and I
am hopeful that Congress will act urgently to make it easier
for veterans to receive the benefits they need and deserve.
As Mr. Liermann noted in his testimony on a related topic,
it has been decades since Congress or the VA has recognized
additional radiation risk activities. Without this recognition,
veterans face insurmountable barriers in having their radiation
diseases recognized, and therefore in receiving the care and
benefits they need. I want to thank the Yale Veterans Clinic
for pursuing claims relating to the Palomares disaster.
I have introduced, and I have led the Palomares Veterans
Act in prior sessions of Congress, and I will introduce it
again in the 117th Congress. The Palomares nuclear accident
caused untold suffering and pain to men and women in uniform
sent to the clean-up without proper protection and guidance,
and the VA's unwillingness to review shoddy data from the
Department of Defense has led to unconscionable delays for
these veterans. They are aging. They cannot wait any longer.
I have been encouraged by what Secretary McDonough has told
me about his pursuing greater disclosure in the future from the
Department of Defense in incidents like this one. The
Department of Defense has a critical role to play in these
toxic exposure incidents, both in providing information that
makes it possible for veterans to pursue their claims, and with
the VA in mitigating toxic exposures in the first place. They
can prevent a lot of these harms. They need to take action. The
DoD has a moral imperative as well as a military one.
So my question is to Mr. Liermann. Could you outline for
the Committee the unique barriers facing radiation-exposed
veterans, including the veterans at Palomares?
Mr. Liermann. Yes. Thank you, Senator. When we start
talking about presumptive diseases related to ionized radiation
exposure, there are several conditions that have to be met. One
of those is veterans must have participated in a recognized
radiation risk activity in order for them to be considered
presumptive to assign one of the diseases. Once they determine
it is a radiation risk activity, then they send it out to
guesstimate on the amount of radiation they were exposed to, or
the rems, to determine if that was enough. Then they send it to
a medical specialist expert within VA who then will make a
determination if that amount of radiation they were exposed to
could have caused their disease.
The problem is this does not sound like a presumptive
process. Making them jump through every one of these hoops no
longer sounds presumptive. It sounds like a direct service
connected requiring all these things. But without that
radiation risk designation, they cannot be considered a part of
the presumptive radiation disease process.
Senator Blumenthal. Excellent answer, and unfortunately my
time has expired. I have more questions, and I may send them to
you in writing. This panel is an excellent one, and again, my
thanks, Mr. Chairman.
Chairman Tester. Thank you. Thanks to all the folks who
asked questions today, and I want to especially thank the
witnesses who, quite frankly, did a marvelous job adding some
meat to the bone on this issue.
We have a lot more work to do. I think this Committee is
committed to doing it, and we are going to need all your help
to get it done. But the bottom line is this is a big issue, and
it costs a lot of money, but the fact is that taking care of
our veterans is a cost of war. We should not send them if we
are not willing to take care of them when they get back.
Thank you all, and we will continue the conversation. This
hearing is adjourned.
[Whereupon, at 11:46 a.m., the Committee was adjourned.]
APPENDIX
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Material Submitted for the Hearing Record
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