Is Cancer a Cost of Military Service?

When U.S. Army senior intelligence analyst Elba Barr was at Karshi-Khanabad, a military base in Uzbekistan known as K2, she triaged decisions based on the type of risk. An active risk was anything that could kill her immediately, like enemy fire and roadside bombs. A passive risk was everything else.

“Most of us in the early phases [of the Afghanistan War] didn't think we were coming home,” Barr said. “So, the question was, ‘Is it an active risk or a passive risk? If it’s a passive risk, I’ll deal with it in 20 years. Because people are actively trying to kill me right now.’”

For Barr, the passive risks soon became active ones.

She started having gynecological issues in 2004. Since then, she has had ovarian cancer, cervical cancer, breast cancer, and throat cancer. Her medical team is currently monitoring her for liver failure. Barr is in her mid-40s, and she is not alone.

Anthony Szema, MD, director of the International Center of Excellence in Deployment Health and Medical Geosciences at Northwell Health and a clinical professor of occupational medicine, epidemiology, and prevention at Hofstra University in New York, is an expert on toxic exposure and a passionate veterans’ advocate. He noticed a major change in the patients he was treating around the time that Barr began having health issues.

“Previously, most of my patients were 80-year-old Caucasian men in wheelchairs with oxygen,” Dr. Szema said. “Now, everybody was in uniform. They were all young. There were women. There were people of all ethnicities. These were the kids who signed up after 9/11. We started seeing them in 2004 when they came back from their one-year deployment.”

Dr. Szema has published multiple studies about the connection between health issues and military deployment. Memorial Day, celebrated on May 29 this year, is a day to honor U.S. military personnel who have died while serving. It is also a reminder of the dangers soldiers face. In addition to immediate or active risks, they are also exposed to hazardous waste, radiation, chemicals, jet fuel spills, and more.

What Are Burn Pits?

Since 2009, Dr. Szema has testified about the effects of burn pits three times in front of government committees, most recently before the U.S. Senate Committee on Veterans Affairs in March 2022.

“Burn pits are garbage fires,” Dr. Szema explained. “Essentially, the military would burn all their trash when they were in Iraq and Afghanistan. They would light it on fire with a jet fuel called JP-8, which should be burned at 40,000 feet in the air at extremely high temperatures with a jet engine. If you just pour it on trash and light it on fire, it generates tons and tons and tons and tons of particles and that's harmful to human health.”

Dr. Szema explained that the danger from burn pits depends on what type of fuel you use and what type of trash you burn. Military JP-8 contains high levels of benzene and naphthalene, both carcinogens. And if you use cancer-causing ingredients to burn cancer-causing substances, the danger increases.

“If you burn a blown-out Humvee, then you're burning metals, batteries, computers, medical waste, and plastic,” Dr. Szema said. “Even something seemingly innocuous, like 10,000 breakfast trays made out of Styrofoam, is not good for inhalation. And if you live or work next to the burn pit, you're going to inhale all that stuff.”

Dr. Szema said the soldiers also inhaled sticky surface dust in the Middle East that sometimes contained burn particles. “Our patients tell us that they used to call it a Iraqi crud, and it would get everywhere,” Dr. Szema said.

Burn pits and dust weren’t the only health concerns for soldiers in the Middle East. Barr and her colleagues nicknamed a chemical pond at the edge of K2 “Skittles Pond” because it changed colors daily.

“We did [physical training] around that pond to stay in shape,” Barr said. “We lived it. We breathed it. We slept on cots near it.” According to a 2015 U.S. Army study, soldiers who served at K2 have a 500% greater chance of developing certain cancers than the general population.

“When you go into the military, you are writing a check for the value of your life,” Barr said. “You are also exponentially exposing yourself to a plethora of hazards. That’s the cost of war. It was repeatedly drilled into us over and over and over again: that's the cost of war.”

The Cost of War

For retired U.S. Army Colonel Marvin Williams, the cost of war has been prostate cancer and diffuse large B-cell lymphoma, both diagnosed in the past three years. Williams, 66, was the commander at K2 from November 2002 through July 2003. He remembers the same “Skittles Pond” that Barr described.

“If you walked up on top of the security berm where we had our fighting positions, you would see two ponds,” Williams said. “On the darkest nights, they glowed in the dark, just like you were looking through night vision goggles. They were a lime green. They called one ‘Skittles Pond,’ but both glowed in the dark.”

Williams was also exposed to jet fuel leftover from when K2 was a Soviet air base. While in command, he was asked to replace the temporary tents with permanent buildings. An environmental team deemed K2 livable with some precautions, but Williams and his team discovered an unpleasant surprise.

“Every time we would dig a foundation, if we dug more than about four inches deep, we would hit old Soviet jet fuel,” he said. “It was orange and red.”

Despite being surrounded by known carcinogens during deployment, the Veterans Administration (VA) denied medical claims for Barr and Williams. For Williams, it was his prostate cancer diagnosis. For Barr, it was numerous claims.

“Those who presented issues immediately post-deployment could easily tie it to their service,” Barr said. “Those of us diagnosed later were gaslighted. We were told that these were isolated incidents and they weren’t connected.” When a test discovered depleted uranium in her system, the VA told her the levels were too insignificant to register for benefits.

What is the PACT Act?

On August 13, 2022, President Joe Biden signed the PACT Act, making it easier for veterans to get health care and benefits if they were exposed to burn pits, Agent Orange, and other toxic substances. PACT stands for Promise to Address Comprehensive Toxics (PACT). The White House called it the “most significant expansion of benefits and services for toxic-exposed veterans in more than 30 years.” Dr. Szema was at the White House on that historic day.

“The PACT Act lists over 20 cancers with presumptive conditions, meaning if you have this diagnosis and you were in this location where there were known to be burn pits, then the VA should cover you for care,” Dr. Szema explained. “That being said, it’s presumptive, meaning when we were helping to write this law with the congressional staff, those were the things we were thinking of. It was based on, ‘We know this toxin or chemical was detected, and it's more likely than not connected.’”

Dr. Szema was also the lead author of one of the studies that led to President Biden signing the act.

“What we do that is unique is we analyze lung tissue and other tissues from biopsies from veterans exposed to burn pits in Iraq and Afghanistan,” Dr. Szema explained. “We’ve detected burned, oxidized titanium that was burned before inhalation, meaning you inhaled a blown-up Humvee, munitions, or an improvised explosive device (IED). And that's bad because titanium in your lung is potentially profibrotic and can cause permanent scarring. We can also detect JP-8 itself.”

Dr. Szema’s most recent project included enrollees from the Burn Pits 360 website who said they were exposed to burn pits and have a form confirming they were deployed in an area with burn pits. The report found that 29% of these veterans reported blood in their urine.

“Nobody should have blood in the urine,” Dr. Szema said. “The fact that it’s 29% is dangerously high.”

Help for Veterans

Because Williams’ DLBCL diagnosis was this year, after the PACT Act was signed, the VA immediately recognized it as connected to his service. They are also revisiting his prostate cancer diagnosis.

Although Barr said the PACT Act is a “good start,” she said there is still a significant amount of work to be done for veterans’ rights and benefits. She and Williams offered advice for other veterans based on their own experience and advocacy efforts. If you or someone you love has served in the military:

• File for VA benefits immediately. “The VA is doing a tiered enrollment,” Barr said. “If you don’t apply by October 1, 2023, you could wait have to wait another decade. File now.”

• Tell your doctor when and where you served. “Civilian doctors don't necessarily know what to look for unless you tell them,” Williams said. “Be open and honest with your doctor about what you’ve been exposed to, and tell them it may not be what they normally see.”

• Don’t assume you don’t qualify. “The PACT Act is not just for those who are gravely ill,” Barr said. “Do not assume what your illnesses are, and do not assume they are not service-connected. Get into the VA system and go from there.”

• Do a complete self-exam. “I tell people to evaluate themselves starting from their left pinky toe and work their way up and then down the other side,” Barr said. “And then have the person closest to you evaluate you as well.”

• Get tested. “Get tested if you were deployed anywhere around the burn pits,” Williams said. “These ailments do not necessarily present as what they are.”

• Be honest about how you feel. “We are trained to push through the pain,” Barr said. “We’re used to limping along in pain, so be holistically honest about what's going on with you to get the care you need.”

• Connect with veterans’ organizations. “Based on what generation of veteran you are, look to veteran service organizations for help,” Barr said. “If you served in Vietnam, try the Veterans of Foreign Wars (VFW) or American Legion. If you’re post-9/11, Wounded Warrior and Disabled American Veterans (DAV) do a great job.”

• Find a care team you trust. “If you’re going to get through these things, you have to pursue the best care possible,” Williams said.

Deborah Williams, who has been married to her husband for 43 years, offered this advice for care partners:

• Speak up if you see that your spouse or partner is ill and not getting any better.

• Listen to your instincts if you feel like something is off.

• Help your veteran advocate for themselves.

She also encourages veterans to look out for each other.

“Even if you didn't serve in Afghanistan, maybe you have a first sergeant or upper-ranking officer that did,” Deborah said. “If you see the signs in somebody, be bold and say, ‘Are you ok? You need to go get checked.’”

Veterans Helping Veterans

While dealing with their own health issues, Barr and the Williamses have become passionate about getting the word out to other veterans.

“It’s kind of our mission in life now,” Deborah said. “We’re trying to get the word out to as many people as we can. I think about the young soldiers who served who don't have that person or organization to help them. They may or may not have health insurance and they’re having to fight for everything. Those are the people we are the most concerned with because they served our country and were exposed to all of this, and they deserve care too.”

For Barr, it comes down to leadership and using her strengths to help others.

“When you enlist in the Army and attend leadership school, you learn the noncommissioned officer’s creed,” Barr explained. “There’s a line that says, ‘All soldiers deserve outstanding leadership, and I will provide that leadership.’ The message is that you're supposed to take care of your people at all costs and at all times.

To learn more about the PACT Act and VA benefits, visit the U.S. Department of Veterans Affairs or contact a veterans service organization. For more information about filing a VA claim online, click here.