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At least 1,000 veterans have fallen ill with mysterious symptoms they say were caused by poisonous pollutants from open-air burn pits, fires and clean-up operations in Iraq and Afghanistan.
Now, the Defense and Veterans Affairs departments are hoping to widen their understanding of war-zone toxins and ultimately help suffering troops.
The departments this week are holding closed-door meetings in Washington to discuss and debate deployment-related airborne pollution. Organizers hope the Joint VA-DoD Airborne Hazards Symposium will "inform current practices and improve future efforts in environmental exposure assessment, clinical surveillance, medical testing and research, ultimately improving the health of veterans and service members," according to the symposium agenda.
Among the topics under scrutiny is whether troops should receive baseline tests of how well their lungs work before and after deployment, as some researchers have recommended.
Officials also want to know how to identify those at risk for developing diseases related to environmental conditions and whether a proposed registry of veterans who are sick after serving in Iraq and Afghanistan would duplicate existing efforts.
The conference of top-level health officials and physicians is the first major collaboration on in-theater pollutants since the Institute of Medicine published a report last October saying existing data is too limited to conclusively link burn-pit smoke and fumes conclusively to troops' lung, heart and skin disorders.
Symposium speakers include Dr. Karen Guice, principal deputy assistant secretary of defense for health affairs, standing in for Assistant Secretary Dr. Jonathan Woodson, and Veterans Affairs Deputy Undersecretary for Policy and Services Dr. Madhulika Agarwal.
Physicians and scientists from the Army Public Health Command, the Armed Forces Health Surveillance Center, the Environmental Protection Agency, the Centers for Disease Control and the Army's Center for Environmental Health Research are giving workshops and briefings.
Some veterans of the wars in Iraq and Afghanistan have reported various ailments and illnesses, including increased cases of asthma and chronic obstructive pulmonary disease, rashes, joint pain and cancers.
They and their physicians attribute the conditions to burn pits used to destroy waste and other sources, including a fire at a sulfur mine near Mosul and chromium-laden dust at a water treatment facility at an oil production plant near Basra.
At least 40 troops have been diagnosed with a rare lung disease, constrictive bronchiolitis, but their diagnosis remains controversial; in a working group at the symposium, Army Dr. Michael Morris and Veterans Benefits Administration Dr. Cornia Negrescu said the "relatively small numbers of individuals with constrictive bronchiolitis and the inconsistent findings of many studies ... have raised concerns regarding case findings and diagnosis."
Constrictive bronchiliotis progressive scarring or blockage of the lung's smallest airways can be diagnosed only through an open lung biopsy. DoD and VA officials do not recommend the invasive procedure, which requires removal of lung tissue, saying other tests can indicate reduced lung function.
Other subjects to be discussed at the symposium include basic diagnosis of those who exhibit symptoms, clinical follow-up and unusual case studies.
"I'm very happy that they are finally discussing these issues," said Rosie Torres of the advocacy group BurnPits 360. "I wish I could have stayed the entire time because a lot of what they were discussing, I've had experience with on a personal level. I'd like to help them understand the impact these illnesses have on troops and their families."
Torres and representatives from the Sgt. Thomas Joseph Sullivan Center, a group that advocates for research on post-deployment health, were invited to morning briefings during the first day of the three-day event.
Three veterans groups The American Legion, Veterans of Foreign Wars and Disabled American Veterans gave presentations on their outreach to service members and veterans affected by environmental exposures, including Vietnam- and 1991 Gulf War-era veterans.
But the groups were not permitted to attend the entire three-day conference. A VA spokesman said the framework of the conference "was not conducive" to media coverage or public attendance.
Sullivan Center President Dan Sullivan praised organizers for holding the event but said the issues of deployment-related illnesses need greater publicity.
He likened the ailments affecting troops including his brother Thomas, a Marine sergeant who deployed to Iraq and later died from complications of undetected cardiovascular, intestinal and respiratory disease to the emergence of AIDS in the early 1980s.
"There's an illness impacting a small group and population that's not easily explained," he said. "There are a lot of people dying when they get back from deployment. It's a health crisis and it's not being treated like one."