The Next Agent Orange.

ONE

At the height of the war in Iraq, US forces operated out of 505 bases scattered across the country. Joint Base Balad, a 15-square-mile outpost north of Baghdad, was the second largest. Home to 36,000 military personnel and contractors at its peak, the base was considered a vital hub for operations throughout Iraq — largely thanks to two 11,000-foot runways and one of the best and biggest trauma centers in the region. Balad also boasted a notorious array of amenities: troops living in the makeshift mini-city could dine on Burger King or Subway, play miniature golf or relax in an air-conditioned movie theater, and browse for TVs or iPods at two different shopping centers.

But when Le Roy arrived at Balad in the summer of 2007, the first thing he noticed was the smell. A noxious, overwhelming stench reminiscent of burning rubber. “I was like, ‘Wow, that is something really bad, really really bad,’” he recalls. Soon, he also noticed the smoke: plumes of it curling into the air at all hours of the day, sometimes lingering over the base as dark, foreboding clouds. That smoke, Le Roy soon learned, was coming from the same place as the stench that had first grabbed him: Balad’s open-air burn pit.

The pit, a shallow excavation measuring a gargantuan 10 acres, was used to incinerate every single piece of refuse generated by Balad’s thousands of residents. That meant seemingly innocuous items, like food scraps or paper. But it also meant plastic, styrofoam, electronics, metal cans, rubber tires, ammunition, explosives, human feces, animal carcasses, lithium batteries, asbestos insulation, and human body parts — all of it doused in jet fuel and lit on fire. The pit wasn’t unique to Balad: open-air burn pits, operated either by servicemembers or contractors, were used to dispose of trash at bases all across Iraq and Afghanistan.

“I remember waking up with soot on me; you’d come out and barely see the sun because it was so dark from the smoke,” says Dan Meyer, a 28-year-old Air Force veteran who lived adjacent to the burn pit at Afghanistan’s Kandahar Air Base. Meyer is now confined to a wheelchair because of inoperable tumors in his knees, and breathes using an oxygen tank due to an obstructive lung disease. “It would just rain down on us. We always called it ‘black snow.’”

It’s no secret that open-air burning poses health hazards. The Environmental Protection Agency (EPA) has long warned that burning waste — even organic refuse like brush or tree branches — is dangerous. Burning items like plastic water bottles or computer parts is even worse. “It’s appalling,” says Anthony Wexler, PhD, director of the Air Quality Research Center at UC Davis and the co-author of a 2010 review of the military’s air-quality surveillance programs in Iraq and Afghanistan. “From a health perspective, this kind of open-pit burning, especially when you’re burning everything under the sun, creates a real mess.” That’s because of both the size of the particulate matter emitted from the pits and its composition. Smoke from any combustion process fills the air with what are known as “fine particles” or PM2.5. Because they’re so small — measuring 2.5 microns in diameter or less — these particles burrow more deeply into the lungs than larger airborne pollutants, and from there can leach into the bloodstream and circulate through the body. The military’s burn pits emitted particulate matter laced with heavy metals and toxins — like sulfur dioxide, arsenic, dioxins, and hydrochloric acid — that are linked to serious health ailments. Among them are chronic respiratory and cardiovascular problems, allergies, neurological conditions, several kinds of cancer, and weakened immune systems.

Le Roy is convinced that burn-pit exposure is behind his health problems, which he says first emerged a few weeks into that 2007 deployment. “It started with a cough. I was coughing up this gunk stuff, like black phlegm that kept coming and coming,” he says. “The medical officer told me it was ‘Iraqi crud’ and it’d go away in a few days. I thought, ‘I’ve been here a month, how much longer?’” The cough never improved, and upon his return to the US in 2008, Le Roy found himself struggling to get answers from military physicians: they brushed it off as bronchitis, asthma, even an anxiety disorder triggering physical symptoms.

As a reservist, Le Roy also had a civilian job as a Texas state trooper. But despite 14 years in the role, his employers couldn’t acquiesce to Le Roy’s declining health: he was put on leave from his job in September 2010, two years after returning from Iraq, for being unable to perform physically challenging tasks.

MAP OF JOINT BASE BALAD, IRAQ

Later that same year, Le Roy was referred to Dr. Robert Miller, a pulmonologist at Vanderbilt University. Dr. Miller had met soldiers like Le Roy before — dozens of men and women with chronic respiratory problems following deployments to Iraq or Afghanistan — and he knew exactly what to do: Le Roy soon underwent a lung biopsy, a procedure wherein surgeons make three incisions in the chest to remove tissue for examination. For Le Roy, much like Dr. Miller’s other patients, the diagnosis was grim: he suffered from constrictive bronchiolitis, an exceedingly rare, sometimes terminal lung disease.

The military has long known, at least internally, that burn pits can harm human health. In a series of waste-management guidelines published in 1978, the DOD cautioned that open-air burning was not a safe option for waste disposal, and should only be used “[when] there is no other alternative.” There’s no doubt that burn pits are an expedient, inexpensive way to dispose of trash — especially in the early phases of a conflict — but replacements like closed incinerators or landfills offer a longer-term solution once a base is established. A few years into the wars in Iraq and Afghanistan, however, some military personnel warned that those replacements weren’t being implemented.

“[Burn pits] should only be used in the interim until other ways of disposal can be found,” notes a 2006 memo from the now-retired Lt. Colonel Darrin Curtis, then a bioenvironmental engineer with the Air Force. “It is amazing that the burn pit [at Balad] has been able to operate without restrictions over the past few years.” Another memo, this one from 2011, warns of “an increased risk of long-term adverse health conditions” caused by the burn pit at Bagram Air Base in Afghanistan.

Meanwhile, some civilian experts like Dr. Miller were seeing patients with worrisome medical problems. “It began to look to me like a perfect storm,” he recalls. “We had one soldier after another, talented capable athletes, who couldn’t pass their fitness tests anymore.” But in 2010, after he warned the military that dozens of his patients had constrictive bronchiolitis — which is almost always caused by toxic exposure in otherwise healthy people — a troubling thing happened: physicians at Fort Campbell were directed to stop referring soldiers to Dr. Miller’s nearby medical practice. “They basically cut us off,” he says. “Needless to say, it’s clear that the DOD hasn’t embraced this as a significant problem.”

The DOD doesn’t see it that way. While representatives declined repeated requests for an in-person interview, they did issue a written statement that reads, in part: “Smoke exposure may cause acute symptoms in some people. Most short-term effects from exposure to particulate matter and burn pit smoke resolve after the individual leaves the deployed area.” Those conclusions are mostly based on air sampling tests, conducted by the military a handful of times in Iraq and Afghanistan. The most extensive survey, done by the Army, collected hundreds of samples around Balad in 2007. Study leaders concluded that airborne toxin levels were “within acceptable standards” and that “no significant short- or long-term health risks and no elevated cancer risks are likely” among personnel living near burn pits. The military has since repeatedly cited those conclusions in an effort to dismiss concerns about ailing soldiers.

But the study’s findings are essentially worthless, according to researchers with intimate knowledge of how they were reached. None of the sampling evaluated PM2.5, nor did it examine dust or ashes from in or around burn pits themselves.

“It’s garbage in, garbage out,” says Dr. Anthony Szema, a pulmonologist at Stony Brook University who has treated soldiers and veterans who suspect they have burn pit-related health woes. “If you don’t collect good data, it goes without saying that your results will be meaningless.” And in a scathing 2009 Senate hearing, Lt. Colonel Curtis — who led the initial team behind the Army study — admitted to serious flaws in both the sampling equipment and the study’s techniques. “I do not feel,” he said, “that the air samples reflected the true exposures that the service members had experienced.”

Eventually, ongoing pleas from soldiers and doctors garnered attention from politicians and military leadership. In 2009, the US government passed legislation to ban the open-air burning of some trash, namely “hazardous or biomedical waste,” and US Central Command ordered the closure of burn pits on bases with more than 100 soldiers, “when the transition is practical.” The military gradually replaced some burn pits with closed incinerators. But by many accounts, this didn’t remedy the problem comprehensively or quickly enough. A 2010 report from the Government Accountability Office found that some pits in Iraq were still burning items, like plastics and styrofoam, banned by those new federal rules. And as recently as July of this year, four pits in Afghanistan were still operating — even as closed incinerators built on two of those bases, at a cost of $16 million, collect dust.

“I don’t know how you can construct an argument that there’s no reasonable alternative for the disposal of the waste when you have two unused incinerators on-site,” says Representative Tim Bishop (D-NY), who has led Congressional efforts to regulate burn pits. “I simply don’t know how you make that justification.”

OTHER HAZARDS

DUST STORMS
Fierce dust storms in Iraq and Afghanistan frequently swept through bases, littering everything in their wake with fine particulate matter. This microscopic dust acts as a scavenger, carrying an array of toxins picked up from various sources through the air.

Le Roy has spent years asking himself that same question. He wants to think the best of the military he dreamt of serving since childhood, the military he enlisted in before even graduating from high school. But Le Roy can’t shake the feeling that they let him, and his fellow soldiers, down.

“I took it personally, that they made a calculation about what was a cheaper and easier way to get rid of trash, versus the cost of someone’s life,” he says. “Here someone is worrying about mortars or IED attacks, and in the end, it was our own guys who got us.”

TWO

Daniel Sullivan wasn’t surprised when his younger brother decided to enlist in the Marine Corps. Tom had always loved challenges, and “in the Marines he found a place where he could do that,” Daniel says. “It was his calling. He loved it.” But after Tom returned from a 2004 deployment to Iraq, the once hardy soldier soon faced a physical trial that proved insurmountable. Tom’s daily rectal bleeding, mysterious swelling, and spasms of agonizing pain grew progressively worse — and Daniel became increasingly concerned that his brother’s physicians weren’t addressing the problems. He was right: in 2009, Daniel found his 30-year-old brother lifeless in a chair, a bag of medical records at his side.

“Tom would carry those records to every doctor’s appointment,” Daniel recalls. “Because he just hoped that someone would finally look at them, and do something to make him better.”

But nobody did, despite the fact that Tom was indeed suffering from a litany of serious health conditions: an autopsy pinpointed bronchopneumonia as his official cause of death, though it was accompanied by widespread organ degeneration, along with colitis and cardiovascular disease. “They basically said that … if the pneumonia hadn’t killed him, something else would have soon,” Daniel says. Even more disturbing is that Tom’s death may have been preventable: when Daniel met with his brother’s doctors, they admitted to brushing off Tom’s symptoms as being psychological in nature. “This was a man at the pinnacle of health, whose body literally fell apart,” Daniel says. “This should not have happened.”

Tom’s death instantly transformed Daniel’s life, turning him into a brash and outspoken advocate for the thousands of veterans he’s convinced could face the same fate as his brother. In 2010, after Daniel’s research revealed that other veterans who’d deployed to the Middle East suffered from similar symptoms to Tom, he and his parents launched a nonprofit agency called the Sergeant Thomas Joseph Sullivan Center. The organization is intent on promoting research and education about what soldiers were exposed to in Iraq and Afghanistan — including burn pit fumes, prevalent dust storms, toxic sand, and severe pollution — and ensuing ailments they refer to as “post-deployment illnesses.” Unraveling the impact of smoke exposure, which Tom noted as a health concern on his post-deployment survey, is now one of Daniel’s priorities. “It’s really only been over the past two years that I fully understood the health risks a burn pit could have,” Daniel says. “[But] the science is clear that toxins cause you to get sick. And there’s a lot of people sick.”

The Sullivan Center is headquartered in a windowless, one-room office in Washington, DC. For Daniel, the Center has become a full-time job: he dedicates his days to doing research, corresponding with civilian and governmental scientific experts, and trying to bring toxic exposures to the attention of members of Congress and the general public. “We need to acknowledge [the] toxic exposures in the Middle East theater of operations, and that the diseases servicemembers get afterwards are almost irrefutably connected to what they were exposed to,” he says. “If you were exposed to these chemicals, it’s going to have an impact on your health, and it needs to be acknowledged, monitored, and treated.”

Pushing for progress hasn’t come easy. It can take dozens of phone calls for Daniel to earn a single meeting with a Congressional aide; someone who, he hopes, will communicate his carefully prepared talking points back to their superior. Correspondence with the military and the VA can be even more frustrating: email correspondences that first seem productive sometimes sour once Daniel appeals for firmer answers and commitments. “There are some roadblocks, but I like to think we have a dialogue,” Daniel says of his interactions with DOD and VA officials. “You know, I like to keep that positive mindset.”

And already, the Center counts one significant victory: the “Helping Veterans Exposed to Toxic Chemicals Act.” Having found political allies in Representatives Tim Bishop and Diana DeGette of Colorado’s first district, Daniel and his father stood alongside both at a press conference earlier this year to propose funding three research centers, run by civilian scientists, that would study exposure-related illnesses and offer comprehensive treatment for ailing veterans — exactly what Daniel and his family had hoped for. Though the act has yet to garner ample support on Capitol Hill, Daniel is intent on seeing it through to the finish line.

“If funding can go to these centers,” he says, “maybe we can finally start to understand these diseases coming out of theater, and get some real answers for what’s happening to these soldiers.”

While Daniel fights for veterans from the nation’s capital, he’s found fellow advocates more than 1,600 miles away. From their home in Robstown, Texas, Le Roy and Rosie Torres have for three years been working doggedly to help military families enduring medical crises similar to their own. The two have lobbied in DC, but the primary focus of their organization — called Burn Pits 360 — is to document the afflictions plaguing individual veterans.

“After what Le Roy went through, I thought to myself, ‘These guys need somewhere to go, and we need a way to capture all of these symptoms,’” Rosie says. “They can’t just think they’re the only ones with something wrong.” Burn Pits 360 operates as an online registry wherein veterans can document their deployments, what they were exposed to, and their current symptoms. The registry now counts over 2,000 entries, some of them submitted by family members of deceased service members.

Burn Pits 360 is more than just a hub for ailing veterans — the Torres’ think it could offer reams of useful information for scientists investigating exposure-related health problems. One civilian researcher agrees. Dr. Szema at Stony Brook is now studying the patient information that Burn Pits 360 has compiled. He doesn’t have final results, but Szema notes that several common themes have emerged: “nearly 100 percent” of respondents complain of respiratory problems, with some also suffering from cancer, GI distress, and migraine headaches, among other ailments. To Szema, the findings and their root cause appear obvious.

“I can’t say that any of his is really surprising to me,” he says matter-of-factly. “Humans aren’t supposed to breathe in smoke like this. There’s no safe level of exposure.”

A handful of other studies about exposures in Iraq and Afghanistan are ongoing. Unfortunately, scientists remain hampered by inadequate funding and a paucity of data. In large part, that’s because the military didn’t collect information on what each burn pit incinerated, when the pits were used, or which soldiers lived or worked close to them (in fact, they didn’t even keep a running list of operational burn pits until 2010). Of course, that kind of data collection is no easy task during a war, but some military officials have also made concerted efforts to “sweep this thing under the rug” by keeping available data to a minimum, says Dr. Cecile Rose, a researcher at National Jewish Hospital in Denver. Rose is conducting two studies — one of them actually military-funded — looking at exposures in Iraq and Afghanistan and subsequent health problems. “Scientists are really trapped in a data-poor environment here,” Rose says. “Frankly, the likelihood that we will be able to really pin it down, what’s causing these soldiers to get sick, is extremely unlikely.”

Rosie and Le Roy, however, don’t buy the claim that scientists can’t offer them and other veterans any answers. Not when they’ve got information from thousands of sick servicemembers — with more entries being submitted to Burn Pits 360 every single day. “The answers are already there,” Rosie says. “It doesn’t take a scientist to look at these chemicals in the air, look at the symptoms, and say people were exposed, people are sick, people are going to die.” They plan to keep the registry open, but Rosie and Le Roy say they can’t cope much longer with the emotional side effects of documenting diagnoses and deaths.

“Some days I don’t even want to open my computer, because there will be another entry to read, and then another,” Rosie says. “It’s like I’m drowning, and I can’t come up for air. I can’t keep hearing that another soldier is sick, that another soldier has passed on.”

THREE

For Daniel Sullivan and the Torres family, acknowledgment from Capitol Hill and answers from scientists are important — but they’re also just a means to an end: medical care and disability benefits for veterans who were exposed to airborne toxins in Iraq and Afghanistan. After all, political influence and conclusive research will be meaningless unless the VA admits to a “presumptive” link between exposures during combat and subsequent health problems. The department has done it before, most notably for thousands of Vietnam veterans who blamed exposure to the herbicide Agent Orange for devastating illnesses. But the fight for that acknowledgment took decades, and today’s advocates are adamant that such a wait won’t happen again.

“I’m sure they would love to dwell in ignorance and bureaucracy for many more years,” Daniel says. “But what we owe to veterans is the best care they can get. Not a protracted battle just to get care in the first place.”

Now, in part because of the dogged efforts of Daniel and the Torres, it looks like that protracted battle might be averted: the Obama administration in January mandated the creation of a VA registry for veterans of Iraq and Afghanistan. Called the “Airborne Hazards and Open Burn Pit Registry,” the online questionnaire is meant to allow veterans to log exposures and note their health concerns for monitoring and scientific research. The information from that registry could ostensibly be used to develop a list of illnesses presumptively linked to toxic exposures — meaning a veteran with constrictive bronchiolitis, like Le Roy, would readily qualify for disability benefits. “It shouldn’t have had to take an act of Congress, or the VA getting pushed against a brick wall,” Rosie says of the registry, which she lobbied for on Capitol Hill in 2012. “But we’ll take it. We want to work with them to make sure this is done right.”

But when the VA in July released a draft version of the questionnaire, scientists and advocates alike voiced significant concerns. Overall, they worried that the agency — already bogged down by costs associated with post-traumatic stress and traumatic brain injuries — was trying to disprove that toxic exposures might be a third serious health repercussion of the wars in Iraq and Afghanistan.

“I think it’s important that such a questionnaire meets at least a basic standard for occupational medicine,” Dr. Miller said at the time. “This one does not.” For Dr. Miller, that standard means offering space for veterans to self-report important information such as exposures, symptoms, doctor’s appointments, and relevant medical prescriptions. But the survey, primarily in multiple-choice form, instead offered a rigid framework that threatened to miss or exclude some ailing participants whose history or conditions didn’t fit tidily inside a checkbox.

Daniel Sullivan, after consulting with several scientists for their input, had a problem with more than just checkboxes. “The questionnaire is an insult,” he said. “It’s calculated in a way to get information to make a case that these illnesses are not exposure related.”

The draft included dozens of questions about non-combat exposures, including whether or not veterans ever smoked, worked in dusty offices, or had hobbies — like woodworking or pottery glazing — that might have exposed them to airborne hazards. In fact, such questions were more extensive than those about a veteran’s tours of duty. On a checklist asking about “current” illnesses, constrictive bronchiolitis was omitted. And then there was this single question on the survey’s eighth page: “During your pre-deployment, deployment, or post-deployment integration period, did you experience an emotional event that you would consider very stressful?” After seeing his own brother die when doctors dismissed his symptoms as psychological, Daniel Sullivan found that unforgivable. “When viewed in the context of what happened to my brother, and other people … this looks like an intentional effort to perpetuate the myth of these diseases being psychosomatic,” he says. “If I were filling this out, I would think it was a trap. I would think it was a trap and I wouldn’t want to do it.”

So Daniel Sullivan and the Torres fought back. Both submitted comprehensive critiques of the survey draft to the VA Office of Public Health, which led the survey’s development. Daniel even included letters from scientists — including Dr. Miller — to bolster the merit of his own statements. And in a heartening development, they won: the VA in September released an amended version of the survey that includes significant changes. Most importantly, constrictive bronchiolitis has been added, and mentions of psychological stress removed. These changes, Daniel hopes, signify a shift away from what he describes as “the polarizing divide that has for decades characterized the relationship between advocates who ask for change … and those officials who have the power to make those changes.”

The survey might now collect more valuable data, but whether that information is ever analyzed and acted on remains another question — one highlighted by the recent resignation of a top VA epidemiologist. In December of 2012, Dr. Steven Coughlin abruptly quit his job with the VA Office of Public Health over what he describes as “serious ethical concerns” with regards to ongoing VA studies. More specifically, Coughlin alleges that his VA colleagues often suppressed or changed valuable data about the health of veterans from OIF, OEF and the Gulf War. In one specific instance, he says he was ordered to conceal data from the VA’s New Generation Study — a long-term questionnaire of 60,000 OIF and OEF veterans — that asked about burn pit proximity, potential airborne exposures, and related health woes.

“I was being told ‘don’t look at the data, we’re not going to look at the data closely,’” Coughlin says, adding that he was threatened with disciplinary action if he didn’t abide the command. “It was just an untenable position for me, because what my supervisors were doing was greatly unethical.”

Where this latest survey is concerned, Coughlin isn’t optimistic. He describes the changes as “positive,” but also notes that the VA doesn’t exactly boast a legacy of excellence.

“The VA often has difficulty doing the right thing when it comes to examining environmental health hazards,” he writes in an email to The Verge. Which makes politicians like Tim Bishop, and advocates like Rosie, Le Roy, and Daniel, all the more important. “Continued congressional oversight and external peer review are essential,” Coughlin warns, in order to keep the VA accountable.

FOUR

“We’re not going to shut up. We’re not going to go away.” Rosie is resolute in that mantra, and vows that she and Le Roy don’t need a whistleblower, or VA data, to tell them what they already know: thousands of veterans are sick, an untold number are at risk, and the military and VA are paying lip-service to a burgeoning crisis. The next Agent Orange, they worry, is already here. “We have to keep going, because time is of the essence for these veterans,” Rosie adds. “How many more need to get sick? How many more need to pass away? I just want to tell the government… to do something.”

After being diagnosed with constrictive bronchiolitis in 2010, Le Roy was permanently dismissed from his state trooper job — leaving him unemployed. Medical bills constantly threaten to overwhelm the family’s mortgage payments, and they’ve already once been forced to vacate their home. Still, there’s no indication that life for the Torres will get any better: after a protracted dispute with the VA, the pair thought they’d achieved a minor victory when the agency agreed to reimburse Le Roy’s cross-country visits to Dr. Miller. Months later, Rosie learned that the VA had “lost” their paperwork. They’ll need to start over. Meanwhile, Le Roy is back in the hospital: his headaches are coming more frequently now, and doctors worry that a mysterious lesion on his brain’s left frontal lobe might somehow be responsible.

But if you ask Rosie and Le Roy, they’ll still tell you they’re among the lucky ones. He is alive, after all, when servicemembers like Tom Sullivan aren’t. Even after experiencing firsthand the lifelong toll that war can impose, and grappling with how he and other veterans are being treated upon their return, Le Roy vows that he’ll never regret having served. In fact, he would go to Iraq all over again — even knowing what he does now.

“They may have taken my health, but they can’t take what I stand for,” Le Roy says. “I will be a patriot until the day that I die. Until they hang that flag on my coffin, I will continue to honor this country.”