Veterans' advocates are pushing to have several blood cancers added to the list of conditions considered to be service-connected under the PACT Act, a move that would make some Gulf War and post-9/11 veterans eligible for expedited health care and benefits.
The Department of Veterans Affairs is conducting a scientific review to decide whether acute leukemias, chronic leukemias and multiple myeloma should be covered by the PACT Act, the landmark legislation passed last year that broadened benefit eligibility for veterans who served in Iraq, Afghanistan and elsewhere and were exposed to burn pits or other battlefield pollutants.
Multiple myeloma already is considered a presumptive condition under the legislation when it originates in the head or neck. Lymphoma, which forms in the lymph system, is covered but leukemias are not, even though they are similar to lymphoma.
In public comment conducted as part of the VA's review, veterans' advocates supported inclusion of these illnesses as service-connected conditions, saying they have seen former service members who are afflicted and now dying.
According to the HunterSeven Foundation, an organization that helps personnel with exposure-related illnesses and supports research on military-associated health conditions, of the 1,239 cancer deaths among the veterans the group represents, 145 were from leukemia, myeloma or sarcoma, a type of cancer of the bone or soft tissues.
The Stronghold Freedom Foundation, established to advocate for veterans who deployed to Karshi-Khanabad Air Base in Uzbekistan, said that, out of 411 veterans in its membership, three have died from multiple myeloma with another four afflicted.
And more have a condition that is considered a precursor to multiple myeloma.
"That is an insane number for such a young, otherwise healthy, population," Chelsey Simoni, an Army veteran and cofounder of the HunterSeven Foundation, said during a public comment session with VA officials last week. "The average age of diagnosis of these warfighters was 32 years old. The average age of death was 35 years old."
"These numbers are way too high for this number of veterans and their relatively younger ages. ... Only 10% of people diagnosed with multiple myeloma are under 50, and 2% of people are under the age of 40," wrote Daryl Riddle, an Air Force widow who serves as care and support team director for the Stronghold Freedom Foundation, on the VA's solicitation for comment in late August.
Two years ago, the VA launched an internal process for determining whether illnesses should be presumed to be related to military service. The designation of a condition as "presumptive" removes the burden from a veteran to prove that their illness or injury was caused by their service and is therefore eligible for expedited health care and benefits.
With the new process, VA reviewers consider all available science and data, including veterans' claims data, to establish new presumptive conditions. Previously, the VA contracted outside panels, usually through the National Academy of Sciences, Engineering and Medicine, to study available research and scientific literature to decide whether a condition was linked to military service
The VA added the first conditions under the new process in 2021, including asthma, rhinitis and sinusitis, to the list of conditions tied to exposure to fine particulate matter generated by burn pits and other pollutants.
If a condition is not considered service-connected, veterans may file a disability claim for it along with documentation supporting their case. The VA decides those on a case-by-case basis. Many of the comments on the VA's proposal to add blood cancers to the list of PACT Act conditions said the proposal didn't go far enough, arguing that those illnesses also affected veterans exposed to chemicals or jet fuel at domestic military installations or operations outside the geographic locations listed in the proposal.
If approved, eligible veterans would include those who served on active duty in the Southwest Asia theater of operations since the Persian Gulf War, or in Somalia, Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen and Uzbekistan since Sept. 11, 2001.
Retired Air Force Col. Vincent Alcazar, director of aviator medical issues at the Red River Valley Fighter Pilots Association, said the nonprofit supports the change but suggested the VA look at exposures and associated cancers that "are not necessarily tied to Southwest Asia service."
"We ... believe that if VA looks elsewhere, it will successfully locate other strong cancer incidence/mortality data and associations that are well beyond the [Southwest Asia] theater of operations and military operations areas in the associated authorization for use of military force," Alcazar wrote.
Jose Ramos, a Navy combat veteran and vice president for government and community relations for Wounded Warrior Project, wrote that his organization supports the expansion but also encourages the VA to look beyond respiratory conditions and cancers under the PACT Act.
"Although these categories of conditions are closely associated with exposure to airborne hazards, they do not capture the full range of illnesses that exposed post-9/11 veterans are experiencing," Ramos wrote.
According to Wounded Warrior Project's annual survey, 35% of veterans with a history of toxic exposure reported neurological issues such as numbness, tingling or weakness in arms or legs, or difficulties with thinking or memory. Also, 33% said they had high blood pressure, and 24% had multisymptom illnesses such as irritable bowel syndrome, chronic fatigue and fibromyalgia.
In announcing the review for blood cancers in July, VA Secretary Denis McDonough encouraged any veteran diagnosed with leukemia or multiple myeloma not to wait to apply for health care and benefits.
"We won't rest until we understand whether there's a connection between these deadly conditions and the service of our nation's heroes," McDonough said in a statement. "But make no mistake: Veterans shouldn't wait for this review process to conclude to apply for the support they deserve."
As of Friday, the VA had received 1.17 million PACT Act-related claims. It had approved more than 544,000. In the first year alone, the department distributed $1.85 billion in disability compensation and other benefits to eligible veterans or their survivors.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on X @patriciakime.