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Doctors, scientists, and patient advocates described the tremendous harms of burn pits to active duty service members and veterans, ranging from cancers to severe respiratory illness and death, during a hearing of the Senate Committee on Armed Services Subcommittee on Personnel on Wednesday.

Subcommittee Chair Kirsten Gillibrand (D-N.Y.) opened the hearing by stating that service members anticipate certain risks in their work, "but those risks should not come from the operations of our own bases, and when they do, we must take responsibility."

Experts and advocates recommended leveraging technology such as wearable bracelets to monitor exposures, comprehensive registries to track the harms and locations of exposures, and pre- and post-deployment breathing assessments.

are "low lying areas" in which the U.S. military set fire to waste, including "pressurized lumber, galvanized metal, significant quantities of plastics, and lithium batteries," explained Stephen Patterson, a witness at the hearing, who served as a senior environmental science officer for Combined Joint Task Force 101 at headquarters in Afghanistan in 2008 and 2009 and is now retired.

Based on Department of Veterans Affairs data, approximately 3.5 million veterans have been exposed to burn pits and other airborne hazards, said hearing witness Tom Porter, executive vice-president for Government Affairs at the Iraq and Afghanistan Veterans of America.

Anthony Szema, MD, director of the Northwell Health International Center of Excellence in Deployment Health and Medical Geosciences in Manhasset, New York, also a witness, said he and his colleagues first identified new onset asthma and deployment-related rhinitis in 2007 and 2008 among soldiers deployed to Iraq and Afghanistan exposed to burn pits. They coined the term (IAW-LI) based on tests of lung function in these soldiers in 2011.

In addition to asthma, Szema diagnosed soldiers exposed to burn pits with "non-smoking related accelerated COPD, constrictive bronchiolitis, carbonaceous burned lung, titanium lung, lung fibrosis, bladder cancer, and pulmonary ossification, or bone in the lung ... As an expert in the field, I've concluded that these lung disorders are directly related to exposure to airborne hazards including burn pits, dust storms, improvised explosive devices, and blast overpressure from mortar fire rounds."

Doctors caring for these patients run into multiple roadblocks including inadequate screening -- which leads to late diagnoses or not being diagnosed at all -- and a lack of information about an individual soldier's exposures.

"Without knowing what they're exposed to or potentially exposed to, it's hard to prove what caused the ailment," he said.

Even at sites where environmental exposures are known to have occurred, soldiers themselves may not have complete documentation of where they were stationed, and consequently, exposures can't be proven.

To overcome such barriers, Szema recommended pre- and post- deployment breathing assessments, overhauling the Department of Defense's (DOD) strategies for documenting sites of deployment, and leveraging wearable particle monitors with GPS in order to track an individual soldier's exposure and location.

Knowing when an exposure is present, the DOD can move troops away from the environmental threat or, at the very least if an exposure does occur, provide information about the exposure to aid in treatment.

Patterson also argued for using wearable technologies, such as silicon bracelets, which can capture more than 15,000 different compounds. He also recommended researching a possible replacement for those bracelets, to provide "near real-time information on exposure and dose" for individual service members.

Szema noted that screening and monitoring for exposures was effective for 9/11 victims of the World Trade Center attacks and could prove similarly helpful to the "analogous exposure" with burn pits.

Patterson also suggested developing a repository of frozen soil samples from every deployment site, which could be tested in the future as new concerns regarding exposures emerge.

Another witness, Rosie Torres, executive director of Burn Pits 360, shared the story of her husband, Leroy Torres, who served in Iraq in 2007 and 2008, where he lived and worked next to the "largest burn pit within the Operation Iraqi Freedom theater of operations, which was the size of approximately a football field."

Torres' husband was diagnosed with autoimmune disease, toxic brain injury, and constrictive bronchiolitis following a lung biopsy at Vanderbilt University and hundreds of medical visits.

Torres argued that the government has denied for years that there's evidence to show that inhaling toxic black smoke causes respiratory illnesses and cancers, instead labeling their concerns as "stories or anecdotes, and not data." Both the Veterans Administration and the DOD routinely misdiagnose the concerns of service members exposed to burn pits, as psychosomatic or "compensation-driven care-seeking," she said.

Torres called for an end to victim-blaming.

"We are asking for the Department of Defense and Veterans Affairs to honor these injuries with compassionate common sense," she said, by passing legislation that addresses the matter of "presumption" in VA compensation claims.

This means, according to Torres' written testimony, establishing that there is in fact a "service-connection for debilitating symptoms and diseases that have been linked to burn pit exposure."

Torres also called for stronger research on the harms of burn pits and to improve burn pit registries and establish evidence-based clinical practice guidelines and screening and treatment protocols for physicians of veterans exposed to burn pits, along with improving the collection of service members' health records of exposure.

Terry Rauch, PhD, acting deputy assistant secretary of defense for health readiness policy and oversight, said the relationship between burn pit exposure and illness is a topic of "active research" at the DOD and VA, along with the National Academies of Sciences, Engineering, and Medicine, and other research institutions. "The department and VA continue to support and fund these research efforts to better understand any health effects that will better inform the health care provided to our service members and veterans," said Rauch.

Gillibrand closed the hearing by thanking witnesses for sharing strategies for addressing illnesses caused by burn pits, including ways to document exposures during active duty, saying their advice will be helpful as the committee moves forward with its work on these issues.

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