For more than three years, the military services have been allowed to ignore a Defense Department order requiring the inclusion of environmental assessments of combat environments in troops' medical records.
The Pentagon in 2006 published an instruction requiring the services add occupational and environmental risk assessments generated for locations during a certain period into medical records of troops who served in the affected place and time.
Some veterans have developed illnesses they believe may be related to exposure to pollutants released by open air burn pits, heavy metals found in fine dust, exposure to chemical weapons and parasites.
Since at least 2012, however, the undersecretary of defense for personnel and readiness waived that requirement, and a memo written in 2013 extended the waiver for another two years, with acting Undersecretary of Defense (P&R) Jessica Wright saying the reports, known as Periodic Occupational and Environmental Monitoring Summaries — POEMS — are summaries of "population-level health risks," and not an indication of exposure to individual service members.
According to Wright, including the information in medical records could sway troops to link any illnesses they may have to their deployment environment, which may lead to "biased assessments of exposure and health risk" and possibly provide "support for disability claims for chronic illnesses that may not be due to exposure."
To troops and veterans sick with respiratory illnesses, cancers and unexplained diseases they think are related to pollution, chemicals or other environmental hazards in Iraq and Afghanistan, the memo, initially released online by the law firm Bergmann & Moore, is an outrage, a concerted effort to squelch the truth about deployment environmental hazards, from burn-pit pollution to dust laden with heavy metals.
"This is a rationale for denying not only patients, but also their physicians, ready access that DoD — and any reasonable American — should consider relevant to diagnosis and treatment," said Peter Sullivan, father of a Marine who died of an unexplained illnesses in 2009 following a deployment to Iraq. He is also director of the Sgt. Sullivan Center, a nonprofit that advocates for research on military environmental exposures.
"It feels like a slap in the face," said a retired Air Force master sergeant who suffers a debilitating lung disease and requested anonymity because she works for the federal government and fears retribution for discussing the subject. "We put our lives on the line over there and these are the people trying to deny me disability."
The original instruction required the services to file any applicable POEMS "in the medical records of each individual for which the exposure applies," or archive them so they are available to "health care providers and redeployed personnel."
Pentagon spokesman Air Force Maj. Ben Sakrisson said the information is available upon request and also is being published online in the Military Exposure Surveillance Library, with plans to post more "upon completion and after clearance for public release."
But the retired airman and others say few troops or medical personnel even know what a POEMS is, and even fewer know to ask for them.
"I never heard of them until I returned from Afghanistan the last time, and I was in the medical field," said the master sergeant, who said she began having respiratory problems after a deployment to Iraq in 2004.
Sakrisson said that since POEMS are not records of individual exposures, they do not provide confirmation of one.
DoD "initially directed placement of POEMS in the individual medical record as a means of having the data available to health care providers and others to provide greater knowledge of ambient environmental conditions and possible health concerns," he said.
"The department later determined not to place a copy of the POEMS in individual medical records because they are valid only on a population basis."
Retired Army Lt. Col. Rick Lamberth, who deployed to Iraq and Afghanistan multiple times and worked near burn pits and in locations where chemical munitions were manufactured, disagreed, saying it would be helpful to have the deployment risk summaries in his medical records.
"It would substantiate what you are saying to your doctor and you wouldn't have to tell your background story over and over," said Lamberth, who says he has sleep apnea, unexplained rashes and respiratory inflammation that produces so much mucus that he chokes in his sleep.
Thousands of troops have reported medical problems they believe are related to living and working near burn pits used for waste disposal in Iraq and Afghanistan, as well as exposure to dust, fine particulates, chemicals and parasites in the region.
The Veterans Affairs Department established a burn-pit registry to track the health of these individuals; as of Oct. 21, a total of 49,980 active-duty troops and veterans have begun the process of enrolling in the VA Airborne Hazards and Open Burn Pit Registry.
Many participants report health conditions ranging from asthma and emphysema to high blood pressure, insomnia and rare lung disorders.
"The pollution over there is so terrible. We knew that, and it seems like they should have been tracking it from the beginning," Lamberth said. "Now for them to deny including what little documentation they have in our medical records ... how fair is that? How is that justice?"
Sullivan, who has asked House lawmakers to initiate an investigation, noted that "not coincidentally," the same office responsible for the waiver "also has a record of minimizing the gravity and prevalence of deployment-related illnesses that appear to be connected to occupational and environmental exposures."
The services still must include any data on individual exposures collected through personal sampling monitoring or medical examination, according to the instruction, DoDI 6490.03.
But Sakrisson said not everyone is monitored during deployments and there may be no personal documentation for many.
DoD is moving to improve its capability to monitor exposures where warranted, Sakrisson added, but "the science and technology has not progressed to make individual environmental monitoring possible in some cases and practical in other cases."
The department is developing an initiative that would track environmental exposures for new accessions from recruitment through retirement, but that program, scheduled to being within the next year, is of no use to veterans or those currently serving.
What exactly sickened many troops who served in the Middle East remains the topic of medical research. Burn pits were used to dispose of items ranging from medical and human waste to plastics, computers and items known to release cancer-causing agents into the air. Other studies have indicated that the fine dust particles in the region contain heavy metals that can cause diseases.
But data from the air quality monitoring for the region is scant.
A 2011 Institute of Medicine report said current literature and research lack conclusive evidence linking burn pits to poor health in troops and veterans.
Many of the POEMS available online state that little air sampling information is available to rate the long-term health risks for some locations.
Other POEMS indicate that levels of particulate matter in certain places during certain periods could potentially cause reduced lung function and asthma, but they do not mention the potential for more severe illnesses like constrictive bronchiolitis, a rare lung disease diagnosed in some troops, or cancer.
Sakrisson said DoD stands by its decision to post the POEMS online and not include the "lengthy summaries" in individual medical records.
"We agree [troops] have a clear right to know what the environment was like in their deployment locations, which is why we ensure the POEMS available and accessible," he said.