The Soldiers Came Home Sick. The Government Denied It Was Responsible

The soldiers with inexplicable breathing complaints started appearing in Dr. Robert F. Miller’s pulmonology clinic in 2004, the year after Baghdad fell to invading United States forces. These new patients were active-duty troops from nearby Fort Campbell, men and women who came home from war with mysterious respiratory ailments. The base asked Miller, an unassuming and soft-spoken lung specialist at Vanderbilt University, to take a look.

Miller was baffled to see formerly healthy soldiers gasping for air after mild exertion. Some of them had been close to the fire at the Mishraq sulfur mine outside Mosul, thought to be the largest release of sulfur dioxide ever caused by humans. But others had never gone anywhere near the burning mine. Some of them could no longer run or climb stairs, and yet their X-rays and pulmonary-function tests looked normal.

Confounded, Miller decided to try something radical: He began ordering lung biopsies under general anesthesia to look for more subtle damage known as small-airways disease. Sure enough, the tissue revealed toxic lung injury, which Miller diagnosed as constrictive bronchiolitis. To the doctor, this meant two things: First, the soldiers were not exaggerating their symptoms. And more important, noninvasive screenings couldn’t be trusted to detect these new post-deployment ailments.

Eager to share his discovery, Miller contacted doctors at Walter Reed Army Medical Center. This led, at first, to what Miller recalls as an enthusiastic collaboration. Army doctors flew to Tennessee to review Miller’s biopsies, and together they went to Fort Campbell to develop a protocol for evaluating patients.

That early collaboration collapsed, however, after Miller presented his findings to a large 2009 conference of doctors, including contingents from the Department of Defense and the Department of Veterans Affairs. In the following months, his Fort Campbell patients stopped coming for treatment. When Miller asked for an explanation, a Department of Defense official told him in an email that the abrupt change was because of a realignment in military command regions. Miller wasn’t convinced: He believes that senior officials realized that the implications of his research could be sweeping — and could stick the government with expensive medical bills for untold numbers of returning troops. Whatever the reason, he says, the military abruptly stopped cooperating or referring patients to Miller. “The D.O.D. said: ‘Well, we’ll take it from here. We don’t need to send any more people to Vanderbilt,’” Miller recalls. (A spokesperson at Fort Campbell said the base had decided to send patients, instead, to an Army medical center in San Antonio for treatment and study within the military’s health system.)

Miller’s breakthrough findings and what he described as the sudden end of collaboration with military officials marked an early clash in what would become a long, bitter struggle over ailments associated with military trash fires and other airborne toxins during America’s post-Sept. 11 wars. More than 200,000 people who deployed to Iraq or Afghanistan believe they suffer permanent damage from exposure to burn pits, as the military’s notorious garbage-disposal fires are known. They describe ailments ranging from shortness of breath to rare cancers but have struggled to convince the government that shipped them off to war that their suffering deserves redress. Instead, veterans’ pleas have been met with bureaucratic inertia and widespread perceptions of stonewalling. Researchers who uncovered early suggestions of links between burn pits and health problems say their work was discouraged or even censored by the V.A. At the same time, citing a lack of conclusive data, the V.A. was denying the vast majority of burn-pit-exposure claims. Since the first anecdotes of mysteriously sickened service members began to filter out of clinics in the early years of the war on terror, the battle over burn pits has unfolded as a bleak saga that brought together foreign wars and military contractors, health care dysfunction and distrust of government.