John Plahovinsak
Constrictive bronchiolitis (CB) was one of the twenty-three (23) diseases listed in the Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act. This disease was cited as presumed to be caused by exposure to the open burn pits.
Because CB was cited as a presumptive condition impacting veterans in the PACT Act, it was supposed to be fast-tracked in the Department of Veterans Affairs (VA) disability claims system.
In theory, this factor allowed negatively impacted veterans to have an easier time in obtaining their medical service benefits and their disability compensation. However, this is not the case for disabled veterans suffering from CB.
A comprehensive review of the twenty-three (23) presumptive illnesses contained in the PACT Act neglects to designate the CB condition with a proper medical code within the VA’s disability claims system.
This lack of a four-digit medical code presents a serious problem for the veteran and prevents the claim from being approved.
Constrictive bronchiolitis is the narrowing of the lungs’ bronchioles, the smallest airways, by scarring the fibrous tissues. The scarring of the bronchioles prevents oxygen exchange between the lungs and the bloodstream and causes extreme fatigue.
The CB condition is difficult to diagnose, with relatively few doctors totally understanding the magnitude of the scope of the disease and how it impacts veterans exposed to open burn pits.
The additional symptoms of CB include shortness of breath and unexplained wheezing or dry cough in the absence of a cold or allergies. The only current way of definitively diagnosing CB is via a lung biopsy.
The lung biopsy is a painful procedure that many veterans fear and VA doctors are reluctant to perform because it is invasive.
A Medical Study was conducted in 2011 of eighty (80) soldiers, based at Fort Campbell, that returned from deployments in Iraq and Afghanistan.
They were evaluated for extreme fatigue which prevented them from meeting the Army’s standards for physical fitness.
Forty-nine (49) soldiers who underwent thoracoscopic lung biopsy after noninvasive evaluation did not provide an explanation for their fatigue symptoms. All the soldiers had a history of inhalational exposure to the 2003 sulfur mine fire in Iraq.
All the soldiers evaluated had biopsy samples that were abnormal and thirty-eight (38) had physical changes that were diagnostic of CB.
Dr. Robert Miller was among the first physicians to diagnose CB in combat veterans in the mid-2000s. “We need a protocol and a system within the VA to help evaluate these people,” said Dr. Miller, “and we need disability benefit structure for them as well.”
Dr. Miller contended that even if veterans receive a diagnosis of CB, they will face challenges because the VA’s disability claims system rejects the disease without a designated medical code.
“Unfortunately, the current patient who has a biopsy-proven diagnosis for CB is not going to be eligible for disability benefits,” stated Miller, “because their X-rays and pulmonary function tests are normal.”
According to the VA’s executive director for the PACT Act, Steve Miska, the VA is currently working to create a CB diagnostic code for its claims system through the federal rulemaking process.
“If there’s not a diagnostic code, we’re not going to stop it. Sometimes, it requires your own advocacy … or other[s] advocating on your behalf,” said PACT Act Executive Director Miska.
Dr. Trishul Siddharthan, a functional lung imaging expert at the University of Miami, believes that advancement in diagnostic tools, such as imaging for CB, can detect lung function and capability in real time.
“Functional lung imaging can detect disease at a much higher rate than you can with traditional methods,” said Dr. Siddharthan.
My Opinion: According to PACT Act Executive Director Miska, the VA has trained ninety (90%) percent of its providers about toxic exposures and provided more advanced specialized training. The VA currently operates six (6) centers of excellence for toxic exposures.
The puzzling thing about this situation is that after a full year after the implementation of the PACT Act, why is there still no specific medical code associated with CB?
In a June 2022 News Conference, VA Secretary Denis McDonough expressed support for updates to the VA’s Schedule for Rating Disabilities, including finding better methods of detecting CB.
In an August 2023 interview, VA Secretary McDonough said, “ I’m not happy about where this stands (relating to the lack of a dedicated diagnosis code for CB). I want to make sure every veteran gets the care and benefits that they have earned.”
History has illustrated that if the current administration is not re-elected, a new VA Secretary will be appointed (along with other key officials) and it will take another year (or two) before a diagnosis code for CB is created.
In the meantime, disabled veterans afflicted with CB will continue to receive a zero-disability rating because of the lack of a four-digit medical code.
BioSketch: John Plahovinsak is a retired 32-year Army veteran, who served from 1967 to 1999. He is the Disabled American Veterans (DAV) Department of Ohio’s Hospital Chairman and Adjutant of DAV Chapter #63 (Clermont County). He can be contacted at: plahovinsak@msn.com.