Call addresses American Legion concerns over delays in detection and treatment of deployment-related respiratory diseases.
American Legion National Commander James LaCoursiere sent a letter to U.S. Department of Veterans Affairs Secretary Denis McDonough on Oct. 21 to address The American Legion’s concerns on delays in detecting and treating for a variety of respiratory diseases under the PACT Act. Here is LaCoursiere’s letter:
I write today regarding the ongoing implementation of The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022. While there has been progress in the processing of PACT Act-related claims, we are concerned about the delays in triaging the influx of PACT veterans coming to the Department of Veterans’ Affairs (VA) for treatment. As the law celebrates its second anniversary, it is our hope that VA will immediately expand pilots or adopt non-invasive lung imaging technologies to screen for service-connected respiratory diseases.
Our concern lies in the delay in detecting and treating for a variety of deployment-related respiratory diseases (DRRDs), the term used for veterans suffering from respiratory issues due to exposure to burn pits and other service-connected respiratory diseases. The lack of existing evaluation protocols for DRRD-related symptoms significantly limits the VA’s ability to treat these veterans. The VA has acknowledged the difficulties in identifying cases of the particularly concerning DRRD, “Constrictive Bronchiolitis” (CB), and creating an appropriate diagnostic code. CB, also known as Obliterative Bronchiolitis, is one of the original 23 conditions covered by the PACT Act. CB remains difficult to diagnose without painful lung biopsies. Without advanced imaging these biopsies can target the wrong areas, present false negatives, delay diagnosis and treatment, and negatively impact veterans’ health outcomes. The proposed advanced imaging technology has an estimated cost of $300 while requiring 30 minutes of the veteran’s time, and provides patients and clinicians with actionable data when deciding if a biopsy is appropriate, without requiring additional instruments at the VA. The VA has had over a year to pilot the program, starting the pilot in Columbus Ohio’s Truman Memorial VHA facility in 2023.
This technology has already been vetted by the American Thoracic Society as the “new standard” for lung function evaluation in 2022 and has been praised by Veteran Health Administration (VHA) respiratory scientists as the next step in diagnosing DRRD. As the invisible wounds of war are becoming more apparent in veterans returning from Iraq and Afghanistan, quick and actionable respiratory diagnostic tools at VHA facilities are imperative.
In July 2024, we hosted a panel discussion celebrating the success of the PACT Act and evaluating what additional steps can be taken to ensure veterans receive the care to which they are entitled. During this panel Danielle Robinson, widow of Sergeant First Class Heath Robinson, shared that her husband searched for answers to his respiratory issues for over nine months before his stage 4 lung cancer diagnosis. She noted that in a postmortem autopsy, Heath’s lungs were reported as “obliterated,” and that because his lung cancer diagnosis was so delayed, he was given only four to six weeks to live.
The panel was also asked about using FDA-approved functional lung imaging technologies to speed up the diagnosing process for veterans suffering from respiratory diseases. The panel member from the VA PACT Act Office informed the audience that the VA is still evaluating imaging technology and has been for several years, and it would be implemented following further research. But any further delays only extend the time our veterans suffering now must wait for answers and care. For veterans and their families, this delay is unacceptable.
The American Legion urges the VA to do three things:
1. Expand the pilot programs utilizing four-dimensional functional lung imaging and regional airflow quantification technologies to screen for respiratory diseases related to burn pit exposure or transition these programs out of the experimental phase by implementing them system-wide across the VHA.
2. Provide guidance to clinicians for the use of functional lung imaging programs in clinical protocols including the Deployment-Related Respiratory Disease Toolkit for Providers and other appropriate sources.
3. Implement accelerated authorization for these technologies to safely operate within VA facilities to ensure that veterans receive timely care.
Incredible progress has been made treating veterans with DRRD in the last two years, but there is still much more work to be done. Our veterans have waited long enough. The time for the VA to do something is now. In the words of Mrs. Danielle Robinson, “If this imaging would have been there for Heath to do, who knows, he could have been here today."
Thank you for your prompt attention to this issue.
Sincerely,
James A. LaCoursiere
National Commander
- Veterans Healthcare