Debate Swirls Around Research Showing Lung Problems for Returned Troops

As a teenager in northern New York, Gary Durham ran cross-country and hiked the Adirondack’s high peaks. In Army basic training, he did two-mile runs in under 13 minutes. But after a yearlong deployment to Iraq with the 101st Airborne Division in 2003, he says he started gasping for air while just mowing the lawn.

An emerging body of research indicates that Mr. Durham is one of a significant number of American service members who are reporting respiratory problems like coughing, wheezing or chest pains that started during deployment and continued after they returned home.

In 2009, a major survey of military personnel, the Millennium Cohort Study, found that 14 percent of troops who had deployed reported new breathing problems, compared with 10 percent among those who had not deployed.

Though the percentage difference seems small, when extrapolated for the two million troops who have deployed since 2001, the survey suggested that at least 80,000 additional service members had developed post-deployment breathing problems.

But now, a fierce debate is under way over just how long-lasting and severe those problems really are.

On one side are scientists, many working for the government, who say that a large number of returning troops have serious and potentially lifelong ailments. They point to an array of respiratory hazards in Iraq and Afghanistan — including powerful dust storms, fine dust laced with toxins and “burn pits” used to incinerate garbage at military bases — as potential culprits.

Those scientists also question whether the government has acted swiftly enough to study the effects of prolonged exposure to dust, allergens and pollution in Iraq and Afghanistan, and whether it is properly compensating those who may have service-connected lung injuries or diseases.

“I’m concerned that this exposure is not getting the serious review it needs,” said Capt. Mark Lyles, the chairman of medical sciences and biotechnology at the Center for Naval Warfare Studies in Newport, R.I., who has studied dust from Iraq and Afghanistan.

On the other side of the debate are officials with the Pentagon and the Department of Veterans Affairs who assert that current research remains inconclusive. They acknowledge that some troops are returning with respiratory symptoms but say those problems vary widely depending on genetic background or location of deployment and are usually temporary.

“I think we are going to find that there is some increase in respiratory symptoms, and maybe even respiratory diagnoses,” said Col. Lisa Zacher, a doctor who is the pulmonary consultant to the Army’s surgeon general. “But I think we’ll find the majority who deploy do not have long-term chronic pulmonary diseases related to deployment.”

Mr. Durham’s breathing struggles have proved to be long-term. When he returned to Fort Campbell, Ky., in 2004, Mr. Durham was coughing up phlegm daily. Running became impossible. Yet a battery of lung tests showed nothing wrong. Before he was medically discharged as a sergeant in 2005, an Army doctor suggested that his problem might be psychological, records show.

Then last year, Mr. Durham read about a specialist at Vanderbilt University Medical Center who had treated Iraq veterans for breathing problems. The doctor did a lung biopsy on Mr. Durham and concluded that he had a debilitating and largely untreatable injury known as constrictive bronchiolitis.

Though the diagnosis might have seemed devastating, Mr. Durham felt vindicated. “I had been told there was nothing wrong with me by so many doctors,” he said. “I just wanted to know what was wrong with me.”

Dr. Robert F. Miller, who treated Mr. Durham, has conducted similar biopsies on 56 previously deployed veterans, many from Fort Campbell. He found that 40 of them had constrictive bronchiolitis, an irreversible scarring of the small airways that can make breathing during moderate exercise feel like “sucking air through a straw,” Dr. Miller said. Fifteen other biopsies led to diagnoses of other lung ailments.

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Almost all of his patients had been through standard lung function tests like CT scans and spirometry that found nothing wrong. Constrictive bronchiolitis is typically found in people with lung transplants or rheumatoid arthritis, or who work with industrial chemicals, but is rare in the general population.

“My concern is that these guys come back from war, can’t do a two-mile run and then are dismissed from the Army,” Dr. Miller said. “They are told: ‘Maybe you’re out of condition.’ ”

Fort Campbell no longer refers cases to Vanderbilt. Dr. Miller said he believed the Army was trying to reduce the number of biopsies that might show serious lung injuries. But Colonel Zacher said the Army was simply trying to standardize its care and avoid unnecessary procedures.

“Anyone who shows up at our clinics is going to get a state-of-the-art workup,” she said.

Respiratory problems among returning troops have been the subject of Senate hearings and Pentagon studies that have focused heavily on the burn pits found at scores of bases across Iraq and Afghanistan. But a growing number of experts say the problem is probably more complex than those fires.

Captain Lyles, whose latest research was described recently by USA Today, argues that air particles found in Iraq and Afghanistan are exceptionally fine and thus more readily inhaled into the lungs. Those particles carry an array of harmful metals, bacteria and fungi that are different from — and potentially more toxic than — dust in the United States, Captain Lyles and his fellow researchers say.

“There is potential acute and chronic risk to that exposure,” Captain Lyles said. “But we don’t yet know what that chronic risk is.”

Another scientist affiliated with the government, Dr. Anthony Szema, was an author last year of a paper that found that previously deployed troops were more likely to report new cases of asthma than troops who had not deployed.

In more recent research, Dr. Szema, an allergy expert at the Stony Brook School of Medicine and the Northport Veterans Affairs Medical Center on Long Island, has found that previously deployed troops are far more likely than nondeployed troops to report breathing problems that lead doctors to order lung function tests. He calls the diverse lung problems he believes exist Iraq-Afghanistan War Lung Injury.

Colonel Zacher and other military officials have raised sharp questions about the research by Dr. Miller, Dr. Szema and Captain Lyles.

The officials say that many of Dr. Miller’s patients were exposed to acidic smoke from a sulfur mine fire near Mosul, Iraq, in 2003 that may have injured their lungs, suggesting that those injuries are unique to a relatively small group of soldiers. Dr. Miller, however, said that some of his patients were deployed after 2003.

In a statement, the Navy said that Captain Lyles’s work lacked “scientific rigor” and that its own studies had found “no increase in the incidence of diseases to which Dr. Lyles inferred a cause-and-effect link from exposure to Middle East sand.”

Colonel Zacher also said that Dr. Szema’s sample of deployed troops included a high percentage of smokers, higher than among the troops that did not deploy. “I don’t want to blame it all on tobacco,” she said, “but tobacco is associated with lung problems.”

But Colonel Zacher also acknowledged that more research was needed, noting that the Army planned to do lung function tests on a sampling of soldiers before and after deployment to look for trends in breathing problems.

“There will be some people truly affected by dust or particulate matter,” she said. “Whether it’s 5 or 10 percent, we just have to define it better.”