Latest News

Exclusive: Veterans want answers as new data shows rise in cancers over two decades of war

“I got cancer because of my service in the military. There could be hundreds, thousands of veterans behind me getting cancer.”

Veterans saw a spike in urinary, prostate, liver and blood cancers during nearly two decades of war, and some military families now question whether their exposure to toxic environments is to blame, according to a McClatchy investigation.

McClatchy found that the rate of cancer treatments for veterans at Department of Veterans Affairs health care centers increased 61 percent for urinary cancers ⁠— which include bladder, kidney and ureter cancers ⁠— from fiscal year 2000 to 2018.

The rate of blood cancer treatments ⁠— lymphoma, myeloma and leukemia ⁠— rose 18 percent in the same period. Liver and pancreatic cancer treatment rates increased 96 percent and prostate cancer treatment rates increased 23 percent.

McClatchy analyzed all billing data for veteran visits involving a cancer diagnosis at VA medical facilities from fiscal year 2000 to 2018. The data was obtained through Freedom of Information Act requests. A more in-depth methodology of the review can be found here.

McClatchy selected that time frame to look at what impact the last two decades of war in Iraq and Afghanistan have had on veterans’ medical needs, even as the VA continues to treat veterans from past wars.

Veteran Marine Corps Sgt. Mark S. Villamac Ho joined the military after the September 11, 2001, terrorist attacks and deployed in early 2003 to Al Numaniyah, Iraq, as an aircraft rescue firefighter.

In Iraq he was exposed to the firefighting foam the military is removing from service due to its links to cancer, and to the open-air trash-burning pits that more than 187,000 veterans have reported made them sick.

Read Next

Ho was 38 when he was diagnosed with multiple myeloma, a type of blood cancer, and a second cancer in his nose and throat. He is still fighting the disease and worries about the service members who deployed to Iraq and Afghanistan in the years after him.

“I got cancer because of my service in the military,” Ho said. “There could be hundreds, thousands of veterans behind me getting cancer.”

VETCANCER-MARKHO2
Former Marine Corps Sgt. Mark S. Villamac Ho (right, back row) deployed to Iraq in 2003 as an aviation rescue firefighter. In this picture, he and the Marines he served with are exposed to firefighting foam in Al Numaniyah, Iraq. The Defense Department is phasing out the foam due to its links to cancer. In 2017 Ho was diagnosed with myeloma, a blood cancer and doctors found a second cancer in his nasal passages. Photo courtesy of Mark S. Villamac Ho

Many veterans still struggle to get their illnesses treated by the VA, said former Veterans Affairs Secretary David Shulkin.

“We’re continuing to repeat the mistakes we have made for 50 or 60 years,” Shulkin told McClatchy. “Letting our veterans continue to wait, without the support and help that they need, is really not fulfilling the responsibility that we committed to them when they joined the military.”

Overall, the rate of cancer treatments received by veterans within the VA peaked in fiscal year 2009 and then declined over the past several years, but is significantly higher than before the September 11, 2001, attacks that led to the wars in Iraq and Afghanistan.

There were decreases too. Across all services, the rate of treatments received by veterans for brain cancer fell 33 percent, testicular cancers fell 22 percent and respiratory cancers fell 13 percent, according to McClatchy’s analysis.

When each service was analyzed, there were also sharp increases in treatments for some cancers. The rate of prostate cancer treatment in the Air Force rose 44 percent; for Marine Corps veterans the increase was 60 percent. The rate of urinary cancer treatments for Army and Navy veterans rose 56 percent; for Marine Corps veterans it was a 98 percent increase.

The rate of treatments for liver and pancreatic cancers more than doubled for both Army and Marine Corps veterans. Within the Marine Corps, there was a 112 percent increase in treatment rates; in the Army there was a 104 percent increase.

Veterans who are cancer survivors have a name for the environmental factors that may have made them sick: toxic exposure.

“If you’re one of our vets who is suffering, we need to get into the fight for you now,” said Jon Stewart, who recently advocated for continued funding for 9/11 first responders. The former late night comedy show host has now joined forces with the veterans advocacy group Burnpits360.

CANCER FINDINGS

When McClatchy presented initial findings to the VA and asked if it was concerned about the rise in cancers, the agency said it disagreed with McClatchy’s approach. The VA said an analysis of billing data would create an overcount, and that its internal cancer registry system did not show a significant rise.

“According to the latest official VA cancer data, the annual total number of cancer cases among enrolled veterans peaked in 2010 and has been declining since,” the VA said in a statement. “Colorectal and prostate cancer have been declining, while hepatocellular and skin (melanoma) cancer have been increasing. These trends largely mirror national cancer trends.”

But when viewed over the longer 2000 to 2017 time frame, the data provided to McClatchy from the VA’s cancer registry system shows an increase in some cancers. It shows the number of blood cancers increased 41 percent, while bladder, kidney and ureter cancers increased 70 percent. Skin cancers have increased 48 percent, brain cancers are up 20 percent. Liver and pancreatic cancers are up 151 percent — although they represent only a small number of actual cases. Prostate cancers are up 9 percent.

McClatchy’s analysis showed decreases in treatments for brain, respiratory and testicular cancers. VA’s cancer registry system showed increases in brain, respiratory and testicular cancers. The differing results are due to differences in methods of calculation and the makeup of the two datasets.

The VA’s cancer registry system does not provide a breakdown by different branches of the military.

While sympathetic to veterans’ concerns, Dr. Michael Kelley, chief of hematology and oncology for the VA, said much more research is needed to link a cause to the cancers.

“The time between possible exposure to a common carcinogen, for example, and the diagnosis of cancer is oftentimes measured in decades,” Kelley said. “It can be very difficult to recreate what was happening in retrospect.”

BEHIND OUR REPORTING

When McClatchy presented initial findings to the VA, the agency said it disagreed with McClatchy’s approach. The VA said an analysis of billing data would create an overcount, and that its internal cancer registry system did not show a significant rise.

“According to the latest official VA cancer data, the annual total number of cancer cases among enrolled veterans peaked in 2010 and has been declining since,” the VA said in a statement. “Colorectal and prostate cancer have been declining, while hepatocellular and skin (melanoma) cancer have been increasing. These trends largely mirror national cancer trends.”

There are multiple ways to track cancer rates, and each has limitations.

Studies have found that the billing data used in McClatchy’s analysis, which covered all treatments provided by the VA coded as cancer according to the International Classification of Diseases (ICD), has a tendency to overcount, while data from cancer registries such as the one used by the VA has a tendency to undercount.

McClatchy asked the VA through a Freedom of Information Act request for the internal data that the VA referenced in the statement above.

For the VA’s response, read more by clicking the arrow in the upper right.

FOIA Response

In its response to that FOIA request, the Veterans Health Administration said parts of the cancer registry system were not being maintained.

“[The VA Central Cancer Registry] is not a viable source of VA cancer registry data at this time,” the Veterans Health Administration wrote in a response to our open records request. “There are no staff working on [the VA Central Cancer Registry] so it is not functioning to any standard.”

The VA then sent McClatchy raw data from its cancer registry that could not be adjusted for population and did not include a breakdown by service.

While the VA in its statement noted a decrease in cancers from 2010, viewing the raw cancer registry data over a longer period, from 2000 to 2017, showed an increase in some cancers. It was a similar trend to McClatchy’s analysis of billing data over fiscal years 2000 to 2018.

The VA’s cancer registry data shows the number of blood cancers increased 41 percent, while bladder, kidney and ureter cancers increased 70 percent. Skin cancers have increased 48 percent, brain cancers are up 20 percent. Liver and pancreatic cancers are up 151 percent — although they represent only a small number of actual cases. Prostate cancers are up 9 percent.

McClatchy’s analysis of billing data showed decreases in treatments for brain, respiratory and testicular cancers. VA’s cancer registry system showed increases in brain, respiratory and testicular cancers. The differing results are due to differences in methods of calculation and the makeup of the two datasets.

“Don’t let anyone convince you that the information you’re pulling is wrong. It’s not wrong. It’s just different from what VA has used,” said Susan Lukas, a former VA official who now advocates for military reservists and veterans through the Reserve Officers Association. “One of the outcomes of your research comparing ICD codes to identify veterans with cancer is that it may be time for VA to use this international system instead of their internal cancer register.”

Why We Did This Story

Military correspondent Tara Copp was in Kuwait, preparing to embed with U.S. forces crossing into Iraq as the 2003 invasion began.

In one early March evening exchange at Kuwait’s Ahmed Al Jaber Air Base, where thousands of U.S. personnel were supporting the air campaign, Copp was in a pickup truck with a member of the National Guard driving around the base. The smell outside, a mixture of jet fuel and burnt air, had already become familiar.

The driver turned to Copp and talked about his concern that as a member of the National Guard, if he got sick, his health care may not be covered.

In the years since, as tens of thousands of service members returned home, questions have been raised about the health effects of their exposure to burn pits, toxic air, cancer-linked firefighting foam or emissions from advanced jets.

In the process of reporting this story, the struggle of veterans from previous conflicts to get their chronic illnesses recognized was also raised.

That’s why we went looking for the data, and reported what we found.

Support investigative journalism

These stories matter, and investigative reporters help hold government agencies accountable by bringing the facts to you.

Subscribe to McClatchyDC for more in-depth journalism from sources you can trust. Subscribe here.

Some veterans aren’t waiting for the VA to establish causality. Instead they are busy collecting names.

‘MORE OUT THERE’

Retired Air National Guard Capt. Shelia Frankenfield and her future husband deployed within 30 days of each other to Balad, Iraq, in 2008.

In 2012, they were diagnosed with cancer two weeks apart. She with breast cancer at age 42, he with testicular cancer at age 38.

“What’s the chance that we deployed 30 days apart, at the same base, and now we both have cancer? This is not the norm,” said Frankenfield, a registered nurse. She asked that her husband not be identified because he is still serving.

VETCANCER-SHELIA
Retired Air National Guard Capt. Shelia Frankenfield and her future husband deployed within 30 days of each other to Balad, Iraq, in 2008. In 2012, they were diagnosed with cancer two weeks apart. She with breast cancer at age 42, he with testicular cancer at age 38. Photo courtesy of Shelia Frankenfield

Frankenfield suspects the burn pit in Balad, where air quality was monitored starting in 2004 due to waste particles that troops were breathing in. It could also be the water sources at Pennsylvania’s Harrisburg International Airport, where she was based with 1,800 members of the 193rd Air National Guard Special Operations Wing. In 2018 the Defense Department acknowledged in a report to Congress that the airfield’s water was contaminated.

Frankenfield has started to collect names of current and former members of the 193rd Air National Guard Special Operations Wing who had cancer, including those who have died, and those like her, who had to retire from the military for medical reasons.

“It’s about 100 names,” she said. “And I know there’s more out there.”

FEWER VETERANS, RISING CANCER

The number of U.S. military veterans receiving medical care from the VA has almost doubled to 6.2 million at the end of fiscal year 2018 from 3.2 million in fiscal year 2000.

The rise has occurred even as the number of U.S. military veterans overall has steadily declined, reflecting the passing of the World War II generation and military cuts in the decades since.

At the end of fiscal year 2018 there were 19.6 million military veterans, down from 26.6 million in fiscal year 2000, according to VA data.

During that same period, the total number of cancer cases treated by the VA more than doubled, to 710,215 in fiscal year 2018 from 336,453 in fiscal year 2000.

One of the limitations is that since not all veterans are eligible for, or choose, VA health care, both the dataset McClatchy obtained through FOIA and the VA’s cancer registry only capture part of the problem. That means the actual number of veterans with cancer is likely even higher.

National Guard and military reserve veterans may be eligible to have their treatments covered by the VA if they were called to active duty and can show that their injuries likely occurred while activated. Veterans who retired after a 20-year military career are eligible for care from a component of the military’s active duty medical system, TRICARE. That data is maintained by a different Defense Department health agency.

For the rest, the VA determines whether a service member is qualified for VA health care coverage based on an assessment of income or whether the illness was likely connected to their time in uniform.

“Claim approval is the gateway to health care from VA, much like a Social Security disability determination opens the door to Medicare-covered health care,” said Anthony Hardie, director of Veterans for Common Sense.

VETCANCER-KendallBrock
Chief Master Sgt. Kendall W. Brock spent 35 years in the Air National Guard working with the 157th Air Refueling Wing at Pease Air National Guard Base in New Hampshire. Brock died in 2017 of bladder and prostate cancer. He was 67. Photo courtesy of Doris Brock

CLAIM DENIED

Doris Brock’s late husband was one of the veterans the VA denied. Chief Master Sgt. Kendall Brock retired in 2005 after serving for 35 years in the Air National Guard in New Hampshire. In late 2015, he was diagnosed with bladder and prostate cancer.

As a member of the National Guard, Kendall Brock wasn’t eligible to have his health care covered unless he could show his cancer was tied to his time in military service. The Brocks’ income level also would have disqualified his claim. He pursued medical treatment outside the VA. But the Brocks also filed paperwork to have the VA recognize the service connection, so they could receive disability compensation.

“We were denied almost immediately after the first form we filled out,” Doris Brock said.

They appealed that decision, this time highlighting “all the chemicals he had worked with as part of being an aircraft maintainer,” Brock said. His claim was denied again.

Kendall Brock died in 2017 at age 67. His widow is still trying to get the VA to recognize his claim.

Read Next

The number of veterans not getting treated, and therefore not being counted, frustrates advocates.

“You cannot get treatment at the VA if you are not service-connected,” said Derek Fronabarger, legislative director of the Wounded Warrior Project. “It irks me a little bit when the [VA] says, ‘Oh no, the data isn’t there.’ But they are not capturing the data because they are not treating all of the individuals who are sick.”

If the government acknowledges widespread service-connected links to cancer, it could get prohibitively expensive, very fast.

Some late-stage cancer treatments can cost upwards of tens of thousands or hundreds of thousands of dollars, said retired Navy Cmdr. Mike Crosby, a career F-14 pilot who formed the group Veterans Prostate Cancer Awareness, Inc.

VETCANCER-FORSHEY2
Army Sgt. Curt Forshey, 22, holds his month-old son, Ben in February 2007 at the church where service members and spouses of the 494th Transportation Company at Fort Campbell, Ky., had gathered to say goodbye as the unit left for its second deployment to Iraq. Curt Forshey called his wife, Laura, that March with news that he was being medically evacuated due to the blood cancer Leukemia. He died days later. Photo courtesy of Laura Forshey

SIMILAR STORIES

Some service members died from cancer while still on active duty. Army Sgt. Curt Forshey was on his second deployment to Iraq when he got a nosebleed that wouldn’t stop.

After his nose bled again, doctors sent him to Kuwait. Curt Forshey called his wife, Laura, and told her he had just been diagnosed with leukemia.

Within hours, he was on a medical evacuation flight to Germany.

By the time Laura Forshey landed in Germany to meet him, Curt was already in a medically induced coma.

He died the next day at age 22.

Laura Forshey waited years to join a support group for grieving military spouses. But now she is meeting more widows like her, who did not lose their spouses to combat, but to cancer.

“Their stories are very similar,” Forshey said. “They were in the same locations, or the same years. The same symptoms,” she said. “The cancer stories start to get linked together. And then the military was the bigger link.”

This year the Defense Department is looking into at least one area of toxic exposure. Defense Secretary Mark Esper has directed a task force to address the widespread concerns about the military’s firefighting foam. The review will include the cost of clean up, an assessment of the foam’s impact and how to make it easier for veterans exposed to it to have their illnesses covered by the VA.

The foam’s cancer-linked compounds were found in the water of “more than 400 installations and their surrounding communities,” Esper wrote in a memo directing the task force. “The Department is committed to taking a strong and proactive stance to address the effects.”

VETCANCER-MARKHO
Former Marine Corps Sgt. Mark S. Villamac Ho deployed to Iraq in 2003 as an aviation rescue firefighter. He and the Marines he served with were exposed to firefighting foam in Al Numaniyah, Iraq, that the Defense Department is phasing out due to its links to cancer. In 2017 Ho was diagnosed with myeloma, a blood cancer and a second cancer in his nasal passages. Photo courtesy of Mark S. Villamac Ho

‘I WANT TO LIVE’

From the hospital bed at the VA Loma Linda Healthcare System in California in 2017, Ho called his older brother, a Marine Corps Master Sergeant. The line got very quiet. Ho started to cry.

“I was literally only able to say, ‘Yeah, they diagnosed me with cancer. Myeloma.’”

The rate of blood cancer treatments for veterans is up 18 percent across the military services and up 30 percent among Marine Corps veterans, according to McClatchy’s analysis of the billing data.

The VA has recognized Ho’s service connection and is covering his cancer treatments.

After doctors gave him the news, Ho went online to find out what myeloma meant for his future. In his post-Marine Corps life, he had focused on work and his hip hop musical career. He had put off marriage.

He looked up survivability rates. “That’s the first thing I was looking for, was hope,” Ho said. He learned he may only have five years.

“I remember being on the hospital bed, and I was like … F**k, I messed up. I should have a family by now. I should be married,” he said. “I was like, now what? You only got five years left. Now it’s too late.”

That was two years ago. Stem cell replacement, radiation and chemotherapy have kept the disease in check, and Ho sees a VA counselor regularly to help him navigate the mental health challenges of living with cancer.

“This has been a very spiritual journey for me,” Ho said. “I want to live. I trust the VA to help me live.”

McClatchy video producer Reshma Kirpalani contributed to this report.

Tara Copp is the national military and veterans affairs correspondent for McClatchy. She has reported extensively through the Middle East, Asia and Europe to cover defense policy and its impact on the lives of service members. She was previously the Pentagon bureau chief for Military Times and a senior defense analyst for the U.S. Government Accountability Office. She is the author of the award-winning book “The Warbird: Three Heroes. Two Wars. One Story.”
Shirsho Dasgupta is a data reporting fellow at McClatchy’s DC bureau. A graduate of the University of Southern California, he also has reporting experience in India and started his journalism career writing about soccer for outlets like The Guardian and VICE.
  Comments