Watts knew other missileers with similar cancers. But the connection really hit home later that same January day, when the results of a blood test revealed that Watts himself had chronic lymphocytic leukemia, a type of non-Hodgkin lymphoma.

“I don’t know if it was ironic or serendipitous or what the right word is, but there it was,” Watts said.

Within the community of U.S. service members who staff nuclear missile silos scattered across the Northern Rockies and Great Plains, suspicions had long been brewing that their workplaces were unsafe. Just months after Watts was diagnosed in 2022, Lt. Col. Danny Sebeck, a former Air Force missileer who had transferred to the U.S. Space Force, wrote a brief on a potential cancer cluster among people who served at Minuteman III launch control centers on Malmstrom Air Force Base in Montana.

Sebeck identified who served primarily from 1993 to 2011 and had been diagnosed with cancer, including himself. Of those, 11 had non-Hodgkin lymphoma; three had died. The Air Force responded swiftly to Sebeck’s findings, into cancer cases and the environment at three intercontinental ballistic missile bases and a California launch facility. The goal is to complete the research by the end of 2025.

The service has released portions of the studies as they conclude, holding online town halls and briefings to highlight its findings. But while former missileers say they are heartened by the rapid response, they remain concerned that the research, which crosses decades and includes thousands of ICBM personnel and administrative workers, may address too large a population or use statistical analyses that won’t show a connection between their illnesses and their military service.

They need that tie to expedite benefits from the Department of Veterans Affairs.

Historically, the Department of Defense has been slow to recognize potential environmental diseases. Veterans sickened by exposure to Agent Orange in Vietnam, Marines who drank contaminated water at Camp Lejeune, North Carolina, and service members who lived and worked near burn pits in Iraq and Afghanistan fought for years to have their illnesses acknowledged as related to military service.

In the case of the missileers, the Air Force already had studied potential contamination and cancer at Malmstrom in and . That research concluded that launch control centers were “safe and healthy working environments.” But with Sebeck’s presentation and the decision to pursue further investigation, Air Force Global Strike Command — the unit responsible for managing nuclear missile silos and aircraft-based nuclear weapons — said the earlier studies may not have included a large enough sampling of medical records to be comprehensive.

Sebeck, who serves as co-director of the Torchlight Initiative, an advocacy group that supports ICBM personnel and their families, told congressional Democrats that the Defense Department has not accurately tracked exposures to the community, making it difficult for veterans to prove a link and obtain VA health care and disability compensation.

“I had to go to a VA person and pull some papers,” Sebeck said, referring to the government system for recording service members’ environmental risks. “It says that I visited Poland once. It doesn’t mention that I pulled 148 alerts in a launch control center with polychlorinated biphenyls and with this contaminated air and water.”

PCBs — And the Missileers Exposed to Them

PCBs are synthetic chemicals once used in industry, including missile control electrical components such as display screens, keyboards, and circuit breakers. They have been banned for manufacture since 1979, deemed toxic and a likely carcinogen by the Environmental Protection Agency.

The Air Force’s Missile Community Cancer Study compares 14 types of common cancers in the general U.S. population and the missile community and also studies the environments at Malmstrom Air Force Base in Montana, F.E. Warren Air Force Base in Wyoming, Minot Air Force Base in North Dakota, and Vandenberg Space Force Base in California to determine whether they may have contributed to the risk of developing cancer.

The Malmstrom, Warren, and Minot bases together field 400 Minuteman III missiles, the land-based leg of the U.S. nuclear triad, which also includes submarine- and aircraft-launched nuclear weapons. The missiles are housed in silos spread across parts of Montana, North Dakota, Wyoming, Colorado, and Nebraska, staffed around the clock by missileers operating from underground, bunkerlike launch control centers.

So far, the Air Force investigation has found from cancer in the missile community compared with the general population, and it found that the death rates for four types of common cancers — non-Hodgkin lymphoma, lung, colon and rectum, and prostate cancer — were significantly lower in missileers than in the general population.

Non-Hodgkin lymphoma accounted for roughly 5.8% of all cancer deaths among people who worked in launch control centers from January 1979 to December 2020.

Early results, derived from Defense Department medical records, found elevated rates of breast and prostate cancers in the missile community, but a later analysis incorporating additional data did not support those findings. The studies also did not find increased rates of non-Hodgkin lymphoma. Air Force officials noted during a June 4 online town hall, however, that these assessments are based on roughly half the data the service expects to review for its final epidemiological reports and cautioned against drawing conclusions given the limitations.

The final incidence report will include federal and state data, including information from civilian cancer registries, and delve into subgroups and exposures, which may “provide deeper insights into the complex relationship” between serving in the missile community and cancer risk, wrote Air Force Col. Richard Speakman in a September 2024 memo on the initial epidemiology results.

Gen. Thomas Bussiere, commander of Air Force Global Strike Command, said during the June town hall that only the final results will determine whether the missile community’s cancer rates are higher than the general population’s.

Some lawmakers share the concern of missileers about the Air Force study. Following the release of a of Torchlight Initiative data that showed higher rates of non-Hodgkin lymphoma — at younger ages — among Malmstrom missileers, Rep. Don Bacon (R-Neb.) to a defense policy bill calling for the National Academies of Sciences, Engineering, and Medicine to review health and safety conditions in the facilities.

“Let’s make sure that we have some outside experts working with the Air Force studying cancer rates with our ICBM missions,” Bacon posted July 30 on the social platform X. “We want to ensure credibility and that whatever results come out, we’ve done total due diligence.”

Regarding additional studies on the working environments at the installations and a possible relationship between exposures and cancer risk, Speakman, who commands the Air Force School of Aerospace Medicine, said Malmstrom had two types of PCBs that the other two missile wing bases did not.

He added that benzene, found in cigarette smoke, vehicle exhaust, and gasoline fumes, was the largest contributor to cancer risk in reviews of the bases.

The assessment concluded that health risks to missileers is “low, but it’s not zero,” Speakman said. He said it would be appropriate to monitor the health of launch control workers.

Next Steps

Watts, whose story has been highlighted by the Torchlight Initiative, has asked the Defense Department’s inspector general to investigate — the watchdog agency referred his request to Global Strike Command — and is closely watching the Air Force research. He said the bulk of the cancer cases reported to Torchlight occurred in the 2000s, when ICBM personnel still used technology that contained PCBs, burned classified material such as treated paper and plastic coding devices indoors, and possibly were exposed to contaminated water.

“I open the door and there’s guys standing there in pressurized suits with sampling equipment,” Watts recalled. “They said, ‘We’re here to check for contaminated water.’ I look at my crew commander, and we’re standing there in cotton uniforms. I said, ‘Do you see anything wrong with this?’”

Launch control operators no longer burn code tapes indoors and the Air Force has made improvements to air circulation in the centers. Sebeck wants Congress to consider including missileers and others sickened by exposure to base contamination in the PACT Act, landmark legislation that mandates health care and benefits for veterans sickened by burn pits and other pollutants.

“It’s documented that there is a large cancer cluster in Montana, probably also in Wyoming. People act surprised, but all they have to do is go to the oncology office in Denver. I can find my missileer buddies there. We are sitting in the same chairs getting chemotherapy,” Sebeck said.

Air Force Global Strike Command spokesperson Maj. Lauren Linscott said in response to Sebeck’s remarks that the unit understands the impact of cancer on its personnel and is committed to supporting them.

“While current findings are preliminary and no conclusions can yet be drawn, we are dedicated to a rigorous, peer-reviewed, data-driven process to better understand potential health risks because the safety of our airmen is our top priority,” Linscott said.

Bills introduced in the House and Senate would address the situation. In addition to Bacon’s amendment, the Senate version of an annual defense policy bill would require a “deep cleaning” of launch control centers every five years until the sites are decommissioned as a new ICBM, the Sentinel, replaces the Minuteman IIIs.

The Air Force aims to release its final epidemiological report by the end of the year.

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“They were marching the snot out of us,” he said, recalling his year and a half stationed on the base, from 1979 to 1980. He also remembers, not so fondly, the poison oak pervasive across the 28,000-acre installation that closed in 1994. He went on sick call at least three times because of the overwhelmingly itchy rash.

Mounting evidence shows that as far back as the 1950s, in an effort to kill the ubiquitous poison oak and other weeds at the Army base, the military experimented with and sprayed the powerful herbicide combination known colloquially as Agent Orange.

While the U.S. military used the herbicide to defoliate the dense jungles of Vietnam and adjoining countries, it was contaminating the land and waters of coastal California with the same chemicals, according to documents.

The Defense Department has publicly acknowledged that during the Vietnam War era it stored Agent Orange at the Naval Construction Battalion Center in Gulfport, Mississippi, and the former Kelly Air Force Base in Texas, and tested it at Florida’s Eglin Air Force Base.

According to the Government Accountability Office, however, the Pentagon’s list of sites where herbicides were tested went more than a decade without being updated and lacked specificity. GAO analysts described the list in 2018 as “inaccurate and incomplete.”

Fort Ord was not included. It is among about four dozen bases that the government has excluded but where Pat Elder, an environmental activist, said he the use or storage of Agent Orange.

According to in the journal The Military Engineer, the use of Agent Orange herbicides at Fort Ord led to a “drastic reduction in trainee dermatitis casualties.”

“In training areas, such as Fort Ord, where poison oak has been extremely troublesome to military personnel, a well-organized chemical war has been waged against this woody plant pest,” the article noted.

Other documents, including a report by an Army agronomist as well as documents related to hazardous material cleanups, point to the use of Agent Orange at the sprawling base that 1.5 million service members cycled through from 1917 to 1994.

‘The Most Toxic Chemical’

Agent Orange is a 50-50 mixture of two ingredients, . Herbicides with the same chemical structure slightly modified were available off the shelf, sold commercially in massive amounts, and used at practically every base in the U.S., said Gerson Smoger, a lawyer who argued before the Supreme Court for Vietnam veterans to have the right to sue Agent Orange manufacturers. The combo was also used by farmers, forest workers, and other civilians across the country.

The chemical 2,4,5-T contains the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin or TCDD, a known carcinogen linked to several . A recent tied Agent Orange exposure to brain tissue damage similar to that caused by Alzheimer’s. Acknowledging its harm to human health, the Environmental Protection Agency in the U.S. in 1979. Still, the other weed killer, 2,4-D is today.

“The bottom line is TCDD is the most toxic chemical that man has ever made,” Smoger said.

For years, the Department of Veteran Affairs has provided vets who served in Vietnam for diseases considered to be connected to exposure to Agent Orange for military use from 1962 to 1975.

Decades after Osborn’s military service, the 68-year-old veteran, who never served in Vietnam, has battled one health crisis after another: a spot on his left lung and kidney, hypothyroidism, and prostate cancer, an illness that has been tied to Agent Orange exposure.

He says many of his old buddies from Fort Ord are sick as well.

“Now we have cancers that we didn’t deserve,” Osborn said.

The VA considers prostate cancer a “” for Agent Orange disability compensation, acknowledging that those who served in specific locations were likely exposed and that their illnesses are tied to their military service. The designation expedites affected veterans’ claims.

But when Osborn requested his benefits, he was denied. The letter said the cancer was “more likely due to your age,” not military service.

“This didn’t happen because of my age. This is happening because we were stationed in the places that were being sprayed and contaminated,” he said.

Studies show that diseases caused by environmental factors to emerge. And to make things more perplexing for veterans stationed at Fort Ord, contamination from other harmful chemicals, like the industrial cleaner trichloroethylene, have been on the former base, landing it on the EPA’s in 1990.

“We typically expect to see the effect years down the line,” said Lawrence Liu, a doctor at City of Hope Comprehensive Cancer Center . “Carcinogens have additive effects.”

In February, the VA that for the first time would allow compensation to veterans for Agent Orange exposure at 17 U.S. bases in a dozen states where the herbicide was tested, used, or stored.

Fort Ord is not on that list either, because the VA’s list is based on the Defense Department’s 2019 update.

“It’s a very tricky question,” Smoger said, emphasizing how widely the herbicides were used both at military bases and by civilians for similar purposes. “On one hand, we were service. We were exposed. On the other hand, why are you different from the people across the road that are privately using it?”

The VA says that it based its proposed rule on information provided by the Defense Department.

“DoD’s review found no documentation of herbicide use, testing or storage at Fort Ord. Therefore, VA does not have sufficient evidence to extend a presumption of exposure to herbicides based on service at Fort Ord at this time,” VA press secretary Terrence Hayes said in an email.

The Documentation

Yet environmental activist Elder, with help from toxic and remediation specialist Denise Trabbic-Pointer and former VA physician Kyle Horton, showing otherwise. They include a journal article, the agronomist report, and cleanup-related documents as recent as 1995 — all pointing to widespread herbicide use and experimentation as well as lasting contamination at the base.

Though the documents do not call the herbicide by its colorful nickname, they routinely cite the combination of 2,4-D and 2,4,5-T. A “” dated 1991 reported 80,000 pounds of herbicides used annually at Fort Ord. It separately lists 2,4,5-T as a product for which “substitutions are necessary to minimize the environmental impacts.”

The poison oak “control program” started in 1951, according to a report by , four years before the U.S. deepened its involvement in Vietnam. Otter detailed the use of these chemicals alone and in combination with diesel oil or other compounds, at rates generally between “one to two gallons of liquid herbicide” per acre.

“In conclusion, we are fairly well satisfied with the methods,” Otter wrote, noting he was interested in “any way in which costs can be lowered or quicker kill obtained.”

An article published in more than a decade later includes before and after photos showing the effectiveness of chemical brush control used in a live-oak woodland at Fort Ord, again citing both chemicals in Agent Orange. The Defense Department did not respond to questions sent April 10 about the contamination or say when the Army stopped using 2,4,5-T at Fort Ord.

“What’s most compelling about Fort Ord is it was actually used for the same purpose it was used for in Vietnam — to kill plants — not just storing it,” said Julie Akey, a former Army linguist who worked at the base in the 1990s and later developed the rare blood cancer multiple myeloma.

Akey, who also worked with Elder, runs a Facebook group and keeps a list of people stationed on the base who later were diagnosed with cancer and other illnesses. So far, she has tallied more than 1,400 former Fort Ord residents who became sick.

Elder’s findings have galvanized the group to speak up during a public comment period for the VA’s proposed rule. Of 546 comments, 67 are from veterans and others urging the inclusion of Fort Ord. Hundreds of others have written in regarding the use of Agent Orange and other chemicals at their bases.

While the herbicide itself sticks around for only a short time, the contaminant TCDD can linger in sediment for decades, said Kenneth Olson, a professor emeritus of soil science at the University of Illinois Urbana-Champaign.

A from the Army’s Sacramento Corps of Engineers, which documented chemicals detected in the soil at Fort Ord, found levels of TCDD at 3.5 parts per trillion, more than double the remediation goal at the time of 1.2 ppt. Olson calls the evidence convincing.

“It clearly supports the fact that 2,4,5-T with unknown amounts of dioxin TCDD was applied on the Fort Ord grounds and border fences,” Olson said. “Some military and civilian personnel would have been exposed.”

The Department of Defense the Agent Orange used in Vietnam as a “tactical herbicide,” what was commercially available in the U.S. But Olson said suggests that even if the grounds maintenance crew used commercial versions of 2,4,5-T, which was available in the federal supply catalog, the soldiers would have been exposed to the dioxin TCDD.

The half dozen veterans who spoke with ºÚÁϳԹÏÍø News said they want the military to take responsibility.

The Pentagon did not respond to questions regarding the upkeep of the list or the process for adding locations.

In the meantime, the Agency for Toxic Substances and Disease Registry is studying potential chemical exposure among people who worked and lived on Fort Ord between 1985 and 1994. However, the agency is evaluating drinking water for contaminants such as trichloroethylene and not contamination or pollution from other chemicals such as Agent Orange or those found in firefighting foams.

Other veterans are frustrated by the VA’s long process to recognize their illnesses and believe they were sickened by exposure at Fort Ord.

“Until Fort Ord is recognized by the VA as a presumptive site, it’s probably going to be a long, difficult struggle to get some kind of compensation,” said Mike Duris, a 72-year-old veteran diagnosed with prostate cancer four years ago who ultimately underwent surgery.

Like so many others, he wonders about the connection to his training at Fort Ord in the early ’70s — drinking the contaminated water and marching, crawling, and digging holes in the dirt.

“Often, where there is smoke, there’s fire,” Duris said.

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Thirteen years later, the community is still waiting on whatever it will take to clean its water. As a result of dogged activism and pressure from government officials, the Air Force has finally taken initial steps simply to contain the chemicals.

Wurtsmith is just one of hundreds of contaminated U.S. military sites. Under congressional pressure, the Defense Department has acknowledged it has a big mess to clean up. It has spent years trying to grasp the scale of the contamination and assess the costs U.S. taxpayers will shoulder to clean it all up. Further, there’s no clear scientific agreement on how to destroy the chemicals, even as companies pitch their scientists’ best solutions in a bid for a share of billions of dollars in looming government contracts.

“We’re really at the forefront,” said Tony Spaniola, a lawyer turned activist whose family owns a home across Van Etten Lake from the former base. “There has been gross mismanagement of this entire program — a lot of stonewalling, a lot of foot-dragging.” He added: “In the meantime, this stuff is continuing to spew into groundwater continuously, into lakes, rivers.”

PFAS chemicals have been linked to increased cholesterol levels, preeclampsia in pregnant women, decreased birth weights, and decreased immune response to vaccines, as well as certain types of cancer. A federal study of U.S. military personnel published in July was the first to show a direct connection between PFAS and testicular cancer, and the chemicals have been linked to increased risk of kidney cancer.

Pentagon Has Lacked ‘Urgency’

Despite rising concerns over the potential effects of these substances, Pentagon officials have defended their use as a matter of national security, asserting in a report to Congress in August that banning them would undermine military readiness.

As many as 600 active or former military installations and adjacent communities are or may be contaminated with per- and polyfluoroalkyl substances, or PFAS. The chemicals are found in a bevy of products used by the U.S. military for decades, including industrial solvents, stain retardants, waterproofing compounds, and firefighting foam.

While the Pentagon was aware of the potential health effects of PFAS as early as the 1970s, the individual military services didn’t begin responding to PFAS pollution at bases until 2014. More than nine years into the Defense Department’s work to analyze its contamination problem and plan for cleanup, frustrated advocates and community residents continue to worry about the safety of their drinking water.

“There hasn’t been an urgency from the DOD that we’ve seen to actually clean up their mess,” said Jared Hayes, a senior policy analyst with the Environmental Working Group, an advocacy organization that focuses on pollution issues nationwide.

The Defense Department did not respond to questions about the pace of the cleanup or provide updated cost estimates.

A spokesperson said the Pentagon is committed to addressing its PFAS contamination. “The Department recognizes the importance of this issue and is committed to addressing PFAS in a deliberative, holistic, and transparent manner,” Jeff Jurgensen wrote in an email to ºÚÁϳԹÏÍø News.

Cleanup Costs Balloon

By June 30, the Defense Department had determined that 359 of 714 active and former bases and National Guard facilities were polluted with PFAS and 107 didn’t meet a threshold for action. Investigations are underway at the remaining 248 sites, with nearly all results expected by year’s end, according to .

Cleanup cost assessments have ballooned as the list of contaminated installations grows and researchers work to develop technologies to remove or destroy the toxic compounds. The Defense Department estimated in 2016 that the “total cleanup liability” — only a portion of which applies to PFAS cleanup — was $27.3 billion.

But according to a from 52 members of Congress, that estimate climbed to $38.7 billion by 2022.

The House version of the Pentagon’s fiscal year 2024 funding bill includes more than $1.1 billion for cleanup of PFAS and contaminants such as PCBs, dioxins, and radiation at active and former installations, while the Senate’s version would boost the military’s PFAS-specific $250 million funding request by more than $67 million to address water contamination. The legislation has yet to pass, mired in congressional debate over the fiscal 2024 appropriations process.

“DOD has a massive backlog of cleanup at their sites and the funding just wasn’t adding up. … The amount of funding that they are putting toward cleaning up the problem isn’t matching the need of the problem,” Hayes said, referring to an .

A November analysis of Pentagon data found that the extent of the contamination may even be broader, with tests showing thousands of samples from private wells near military installations contained levels of PFAS that the Environmental Protection Agency considers unsafe.

The EPA has proposed stringent limits on multiple types of PFAS, including PFOA and PFOS, in drinking water. The new standard, expected to take effect by the end of the year, would set a cap of 4 parts per trillion for those two compounds. Meanwhile, the Pentagon has been evaluating its sites using a 2016 EPA health advisory of 70 parts per trillion.

If the EPA limit becomes the standard, the Defense Department will need to incorporate it into the review, planning, and cleanup process, Jurgensen said.

But activists, including Spaniola, are pushing the Biden administration to start the cleanup process even while investigations are ongoing. In a , Brendan Owens, assistant secretary of defense for energy, installations, and environment, directed the Defense Department to find locations near current and former bases where PFAS can be extracted from groundwater and soil while a cleanup plan is developed.

At Wurtsmith — the first military site where contamination was discovered — officials started by installing two groundwater treatment systems, adding to a handful of installed over the years.

The two systems won’t destroy the chemicals, but they will stop some of the flow of contaminated groundwater into Van Etten Lake from a landfill and a repository that once held discarded or unused equipment, .

As for completely ridding the environment of PFAS chemicals, a long, bumpy road remains.

‘Multiple Decades of Cleanup’

For years, the Defense Department had disposed of the chemicals by burning them in incinerators. In 2018, the Defense Department paid contractors to begin work to incinerate more than 2 million gallons of stockpiled firefighting foam. In 2021, Congress ordered the Pentagon to stop the practice in anticipation of new EPA guidelines for PFAS disposal and destruction, which the agency says it expects to update this winter, but the Pentagon on incineration on July 11.

burning the chemicals can release toxic gases into the air.

In suspending the moratorium, the Defense Department said it had found four commercially available options for effectively burning PFAS.

EPA spokesperson Tim Carroll said in a statement the agency understands the Pentagon needed to provide guidance to its personnel regarding destruction and disposal of PFAS.

But communities already affected by PFAS contamination should be protected when making decisions about how to dispose of the chemicals, according to the statement.

“EPA understands that DoD considers high temperature incinerators to be an effective destruction option,” Carroll said. “EPA notes that, at this time, it is difficult to determine whether high temperature incinerators are an effective PFAS destruction option because data on PFAS releases from incinerators are generally lacking.”

Besides incinerating waste, injecting it deep into the earth, and putting it in landfills, a number of companies are testing technologies they hope will work to destroy PFAS. Among those methods is supercritical water oxidation, known as SCWO, which oxidizes organic compounds at high temperatures.

Conventional incineration plants are “nowhere close to being able to destroy PFAS,” said Zhuoyan Cai, director of Denmark-based Aquarden Technologies, which he said is currently in talks with U.S. companies about its SCWO technology. “The PFAS is used in firefighting foam, so it’s highly thermally resistant, so it’s very difficult to just burn it away in a traditional plant.”

Supercritical water is essentially a fourth state of water under extremely high pressure and temperature — different from ice, liquid water, and steam — with special characteristics that dissolve oil and other organic compounds, including PFAS and pesticides.

When wastewater is under those conditions, the salts fall away and the oils and pesticides blend into the supercritical water. Mix in oxygen and it reacts aggressively and rips the PFAS carbon bonds apart, with greater than 99.999% destruction, Cai said. said the method “could be a permanent solution for PFAS-laden wastewaters.”

A handful of companies are working with the Pentagon to bring mobile SCWO technology to widespread use, including , a spinoff of the Ohio-based nonprofit Battelle, and , which originated from research at Duke University in North Carolina.

“Unfortunately, we as a society are still manufacturing and selling [PFAS] into the market. So I think the first thing we need to do is stop putting it in our ecosystem,” 374Water’s board chairman, Kobe Nagar, said. “It’s multiple decades of cleanup.”

Other companies are developing and testing their own approaches, using everything from to .

Dallas-based AECOM, a consulting firm that handles PFAS response work for the U.S. military, uses electrodes to break down the chemicals by removing electrons.

But Rosa Gwinn, global PFAS technical lead at AECOM, cautioned that none of these emerging technologies is a perfect response to the cleanup predicament. “There is not going to be a single solution, no matter what somebody says,” she said.

But as industry chases billions of dollars in government contracts, towns like Oscoda linger under a cloud of health concerns with little action.

Well over a decade after the discovery of the chemicals surrounding Wurtsmith, a bounty of public health warnings about PFAS exposure remain, including for drinking water, fish and wildlife, and the chemical-laced foam that still washes ashore. One site now finally being targeted is a beach with a YMCA camp for children, Spaniola said.

“Am I concerned for my health? Yes,” he said. “Am I concerned for my family’s health? Yes.”

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According to the Environmental Working Group, a Washington, D.C.-based nonprofit that analyzed Department of Defense testing data, 2,805 wells spread across 29 states with at least one of two types of per- and polyfluoroalkyl substances, or PFAS, above 4 parts per trillion, a limit proposed earlier this year by the Environmental Protection Agency. That new drinking water standard is expected to take effect by the end of the year.

But contamination in those wells was lower than the 70 parts per trillion threshold the Pentagon uses to trigger remediation.

EWG researchers said they did not know how many people rely on the wells for drinking, cooking, and bathing, but the 76 tested locations represent just a fraction of the private wells near 714 current or former military sites spread across the U.S. According to EWG, Texas had nearly a third of the contaminated wells, with 909. Researchers recorded clusters of tainted wells in both urban and rural areas, from Riverside County and Sacramento in California to Rapid City, South Dakota, and Helena, Montana.

“They are going to have to test more bases,” said Jared Hayes, a senior policy analyst with EWG, in an interview with ºÚÁϳԹÏÍø News. “Those 2,805 are going to be a small number when they start testing drinking water wells near every single base.”

Defense Department officials are investigating hundreds of current and former domestic U.S. military installations and communities that surround them to determine whether their soil, groundwater, or drinking water is contaminated with PFAS chemicals.

The Defense Department is a major contributor of PFAS pollution nationwide — the result of spills, dumping, or use of industrial solvents, firefighting foam, and other substances that contain what have been dubbed forever chemicals because they do not break down in the environment and can accumulate in the human body.

Exposure to PFAS has been associated with health problems such as decreased response to vaccines, some types of cancer, low birth weight, and high blood pressure during pregnancy, according to published last year by the National Academies of Sciences, Engineering, and Medicine.

A study published this year linked testicular cancer in military personnel to exposure to PFOS, the main type of PFAS chemical used in firefighting foam.

In July, a U.S. Geological Survey study estimated that of U.S. tap water contains at least one type of PFAS chemical.

USGS researchers tested 716 locations nationwide and found the forever chemicals more frequently in samples that were collected near urban areas and potential sources of PFAS like military installations, airports, industrial sites, and wastewater treatment plants, according to Kelly Smalling, a USGS research chemist and lead author of the study.

“We knew we would find PFAS in tap water,” she told ºÚÁϳԹÏÍø News in July. “But what was really interesting was the similarities between the private wells and the public supply.”

Drinking water sources near military installations that test above 70 parts per trillion draw immediate action from the Defense Department. Those responses include providing alternate drinking water sources, treatment, or water filtration systems.

Below that threshold, federal officials leave it up to homeowners to weigh and mitigate the health risks of contamination, Hayes said.

“It’s unclear what, if anything, these private individuals are being advised,” Hayes said. “If DoD is saying that 70 parts per trillion is the level they are going to provide clean water … the understanding would be if it’s below that, it must be fine.”

The Pentagon bases its 70 parts per trillion standard for PFOS and PFOA chemicals on a 2016 health advisory issued by the EPA. Officials have said they’re waiting for the new federal standard to go into effect before changing Defense Department parameters.

The Department of Defense did not respond by publication deadline to questions about EWG’s findings, or how it will address the new EPA limits.

While EWG’s examination found that thousands of wells contained PFAS at levels above the new EPA standard, but below the military’s 70 ppt threshold for action, it also learned that the Defense Department had found 1,800 private wells that registered higher than 70 ppt and had provided mitigation services to the owners of those wells.

Hayes said the combined levels of PFOS and PFOA in some wells were as high as 10,000 ppt.

Hayes said it’s unclear how long people near those military sites have been drinking contaminated water. “Chances are it’s been years, decades,” he said.

Federal law requires public water systems to be monitored regularly for pollutants, but private wells have no similar requirements. Hayes recommended that people who live near any current or former military installations and use a well for their drinking water have their water tested and use a filter designed specifically to remove PFAS.

According to the Defense Department’s PFAS remediation website, as part of its ongoing investigation and remediation effort, it has closed contaminated wells, installed new water sources, and treated drinking water on military bases. According to the Pentagon, it is working “to ensure no one on-base is exposed to PFOS or PFOA in drinking water above 70ppt.”

“Addressing DoD’s PFAS releases is at the core of the Department’s commitment to protect the health and safety of its Service members, their families, the DoD civilian workforce, and the communities in which DoD serves,” Pentagon officials .

ºÚÁϳԹÏÍø News’ Hannah Norman contributed to this report.

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Now, as regulators propose restrictions on their use or manufacturing, Pentagon officials have told Congress that eliminating the chemicals would undermine military readiness.

PFAS, known as “forever chemicals” because they don’t break down in the environment and can build up in the human body, have been associated with such health problems as cancer. In July, a showed a direct link between testicular cancer and PFOS, a PFAS chemical that has been found in the blood of thousands of military personnel.

Congress has pressured the Defense Department to clean up U.S. military sites and take health concerns more seriously. Under the fiscal 2023 James M. Inhofe National Defense Authorization Act, the Pentagon was required to assess the ubiquity of per- and polyfluoroalkyl substances, or PFAS, in products and equipment used by the military.

In a report delivered to Congress in August, Defense Department officials pushed back against health concerns raised by environmental groups and regulators. “DoD is reliant on the critically important chemical and physical properties of PFAS to provide required performance for the technologies and consumable items and articles which enable military readiness and sustainment,” the authors said.

Further, they wrote: “Losing access to PFAS due to overly broad regulations or severe market contractions would greatly impact national security and DoD’s ability to fulfill its mission.”

, most major weapons systems, their components, microelectronic chips, lithium-ion batteries, and other products contain PFAS chemicals. These include helicopters, airplanes, submarines, missiles, torpedoes, tanks, and assault vehicles; munitions; semiconductors and microelectronics; and metalworking, cooling, and fire suppression systems — the latter especially aboard Navy ships.

PFAS are also present in textiles such as uniforms, footwear, tents, and duffel bags, for which the chemicals help repel water and oil and increase durability, as well as nuclear, chemical, and biological warfare protective gear, the report says.

The Pentagon’s report to Congress was released last month by the American Chemistry Council.

Defending a Tradition of Defense

Military officials’ defense of PFAS use comes as concerns mount over the health risks associated with the chemicals. Beyond cancer, some types of PFAS have been linked to low birth weight, developmental delays in children, thyroid dysfunction, and reduced response to immunizations. Health concerns grew with the release of the study definitively linking testicular cancer in military firefighters to a foam retardant containing PFAS.

But that wasn’t the first time U.S. military officials were warned about the potential health threat. In the 1970s, Air Force researchers found that firefighting foam containing PFAS was poisonous to fish and, by the 1980s, to mice.

In 1991, the U.S. Army Corps of Engineers told Fort Carson, Colorado, to stop using firefighting retardants containing PFAS because they were “considered hazardous material in a number of states.”

The Environmental Protection Agency has struggled to determine whether there are acceptable levels of PFAS in drinking water supplies, given the existence of hundreds of varieties of these chemicals. But in March, the EPA did propose federal limits on the levels of PFAS in drinking water supplies.

The regulation would dramatically reduce limits on six types of the chemicals, with caps on the most common compounds, known as PFOA and PFOS, at 4 parts per trillion. Currently, the Defense Department’s threshold for drinking water is 70 parts per trillion based on a 2016 EPA advisory. As part of a widespread testing program, if levels are found on installations or in communities above that amount, the military furnishes alternative drinking water supplies.

The Defense Department has used PFAS-laced firefighting foam along with other products containing the chemicals , leading to the contamination of at least 359 military sites or nearby communities, with an additional 248 under investigation, according to the department.

In its report, however, the Department of Defense did not address the health concerns and noted that there is “no consensus definition of PFAS as a chemical class.” Further, it said that the broad term, which addresses thousands of man-made chemical chains, “does not inform whether a compound is harmful or not.”

Researchers with the Environmental Working Group, an advocacy group that focuses on PFAS contamination nationwide, said the report lacked acknowledgment of the health risks or concerns posed by PFAS and ignored the availability of PFAS-free replacements for material, tents, and duffel bags.

The military report also did not address possible solutions or research on non-PFAS alternatives or address replacement costs, noted EWG’s Jared Hayes, a senior policy analyst, and David Andrews, a senior scientist.

“It’s kind of like that report you turn in at school,” Andrews said, “when you get a comment back that you did the minimum amount possible.”

Andrews added that the report fell short in effort and scope.

The Defense Department announced this year it would stop buying firefighting foam containing PFAS by year’s end and phase it out altogether in 2024. It stopped using the foam for training in 2020, by order of Congress.

The report noted, however, that while new Navy ships are being designed with alternative fire suppression systems such as water mists, “limited use of [PFAS-containing systems] remains for those spaces where the alternatives are not appropriate,” such as existing ships where there is no alternative foam that could be swapped into current systems.

According to the report, “the safety and survivability of naval ships and crew” from fires on ships depends on current PFAS-based firefighting foams and their use will continue until a capable alternative is found.

Pervasive Yet Elusive

Commercially, PFAS chemicals are used in food packaging, nonstick cookware, stain repellents, cosmetics, and other consumer products.

The fiscal 2023 National Defense Authorization Act also required the Defense Department to identify consumer products containing PFAS and stop purchasing them, including nonstick cookware and utensils in dining facilities and ship galleys as well as stain-repellent upholstered furniture, carpeting, and rugs.

But in a briefing to Congress in August accompanying the report on essential uses, Pentagon officials said they couldn’t comply with the law’s deadline of April 1, 2023, because manufacturers don’t usually disclose the levels of PFAS in their products and no federal laws require them to do so.

Come Jan. 1, however, makers of these chemicals and products containing them to identify these chemicals and notify “downstream” manufacturers of other products of the levels of PFAS contained in such products and ingredients, even in low concentrations, according to a federal rule published Oct. 31 by the EPA.

This would include household items like shampoo, dental floss, and food containers.

Officials reiterated that the Defense Department is committed to phasing out nonessential and noncritical products containing PFAS, including those named above as well as food packaging and personal protective firefighting equipment.

And it is “developing an approach” to remove items containing PFAS from military stores, known as exchanges, also required by the fiscal 2023 NDAA.

Risk-Benefit Assessments

In terms of “mission critical PFAS uses,” however, the Pentagon said the chemicals provide “significant benefits to the framework of U.S. critical infrastructure and national and economic security.”

Andrews of EWG noted that the industry is stepping up production of the chemicals due to market demand and added that the federal government has not proposed banning PFAS chemicals, as the Defense Department alluded to when it emphasized the critical role these substances play in national security and warned against “overly broad regulations.”

“The statements are completely unsubstantiated, and it’s almost a fear-mongering statement,” Andrews said. “I think the statement is really going beyond anything that’s even being considered in the regulatory space.”

“There haven’t been realistic proposals policy-wise of a complete ban on PFAS,” his colleague Hayes added. “What people have been pushing for and talking about are certain categories of products where there are viable alternatives, where there is a PFAS-free option. But to ban it outright? I haven’t really seen that as a realistic policy proposal.”

Kevin Fay, executive director of the Sustainable PFAS Action Network, a coalition of corporations, industry advocates, and researchers who support the use and management of PFAS compounds, said the Defense Department has a point and it is up to federal regulators to “responsibly manage” these chemicals and their use to strike a balance among environmental, health, and industrial needs.

“The U.S. Department of Defense’s report on critical PFAS uses is crystal clear: regulating PFAS through a one-size fits all approach will gravely harm national security and economic competitiveness,” Fay wrote in an email to ºÚÁϳԹÏÍø News.

Adding that not all PFAS compounds are the same and arguing that not all are harmful to human health, Fay said risk-based categorization and control is vital to the continued use of the chemicals.

But, he added, in locations where the chemicals pose a risk to human health, the government should act.

“The federal government should implement plans to identify and remediate contaminated sites, properly identify risk profiles of the many types of PFAS compounds, and encourage innovation by clearing the regulatory path for viable alternatives to specific dangerous compounds,” Fay wrote.

Assessments are completed or underway at 714 active and former military installations, National Guard facilities, and other former defense sites to determine the extent of contamination in groundwater, soil, and the water supply to these locations and nearby communities.

Last year, the Pentagon issued a temporary moratorium on burning materials containing PFAS. that the practice can release toxic gases. But on July 11, the Defense Department on incineration, along with interim guidance on PFAS disposal.

Military personnel who were exposed to PFAS — including through firefighting foam — say they live in fear that they or their family members will develop cancer as a result of their service.

“I’ve got more of some of those materials in my system than 90-plus percent of those on the planet. This is bad. It doesn’t go away,” said Christian Jacobs, who served in the Army for four years and worked as a civilian Defense Department firefighter for nearly three decades. “It keeps me up at night.”

ºÚÁϳԹÏÍø News visual reporter Hannah Norman contributed to this report.

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New federal research links testicular cancer in U.S. service members to the “forever chemicals,” adding to a growing body of evidence of the dangers they pose. Rhodes lives in fear that he, like many of his colleagues, will get sick.

“It’s kind of like a Russian roulette,” he said. “Are you going to get the cancers or are you going to be one of the lucky ones who doesn’t?”

The chemicals in the firefighting foam are suspected to have polluted more than 700 active and former military installations as well as thousands of towns across the U.S., potentially exposing millions of people to long-term health risks, say the scientists and public health experts who study the chemicals. The contamination was the result of industrial spills, dumping, and firefighting.

The new testicular cancer findings, as well as new requirements to fund PFAS testing in some communities, have firefighters like Rhodes on edge.

Many have sought recently developed blood serum tests to determine their cumulative levels of perfluoroalkyl and polyfluoroalkyl substances, or PFAS. But it’s unclear what they should do with those test results, given there are no medical treatments to remove PFAS from the body.

“It is stressful, especially when you know there is a chance of cancer,” said former Air National Guard firefighter Jeffrey Warrick, noting he has a worrisome skin condition he believes was caused by PFAS exposure. It worsens in warm weather, he said, and “freaks me out.”

In 2020, Congress required the Department of Defense to offer active-duty military firefighters blood tests for PFAS, thousands of compounds dubbed “forever chemicals” because they accumulate in the human body and don’t break down in the environment. Some states followed suit or even preceded the federal legislative action.

Indiana passed a bill effective July 1 that establishes a biomonitoring pilot program to provide PFAS blood testing for 1,000 of the state’s firefighters. New Hampshire requires insurers to cover PFAS blood tests, and a bill introduced in Maine would do the same.

But while the tests have been a major step forward in understanding the scope of the issue across the country, medical providers often aren’t sure how to interpret the results.

Breaking the Code

The National Academies of Sciences, Engineering, and Medicine issued preventive medical guidance last year for those whose test results confirm a level of PFAS chemicals in their blood meriting concern.

The national academies recommended that patients with readings between 2 and 20 nanograms per milliliter limit additional exposure and screen for high cholesterol, breast cancer, and, if pregnant, high blood pressure. At 20 ng/mL and above, the report recommends further assessment.

But even with these published guidelines, finding doctors knowledgeable about interpreting the blood test results and inferring the possible health effects of PFAS exposure can be slow going.

Kevin Ferrara, a former Air Force firefighter who now advocates for military personnel and firefighters, said they simply want their physicians to be more educated on PFAS contamination and its health consequences.

“Firefighters really need to concentrate on their jobs, not ‘How do I decipher my blood tests?’” Ferrara said. “Physicians should have a basic understanding of PFAS, and they simply don’t.”

To muddy matters further: With so many types of PFAS, not all of them show up in the blood tests. Some compounds manifest elsewhere, such as in organ tissue or other parts of the blood, said Neil McMillan, the International Association of Fire Fighters’ director of science and research.

“These PFAS blood panels are complicated,” McMillan said. “The results you get back may not show the full picture of your body burden.”

Graham Peaslee, a University of Notre Dame professor who studies PFAS, said he knows of seven civilian and military firefighters who have had a rare form of brain cancer, glioblastoma, three of whom resided in South Bend, Indiana.

The aggressive disease has only sparsely been studied and its causes are not understood, although scientists suspect environmental exposures may be to blame.

“What’s really interesting is it’s [about] a one-in-a-million disease,” Peaslee said. “There aren’t 7 million firefighters in this country. How was that possible?”

State Rep. Maureen Bauer, a Democrat who authored the Indiana PFAS testing bill and represents South Bend, said the program was inspired in part by those firefighters .

“Blood testing is providing one more useful bit of information,” Bauer said. “If you’re exposed, but you don’t know what your levels are, if you have fertility issues, high blood pressure, thyroid problems, that could all go back to your blood levels.”

Guarding Against Risks

Ned Calonge, who is the associate dean for public health practice of the Colorado School of Public Health and co-authored the national academies’ report, said that taking proactive measures in communities with known high exposure, such as among firefighters and military service members and their families who lived on bases, is particularly important.

“It depends on how much different states have paid attention to it,” Calonge said. “I wouldn’t say that we’ve advanced very far in terms of clinician education in the area of the PFAS exposure.”

Congress passed legislation last year that gave medical benefits and disability compensation to federal firefighters who develop one or more of 16 health conditions within 10 years of service. The illnesses include 14 types of cancer, chronic obstructive pulmonary disease, and cardiovascular events such as heart attack and stroke that occur within 24 hours of engaging in their jobs.

But firefighters want to learn how to prevent these illnesses from taking hold. Because PFAS chemicals accumulate in the body, older people typically have higher levels than younger people. Men tend to have higher levels than women, which to menstruation helping eliminate the chemicals from the body.

Over time, if people limit exposure, PFAS levels in the blood as the chemicals are excreted. For example, PFOS, the legacy chemical found in AFFF that’s no longer used, has a . While researchers estimate that everyone has some level of PFAS in their bodies, Calonge said, people with levels above 20 ng/mL in their blood should particularly avoid additional exposure.

Although full avoidance may be nearly impossible — these chemicals can be found in nonstick cookware, industrial lubricants, cosmetics, and even food wrappers — those with high amounts of known exposure should consider filtering their drinking water and removing stain-resistant carpet, water-repellent clothing, and other PFAS-containing household goods from their homes, Calonge said.

Experts point to reverse osmosis filters under a kitchen sink or at the tap as the to remove PFAS from drinking water, but the systems can be expensive, putting them out of reach for some Americans. Some seem pretty effective, too. The American National Standards Institute and NSF from 15 manufacturers for the reduction of select PFAS chemicals.

Holding Out Hope

While there are no known treatments for the buildup of PFAS chemicals in one’s body, an Australian study published last year found that firefighters with high levels of PFAS reduced their levels by 10% over a year when they donated blood every 12 weeks and by 30% if they donated plasma every six weeks.

Jeff Burgess, a University of Arizona Health Sciences researcher, seeks to duplicate the findings and take it a step further — determining whether a reduction in PFAS levels yields lower cardiovascular and cancer risk.

The plan is to enroll 1,500 firefighters in the study who will donate blood or plasma for a year, monitoring for DNA methylation cancer biomarkers.

As for the ethics of letting firefighters with known PFAS contamination contribute to the nation’s blood banks, Burgess noted that nearly everyone in the U.S. is thought to have some PFAS in their bodies and that, given chronic shortages, the need for donated blood outweighs the risks.

“From my perspective, the benefits of giving blood, even though it has some degree of PFAS in it, are much greater than the potential harm from the PFAS that people might receive because, again, blood products can be lifesaving,” Burgess said.

Citing the Australian study, Nicole Maul, director of media relations for the American Red Cross, which manages standards and quality control for the blood banks, said further study is needed to determine whether donations by firefighters have any “clinical implications.”

“No study has shown a detrimental effect of such substances in blood for donors or recipients,” Maul said. “The Red Cross and the FDA work together to ensure the blood supply is as safe as possible, and individuals should not worry about the safety of donating or receiving blood.”

A Department of Defense spokesperson said Aug. 29 that the Pentagon uses the Centers for Disease Control and Prevention’s Agency for Toxic Substances and Disease Registry to guide its firefighter PFAS testing program and develop information it provides to personnel, including military physicians, on the potential health effects of PFAS.

“It is not possible yet to distinguish PFAS exposures by DoD personnel in their occupational setting from those they may experience from consumer products, so much of the information provided is general PFAS health effects information,” said Peter Graves, chief of media operations for the Defense Health Agency. “The DoD will update occupational health provider fact sheets when ATSDR updates their PFAS clinical guidelines and develop or incorporate available PFAS training modules for healthcare providers, as appropriate.”

Graves added that the Defense Department is interested in the outcomes of ongoing health studies by the Agency for Toxic Substances and Disease Registry as well as toxicology assessments by the Environmental Protection Agency and noted that the Pentagon supported the testicular cancer study by allowing use of the Department of Defense and including it in the Pentagon’s .

CDMRP research projects are not requested by the Pentagon in its annual budget, but instead are supported by extra money that Congress gives the department to manage research projects that members deem necessary to advance medical science and promote the health of the armed forces.

Rhodes, the veteran military firefighter, said he has high hopes for the University of Arizona research and would like to see more studies done on reducing PFAS exposure as well as the illnesses linked to PFAS. He also wants Congress to extend the health and disability benefits for a lifetime for those illnesses.

“I put my life on the line for 30 years for people I didn’t know, and I did it willingly,” he said. “That is every firefighter’s mindset. Now we are asking for a little bit. There’s something out there killing us. Keep researching and don’t give us pushback when we want testing. Make it easier for us.”

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Flook volunteered at his local fire department, where he also used the foam, unaware of the health risks it posed. In 2000, at age 45, he received devastating news: He had testicular cancer, which would require an orchiectomy followed by chemotherapy.

Hundreds of lawsuits, including one by Flook, have been filed against companies that make firefighting products and the chemicals used in them.

And show that firefighters, both military and civilian, have been diagnosed with testicular cancer at higher rates than people in most other occupations, often pointing to the presence of perfluoroalkyl and polyfluoroalkyl substances, or PFAS, in the foam.

But the link between PFAS and testicular cancer among service members was never directly proven — until now.

A for the first time shows a direct association between PFOS, a PFAS chemical, found in the blood of thousands of military personnel and testicular cancer.

Using banked blood drawn from Air Force servicemen, researchers at the National Cancer Institute and Uniformed Services University of the Health Sciences found strong evidence that airmen who were firefighters had elevated levels of PFAS in their bloodstreams and weaker evidence for those who lived on installations with high levels of PFAS in the drinking water. And the airmen with testicular cancer had higher serum levels of PFOS than those who had not been diagnosed with cancer, said study co-author Mark Purdue, a senior investigator at NCI.

“To my knowledge,” Purdue said, “this is the first study to measure PFAS levels in the U.S. military population and to investigate associations with a cancer endpoint in this population, so that brings new evidence to the table.”

In in the journal Environmental Health Perspectives, Kyle Steenland, a professor at Emory University’s Rollins School of Public Health, said the research “provides a valuable contribution to the literature,” which he described as “rather sparse” in demonstrating a link between PFAS and testicular cancer.

More studies are needed, he said, “as is always the case for environmental chemicals.”

Not ‘Just Soap and Water’

Old stocks of AFFF that contained PFOS were replaced by foam that contains newer-generation PFAS, which now also are known to be toxic. By congressional order, the Department of Defense must stop using all PFAS-containing foams by October 2024, though it can keep buying them until this October. That’s decades after the military first documented the chemicals’ potential health concerns.

A DoD study in 1974 found that PFAS was fatal to fish. By 1983, an Air Force technical report showed its deadly effects on mice.

But given its effectiveness in fighting extremely hot fires, like aircraft crashes and shipboard blazes, the Defense Department still uses it in operations. Rarely, if ever, had the military warned of its dangers, according to Kevin Ferrara, a retired Air Force firefighter, as well as several military firefighters who contacted ºÚÁϳԹÏÍø News.

“We were told that it was just soap and water, completely harmless,” Ferrara said. “We were completely slathered in the foam — hands, mouth, eyes. It looked just like if you were going to fill up your sink with dish soap.”

by the Defense Visual Information Distribution Service in 2013 show personnel working in the foam without protective gear. The description calls the “small sea of fire retardant foam” at Travis Air Force Base in California “non-hazardous” and “similar to soap.”

“No people or aircraft were harmed in the incident,” it reads.

There are thousands of PFAS chemicals, invented in the 1940s to ward off stains and prevent sticking in industrial and household goods. Along with foam used for decades by firefighters and the military, the chemicals are in makeup, nonstick cookware, water-repellent clothing, rugs, food wrappers, and a myriad of other consumer goods.

Known as “forever chemicals,” they do not break down in the environment and do accumulate in the human body. Researchers estimate that nearly all Americans have PFAS in their blood, exposed primarily by groundwater, drinking water, soil, and foods. A recent U.S. Geological Survey study estimated that of U.S. tap water has at least one type of forever chemical from both private wells and public water supplies.

Health and environmental concerns associated with the chemicals have spurred a cascade of lawsuits, plus state and federal legislation that targets the manufacturers and sellers of PFAS-laden products. Gary Flook is suing 3M and associated companies that manufactured PFAS and the firefighting foam, including DuPont and Kidde-Fenwal.

Congress has prodded the Department of Defense to clean up military sites and take related health concerns more seriously, funding site inspections for PFAS and mandating blood testing for military firefighters. Advocates argue those actions are not enough.

“How long has [DoD] spent on this issue without any real results except for putting some filters on drinking water?” said Jared Hayes, a senior policy analyst at the Environmental Working Group. “When it comes to cleaning up the problem, we are in the same place we were years ago.”

On a Mission to Get Screening

The Department of Veterans Affairs blood testing for PFAS, stating on its website that “blood tests cannot be linked to current or future health conditions or guide medical treatment decisions.”

But that could change soon. Rep. Dan Kildee (D-Mich.), co-chair of the congressional PFAS Task Force, in June introduced the Veterans Exposed to Toxic PFAS Act, which would require the VA to treat conditions linked to exposure and provide disability benefits for those affected, including for testicular cancer.

“The last thing [veterans] and their families need to go through is to fight with VA to get access to benefits we promised them when they put that uniform on,” Kildee said.

Evidence is strong that exposure to PFAS is associated with health effects such as decreased response to vaccines, kidney cancer, and low birth weight, according to published last year by the National Academies of Sciences, Engineering, and Medicine. The nonprofit institution recommended blood testing for communities with high exposure to PFAS, followed by health screenings for those above certain levels.

It also said that, based on limited evidence, there is “moderate confidence” of an association between exposure and thyroid dysfunction, preeclampsia in pregnant women, and breast and testicular cancers.

The new study of Air Force servicemen published July 17 goes further, linking PFAS exposure directly to testicular germ cell tumors, .

Testicular cancer is the cancer among young adult men. It is also the type of cancer diagnosed at the highest rate among active military personnel, most of whom are male, ages 18 to 40, and in peak physical condition.

That age distribution and knowing AFFF was a source of PFAS contamination drove Purdue and USUHS researcher Jennifer Rusiecki to investigate a possible connection.

Using samples from the , a biobank of more than 62 million blood serum specimens from service members, the researchers examined samples from 530 troops who later developed testicular cancer and those of 530 members of a control group. The blood had been collected between 1988 and 2017.

A second sampling collected four years after the first samples were taken showed the higher PFOS concentrations positively associated with testicular cancer.

Ferrara does not have testicular cancer, though he does have other health concerns he attributes to PFAS, and he worries for himself and his fellow firefighters. He recalled working at Air Combat Command headquarters at Joint Base Langley-Eustis in Virginia in the early 2010s and seeing emails mentioning two types of PFAS chemicals: PFOS and perfluorooctanoic acid, or PFOA.

But employees on the base remained largely unfamiliar with the jumble of acronyms, Ferrara said.

Even as the evidence grew that the chemicals in AFFF were toxic, “we were still led to believe that it’s perfectly safe,” Ferrara said. “They kept putting out vague and cryptic messages, citing environmental concerns.”

When Ferrara was working a desk job at Air Combat Command and no longer fighting fires, his exposure likely continued: Joint Base Langley-Eustis is among the top five most PFAS-contaminated military sites, according to the EWG, with groundwater at the former Langley Air Force Base registering 2.2 million parts per trillion for PFOS and PFOA.

According to the EPA, just 40 parts per trillion would “warrant further attention,” such as testing and amelioration.

The Defense Department did not provide comment on the new study.

Air Force officials told ºÚÁϳԹÏÍø News that the service has swapped products and no longer allows uncontrolled discharges of firefighting foam for maintenance, testing, or training.

“The Department of the Air Force has replaced Aqueous Film Forming Foam, which contained PFAS, with a foam that meets Environmental Protection Agency recommendations at all installations,” the Air Force said in a statement provided to ºÚÁϳԹÏÍø News.

Both older-generation forever chemicals are no longer made in the U.S. 3M, the main manufacturer of PFOS, agreed to start phasing it out . In June, the industrial giant announced it would pay at least $10.3 billion to settle a class-action suit.

Alarmed over what it perceived as the Defense Department’s unwillingness to address PFAS contamination or stop using AFFF, to offer annual testing for all active-duty military firefighters and banned the use of PFAS foam by 2024.

According to data provided by DoD, among more than 9,000 firefighters who requested the tests in fiscal year 2021, 96% had at least one of two types of PFAS in their blood serum, with PFOS being the most commonly detected at an average level of 3.1 nanograms per milliliter.

Readings between 2 and 20 ng/mL carry concern for adverse effects, according to the national academies. In that range, it recommends people limit additional exposure and screen for high cholesterol, breast cancer, and, if pregnant, high blood pressure.

According to DoD, 707 active and former defense sites are contaminated with PFAS or have had suspected PFAS discharges. The department is in the early stages of a decades-long testing and cleaning process.

More than 3,300 lawsuits have been filed over AFFF and PFAS contamination; beyond 3M’s massive settlement, DuPont and other manufacturers reached a $1.185 billion agreement with water utility companies in June.

Attorneys general from 22 states have urged the court to reject the 3M settlement, saying in it would not adequately cover the damage caused.

For now, many firefighters, like Ferrara, live with anxiety that their blood PFAS levels may lead to cancer. Flook declined to speak to ºÚÁϳԹÏÍø News because he is part of the . The cancer wreaked havoc on his marriage, robbing him and his wife, Linda, of “affection, assistance, and conjugal fellowship,” according to the lawsuit.

Congress is again trying to push the Pentagon. This year, Sen. Jeanne Shaheen (D-N.H.) reintroduced the PFAS Exposure Assessment and Documentation Act, which would require DoD to test all service members — not just firefighters — stationed at installations with known or suspected contamination as part of their annual health checkups as well as family members and veterans.

The tests, which aren’t covered by the military health program or most insurers, typically cost from $400 to $600.

In June, Kildee said veterans have been stymied in getting assistance with exposure-related illnesses that include PFAS.

“For too long, the federal government has been too slow to act to deal with the threat posed by PFAS exposure,” Kildee said. “This situation is completely unacceptable.”

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Spatz found a local pharmacy in her Alexandria, Virginia, neighborhood and was getting the life-preserving medicine there.

That is, until Oct. 24, when Express Scripts, the pharmacy benefit manager for Tricare, dropped nearly 15,000 pharmacies from its network. Many of them were small, independent pharmacies, like Neighborhood Pharmacy of Del Ray, where Spatz was a customer.

That decision created problems, according to Doris’ husband, Dr. Michael Spatz, because the breast cancer drug is not carried by every pharmacy. And some larger chains require patients to use a branch of their business known as a specialty pharmacy for pricey or scarce medications for complex diseases.

“Express Scripts told us, ‘You can just go to CVS,’” Michael Spatz said. “But that was kind of a mess because you can’t just go into CVS and get a $1,500 medicine. You have to be in their special pharmacy system.”

About 27% of all pharmacies in the Tricare network are no longer covered, leaving more than 400,000 military beneficiaries affected. The move has upset customers and many independent pharmacies and has raised concerns among some service member advocates and lawmakers, especially those in rural states, who feel it disproportionally affects rural veterans.

In to the Defense Department, U.S. Sen. Jon Tester (D-Mont.), chair of the Senate Veterans’ Affairs Committee, said: “No longer able to rely upon their local pharmacy to access needed medications and in-person pharmacist counseling, they would be forced to drive long distances to find corporate in-network pharmacies or be funneled into Express Scripts’ mail delivery program. That is unacceptable.”

Many of the affected pharmacies knew they would be dropped from the network at the end of the year because they didn’t accept Express Scripts’ terms, which included reduced reimbursement rates. But they were surprised by the early ejection, said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association. “This was a very botched rollout of this new network and unfortunate, ultimately, for the patients,” she said.

The Military Officers Association of America, an advocacy group for active-duty and retired personnel, said it was pressing for a reversal of the decision.

While acknowledging that the Defense Department is under pressure to control health care costs, Karen Ruedisueli, the association’s director of government relations for health affairs, called the change “unprecedented and shortsighted.”

Peter Graves, a spokesperson for the Defense Health Agency, which oversees medical care and services for 9.6 million beneficiaries, including service members, military retirees, and their families, said the Pentagon does not participate in contract negotiations between its pharmacy benefit manager and retail pharmacies.

But, he said in an emailed statement, the changes will not inconvenience many of the people in the program. Roughly 95% of beneficiaries will have access to at least two network pharmacies within a 15-minute drive, he said, and “99.8%” will have access within 30 minutes.

“The Tricare retail network will continue to meet or exceed Tricare’s standard for pharmacy access,” Graves said. “Beneficiaries will continue to have many convenient, local in-network options for filling their medications, including those beneficiaries in rural locations.”

In a separate email, Express Scripts spokesperson Justine Sessions said the decision to leave the network was “up to the pharmacy and/or the wholesalers that negotiate on their behalf.” She added that roughly 80% of pharmacies being dropped from the network had fewer than 50 prescription claims in the past six months from Tricare and that 25% had none. Sessions said Express Scripts has a team dedicated to contacting the “small percentage of beneficiaries that may be impacted by these changes” and helping them move their prescriptions.

“Our charge is to ensure Tricare beneficiaries can access their prescription medication safely, affordably, and conveniently, and at the best value for the Department of Defense and taxpayers,” Sessions said.

The transition is especially problematic for a small group of Tricare beneficiaries who are chronically ill, have a disability, and receive infusion medications in their homes, according to pharmacists.

Logan Davis, vice president of trade at Vital Care Infusion Services, which serves customers in 30 states, said that the company’s services are covered under Tricare’s medical benefit but that the medications used for the infusions are often purchased from independent pharmacies.

The move could delay care for patients with chronic conditions such as rheumatoid arthritis, myasthenia gravis, and Crohn’s disease, Davis said. Swapping out intravenous prescriptions isn’t simple, he said.

“It may not be a huge number of patients, but these are patients on complex drugs that are very ill who depend on getting these drugs to stay out of the hospital and to have a quality of life,” Davis said.

Some lawmakers and advocacy groups have decried the move. Sen. Tom Cotton (R-Ark.), Rep. Buddy Carter (R-Ga.), and 98 members of Congress, both Republicans and Democrats, Sept. 29 to Seileen Mullen, acting assistant secretary for health affairs at the Defense Department, protesting the decision. They said the move could affect beneficiaries’ health and lead to higher administrative fees for the Defense Health Agency.

“What reasons has Express Scripts given DHA for terminating the 2022 contracts early?” they asked. “This will only further reduce the pharmacy network for Tricare patients and their families, and may force beneficiaries to change pharmacies at a time when many receive annual vaccinations.”

Carter’s website now includes that asks affected patients, pharmacists, and health care providers for feedback so the lawmaker can catalog them and press the Biden administration for a reversal. “We’ve been told by the Biden Administration that they do not believe patients and pharmacists care about losing this access,” the website says. “We know you do, and we are bringing your stories to them.”

Sessions, with Express Scripts, did not give a reason for expediting the pharmacies’ departure from the network but said pharmacies may have been blindsided because “apparently some wholesalers declined on behalf of their pharmacies without communicating that to them.”

The National Home Infusion Association reached out to Humana Military and Health Net Federal Services, the private companies that provide medical care and services to the Tricare network, to obtain authorization to provide services but was told that Express Scripts, as the pharmacy arm of the process, will be trying to transition patients to a network provider or send them to a physician’s office for their treatment.

“This is not an acceptable answer for a disabled veteran,” said Connie Sullivan, CEO of the National Home Infusion Association. “They are usually getting our services because they don’t have a provider who can do an infusion without spending hours getting there. Transportation is very challenging.”

The National Community Pharmacists Association Oct. 18 to Defense Secretary Lloyd Austin urging him to allow the pharmacies to stay in the network through 2023 under the same terms as they had this year.

“With the vast majority of independent pharmacies out of the network, it is difficult to see how Cigna/Express Scripts is meeting even the reduced access standards in its new contract with DoD,” wrote the group’s CEO, B. Douglas Hoey, referring to Tricare’s standard that 90% of patients have at least one network pharmacy within a 15-minute drive.

“Without this action, access to needed medications for Tricare beneficiaries is in peril,” he said.

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Even in a state where 80-mph speed limits are normal, ground transportation across long distances is risky for the Moderna mRNA-1273 vaccine,

The group’s destination was Havre, Montana, 30 miles from the Canadian border. About 500 military veterans live in and around this small town of roughly 9,800, and millions more reside in similarly rural, hard-to-reach areas across the United States.

About 2.7 million veterans who use the VA health system are classified as “rural” or “highly rural” patients, residing in communities or on land with fewer services and less access to health care than those in densely populated towns and cities. An additional 2 million veterans live in remote areas who do not receive their health care from VA, according to the department. To ensure these rural vets have access to the covid vaccines, the VA is relying on a mix of tools, like charter and commercial aircraft and partnerships with civilian health organizations.

The challenges of vaccinating veterans in rural areas — which the VA considers anything outside an urban population center — and “highly rural” areas — defined as having fewer than 10% of the workforce commuting to an urban hub and with a population no greater than 2,500 — extend beyond geography, as more than 55% of them are 65 or older and at risk for serious cases of covid and .

For the Havre event, VA clinic workers called each patient served by the Merril Lundman VA Outpatient Clinic in a vast region made up of small farming and ranching communities and two Native American reservations. And for those hesitant to get the vaccine, a nurse called them back to answer questions.

“At least 10 additional veterans elected to be vaccinated once we answered their questions,” said Judy Hayman, executive director of the Montana VA Health Care System, serving all 147,000 square miles of the state.

The Havre mission was a test flight for similar efforts in other rural locations. Thirteen days later, another aircraft took off for Kalispell, Montana, carrying vaccines for 400 veterans.

In Alaska, another rural state, Anchorage Veterans Affairs Medical Center administrators finalized plans for providers to hop a commercial Alaska Airlines flight on Thursday to Kodiak Island. There, VA workers expected to administer 100 to 150 doses at a vaccine clinic conducted in partnership with the Kodiak Area Native Association.

“Our goal is to vaccinate all veterans who have not been vaccinated in and around the Kodiak community,” said Tom Steinbrunner, acting director of the Alaska VA Healthcare System.

VA began its outreach to rural veterans for the vaccine program late last year, as the Food and Drug Administration approached the dates for issuing emergency use authorizations for the Pfizer-BioNTech and Moderna vaccines, according to Dr. Richard Stone, the Veterans Health Administration’s acting undersecretary. It made sense to look to aircraft to deliver vaccines. “It just seemed logical that we would reach into rural areas that, [like] up in Montana, we had a contract with, a company that had small propeller-driven aircraft and short runway capability,” said Stone, a retired Army Reserve major general.

Veterans have responded, Stone added, with more than 50% of veterans in rural areas making appointments.

As of Wednesday, the VA had tallied 220,992 confirmed cases of covid among veterans and VA employees and 10,065 known deaths, including 128 employees. VA had administered 1,344,210 doses of either the Pfizer or Moderna vaccine, including 329,685 second vaccines, to veterans as of Wednesday. According to the VA, roughly 25% of those veterans live in rural areas, 2.81% live in highly rural areas and 1.13% live on remote islands.

For rural areas, the VA has primarily relied on the Moderna vaccine, which requires cold storage between minus 25 degrees Centigrade (minus 13 degrees Fahrenheit) and minus 15 degrees C (5 degrees F) but not the deep freeze needed to store the Pfizer vaccine (minus 70 degrees C, or minus 94 degrees F). That, according to the VA, makes it more “transportable to rural locations.”

The VA anticipates that the one-dose Johnson & Johnson vaccine, if it receives an emergency use authorization from the FDA, will make it even easier to reach remote veterans. The vaccines from Moderna and Pfizer-BioNTech both require two shots, spaced a few weeks apart. “One dose will make it easier for veterans in rural locations, who often have to travel long distances, to get their full vaccination coverage,” said VA spokesperson Gina Jackson. The FDA’s vaccine advisory committee is set to meet on Feb. 26 to review J&J’s application for authorization.

Meanwhile, in places like Alaska, where hundreds of veterans live off the grid, VA officials have had to be creative. Flying out to serve individual veterans would be too costly, so the Anchorage VA Medical Center has partnered with tribal health care organizations to ensure veterans have access to a vaccine. Under these agreements, all veterans, including non-Native veterans, can be seen at tribal facilities.

“That is our primary outreach in much of Alaska because the tribal health system is the only health system in these communities,” Steinbrunner said.

In some rural areas, however, the process has proved frustrating. Army veteran John Hoefen, 73, served in Vietnam and has a 100% disability rating from the VA for Parkinson’s disease related to Agent Orange exposure. He gets his medical care from a VA location in Canandaigua, New York, 20 miles from his home, but the facility hasn’t made clear what phase of the vaccine rollout it’s in, Hoefen said.

The hospital’s website simply says a staff member will contact veterans when they become eligible — a “don’t call us, we’ll call you,” situation, he said. “I know a lot of veterans like me, 100% disabled and no word,” Hoefen said. “I went there for audiology a few weeks ago and my tech hadn’t even gotten her vaccine yet.”

VA Canandaigua referred questions about the facility’s current phase back to its website: “If you’re eligible to get a vaccine, your VA health care team will contact you by phone, text message or Secure Message (through ) to schedule an appointment,” it states. A call to the special covid-19 phone number established for the Canandaigua VA, which falls under the department’s Finger Lakes Healthcare System, puts the caller into the main menu for hospital services, with no information specifically on vaccine distribution.

For the most part, the VA is using Centers for Disease Control and Prevention guidelines to determine priority groups for vaccines. Having vaccinated the bulk of its health care workers and first responders, as well as residents of VA nursing homes, it has been vaccinating those 75 and older, as well as those with chronic conditions that place them at risk for severe cases of covid. In some locations, like Anchorage and across Montana, clinics are vaccinating those 65 and older and walk-ins when extra doses are available.

According to Lori FitzGerald, chief of pharmacy at the VA hospital in Fort Harrison, Montana, providers have ended up with extra doses that went to hospitalized patients or veterans being seen at the facility. Only one dose has gone to waste in Montana, she said.

To determine eligibility for the vaccine, facilities are using the Veterans Health Administration Support Service Center databases and algorithms to help with the decision-making process. Facilities then notify veterans by mail, email or phone or through VA portals of their eligibility and when they can expect to get a shot, according to the department.

Air Force veteran Theresa Petersen, 83, was thrilled that she and her husband, an 89-year-old U.S. Navy veteran, were able to get vaccinated at the Kalispell event. She said they were notified by their primary care provider of the opportunity and jumped at the chance.

“I would do anything to give as many kudos as I can to the Veterans Affairs medical system,” Petersen said. “I’m so enamored with the concept that ‘Yes, there are people who live in rural America and they have health issues too.’”

The VA is allowed to provide vaccines only to veterans currently enrolled in VA health care. About 9 million U.S. veterans are not enrolled at the VA, including 2 million rural veterans.

After veterans were turned away from a VA clinic in West Palm Beach, Florida, in January, Rep. Debbie Wasserman Schultz (D-Fla.) wrote to Acting VA Secretary Dat Tran, urging him to include these veterans in their covid vaccination program.

Stone said the agency does not have the authorization to provide services to these veterans. “We have been talking to Capitol Hill about how to reconcile that,” he said. “Some of these are very elderly veterans and we don’t want to turn anybody away.”

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The largely unpublicized effort follows a Department of Defense announcement in September that it has partnered with AstraZeneca to recruit volunteers at five of its medical facilities, which are separate from the VA system.

DOD is also is in talks with developers of other vaccine candidates, although officials won’t say which ones.

Both federal departments have long experience in medical research and diverse populations — a crucial component of effective clinical trials, said J. Stephen Morrison, senior vice president and director of global health policy at the Center for Strategic and International Studies, a bipartisan think tank in Washington, D.C.

Since active troops are essential to national security, and veterans are extremely vulnerable to COVID-19, both departments have a vested interest in supporting the development of safe, effective vaccines, Morrison said.

“On the DOD active servicemen and -women side, it’s a question of making sure they’re ready, they are protected,” Morrison said. “With VA, their population, all elderly and infirm with underlying conditions, they could really be suffering if we don’t get a vaccine.”

According to a VA website, of its 20 medical centers involved, 17 would be part of the Johnson & Johnson vaccine trial, while the three others are recruiting — or have completed recruitment — for advanced-stage trials for Moderna, AstraZeneca and Pfizer vaccines.

Dr. Matthew Hepburn, head of vaccine development at Operation Warp Speed, said the VA effort lets veterans contribute to the overall well-being of the country.

“This is another way they can continue to serve in this way, fighting the pandemic as a volunteer,” Hepburn said during a discussion of vaccine and therapeutics development hosted by the Heritage Foundation on Oct. 27.

It’s not unusual for the military to participate in multicenter trials for treatments of ailments as diverse as cancer and trauma. Historically, many vaccines have been tested first by the military.

In the general population, clinicians often have difficulty recruiting African Americans and other minorities for medical research, and “the military provides a rich opportunity to find volunteers for those groups,” said retired Rear Adm. Thomas Cullison, a doctor and former deputy surgeon general for the Navy.

Military health facilities are held to the same standards as private research facilities, he said.

No service members will be required to participate in the COVID vaccine trials. All volunteers will be paid by the developer.

Support for routine vaccinations runs high in the military, but some have expressed concerns about new vaccines and mandatory inoculations, especially for anthrax. In a , 85% of those who received that vaccine reported an adverse reaction, with just under half noticing minor redness at the injection site. But nearly a quarter of the side effects reported were more systemic, including fevers, chills, fatigue and joint pain.

That survey of a small group of National Guard and Reserve members found that, while 73% said they believe immunizations are effective, two-thirds said they did not support the mandatory anthrax program and 6 in 10 said they were not satisfied with the information they were given on the vaccines.

To quell concerns over the military’s role in supporting COVID vaccine development, the Pentagon has reiterated that troops or their dependents interested in participating in the research must provide voluntary written consent, and they will be allowed to take part only if they will be in the same location for the length of the research, expected to last at least two years.

In addition, active-duty members such as new recruits and boot camp participants will not be allowed to volunteer because they are “considered vulnerable from an ethical and regulatory standpoint,” an official said.

At the VA, officials are seeking to recruit healthy veterans from 18 to 65 years old who are not pregnant and may be at risk for exposure. As with trials conducted in civilian facilities, participants will be paid by the developer, VA spokesperson Christina Noel said.

Also, VA nurses and caseworkers also are being asked to identify their sickest, highest-risk patients to determine who should be at the top of the list once a vaccine is approved, according to a VA nurse and other health officials who asked not to be identified because they were not authorized to speak with the press.

The U.S. military has a long history of contributing to research on vaccines, including a key role in developing inoculations against yellow fever and adenovirus, and the Walter Reed Army Institute of Research is developing its own vaccine against the coronavirus.

Some segments of the population remain skeptical of federal medical experiments. A in May found that Black people are particularly reluctant to get the coronavirus vaccine. Many about federal research in part because of associations with the infamous Tuskegee Institute syphilis experiments, in which U.S. Public Health Service officials intentionally withheld a cure from Black men infected with the disease.

But Morrison, of the Center for Strategic and International Studies, said the Defense Department and VA are a “natural fit” for the COVID vaccine trials.

“DOD has lots of expertise. They know how to vaccinate; they know how to reach communities. They have a whole science infrastructure and research-and-development infrastructure. And when you are thinking what the mission of VA is, [VA] sees this is part of their mission,” Morrison said.

The Defense Department announced its agreement with AstraZeneca in September, shortly before the drugmaker’s vaccine trial was put on hold to study a serious medical condition that one participant reported. That research was approved by the Food and Drug Administration to begin again Oct. 23. The military plans to restart its efforts to recruit 3,000 volunteers.

The Pentagon has also signed an agreement with another vaccine developer, the head of the Defense Health Agency, Army Lt. Gen. Ronald Place, told reporters Oct. 8. He wouldn’t provide the company’s name.

Democratic Sens. Elizabeth Warren of Massachusetts and Mazie Hirono of Hawaii have called, unsuccessfully, for the Senate Armed Services Committee to investigate what they say is a lack of Pentagon transparency on its role in vaccine development and distribution.

The Defense Department has awarded more than $6 billion in Operation Warp Speed contracts through an intermediary, Advanced Technology International, and the two senators want more information about those contracts.

“There may well be a valuable role for DoD officials in [Operation Warp Speed] — particularly given the department’s logistical capacity,” they wrote to the committee chair and ranking member. “But it is important that Congress conduct appropriate oversight of, and understand, DoD’s activities in this area.”

Neither department has disclosed the financial arrangements they have made with developers to support the vaccine research.

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