WASHINGTON — The House on Wednesday passed a bill that would make millions of veterans who were exposed to trash burn pits on U.S. military bases around the world eligible for medical care, the most sweeping action by the federal government to recognize that the sites may have caused a range of diseases.
The legislation would effectively presume that any American service member stationed in a combat zone for the last 32 years could have been exposed to toxic substances, authorizing a projected $285 billion over the next decade to treat ailments tied to those exposures and streamlining veterans’ access to such care.
It would be one of the largest expansions of veterans benefits in the history of the Department of Veterans Affairs, said Denis McDonough, the agency’s secretary, on par with the Agent Orange Act that broadened access for Vietnam War veterans exposed to the toxic substance that was used as an herbicide and endangered generations of Laotians.
The House passed the measure 342 to 88, sending it to the Senate, which was expected to quickly clear it and send it to President Biden for his signature.
Mr. Biden has long advocated expanded care, speculating that toxic substances from burn pits contributed to the brain cancer that killed his son Beau, who served in Iraq, in 2015.
Open-air burn pits were standard on American military bases in Afghanistan starting in 2001, as well as bases established later in Iraq. They were frequently used to dispose of all unneeded items and were ignited by jet fuel as the bases lacked infrastructure for proper disposal and existing sanitation services had been destroyed by combat.
Toxic exposure from these trash fires overseas, as well as from contaminated drinking water on bases in the United States, has led to a number of conditions and respiratory illnesses such as bronchial asthma, allergic rhinitis, sleep apnea, bronchitis and sinusitis, as well as different kinds of cancer.
An estimated 3.5 million veterans who have been exposed to toxic substances since the Sept. 11 attacks could see expanded health care eligibility under the legislation, according to the House Veterans Affairs Committee.
The legislation would modify the definition of what constitutes “toxic exposure” for the purposes of determining veterans’ eligibility for medical and nursing home care, as well as for mental health services. It would require the Department of Veterans Affairs to recognize dozens of cancers and respiratory illnesses that could be linked to toxic exposure. And it would order the department to include such exposures in patient questionnaires in an effort to reach patients who are unaware that their conditions could be linked to burn pits.
“We have an opportunity to make good on the promise we made to our service members when our country sent them into harm’s way: that we would take care of them and pay for that care when they come home,” said Representative Mark Takano, Democrat of California and the chairman of the Veterans Affairs Committee.
Mr. Biden announced in his State of the Union address this year a policy that would give veterans with certain respiratory cancers — such as squamous cell carcinoma of the larynx and trachea, as well as different kinds of lung cancers — a lower burden of proof to have those conditions treated by the Department of Veterans Affairs health care system.
In 2020, Laurine Carson, the department’s deputy executive director, told the committee that 12,582 veterans had claimed conditions related to burn pit exposure from June 2007 through July 2020, but that only 2,828 claims were granted.
A department spokesman was not able to immediately provide updated data on Wednesday. But there has been a groundswell of pressure from veterans’ groups to change the law governing eligibility so that it would be easier to secure care, an effort that has gained traction at the White House, with Mr. Biden’s interest in the issue, and on Capitol Hill.
The Supreme Court has also taken up the question. In June, it issued a 5-to-4 decision in favor of an Army reservist who sued Texas for refusing to allow him to return to his job as a state trooper because of a medical condition that he claimed resulted from toxic exposure while serving overseas.
Opponents of the legislation objected to its cost, complaining that without cuts to other programs to compensate, the expansion of veterans’ health benefits would swell the deficit.
“You have to pay for that which we are spending,” said Representative Chip Roy, Republican of Texas. “We are undermining the sacrifice of the very veterans that we say we are helping with this measure by not doing it” in a “fiscally responsible” way, he said.
Senators concerned with the price tag cut a deal to phase in the benefits over a series of years, meaning that in most cases those who served earliest would be eligible for care in 2024, but those discharged more recently would have to wait several years — and in some cases, a decade.
But Representative Mike Bost of Illinois, the top Republican on the Veterans Affairs Committee, said much of the bill’s cost was already being funded under current law.
“The bill is not perfect, but expanding health care and benefits for veterans who are exposed to burn pits or other dangerous toxins while serving our country is the right thing to do,” Mr. Bost added.
Mr. McDonough said the measure would help meet the department’s goal of getting more veterans care. He said the agency would “work to ensure that the expansion of eligibility for health care does not result in the delay or disruption of care for those veterans already receiving health care from V.A.”
Tom Porter, the executive vice president of the Iraq and Afghanistan Veterans of America, called the bill “an enormous step toward proving that we fully support our military and veterans.”