The Soldiers Came Home Sick. The Government Denied It Was Responsible.

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The soldiers with inexplicable breathing complaints started appearing in Dr. Robert F. Miller’s pulmonology clinic in 2004, the year after Baghdad fell to invading United States forces. These new patients were active-duty troops from nearby Fort Campbell, men and women who came home from war with mysterious respiratory ailments. The base asked Miller, an unassuming and soft-spoken lung specialist at Vanderbilt University, to take a look.

Miller was baffled to see formerly healthy soldiers gasping for air after mild exertion. Some of them had been close to the fire at the Mishraq sulfur mine outside Mosul, thought to be the largest release of sulfur dioxide ever caused by humans. But others had never gone anywhere near the burning mine. Some of them could no longer run or climb stairs, and yet their X-rays and pulmonary-function tests looked normal.

Confounded, Miller decided to try something radical: He began ordering lung biopsies under general anesthesia to look for more subtle damage known as small-airways disease. Sure enough, the tissue revealed toxic lung injury, which Miller diagnosed as constrictive bronchiolitis. To the doctor, this meant two things: First, the soldiers were not exaggerating their symptoms. And more important, noninvasive screenings couldn’t be trusted to detect these new post-deployment ailments.

Eager to share his discovery, Miller contacted doctors at Walter Reed Army Medical Center. This led, at first, to what Miller recalls as an enthusiastic collaboration. Army doctors flew to Tennessee to review Miller’s biopsies, and together they went to Fort Campbell to develop a protocol for evaluating patients.

That early collaboration collapsed, however, after Miller presented his findings to a large 2009 conference of doctors, including contingents from the Department of Defense and the Department of Veterans Affairs. In the following months, his Fort Campbell patients stopped coming for treatment. When Miller asked for an explanation, a Department of Defense official told him in an email that the abrupt change was because of a realignment in military command regions. Miller wasn’t convinced: He believes that senior officials realized that the implications of his research could be sweeping — and could stick the government with expensive medical bills for untold numbers of returning troops. Whatever the reason, he says, the military abruptly stopped cooperating or referring patients to Miller. “The D.O.D. said: ‘Well, we’ll take it from here. We don’t need to send any more people to Vanderbilt,’” Miller recalls. (A spokesperson at Fort Campbell said the base had decided to send patients, instead, to an Army medical center in San Antonio for treatment and study within the military’s health system.)

Miller’s breakthrough findings and what he described as the sudden end of collaboration with military officials marked an early clash in what would become a long, bitter struggle over ailments associated with military trash fires and other airborne toxins during America’s post-Sept. 11 wars. More than 200,000 people who deployed to Iraq or Afghanistan believe they suffer permanent damage from exposure to burn pits, as the military’s notorious garbage-disposal fires are known. They describe ailments ranging from shortness of breath to rare cancers but have struggled to convince the government that shipped them off to war that their suffering deserves redress. Instead, veterans’ pleas have been met with bureaucratic inertia and widespread perceptions of stonewalling. Researchers who uncovered early suggestions of links between burn pits and health problems say their work was discouraged or even censored by the V.A. At the same time, citing a lack of conclusive data, the V.A. was denying the vast majority of burn-pit-exposure claims. Since the first anecdotes of mysteriously sickened service members began to filter out of clinics in the early years of the war on terror, the battle over burn pits has unfolded as a bleak saga that brought together foreign wars and military contractors, health care dysfunction and distrust of government.

It was clear from the beginning that this new problem could be disruptive, costly and vast in scale. If burn pits were indeed causing health problems, a staggering number of service members — pretty much anybody who spent time on bases in Iraq or Afghanistan — could make a reasonable claim. What’s more, because military trash fires were still common practice on overseas campaigns even as backlash to burn pits was rising back home, any acknowledgment that troops were getting sick could force the Pentagon to adjust the logistics of ongoing wars. Only in 2009 did the Pentagon begin to scale back the practice, which is still used when the military can’t find another way to dispose of garbage. On top of the cost to taxpayers and disruption to war planners, burn-pit fallout threatened private industry: Many of the burn pits were operated by KBR, a powerful contracting company that won, and continues to win, billions of dollars in contracts from the Department of Defense.

Pieces of burn-pit legislation were periodically drafted in a show of support for the troops but never seemed to pick up much momentum. The most significant breakthrough came in 2013 when Congress ordered the V.A. to establish the Airborne Hazards and Open Burn Pit Registry so that veterans could log their symptoms. (Officials at the V.A. had fought against creating the database until lawmakers forced the department to do it, several former V.A. employees told me.) For years, that relatively minor concession was as close as the federal government came to a large-scale response to burn pits.

It would take a pressure campaign from an unexpected source before burn pits finally started to pick up political momentum. Starting in 2020, the comedian and political commentator Jon Stewart and a coalition of Sept. 11 first responders threw their considerable lobbying muscle behind the long-marginalized movement. These new allies proved remarkably effective. By the end of 2021, 16 distinct bills were introduced as lawmakers vied to affix their names atop a piece of burn-pit legislation.

The bustle of interest in Congress, in turn, sparked a rare reaction within the opaque and ponderous offices of the V.A. In August, breaking with years of precedent, the department abruptly reversed its position on the damages wrought by “fine, particulate matter,” including burn pits. Veterans diagnosed with asthma, rhinitis or sinusitis within 10 years of returning from Iraq, Afghanistan or certain other foreign deployments are now presumed to have suffered respiratory damage during their service and are eligible for benefits.

In November, President Biden, who has publicly blamed his son Beau’s death — from glioblastoma brain cancer at 46 — on burn pits in Iraq, followed up by ordering the V.A. to look into potential links between toxic exposure and rare cancers.

While advocates cautioned that the expansion of V.A. benefits has so far been relatively modest, it’s still a radical turnaround for a department that, until late in 2020, kept the same line of denial emblazoned on its website: “Research does not show evidence of long-term health problems from exposure to burn pits.” The message to veterans had long been clear: You can’t prove that military service made you sick, and that means your illness is not our problem. Now, suddenly, the V.A. had swung abruptly to align with the department’s most vocal critics, openly acknowledging that respiratory disease was a likely result of airborne particulate exposure during deployment.

A burn pit is exactly what it sounds like: A hole is dug in the ground and filled with trash, including medical waste, vehicles and plastics. Then the whole mess is doused with jet fuel and set on fire. Operated in large part by KBR, the huge contracting firm that was enriched by lucrative wartime contracts, burn pits were a ubiquitous feature of the post-Sept. 11 wars — a primitive disposal method for the tremendous loads of garbage generated by occupying forces.

At least some of the health issues ascribed to burn pits were probably caused by particulate matter, smoke inhalation or air pollution breathed on deployment, and specialists are generally careful to refer to “toxic exposure” or “airborne hazards” instead of singling out burn pits. But returning service members and their families tend to zero in on the trash fires. Monstrous conflagrations consumed acres of American bases, sometimes adjacent to working and sleeping quarters. The troops grumbled about the noxious smoke but to no avail: The burn pits were considered an imperfect but inevitable way to avoid hauling garbage through streets held by hostile occupation.

To understand the scale and toxicity of burn pits, you have to realize how much material the United States dragged into these wars. Artificial villages hardened like scabs over the landscape in Iraq and Afghanistan. Teeming communities of trailers, air-conditioners, table-tennis sets, weapons depots, a thousand things fetched by armed guards in truck caravans that traveled over the weakened highways, cracking them apart.

Hundreds of thousands of troops passed through those bases, and that’s not counting the civilian bureaucrats and local employees, diplomats and contractors. There were hospitals, prisons, offices, garages, industrial kitchens, all of it generating waste of every imaginable kind, and nowhere to put it but into the fire. Some soldiers spent months in the thick smoke, inhaling particles small enough to lodge into tissue, pass through lungs and swim through the blood. The burn pits melted the mundane waste of the wars off the landscape and hid it deep in the bodies of the troops. According to V.A. estimates, about 3.5 million military members have been exposed to burn-pit smoke since the 1991 invasion of Iraq.

But when they got home, claims of burn-pit exposure were met with institutional skepticism at both the Pentagon and the V.A. Service members and veterans were dismissed as anxious or out of shape, prescribed psychiatric drugs and asked to produce trash-fire documentation they couldn’t possibly have: Where were they deployed? Where was the burn pit? Had they smoked or experienced stress? How did they know what had made them sick? From 2007 to 2020, the V.A. denied 78 percent of veterans’ disability claims mentioning burn pits, a senior V.A. official testified before Congress in September 2020.

KBR, meanwhile, fought a class-action lawsuit all the way up to the United States Supreme Court to avoid paying damages to sickened soldiers. In 2019, the court let stand a ruling that private contractors were protected by the same immunity that covers the military’s battlefield decisions.

Many Americans are under the mistaken impression that veterans receive free health care. They don’t. Combat veterans who were discharged in 2003 or later are entitled to five years of free V.A. health care. After that, they are eligible for free or subsidized treatment and disability benefits for any diagnosed health conditions or chronic injuries linked to their military service. But because burn-pit ailments were new, and therefore, research was scarce, veterans had little chance of meeting the threshold of proof tying their symptoms to deployment — a point the V.A. seemed keen to emphasize in the website message that categorically rejected any link between burn pits and illness.

David Shulkin, a doctor and hospital manager known for his patient-friendly policies, became under secretary for health at the V.A. in 2015 and ascended to the agency’s top job in 2017 — the lone holdover from the Obama administration appointed to a Trump cabinet position — only to be pushed out 15 months later. Since then, he has emerged as a passionate advocate for burn-pit victims.

“Simply outrageous,” he told me in August when I asked about the website’s message rejecting a correlation between burn pits and health issues. “It was a slap in the face to anybody who was suffering and to the families, and I was very outspoken that it needed to be removed.” I pointed out that the message had stayed on the V.A. website all the way through his time overseeing the agency and had only disappeared in late 2020. Shulkin told me I was wrong. I assured him that I was not.

That’s when Shulkin said that all through his three years in senior V.A. leadership, nobody had ever discussed burn pits with him. But this seemed impossible: During his tenure, the V.A. had already started logging details of toxic-exposure claims in its national burn-pit registry, and, in 2017, Shulkin signed off on the National Academy of Sciences, Engineering and Medicine’s review of the use of the data. PBS, The New York Times and others had reported on the controversies around burn pits. The class-action lawsuit against KBR was winding through the courts, making headlines along the way. Shulkin had also visited a New Jersey research facility focused on studying airborne hazards and burn-pit exposure in 2016.

But Shulkin doubled down, even suggesting that the topic may have been purposely downplayed: “Burn pits weren’t even an issue while I was there,” he said. “There are very good mechanisms that prevent things from surfacing, and I can’t say whether it was deliberate. There was no discussion or visibility on it.”

I repeated Shulkin’s description of V.A. silence about burn pits during a phone call with current V.A. officials. “I’d find it surprising,” Dr. Patricia Hastings, the V.A.’s chief consultant for health outcomes of military exposures, finally said.

In months of reporting, I interviewed a range of current and former V.A. employees, both on and off the record, and ran into many professed gaps in knowledge. Nobody at the V.A. seemed willing or able to articulate a coherent explanation for the department’s shifting position on burn pits. Officials pointed out that the agency was enormous, the largest after the Department of Defense, and that some of the clashes over the science had taken place a long time ago. The V.A., they said, has always prided itself on rigorous research, academic freedom and compassionate care for veterans. Over the years, the agency has commissioned four reports related to airborne hazards; none of them uncovered any connections between health problems and burn pits, officials said. Nevertheless, after reviewing the existing research in late 2020 and 2021, the V.A. last year decided to reverse its position. The science, the V.A. said in a statement, “has changed and represents less of an abrupt shift than an evolution in the V.A.’s understanding.”

The Miller biopsies have remained a landmark, albeit controversial, breakthrough in burn-pit research. Some returning soldiers grew so desperate to prove they were truly ill — not malingering or delusional, as other doctors had suggested — that they traveled to Tennessee and paid for a biopsy using private insurance. But Miller has also been criticized, in particular by military doctors, for encouraging patients with normal test results to undergo the painful and invasive procedure.

In the contentious realm of burn-pit research, doctors have squared off against one another with unusual rancor. The stakes are both professional and personal, with some scientists believing their life’s work has been ignored or misused for political purposes. There are burn-pit believers (activists, their critics say) and burn-pit skeptics (obstructionists, the others say).

In 2013, after years of silence, Miller heard from the V.A.: He was one of two pulmonologists asked to develop a criterion to evaluate respiratory disability. But when it came to constrictive bronchiolitis — the disease Miller believed he found in his biopsies — the agency stymied his efforts to create a criterion, he says. In email exchanged that year, Miller pressed Dr. Gary Reynolds, a medical officer with the V.A.’s benefits administration, for an explanation, even threatening to “make a congressional inquiry,” citing his past work with the Senate Committee on Veterans’ Affairs. But Reynolds deflected, citing “some unanticipated administrative issues.” In an email to me, Reynolds said that he couldn’t comment.

In the years since then, Miller has remained outspoken and doggedly weathered the resulting criticism. “It’s horrible,” he said of service members’ struggle for care. “I know these stories, and I know how impaired they are, and I know how they’ve been treated.”

The dearth of evidence was repeatedly invoked over the years as justification for denying burn-pit-related claims. V.A. officials had long maintained that there simply wasn’t enough data to prove a link between trash fires and health problems. And why not? One explanation upon which all of the doctors can agree: Symptoms might take years to manifest and evolve, and patients should be tracked for decades after deployment to get a full picture.

But that’s not a complete explanation. Because the military knew (or should have known) the range of materials being burned, presumably the established knowledge behind the Environmental Protection Agency’s online warnings that burning plastic and trash “can be toxic,” for example, could have been applied to the cases of the returning soldiers.

Instead, interviews with medical researchers suggest a troubling pattern of denial and cover-up. Several V.A. doctors told me that their bosses pressured them to ignore data pertaining to burn-pit exposure; prevented them from publishing findings; and threatened or retaliated against those who persistently argued for a link between such exposure and illness.

Dr. Anthony Szema was the allergy section head at the Northport V.A. Medical Center in New York from 1998 until he quit in 2015. In recent years, he and his team have studied lung tissue from returning service members in the brilliant X-ray beams of the National Synchrotron Light Source II. The metal-detecting beam lines, which are not generally used to study body parts, revealed a dramatic abnormality in patients’ lungs: titanium bonded to iron in a fixed 1:7 ratio. This was shocking, Szema says, because the compound hardly exists in nature, suggesting man-made car parts or computer equipment.

Szema’s team also exposed laboratory mice to dust samples that had been gathered by a colleague from war zones. As a control, they exposed other mice to dust from similar geological regions outside combat — inert titanium dioxide from Georgia clay; samples from a Montana titanium mine; dirt from Camp Pendleton in California. The pattern was clear: Lung tissues of mice and humans exposed to the war dust were marked with crystals. “Those crystals are metals, and they’re from inhaling the dust and everything else that got into the dust,” he said. “The burning smoke and the burning computers, the Humvee that blew up in the air.”

Szema started investigating this issue to try to understand the unexplained breathing ailments he was seeing among post-Sept. 11 veterans. His 2011 analysis of health data from thousands of troops concluded that those who served in Iraq or Afghanistan were far more likely to struggle with breathing symptoms requiring lung-function tests — a phenomenon Szema’s team called “Iraq/Afghanistan war lung injury.” But his supervisors became angry about the team’s findings, Szema says, and warned him that the V.A. wanted it “squashed.” “They told me to change stuff in the paper, which I refused to do,” Szema says. (A V.A. adviser says he raised concerns with Szema about his methodology but that he did not ask Szema to alter his findings.) After the research was published in The Journal of Environmental and Occupational Medicine, Szema’s colleagues from the V.A.’s public-health office wrote a letter to the publication that criticized the paper for failing to adjust the data to account for respiratory risk factors. Szema rejects their criticism.

Szema is not the only V.A. scientist who says he was pressured over burn pits. In 2009, the V.A. began the National Health Study for a New Generation of U.S. Veterans, a sweeping survey of 20,500 veterans meant to evaluate the overall health of those who deployed to Iraq or Afghanistan. When Steven Coughlin, the study’s lead epidemiologist, began to analyze the results for publication, he found that service members who reported exposure to burn pits suffered higher rates of asthma, chronic bronchitis and other respiratory problems compared with troops who were not deployed. But Coughlin’s V.A. supervisors ordered him to ignore that data, he said, and forbade him to publish any suggestions of links between burn pits and illness. When a defiant Coughlin included his findings anyway, he says, his supervisor edited out those sections. Outraged, Coughlin demanded his name be removed as co-author of the study. “They weren’t publishing the results,” Coughlin said. “They either manipulate the findings or they don’t release them.”

Coughlin left the V.A. in 2012 after becoming a whistle-blower. He testified to Congress the next year about what he described as the agency’s mishandling of both burn-pit data and suicidal impulses among veterans. He lived briefly in his brother’s basement before rebuilding his career in academic research.

“The V.A. has a not-so-subtle conflict of interest,” Coughlin says, echoing a complaint I heard frequently. The agency’s dual responsibility for paying out disability compensation and for research, V.A. critics say, puts the department at odds with itself. Current V.A. officials pushed back against suggestions of stifled research, insisting their commitment to science was unassailable. They also denied having any financial incentive to deny benefits, pointing out that the disability-compensation budget is separate from the research budget and that the two budgets do not affect each other. The V.A. and the Pentagon have recently collaborated on what officials say is a groundbreaking new data-gathering app (the Individual Longitudinal Exposure Record) that will create a detailed portrait of every service member, including deployments, potential exposures and symptoms. This, they say, will help clear up the lingering ambiguity around toxic exposures. “We are taking this seriously and are actively engaged in outreach,” says John Kirby, the Department of Defense spokesman.

Dr. Cecile Rose occupies a somewhat singular position among the lung researchers I interviewed. As director of the Center for Deployment-Related Lung Disease at Denver’s National Jewish Health, a respiratory hospital that has received millions of dollars in Defense Department grants, Rose has treated hundreds of patients. She believes that the damage from airborne toxins is real and can be severe, and she told me that Miller’s controversial biopsies were “seminal.” But she objected to the suggestion that research had been stymied.

“It’s probably simplistic to say the V.A. has no interest in this or is just trying to bury it,” she said. Rose acknowledged the widespread perception of “nefarious efforts going on,” but suggested that researchers on both sides had taken hardened stances on a little-understood medical question. “There are people who I think have been kind of unpersuaded and unsympathetic and unconvinced from the outset and have brought bias to the discussion,” she said. “And there are people who are advocates.”

Rose seemed to be choosing her words carefully, and she asked several times what this article was going to say. When I described the other researchers’ run-ins with the V.A., she replied that she wasn’t the best person to comment. “Everybody has a conflict of interest here,” she said. “I mean, you know, people can argue that we get D.O.D. funding so we’re part of the problem.”

Perhaps the researcher least convinced of a link between burn pits and health problems is Dr. Michael Morris, a pulmonologist at Brooke Army Medical Center in San Antonio and a frequent critic of Miller’s biopsies. Having carried out a sweeping series of studies from 2011 through 2020 into the lungs of active-duty military members, Morris maintains there isn’t enough evidence to say that toxic exposure during deployment is causing disease. He feels strongly that Miller should not have ordered the lung biopsies. Morris suggested asthma, sleep problems, anxiety or depression as alternative explanations for the breathing complaints, adding that many of the patients are neither young nor healthy. “Just because you have a headache doesn’t mean you have a brain tumor, OK?” he said. “Just because you’re short of breath doesn’t necessarily mean you have lung disease.”

Morris described himself as a beleaguered researcher dutybound to follow the data to unpopular conclusions. He has been frustrated by the perception that his studies and those of others, which have not established links between burn pits and disease, have been largely ignored by the press and the public, even as critics accuse the Defense Department of inaction and indifference. “I don’t have any evidence that it’s definitely the burn pits,” he said. “I’d be the first to be honest with you and say, ‘Hey, I don’t know.’”

One day in 2008, a lawyer named Susan L. Burke picked up the phone in her Philadelphia office. A onetime military kid who spent her childhood on bases, Burke specialized in suing military officials and contractors. Now she found herself talking to a former KBR employee who said he had watched a dog pull a human arm from a burn pit in Iraq. The man said he was traumatized and that he wanted to sue his former employer. Burke took the case and, as word of the litigation spread, found herself flooded with other complaints about burn pits from sick veterans and contractors. By the following year, her clients’ grievances would be among 63 claims consolidated into a class-action lawsuit accusing KBR of negligence. Burke was one of the lead lawyers.

At the time of the invasions of Iraq and Afghanistan, KBR was a wholly owned subsidiary of the multinational conglomerate Halliburton, which was run by Dick Cheney until he ran for vice president. When the United States invaded Iraq, KBR received a no-bid contract capped at $7 billion to rebuild Iraq’s oil infrastructure; the company also won a number of contracts to provide wide-ranging logistical services in Afghanistan and Iraq, including trash disposal.

The relationship between KBR and the United States government is close, occasionally contentious, and peppered with litigation. The government has repeatedly sued KBR for alleged malfeasance, including inflating costs, arming security subcontractors without authorization and taking kickbacks, although most of the cases were dismissed in court. KBR has also sued the government for access to documents it wanted to help defend against separate civil lawsuits, although none of the legal bickering has hindered the company from continuing to win government contracts.

By the time the burn-pit lawsuit reached the Supreme Court in 2019, more than 800 current and former service members, family members and former employees had joined as litigants. The case was regarded not only as a David-and-Goliath contest between veterans and a sophisticated corporate giant but also as a test of the legal protections a company might expect while engaging in war for profit.

The veterans had argued that KBR was functioning outside the chain of command, even operating some burn pits without military authorization. But the Fourth Circuit Court of Appeals flatly rejected that argument, finding that KBR was following the instructions of the military and, therefore, could not be judged in civil court.

In the end, the Supreme Court declined to hear the case, letting stand the appeals ruling that favored KBR. The case turned on the “political question” doctrine, which holds that battlefield decisions by the military can be overseen only by the White House or Congress, without second-guessing from the courts. If taken as precedent, legal experts say, the ruling would solidify an even greater degree of integration of for-profit companies within the military command structure. It also suggests that contractors in theaters of war exist in a legal twilight zone, unanswerable to either civilian or military court.

Military contractors have pressed for, and received, some measure of immunity as early as World War II, when the war effort leaned heavily on private industry to produce vehicles, weapons and hardware. Since 2001, that legal protection mushroomed as the military outsourced more and more of the tasks once performed by soldiers.

It’s impossible to talk about the dynamic between the government and its contractors without acknowledging a broader reality: the personal relationships and professional crossover between military commanders and the companies that dangle a lucrative retirement for high-ranking officers looking to cash in on their experience.

Kerry Baker is a former V.A. policy chief who, in 2010, wrote a department-wide letter (which he says went largely ignored by V.A. clinicians) detailing the toxic exposure risks of trash fires. Baker told me that military officials “hated” the issue of burn pits and, like the V.A., had tried to downplay links between airborne toxins and health issues. At the time, he says, he assumed it was because the Pentagon didn’t want to give people still deployed the idea that they would get sick. But he has come to think there was another explanation.

“I now think they were protecting their contractors,” says Baker, pointing out that the class-action lawsuit was already underway during his time at the V.A. and that military officials were providing testimony on behalf of KBR. (Other military officials testified on behalf of the plaintiffs.) “The more the lawsuit got traction, it seemed like the more the D.O.D. stepped up and defended them,” he said.

Chris Heinrich, a lawyer for KBR, gave a sworn deposition in 2010 acknowledging that, on the eve of the Iraq invasion, he personally pressured the Pentagon to sign an unusually broad indemnification clause as part of the contract to rebuild Iraq’s oil infrastructure. The Pentagon ended up granting KBR sweeping protection from lawsuits, including negligence or death, and agreed that United States taxpayers would reimburse KBR for any legal costs if anyone sued the company. (Philip Ivy, KBR’s vice president of global marketing and communications, denies that KBR’s lawyers coerced the Pentagon and says the indemnification for “extraordinary situations” was authorized under federal law.) The indemnification deal was classified until it was finally made public in 2012.

This was another way that KBR insulated itself from being held accountable. The oil contract did not cover the burn pits, but KBR claimed in a 2015 lawsuit filed against the Department of Defense that the logistical agreement that included garbage disposal also obligated the government to “reimburse KBR for costs incurred defending third-party tort suits.” That means that, by the time all the lawsuits and legislation play out, taxpayers will be required to pay the original cost of KBR’s contracts, the price of health care and benefits for troops disabled by burn pits and, finally, reimbursement for damages and any corporate legal fees paid out by KBR as the company fought against the veterans’ claims. “This kind of reimbursement is not at all unusual,” Ivy says. The Department of Defense declined to comment on its previous contracts with KBR, citing potential for future litigation.

KBR has toggled cannily between leveraging personal ties to the government and, when necessary, bringing to bear the impersonal might of expensive legal teams. A 2010 letter from KBR to the Army pressed for Lt. Gen. Ricardo Sanchez, former commander of the multinational forces in Iraq, to testify on behalf of the company in yet another lawsuit, warning “KBR has carefully refrained from pointing its finger at the United States as the culpable entity” and “KBR can no longer sit silent, and instead intends to aggressively make its case to the public.” (A KBR spokesman said this was not a threat but an “affirmative statement” that KBR would “correct false and misleading statements.”) Sanchez acknowledged under oath that KBR paid him $650 an hour for time spent preparing and delivering his burn-pit testimony.

Sanchez testified that when problems with KBR arose, “I would call in my buddies, the retired general that was in charge of KBR, and we would have a session to sort out the issues.” But for military leaders lower in rank, wrangling KBR was impossible. In 2006, Lt. Col. Greg Kleponis became the commander of the security unit in Camp Bucca, Iraq, a congested encampment containing a large United States-run prison (which would eventually gain notoriety as an Islamic State radicalization hub), a hospital, sleeping quarters for about 10,000 detainees and personnel and a foul-smelling burn pit run by KBR.

A kind of grim gallows humor infected the encampment, Kleponis recalls. A running joke held that the government forced soldiers to sleep near a burn pit so they would die too young to collect pensions. Kleponis complained to his own superiors as well as to the KBR supervisors on the site. He asked if the garbage could be taken elsewhere to burn or dump, but KBR balked at the idea. So Kleponis suggested they hire a local subcontractor to come and collect the trash. They refused. (Ivy says that the contractors didn’t have the authority to make changes to military decisions about the burn pits.)

“I have zero power over what they serve for breakfast, let alone whether they’re going to burn hazardous waste on our living site,” Kleponis recalls of his KBR counterparts. “I’m sort of a pawn in the game, and they are too.”

On a chilly morning in Washington last April, Susan Zeier, a graying grandmother from Ohio, put on a dead man’s uniform and positioned herself on the sidewalk outside the V.F.W. office. The hem of the camouflage Army jacket dangled long down her thin legs, making her look like a child playing dress up. The clothes had belonged to Zeier’s son-in-law, a young man who survived Iraq only to die slowly of lung cancer back home, leaving Zeier’s daughter a single mother. Zeier had stuck a sign to her back: “Ask me why the soldier who wore this uniform in Iraq is dead.”

Zeier stood with a group of ailing veterans and the survivors of dead veterans who had traveled to the capital from places like Tennessee, Minnesota and New York. A few wore oxygen concentrators strapped to their torsos, hissing and sighing softly like a distant shoreline. These were the contemporary torchbearers of a sorrowful tradition stretching back to the enraged Revolutionary War militiamen who barricaded a group of the founding fathers into the Philadelphia capital to demand unpaid wages: disillusioned veterans begging the federal government to take care of them.

Zeier had been trying for years to get the government’s attention. Years before President Biden was elected, she drove to his book event in Pittsburgh and paid $400 for a meet-and-greet ticket just so she could ask him, in person, to help burn-pit victims. Biden, she recalled, said: “I want what you want. I’m working on this.”

But it was Jon Stewart who finally supercharged the burn-pit movement. As Zeier stood on the pavement last spring, Stewart was arguing her cause in a closed-door meeting with Jon Tester, the chairman of the Senate Appropriations Subcommittee on Defense. Stewart was accompanied by his lobbying partner, John Feal, a tough-talking demolition expert who lost a foot after it was crushed at ground zero only to emerge as a ruthless advocate for Sept. 11 first responders and, now, burn-pit victims. Nobody was surprised that Tester had agreed to see them; few in Washington were willing to risk snubbing the pair.

Stewart wasn’t just famous; he was also feared, having shown himself willing to subject feckless politicians to public shame. A protracted struggle to force Congress to pay for the medical costs of sickened Sept. 11 first responders came to a head when a tearful and indignant Stewart dressed down lawmakers for their indifference. “You should be ashamed of yourselves,” he told a half-empty chamber in 2019, “but you won’t be.” The video went viral and, the next month, Congress approved permanent funding for the 9/11 victims. Only two lawmakers dared to vote no.

“Members of Congress wouldn’t give us the time of day,” says Rosie Torres, a founder of the advocacy group Burn Pits 360, when I asked her about Stewart’s influence. “If you said, ‘Here’s a widow,’ they’d have their staff playing goalie. And then Jon Stewart walks in, and they say, ‘Absolutely,’ and the whole staff wants to be at the meeting.”

No matter whom I interviewed for this article — doctors and veterans; lawyers and scientists — they all, eventually, pointed to Stewart’s involvement as a driving force of the long-awaited acknowledgment of burn pits as a legitimate health threat. And maybe it’s true; maybe the science and the victims’ stories were never going to be enough. Maybe it was always a matter of publicity and political appetite. “I’ve got one monkey trick,” Stewart told me. “I can get a media organism to turn with me and to focus on something in particular. A moment in time. If we can make that moment count, maybe we can get something done.”

With Stewart and Feal hounding lawmakers to take action, the V.A. went to Congress in May to ask for a grace period before imposing any new legislation, promising to use the time to review its own airborne-exposure policies. The new, more generous burn-pit coverage was announced three months later. In another indication of a changed federal approach to airborne hazards, Miller has recently been called to join a V.A. working group to study constrictive bronchiolitis. “I’m kind of being asked back to the table,” he says.

But even Stewart has struggled to get a clear answer on what prompted the V.A.’s policy change in August. No significant research breakthrough had occurred; no study had suddenly proven toxic-smoke exposure to be more harmful than previously understood.

In a September interview on his new current-affairs show, Stewart repeatedly asked Denis McDonough, the V.A. secretary, to explain the precise research metrics or standards that decided which ailments were “presumptive.” Why had the respiratory conditions qualified while cancers and autoimmune diseases had not? “I’m asking them to go get as much science as there is on this,” McDonough said.

“What’s the bar you’re looking for?” Stewart pressed. “If you don’t know the answer, how do you know when you’ve found it?”

“I wish it were like a puzzle,” McDonough said. “I keep asking the same series of questions. OK, so like, we’ve got all these pieces and just tell me where to put them and then let’s figure out which piece we’re missing and then we’ll build that.”

“This delay is killing people,” Stewart said.

McDonough replied: “I’m not rebutting that notion.”

Megan K. Stack is an author and a journalist in Washington. Her most recent book is “Women’s Work: A Personal Reckoning With Labor, Motherhood and Privilege.” She last wrote a feature about the journalist Behrouz Boochani. João Ruas is a painter and an illustrator from São Paulo, Brazil, whose work focuses on folklore, magical realism, the concept of wabi-sabi and human conflict.