Toxic Legacy in Youngstown: Veterans Battle PFAS-Linked Kidney Cancer Without PACT Act Support

Since the introduction of the PACT Act in 2022, veterans suffering from over 20 diseases caused by toxic agents listed under the Act are granted automatic compensation and healthcare benefits. This list is updated periodically by the Department of Veterans Affairs (VA). However, several conditions and toxic agents are yet to be recognized under this legislation.

Veterans who were exposed to toxins not yet included here still need to prove a causal link between the chemicals they were exposed to and the development of their illness. Those exposed to per- and poly-fluoroalkyl substances or PFAS find themselves in this position, where they need to submit proof of exposure, data on their health status before exposure, and medical evidence of their conditions. Many times, collecting data for proof is difficult, leading to substantial delays in treatment for serious diseases, including cancers. Nonetheless, the process remains a mandatory requirement for compensation, and many veterans are denied benefits, although there is sufficient evidence to attest to the toxicity of PFAS.

Presently, kidney cancer is included under the PACT Act as a condition for which automatic benefits are provided. However, veterans diagnosed with kidney cancer resulting from PFAS exposure are not eligible for automatic compensation, as PFAS have not yet been classified as a recognized category of toxic substances linked to this condition under current policy. Notably, recent evidence from studies collecting and analyzing data across several years proves a causal and indubitable link between PFAS exposure and the subsequent development of kidney cancer.

Youngstown Veterans Exposed to PFAS and Kidney Cancer Incidence

For the vast majority of veterans exposed to PFAS, exposure occurred during fire drill exercises using PFAS-based firefighting foams, also known as aqueous film-forming foams or AFFF. In the U.S., 720 military bases are now known to be or suspected to be highly contaminated sites. Among these, in the close vicinity of Youngstown, the Youngstown Air Reserve Station (YARS) is known for its historic use of AFFF during training exercises and emergency responses, with action taken now by the Department of Defense (DoD) to phase out AFFF at this location.

Around 3.100 veterans live in Youngstown, and almost 13,000 live throughout Mahoning County. Ohio, where there are several known contaminated military bases, is home to over 600.000 veterans. Given their history, these people may now experience a higher incidence of kidney cancers and other PFAS-related conditions. Population-wise, Ohio has a slightly higher incidence of kidney cancer (18.2 per 100.000) when compared to the national average (17.3 per 100,000). In Mahoning County, the rate of kidney cancer is slightly lower when compared to the national average, at 16.2 per 100.000.

Noting Ohio’s history with AFFF and the presence of known contaminated sites in the county, a substantial portion of these cases may be attributed to veterans alone, resulting in a higher incidence in these groups when compared to the general population. As with any other cancer, kidney cancer has a higher chance of recovery with early diagnosis and treatment. Veterans suffering from this disease as a result of PFAS exposure should therefore benefit from quality healthcare and easy access to compensation, without going through the current administrative burden of proving exposure to a well-documented toxic agent.

The Cost of VA Recognizing PFAS as a Cause of Kidney Cancer

The exclusion of PFAS from the list of recognized substances under the PACT Act creates an inequitable system where the burden of proof falls on those least equipped to meet it. Bearing in mind the mounting scientific evidence and the known presence of PFAS at military installations, it is both a public health necessity and a matter of justice to formally acknowledge PFAS as a presumptive toxic exposure.

However, doing so will likely create a significant financial burden for the VA. While the department is currently investigating the evidence linking PFAS exposure to kidney cancer, as part of their update procedures, recognizing just one disease linked to PFAS exposure will likely not be possible. PFAS are now connected by strong evidence with a series of conditions, such as ulcerative colitis, hypertension, and other types of cancers, such as thyroid cancer and testicular cancer. Once PFAS become recognized as exposure agents under the PACT Act, these diseases are certain to follow in acknowledgement in the upcoming years.

Since the implementation of the PACT Act, up until 2024, the VA provided over 1.7 million claims, with a total of $6.8 billion, of which 75% come directly from the PACT Act. Recognizing PFAS as a presumptive exposure source for kidney cancer would therefore open the door to a new wave of claims. Taking into account the prevalence of PFAS contamination at hundreds of military installations nationwide and the number of veterans potentially affected, this policy shift could represent a considerable fiscal impact. Nevertheless, the potential financial implications must be weighed against the moral and medical necessity of addressing the needs of affected veterans. Denying automatic compensation for PFAS-related kidney cancer not only delays care but also places an unjust burden on veterans to prove what scientific research has already confirmed.