Exclusive: Blood tests reveal PFAS among servicemembers as Congress pushes for action from DoD

WASHINGTON (SOA) — There’s a growing national conversation about toxic chemicals known as PFAS, as federal health bodies take action to address contamination and assess health risks. We first reported on a new study linking a PFAS chemical to testicular cancer earlier this week. Now, in an exclusive report, we examined new data about PFAS found in servicemembers’ blood and new efforts in Washington to get care and compensation for those exposed.

Retired Air Force firefighter Kevin Ferrara remembers working with AFFF, firefighting foam we now know was made with PFAS, toxic forever chemicals that have been tied to a host of health problems including cancer.

“They told us it’s soap and water and we believed it,” Kevin Ferrara told Spotlight on America. “We slathered ourselves in this stuff, it came into contact with bare skin and eyes, nose and mouth.”

Today, Ferrara has made it his mission to help firefighters understand the potential risks from their exposure to that foam. He told us firefighters come to him and ask about the health risks. “Usually the first question I get is, ‘Am I going to get cancer?'” said Ferrara.

Answering those questions is complicated, but new studies are shedding light.

As we first reported earlier this month, a first-of-its-kind federal study performed the largest examination of PFAS exposure and testicular cancer to date, by looking at the banked blood of Air Force servicemembers. It found those employed in fire protection had elevated concentrations of PFOS, a PFAS chemical, in their blood. Higher blood levels of PFOS were linked to testicular cancer.

It’s the latest in a growing body of research tying PFAS to health effects, but despite widespread use of firefighting foam, and suspected contamination in the groundwater of hundreds of military bases, exposure to PFAS is not widely considered a service-connected injury, and sources tell Spotlight on America there’s a lack of understanding and uniformity among medical providers.

“We’re calling PFAS, the new Agent Orange,” said Kevin Ferrara. “It’s frightening because you look at what the DoD has done to veterans that were exposed to Agent Orange, they strung them along for decades until they finally recognized it.”

Congress mandated that the Department of Defense offer blood tests to military firefighters to look for PFAS chemicals in 2020.

The first results were reported to Congress this year. Spotlight on America dug through the data, finding that more than 9,100 firefighters opted for a blood test in 2021.

You can read the full report to Congress below.

We took the results to PFAS researcher and former West Virginia University Professor Dr. Alan Ducatman.

“When you get to the 95th percentile, which is 5% of people, those exposures get to be quite high,” Dr. Ducatman said. “There are some people with extraordinary exposures, and there’s every opportunity to figure out what those people are doing and to think about the jobs and what may be leading to those exposures that could be backtracked, and public health could be improved.”

Most of the blood tests performed, about one third, were servicemembers in the Air Force. The PFAS detected most often in the serum was PFOS, which was found in 95.6% of the samples.

Overall PFAS geometric mean blood concentrations ranged from a high for PFOS at 3.1 nanograms per milliliter (ng/mL), followed by PFHxS (2.8 ng/mL), PFOA (1.1 ng/mL), and PFNA (0.42 ng/mL).

In a 300-page report, the National Academies of Sciences suggested that 20ng/mL of PFAS in blood is serious enough to screen patients for signs of testicular cancer and other health effects.

Among the DoD’s blood test results, levels of just one PFAS chemical at 150 ng/mL. That’s more than seven times higher than the NAS designated level that could indicate potential health effects.

Still, the full extent of exposure in the military community at large is unknown.

Blood tests are only offered to active duty and reserve firefighters, not veterans or other servicemembers who may have worked with AFFF.

The VA’s web site does not recommend blood tests, saying most Americans have PFAS in their blood and saying “blood tests cannot be linked to current or future health conditions.”

Congressman Dan Kildee (D-MI) doesn’t believe people understand the risk to veterans. He created the Congressional PFAS Task Force in 2019.

“We have not seen, whether it’s in the VA or the DOD, we haven’t seen the kind of urgency that we think should be applied to PFAS contamination,” Rep. Kildee said. “I just don’t think the the federal government is doing anywhere near enough.”

For now, even with the results of a blood test in hand, we discovered military firefighters are fending for themselves.

Kevin Ferrara said he’s spoken with firefighters left confused by their results.

“A lot of times they say, the doctor looks at them and says, ‘I have no idea what this data means. Good luck.'” Kevin Ferrara said. “That’s not what these firefighters need to encounter when they see a physician.”

Dr. Alan Ducatman told us it’s unreasonable to expect that not all doctors are PFAS experts, but it’s important for medical monitoring systems to be in place. “It would be good to get a cadre of doctors for the military and for communities who have had these elevated exposures who do understand the problem and who can help those community members.”

Spotlight on America obtained guidance the military gave to its practitioners offering PFAS blood tests, telling them to inform patients “any follow-on health care or medical evaluations based on the PFAS laboratory result must be sought from their private healthcare at their own expense.”

Congressman Kildee calls that “unconscionable.”

He’s introducing legislation called the Veterans Exposed to Toxic PFAS Act, which would require the VA medical system to treat those cases as duty-related, to include high cholesterol, ulcerative colitis, thyroid disease, testicular cancer, kidney cancer and pregnancy-induced hypertension.

But the bill has not advanced.

“When a person puts on the uniform of the country, they accept certain risk,” Rep. Kildee said. “But we also say to them, if you get injured, we’re going to take care of you. We’re gonna have your back. And the very idea that we have to pass legislation to codify a promise that I think is implicit is very frustrating to me.”

It’s frustration shared by Kevin Ferrara.

“Congress can make change within a day with a swipe of a pen,” he said. “Every single day that Congress is sitting on this and arguing over whose name’s going to be on the bill, who’s going to sponsor it, who’s gonna vote on it? We have veterans out there every day that are suffering from PFAS, and they’re dying from this stuff.”

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The VA told Spotlight on America it’s reviewing new studies about PFAS. You can read our full Q&A with the VA below:

Q1. (VHA) Is the VA aware of the federal study that linked PFOS in service members to testicular cancer ? What is the VA’s response to that study? Is there discussion about how those findings may inform the treatment of military members?

A1. We are currently reviewing this study. Veterans who feel as though their health has been impacted by exposure to PFAS during their military service are encouraged to file a claim for disability benefits. These claims are considered on a case-by-case basis.

Q2. (VBA) Is the VA aware of legislative efforts to designate PFAS exposure as a service-connected injury? What is the VA’s response to those efforts, and does it plan to comply with the law if passed?

A2. We are closely monitoring the research regarding exposure of service members to PFAS. PFAS are synthetic chemicals that are contained in many products such as fire-fighting foams (aqueous film forming foams (AFFF)), clothing, furniture, food packaging, and may be contained in drinking water and certain foods.

While no presumptions have been established to date for any specific medical condition based on exposure to PFAS, a presumption is not required to establish service connection. VA makes decisions on claims based on exposure to PFAS or a specific source of PFAS, such as aqueous film forming foams, on a case-by-case basis. For example, for a Veteran filing a claim for disability due to exposure to aqueous film forming foams, VA reviews the facts and evidence such as the types, levels, and duration of exposure (if known), onset and nature of claimed medical condition(s) and other factors to determine if disability compensation is warranted. If there is an approximate balance of positive and negative evidence, VA gives the benefit of the doubt to the Veteran.

Our general policy has always been that disability compensation can be granted if a Veteran has a current disability that is related to his or her military service including disabilities related to in-service exposures like PFAS. Any Veteran who feels that military service has negatively impacted his/her health is encouraged to submit a claim for disability compensation.

Q3. (VHA) Does the VA recommend that military firefighters receive blood tests for PFAS, in light of the study finding that those employed in fire protection had elevated levels of PFOS?

A3. We are currently reviewing scientific information related to PFAS blood testing and the utility of such tests in a clinical setting. It has been established that a blood test for PFAS gives only a snapshot of what is in the body at that time; it cannot inform on when an exposure occurred, source of exposure, or current or future health outcomes. We will continue to discuss this issue and will review additional information as it becomes available. We are also actively working to address research gaps related to PFAS-related health outcomes in the following efforts:

A collaboration between VA’s Health Outcomes Military Exposures (HOME) program, Central Arkansas VAMC and Naval Health Research Center is leveraging assets from the Millennium Cohort Study to investigate PFAS levels in military firefighters (occupationally exposed) and construction workers (occupationally unexposed) as identified by military occupational specialty (MOS) codes. The study will also investigate correlations between PFAS levels and cardiometabolic outcomes and biomarkers.

A pilot study collaboration between HOME’s Exposure Science Program, Defense Centers for Public Health – Aberdeen and the National Institute for Environmental Health Sciences is to investigate and track PFAS exposures in active-duty firefighters via dried blood spots. Correlations with biomarkers of effect will be evaluated.

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Spotlight on America also posed a list of questions about blood testing to the Department of Defense. You can read their full responses below:

1) What is being done to analyze blood test results on a wide scale?

Response. Since October 2020, PFAS testing has been offered to all DoD firefighters during their annual physical exams as directed by Congress (Section 707 of the National Defense Authorization Act for Fiscal Year 2020). The PFAS testing offered to each DoD firefighter is directed in DoD Policy, “DoD Manual 6055.05-Occupational Medical Examinations: Medical Surveillance and Medical Qualification, Section 5.13”, available at https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/605505m.PDF?ver=3u-UoR7v7wydz-RIKQkI_Q%3D%3D. Currently, an individual’s PFAS levels cannot be used to predict adverse health effects and no occupational screening values for PFAS have been established. Exposure assessments and health studies are under way by organizations such as the Department of Health and Human Services (DHHS) Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances Disease Registry (ATSDR). They may inform whether screening values can be determined for PFAS in the blood of the general public and for occupational settings. Results from our analysis of DoD firefighters is included in the response to the second question.

2) Can your office provide data on what has been collected and found?

Response. PFAS levels in blood are the result of exposures from all sources: environmental, occupational, and use of consumer products. The presence of PFAS in DoD firefighter blood does not tell us how, where, when, or for how long a person was exposed to PFAS, and whether it was from firefighting or other sources of PFAS. The following six PFAS were tested in the blood of DoD firefighters from October 1, 2020 through May 1, 2023: perfluorooctanoic acid (PFOA); perfluorooctane sulfonate (PFOS); perfluorohexanesulfonic acid (PFHxS); perfluorononanoic acid (PFNA); perfluoroheptanoic acid (PFHpA); and perfluorobutanesulfonic acid (PFBS). Additional PFAS were added, beginning in May 1, 2023. Summary statistics for the first year of DoD firefighter blood testing can be found on https://www.health.mil/Reference-Center/Reports/2023/02/14/Perfluorinated-Chemicals-PFCs-Contamination-and-First-Responder-Exposure.

Analysis of results from samples collected from the second year of testing (October 1, 2021 through September 30, 2022) is currently underway. In addition to similar summary statistics, the DoD will include some initial trending information between the first and second year of offering tests to DoD firefighters.

Additionally, the DoD is currently planning to have future blood samples analyzed using the CDC’s analytical method. This will allow the DoD to reevaluate PFAS being analyzed and consider additional PFAS analytes to better align with those being analyzed by the CDC. The CDC indicates that their scientists found four specific PFAS (PFOS, PFOA, PFHxS, and PFNA) in the blood of nearly all of the people tested, indicating widespread exposure to these PFAS in the U.S. population. CDC data suggest that over 98% of Americans have detectable levels of PFAS in their blood. The data tables showing PFAS blood testing results for the general population since 1999 can be viewed at: https://www.cdc.gov/exposurereport/.

3) What examinations are underway?

Response. The DoD is collaborating with other Federal agencies that are leading efforts associated with the completion of environmental and occupational exposure assessments, risk assessments, and health studies. The ATSDR and CDC’s National Institute for Occupational Safety and Health (NIOSH) are conducting health and exposure studies to understand PFAS exposure pathways from environmental and occupational PFAS sources, and whether these exposures are linked with potential health outcomes. The results of these studies will inform the development of exposure assessments, occupational exposure limits and medical surveillance requirements for the DoD. In addition, the Department will update its guidance to DoD healthcare providers when ATSDR revises their PFAS clinical guidelines.

4) How many of these blood tests have been performed?

Response. DoD records indicate that in Fiscal Year (FY) 2021, 10,208 DoD firefighters were offered a blood test for PFAS as part of their existing annual firefighter occupational medical surveillance exam. Of these, 9,104 DoD firefighters chose to have their blood tested and 1,004 DoD firefighters opted not to have their blood tested. A complete analysis of recent (FY2022 and beyond) blood testing data is ongoing and unavailable at this time.