What is Fair? A National Mesothelioma Registry to Improve Health Outcomes for Los Angeles Veterans

Shortly following WWII asbestos use in America increased exponentially, with this material being integrated into civilian and military constructions and installations. By 1970, the U.S. used more than 1,400 million pounds of asbestos with limited knowledge of its effects on human health. While asbestos is generally harmless if left undisturbed, breaking this material disperses tiny fibers into the air which, when inhaled or ingested, have malignant potential.

Among all asbestos-related illnesses, mesothelioma, a rare cancer, currently has no known treatment while diagnosis still poses challenges leading to a high rate of error.

Asbestos exposure influences the emergence of mesothelioma in a dose-dependent manner, meaning that the more fibers inhaled and the longer the exposure, the more likely it is for this disease to occur even decades later. Around 3,000 people are diagnosed in America every year and a third of them are veterans who were exposed in the military during peak asbestos use. Among all veteran groups, Navy veterans have a 540% increased risk of mesothelioma, as these people inhaled substantial amounts of asbestos working below deck in Navy ships.

To improve care for these people, a National Mesothelioma Registry was opened for discussion in 2019, supported by the Centers for Disease Control and Prevention (CDC) and the Dept. of Health and Human Services (HHS). Now, six years later, the project has made no progress. Noting that a large number of those affected are former military staff, support from the Dept. for Veterans Affairs (VA) and the Dept. of Defense (DoD) is necessary.

These federal bodies could not only fund feasibility testing and research but could also share data on asbestos exposure and support the development of this national database.

Coastal states carry a significant burden of asbestos-related illnesses due to shipbuilding activities carried out for decades in these regions. In California, a total of 27,080 asbestos-related deaths were reported between 1999 and 2017 with 5,100 attributed to mesothelioma alone. In Los Angeles for the same period, 4,979 people lost their lives to asbestos illnesses including mesothelioma, asbestosis and lung cancer.

In California, 4.3% of the adult population served in the military, totaling more than 1.4 million people. Almost half a million served in the military when asbestos regulations were not yet implemented, leading to an increased incidence of disease among these groups. In Los Angeles, from a total veteran population counting 62,818 individuals, more than 20,000 served in Vietnam, over 3,000 in Korea and more than 400 served in the Second World War, all periods aligned with unrestricted asbestos use. In La Crescenta-Montrose, out of the approximately 500 veterans who live here, 400 served during this time, making this group particularly vulnerable to developing asbestos-related illness.

In early stages, mesothelioma manifests with non-specific symptoms including shortness of breath, chest pain and dry cough. As mesothelioma is rare, and decades can pass between exposure and disease development, many people fail to connect these symptoms with past asbestos inhalation, further contributing to a delay in diagnosis. In this context, the national registry includes periodic survey-based rapid screenings, collecting data on patient histories and triggering further investigations when past asbestos exposure is present.

Mesothelioma is severely under-researched, not only because of its rarity but also because researchers face statistical barriers in conducting these investigations, given the reduced number of available patients who may take part in clinical trials. In this case, a common database as proposed by the national registry could facilitate access to larger sample pools and drive-up scientific efforts for developing better diagnosis and treatment approaches.

Considering the potential positive effects that a National Mesothelioma Registry could have on improving care and research efforts for this disease, implementing this project is essential not only for people suffering today but also for future generations. Although the VA does provide compensation for asbestos exposure for claims filed under the PACT Act, veterans who receive healthcare and resource access have little use for these benefits if clinical practice is underdeveloped. For the VA, upholding its promise and duty of care in the event of illness also

means supporting research efforts and clinical developments that would provide fair access to improved diagnosis and treatment methods to veterans who need it most.

Jonathan Sharp is the director of Financial Operations for the Environmental Litigation Group, P.C. He is also an environmental attorney, handling cases of toxic exposure, including claims processing and preparations for veterans exposed to asbestos, advocating for policy improvements and just compensation.