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April 21, 2021
Presumptive Service Connection: Former Servicemembers of
Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
In recent years, exposure to potentially toxic hazards, like
environmental health risks and determined that health
open-air burn pits, has gained congressional attention. In
effects from the short-term, low-dose exposures present at
the 117th Congress, the House and Senate Veterans’ Affairs
K2 were “unlikely.”
Committees have indicated ongoing interest in examining
What concerns do former K2 servicemembers and
the association of illnesses with exposure to certain toxic
veterans have?
hazards during military service. It is possible that Congress
Former K2 servicemembers and veterans have expressed
may debate legislative proposals to establish presumptive
concerns about ongoing or potential health issues or
service connection for veterans potentially exposed to toxic
disabilities that may be associated with their service at
hazards while conducting military operations or while
Camp Stronghold Freedom. Since neither Congress nor the
stationed at specific military installations. One in particular
Department of Veterans Affairs (VA) has authorized
includes those formerly stationed at Camp Stronghold
presumptive or direct service connection for service at K2,
Freedom and who have since developed certain health
veterans may have perceived challenges with accessing VA
issues or disabilities.
health benefits or disability compensation.
What is Camp Stronghold Freedom?
What DOD or VA benefits are available to
In October 2001, the U.S. military established Camp
servicemembers and veterans who served at K2?
Stronghold Freedom at Karshi-Khanabad (K2) Airbase in
Health Benefits. Current servicemembers and military
Uzbekistan (see Figure 1). Located on a former Soviet-era
retirees who served at Camp Stronghold Freedom, and
air base, Camp Stronghold Freedom served as an
elsewhere, are eligible for health benefits through DOD’s
intermediate staging base to support logistics and air base
TRICARE program. Individuals enrolled in a TRICARE
requirements for Operation Enduring Freedom and other
health plan may receive care at military treatment facilities
military operations in the region. In November 2005, at the
or from participating civilian health care providers.
request of the Government of Uzbekistan, the U.S. military
Veterans, including military retirees, may be eligible for
departed Camp Stronghold Freedom. The Department of
VA health care if they have documented service-connected
Defense (DOD) estimates 15,767 servicemembers deployed
disabilities, are Medal of Honor or Purple Heart recipients,
to Camp Stronghold Freedom between 2001 and 2005.
or were exposed to certain toxic substances or
Figure 1. Karshi-Khanabad Airbase, Uzbekistan
environmental hazards (e.g., Agent Orange). After VA
health care eligibility has been determined, veterans may
formally enroll in VA’s health care system to receive
services.
Occasionally, Congress has granted special eligibility for
health care to those veterans possibly exposed to toxic
substances and environmental hazards under special
treatment authorities. For instance, Congress addressed the
health concerns of Vietnam-era veterans in 1981 with the
passage of the Veterans’ Health Care, Training, and Small
Business Loan Act (P.L. 97-72). Similarly, Congress first
authorized priority health care for Persian Gulf War
veterans with potential, service-related conditions through
P.L. 103-210 in 1993. Veterans returning from current
Source: CRS graphic.
combat theaters of operations may enroll in VA health care
for five years from the date of their discharge without the
Were harmful or toxic substances present at K2?
need to demonstrate a service-connected disability or
Between 2001 and 2005, DOD conducted three classified
satisfy a means-test requirement. Veterans eligible under
“occupational and environmental surveys” of K2.
this condition may be assigned to Priority Group 6 and are
Unclassified summaries of these surveys described the
generally not subject to any VA cost sharing requirements.
presence of underground jet-fuel plumes, asbestos-
After the five-year period ends, these veterans may be
contaminated surface dirt, trace amounts of depleted
reassigned to a different priority group depending on other
uranium, periodic high levels of dust and other air
eligibility requirements.
particulate matter. DOD noted that military officials
implemented mitigation efforts (e.g., covering contaminated
Disability Compensation. Veterans with a presumptive or
soil and declaring off-limits areas) to reduce the
confirmed service-connected disability may apply for VA
https://crsreports.congress.gov
Presumptive Service Connection: Former Servicemembers of Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
disability compensation. If a disease or illness is designated,
Selected Issues for Congress
by statute or regulation, as presumptively service-
Consideration of Establishing Presumptive Service
connected, veterans must only demonstrate they served at a
Connection. Currently there are no statutory nor regulatory
specific place and time, and later incurred an illness that is
presumptive conditions associated with service at Camp
then presumed to be connected to military service through
Stronghold Freedom. Congress could consider existing
exposure. Veterans need not prove exposure. Currently,
medical evidence and presumptions associated with similar
there is no presumption for health conditions associated
toxic exposures seen at K2 to determine whether or not
with service at K2. Veterans with a health condition that
sufficient evidence exists to establish presumption of
may be related to their service at K2 must establish direct
service at K2. Such a presumption would require an
service connection in order to be considered for disability
increase to mandatory spending for VA’s disability
compensation.
compensation fund. Finally if Congress considers granting
presumption, it is important to note that this would counter
Diseases or conditions with Presumptive Service
VA’s current stance that the scientific support “is not there
Connection are those “incurred in or aggravated by
at this time” to establish a service presumption (as stated in
service if manifested to a compensable level within the
a November 2020 House Committee on Oversight and
time frame specified for that certain disease under the
Government Reform hearing on toxic exposures at K2).
regulation, even if there is no evidence of such disease
during service.”
Limited research studies to evaluate potential
- Department of Veterans Affairs M21-1 IV.ii.2.B.2.a. Adjudication
associations between toxic exposures at K2 and adverse
Procedures Manual
health effects. In 2015, the Army Public Health Command
found that there may be an increased risk of developing
Direct service connection refers to an injury or disease
certain types of cancers among servicemembers who served
incurred or aggravated during military service and
at K2 and indicated that “broader studies to evaluate
documented through relevant medical and lay evidence.
incidence of cancers following military deployment” would
Documentation includes the veteran’s service records, type
be needed. DOD and VA are in the process of developing a
of deployments, and the circumstances of service. The
“much larger and more comprehensive study to evaluate the
“burden of proof” generally falls on the veteran to
potential associations of K2 deployment on health.”
demonstrate to VA that a direct connection exists between
Congress could direct or appropriate funds for additional
his or her condition or illness and exposure to a toxic
research to identify sufficient evidence of an association or
hazard.
non-association between exposures at K2 and health
outcomes.
What recent actions have the President or
Congress taken to address toxic exposures at K2?
Expanded benefits may impact discretionary and
In addition to congressional lines of inquiry with DOD and
mandatory spending. As noted above, a new presumption
VA, congressional hearings, and several bills introduced
would require an increase to VA’s mandatory spending for
during the 116th Congress, the following are recently
disability compensation. In addition, expanding eligibility
enacted executive actions and legislative provisions:
for VA health care or other disability benefits to certain
veterans who served at K2 may increase VA discretionary
Veterans Health Care and Benefits Improvement Act
and mandatory spending.
of 2020 (P.L. 116-315). Section 2010 directs the VA
Secretary to enter into an agreement with the Agency for
CRS Products
Toxic Substances and Disease Registry to study and
CRS In Focus IF10302, Uzbekistan, by Maria A. Blackwood
report to Congress the incidence of cancer and other
diseases of servicemembers who previously served at
CRS Report R44837, Benefits for Service-Disabled Veterans,
K2, develop a list of toxic substances or hazards that
coordinated by Heather M. Salazar
such servicemembers may have been exposed to, and
CRS In Focus IF10555, Introduction to Veterans Health Care, by
the health consequences of such exposures.
Sidath Viranga Panangala and Jared S. Sussman
National Defense Authorization Act for Fiscal Year
CRS In Focus IF10530, Defense Primer: Military Health System,
2021 (P.L. 116-283). Section 751 directs the Defense
by Bryce H. P. Mendez
Secretary to study and submit a report, within 180 days,
to Congress on toxic exposures of servicemembers
Other Resources
previously deployed to K2, related health consequences,
Army Public Health Command Factsheet “Environmental
and associations between such exposures and health
Conditions at Karshi Khanabad (K-2) Air Base, Uzbekistan,”
consequences.
accessed March 23, 2021
Executive Order 13982—“Care of Veterans with
Jessica M. Sharkey and Joseph H. Abraham, “Evaluation of
Service in Uzbekistan.” Directs the VA Secretary to
Postdeployment Cancers Among Active Duty Military
consider expanding health care eligibility to K2 veterans
Personnel,” US Army Medical Department Journal, 2015
for certain presumptive service-connected disabilities;
and within one year conduct a study of the toxic hazards
and servicemember exposures at K2, health
consequences of such exposures, and causal links
Bryce H. P. Mendez, Analyst in Defense Health Care
between such exposures and identified health
Policy
consequences.
Heather M. Salazar, Analyst in Veterans Policy
IF11813
https://crsreports.congress.gov
Presumptive Service Connection: Former Servicemembers of Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
Disclaimer
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https://crsreports.congress.gov | IF11813 · VERSION 1 · NEW