Presumptive Service Connection: Former Servicemembers of Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
link to page 1 
Updated September 2, 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. Congress has debated
Former K2 servicemembers and veterans have expressed
multiple 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. Though the Department of
stationed at specific military installations. One proposal
Veterans Affairs (VA) has acknowledged a connection
specifically includes those formerly stationed at Camp
between certain respiratory conditions associated with
Stronghold Freedom and who have since developed certain
health issues or disabilities.
service at K2 and other locations, veterans (including those
with other health conditions) may still believe there could
What is Camp Stronghold Freedom?
be challenges with accessing VA health benefits or
In October 2001, the U.S. military established Camp
disability compensation.
Stronghold Freedom at Karshi-Khanabad (K2) Airbase in
What DOD or VA benefits are available to
Uzbekistan (see Figure 1). Located on a former Soviet-era
servicemembers and veterans who served at K2?
air base, Camp Stronghold Freedom served as an
Health Benefits. Current servicemembers and military
intermediate staging base to support logistics and air base
retirees who served at Camp Stronghold Freedom, and
requirements for Operation Enduring Freedom and other
elsewhere, are eligible for health benefits through DOD’s
military operations in the region. In November 2005, at the
TRICARE program. Individuals enrolled in a TRICARE
request of the Government of Uzbekistan, the U.S. military
health plan may receive care at military treatment facilities
departed Camp Stronghold Freedom. The Department of
or from participating civilian health care providers.
Defense (DOD) estimates 15,767 servicemembers deployed
Veterans, including military retirees, may be eligible for
to Camp Stronghold Freedom between 2001 and 2005.
VA health care if they have documented service-connected
Figure 1. Karshi-Khanabad Airbase, Uzbekistan
disabilities, are Medal of Honor or Purple Heart recipients,
or were exposed to certain toxic substances or
environmental hazards (e.g., Agent Orange). After VA
health care eligibility is 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
Source: CRS graphic.
P.L. 103-210 in 1993. Veterans returning from current
Were harmful or toxic substances present at K2?
combat theaters of operations may enroll in VA health care
for five years from the date of their discharge without the
Between 2001 and 2005, DOD conducted three classified
need to demonstrate a service-connected disability or
“occupational and environmental surveys” of K2.
satisfy a means-test requirement. Veterans eligible under
Unclassified summaries of these surveys described the
this condition may be assigned to Priority Group 6 and are
presence of underground jet-fuel plumes, asbestos-
generally not subject to any VA cost sharing requirements.
contaminated surface dirt, trace amounts of depleted
After the five-year period ends, these veterans may be
uranium, and periodic high levels of dust and other air
reassigned to a different priority group depending on other
particulate matter. DOD noted that military officials
eligibility requirements.
implemented mitigation efforts (e.g., covering contaminated
soil and declaring off-limits areas) to reduce the
https://crsreports.congress.gov
Presumptive Service Connection: Former Servicemembers of Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
Disability Compensation. Veterans with a presumptive or
consider expanding health care eligibility to K2 veterans
confirmed service-connected disability may apply for VA
for certain presumptive service-connected disabilities;
disability compensation. If a disease or illness is designated,
and within one year conduct a study of the toxic hazards
by statute or regulation, as presumptively service-
and servicemember exposures at K2, health
connected, veterans must only demonstrate they served at a
consequences of such exposures, and causal links
specific place and time, and later incurred an illness that is
between such exposures and identified health
then presumed to be connected to military service through
consequences.
exposure. Veterans need not prove exposure.
Selected Issues for Congress
Diseases or conditions with Presumptive Service
Limited research studies to evaluate potential
Connection are those “incurred in or aggravated by
associations between toxic exposures at K2 and adverse
service if manifested to a compensable level within the
health effects. In 2015, the Army Public Health Command
time frame specified for that certain disease under the
found that there may be an increased risk of developing
regulation, even if there is no evidence of such disease
certain types of cancers among servicemembers who served
during service.”
at K2 and indicated that “broader studies to evaluate
- Department of Veterans Affairs M21-1 IV.i .2.B.2.a. Adjudication
incidence of cancers following military deployment” would
Procedures Manual
be needed. DOD and VA are in the process of developing a
“much larger and more comprehensive study to evaluate the
In August 2021, VA began processing disability claims for
potential associations of K2 deployment on health.”
newly established service presumptions for asthma, rhinitis,
Congress could direct or appropriate funds for additional
and sinusitis. VA is automatically reviewing pending claims
research to identify sufficient evidence of an association or
of K2 veterans, among others, with one or more of these
non-association between exposures at K2 and additional
conditions and will notify claimants of their decisions. If a
health outcomes that are currently not presumptions.
veteran has other health conditions that may be related to
Consideration of expanding presumptive service
his or her service at K2, the veteran must establish direct
connection and impact on spending. Other than VA-
service connection for those conditions in order to be
authorized presumptions for three respiratory conditions,
considered for disability compensation.
there are no other statutory or regulatory presumptive
Direct service connection refers to an injury or disease
conditions associated with service at Camp Stronghold.
incurred or aggravated during military service and
Congress could consider existing medical evidence and
documented through relevant medical and lay evidence.
presumptions associated with possible exposures at K2 to
Documentation includes the veteran’s service records, type
determine whether or not sufficient evidence exists to
of deployments, and the circumstances of service. The
expand presumptions of service at K2. An expanded list of
“burden of proof” generally falls on the veteran to
presumptions would likely require an increase to mandatory
demonstrate to VA that a direct connection exists between
spending for VA’s disability compensation fund. In
his or her condition or illness and exposure to a toxic
addition, expanding eligibility for VA health care to certain
hazard.
veterans who served at K2 may increase VA discretionary
spending.
What recent actions have the President or
Congress taken to address toxic exposures at K2?
CRS Products
Several bills were introduced during the 117th Congress,
CRS In Focus IF10302, Uzbekistan.
and are still under consideration, that would establish
certain presumptions for K2 veterans. During the 116th
CRS Report R44837, Benefits for Service-Disabled Veterans.
Congress, the following executive actions and legislative
CRS Insight IN11724, VA Now Processing Gulf War Veterans’
provisions were enacted:
Disability Claims for New Respiratory Presumptive Conditions.
Veterans Health Care and Benefits Improvement Act
CRS In Focus IF10555, Introduction to Veterans Health Care.
of 2020 (P.L. 116-315). Section 2010 directs the VA
CRS In Focus IF10530, Defense Primer: Military Health System.
Secretary to enter into an agreement with the Agency for
Toxic Substances and Disease Registry to study and
report to Congress the incidence of cancer and other
Other Resources
diseases of servicemembers who previously served at
Army Public Health Command, “Environmental Conditions at
K2, develop a list of toxic substances or hazards that
Karshi Khanabad (K-2) Air Base, Uzbekistan,” accessed March
such servicemembers may have been exposed to, and
23, 2021.
the health consequences of such exposures.
Jessica M. Sharkey and Joseph H. Abraham, “Evaluation of
National Defense Authorization Act for Fiscal Year
Postdeployment Cancers Among Active Duty Military
2021 (P.L. 116-283). Section 751 directs the Defense
Personnel,” US Army Medical Department Journal, 2015.
Secretary to study and submit a report, within 180 days,
to Congress on toxic exposures of servicemembers
previously deployed to K2, related health consequences,
Bryce H. P. Mendez, Analyst in Defense Health Care
and associations between such exposures and health
consequences.
Policy
Executive Order 13982—“Care of Veterans with
Heather M. Salazar, Analyst in Veterans Policy
Service in Uzbekistan.” Directs the VA Secretary to
IF11813
https://crsreports.congress.gov
Presumptive Service Connection: Former Servicemembers of Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permissio n of the copyright holder if you
wish to copy or otherwise use copyrighted material.
https://crsreports.congress.gov | IF11813 · VERSION 3 · UPDATED
Updated September 2, 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. Congress has debated
Former K2 servicemembers and veterans have expressed
multiple 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. Though the Department of
stationed at specific military installations. One proposal
Veterans Affairs (VA) has acknowledged a connection
specifically includes those formerly stationed at Camp
between certain respiratory conditions associated with
Stronghold Freedom and who have since developed certain
health issues or disabilities.
service at K2 and other locations, veterans (including those
with other health conditions) may still believe there could
What is Camp Stronghold Freedom?
be challenges with accessing VA health benefits or
In October 2001, the U.S. military established Camp
disability compensation.
Stronghold Freedom at Karshi-Khanabad (K2) Airbase in
What DOD or VA benefits are available to
Uzbekistan (see Figure 1). Located on a former Soviet-era
servicemembers and veterans who served at K2?
air base, Camp Stronghold Freedom served as an
Health Benefits. Current servicemembers and military
intermediate staging base to support logistics and air base
retirees who served at Camp Stronghold Freedom, and
requirements for Operation Enduring Freedom and other
elsewhere, are eligible for health benefits through DOD’s
military operations in the region. In November 2005, at the
TRICARE program. Individuals enrolled in a TRICARE
request of the Government of Uzbekistan, the U.S. military
health plan may receive care at military treatment facilities
departed Camp Stronghold Freedom. The Department of
or from participating civilian health care providers.
Defense (DOD) estimates 15,767 servicemembers deployed
Veterans, including military retirees, may be eligible for
to Camp Stronghold Freedom between 2001 and 2005.
VA health care if they have documented service-connected
Figure 1. Karshi-Khanabad Airbase, Uzbekistan
disabilities, are Medal of Honor or Purple Heart recipients,
or were exposed to certain toxic substances or
environmental hazards (e.g., Agent Orange). After VA
health care eligibility is 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
Source: CRS graphic.
P.L. 103-210 in 1993. Veterans returning from current
Were harmful or toxic substances present at K2?
combat theaters of operations may enroll in VA health care
for five years from the date of their discharge without the
Between 2001 and 2005, DOD conducted three classified
need to demonstrate a service-connected disability or
“occupational and environmental surveys” of K2.
satisfy a means-test requirement. Veterans eligible under
Unclassified summaries of these surveys described the
this condition may be assigned to Priority Group 6 and are
presence of underground jet-fuel plumes, asbestos-
generally not subject to any VA cost sharing requirements.
contaminated surface dirt, trace amounts of depleted
After the five-year period ends, these veterans may be
uranium, and periodic high levels of dust and other air
reassigned to a different priority group depending on other
particulate matter. DOD noted that military officials
eligibility requirements.
implemented mitigation efforts (e.g., covering contaminated
soil and declaring off-limits areas) to reduce the
https://crsreports.congress.gov
Presumptive Service Connection: Former Servicemembers of Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
Disability Compensation. Veterans with a presumptive or
consider expanding health care eligibility to K2 veterans
confirmed service-connected disability may apply for VA
for certain presumptive service-connected disabilities;
disability compensation. If a disease or illness is designated,
and within one year conduct a study of the toxic hazards
by statute or regulation, as presumptively service-
and servicemember exposures at K2, health
connected, veterans must only demonstrate they served at a
consequences of such exposures, and causal links
specific place and time, and later incurred an illness that is
between such exposures and identified health
then presumed to be connected to military service through
consequences.
exposure. Veterans need not prove exposure.
Selected Issues for Congress
Diseases or conditions with Presumptive Service
Limited research studies to evaluate potential
Connection are those “incurred in or aggravated by
associations between toxic exposures at K2 and adverse
service if manifested to a compensable level within the
health effects. In 2015, the Army Public Health Command
time frame specified for that certain disease under the
found that there may be an increased risk of developing
regulation, even if there is no evidence of such disease
certain types of cancers among servicemembers who served
during service.”
at K2 and indicated that “broader studies to evaluate
- Department of Veterans Affairs M21-1 IV.i .2.B.2.a. Adjudication
incidence of cancers following military deployment” would
Procedures Manual
be needed. DOD and VA are in the process of developing a
“much larger and more comprehensive study to evaluate the
In August 2021, VA began processing disability claims for
potential associations of K2 deployment on health.”
newly established service presumptions for asthma, rhinitis,
Congress could direct or appropriate funds for additional
and sinusitis. VA is automatically reviewing pending claims
research to identify sufficient evidence of an association or
of K2 veterans, among others, with one or more of these
non-association between exposures at K2 and additional
conditions and will notify claimants of their decisions. If a
health outcomes that are currently not presumptions.
veteran has other health conditions that may be related to
Consideration of expanding presumptive service
his or her service at K2, the veteran must establish direct
connection and impact on spending. Other than VA-
service connection for those conditions in order to be
authorized presumptions for three respiratory conditions,
considered for disability compensation.
there are no other statutory or regulatory presumptive
Direct service connection refers to an injury or disease
conditions associated with service at Camp Stronghold.
incurred or aggravated during military service and
Congress could consider existing medical evidence and
documented through relevant medical and lay evidence.
presumptions associated with possible exposures at K2 to
Documentation includes the veteran’s service records, type
determine whether or not sufficient evidence exists to
of deployments, and the circumstances of service. The
expand presumptions of service at K2. An expanded list of
“burden of proof” generally falls on the veteran to
presumptions would likely require an increase to mandatory
demonstrate to VA that a direct connection exists between
spending for VA’s disability compensation fund. In
his or her condition or illness and exposure to a toxic
addition, expanding eligibility for VA health care to certain
hazard.
veterans who served at K2 may increase VA discretionary
spending.
What recent actions have the President or
Congress taken to address toxic exposures at K2?
CRS Products
Several bills were introduced during the 117th Congress,
CRS In Focus IF10302, Uzbekistan.
and are still under consideration, that would establish
certain presumptions for K2 veterans. During the 116th
CRS Report R44837, Benefits for Service-Disabled Veterans.
Congress, the following executive actions and legislative
CRS Insight IN11724, VA Now Processing Gulf War Veterans’
provisions were enacted:
Disability Claims for New Respiratory Presumptive Conditions.
Veterans Health Care and Benefits Improvement Act
CRS In Focus IF10555, Introduction to Veterans Health Care.
of 2020 (P.L. 116-315). Section 2010 directs the VA
CRS In Focus IF10530, Defense Primer: Military Health System.
Secretary to enter into an agreement with the Agency for
Toxic Substances and Disease Registry to study and
report to Congress the incidence of cancer and other
Other Resources
diseases of servicemembers who previously served at
Army Public Health Command, “Environmental Conditions at
K2, develop a list of toxic substances or hazards that
Karshi Khanabad (K-2) Air Base, Uzbekistan,” accessed March
such servicemembers may have been exposed to, and
23, 2021.
the health consequences of such exposures.
Jessica M. Sharkey and Joseph H. Abraham, “Evaluation of
National Defense Authorization Act for Fiscal Year
Postdeployment Cancers Among Active Duty Military
2021 (P.L. 116-283). Section 751 directs the Defense
Personnel,” US Army Medical Department Journal, 2015.
Secretary to study and submit a report, within 180 days,
to Congress on toxic exposures of servicemembers
previously deployed to K2, related health consequences,
Bryce H. P. Mendez, Analyst in Defense Health Care
and associations between such exposures and health
consequences.
Policy
Executive Order 13982—“Care of Veterans with
Heather M. Salazar, Analyst in Veterans Policy
Service in Uzbekistan.” Directs the VA Secretary to
IF11813
https://crsreports.congress.gov
Presumptive Service Connection: Former Servicemembers of Camp Stronghold Freedom at Karshi-Khanabad (K2) Airbase
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permissio n of the copyright holder if you
wish to copy or otherwise use copyrighted material.
https://crsreports.congress.gov | IF11813 · VERSION 3 · UPDATED