Can AFFF Exposure Cause Ulcerative Colitis in Veterans?

The use of AFFF by firefighters, particularly in military settings, has been drawing increasing attention to exposure risks and health conditions deriving from it. Military bases, airports, and industrial facilities applied AFFF for decades, setting the base for generations of service members facing PFAS contamination.

Because PFAS persist in the environment and the human body for years, concerns about the long-term effects of AFFF exposure continue to grow for firefighters, military personnel, airport workers, and communities living near contaminated water sources. While much attention has been directed towards the link between PFAS, various cancers, and metabolic disorders, medical evidence also suggests that PFAS may also play a significant role in autoimmune diseases. particularly ulcerative colitis (UC), by:

• altering gut bacteria
• disrupting immune responses
• increasing chronic inflammation throughout the body

UC is a long-term disease, an abnormal immune reaction that affects the lining of the large intestine and occurs in approximately 750,000 people nationwide. UC is also one of the most common types of inflammatory bowel disease (IBD), with symptoms usually developing over time. It can sometimes lead to life-threatening complications if not properly treated. While there is no current cure, treatment can significantly reduce symptoms and heal the lining of the colon, potentially leading to long-term remission.

Ulcerative Colitis Cases Continue to Rise in Veterans

According to the NCBI StatPearls medical reference, UC affects approximately 1 to 3 individuals per 1,000. Additionally, 9 to 20 people per 100,000 are diagnosed yearly, leading to thousands of new cases nationwide. Moreover, data from the VA shows that, within the veteran population, UC is also present at increasing levels. VA healthcare records show a range of hundreds of veteran cases per 100,000 patients, with prevalence continuing to rise over time, consistent with broader national trends. Though current research doesn't confirm a direct link between military service and UC, the condition is regularly monitored and managed within the VA healthcare system.

What Increases the Risk of Ulcerative Colitis?

Besides the widely accepted role of genetics and immune system dysfunction in susceptibility to UC, long-term chemical exposure in military settings has gained attention. It's an obvious risk factor, particularly in environments with:

• PFAS industrial materials
• fuel combustion
• firefighting activities

These exposures are not only limited to deployment conditions but can also overlap with certain jobs after service, such as firefighting. Among veterans' chemical exposures, PFAS are still being researched in relation to chronic inflammation and immune system effects. While a direct link to UC is yet to be confirmed, PFAS exposure is currently being examined within broader research on environmental factors linked to chronic digestive and autoimmune diseases. Generally, UC is attributed to a combination of genetics, immune response, and environmental factors due to:

• increased rates in highly industrialized regions
• possible links to gut microbiome changes
• associations with air pollution and chemical exposure (under study)
• stress and disrupted daily routines ( active research)

Types of Ulcerative Colitis

The disease is classified according to the location and extent of inflammation in the colon. UC typically begins in the rectum and may spread to involve part or all of the colon. Based on the area affected, UC is categorized into the following types:

• ulcerative proctitis
• left-sided colitis
• pancolitis

Depending on the symptoms, UC may be:

• mild
• moderate
• severe

About half of the individuals diagnosed with UC usually have mild to moderate symptoms. However, symptoms can vary depending on how severe the inflammation is, including:

• diarrhea, with blood, mucus, or pus
• blood in the stool
• abdominal pain and cramping
• rectal pain
• sudden or urgent need to defecate
• difficulty passing stool despite the urge
• weight loss
• fatigue
• fever

The course of UC varies from person to person. Some individuals experience long symptom-free periods, known as remission.

Ulcerative Colitis Diagnosis and Treatment

While someone may look fine, their intestines may be inflamed and ulcerated, causing excruciating pain. Being one of the invisible diseases, as it cannot be seen from the outside, testing for UC can help with the diagnosis. Physical exam is also a common diagnostic procedure, during which a doctor may also ask questions about:

• medical history
• family history
• diet
• daily activities

Some diagnostic testing may include:

• endoscopy
• sigmoidoscopy
• colonoscopy
• biopsy
• chromoendoscopy
• X-rays
• CT scans
• MRI

The primary goals of UC treatment are to control symptoms, reduce inflammation, and regulate the immune system to help maintain longer periods of remission. Common treatment options include:

• anti-inflammatory medication
• immune system suppressors
• diet and nutrition changes
• surgery

In all cases, it's important to routinely check for cancer development if a person has UC, as practice has shown that those diagnosed with this illness face a substantial risk of developing colorectal cancer.

High Misdiagnosis Rates in Firefighters Exposed to AFFF

If you are or have been a military firefighter and are concerned about possible UC, you should be aware of the symptoms and seek medical attention promptly.

In case of a different diagnosis with another disease, it is essential to look for a second and even a third medical opinion, just to be sure. UC can easily be mistaken for the other conditions in the inflammatory bowel disease group, often misdiagnosed as:

• colon cancer
• bacterial infection
• Chron's disease
• irritable bowel syndrome
• colitis from other causes
• H. pylori infection
• medication reactions
• colon polyps

An accurate UC diagnosis is important not only for proper treatment but also for filing an AFFF exposure claim, given that UC is the only inflammatory bowel disease that qualifies firefighters for compensation.

Direct Service Connection for Ulcerative Colitis

Direct service connection is granted when veterans can prove that their UC was caused or worsened by military service. Typically, former service members must present the VA with the following evidence:

• an in-service event, injury, or illness
• a current diagnosis of UC by a medical professional
• a medical link between the in-service event, injury, or illness and the current diagnosis

To support the claim for service connection, veterans may also submit lay evidence or lay statements, which can be written by veterans themselves or anyone who knows the veteran and can speak to their condition. It's important to know that lay evidence may also be submitted by fellow service members.

Secondary Service Connection for Ulcerative Colitis

In claims for UC as a secondary service connection, proving a nexus is especially important. The link between a veteran's primary disability and secondary disability must be clearly established for secondary service connection to be granted. Conditions connected and claimed as secondary to UC include:

• PTSD
• endometriosis
• rectal disorder
• COPD

However, this is not a complete list, as many other conditions may also be associated with UC. In addition, a diagnosis received after military service does not automatically disqualify a former service member from establishing a claim. If medical records or a physician's opinion indicate that symptoms began during or shortly after service, that evidence may still be sufficient to support the case. UC is rated by the VA under 38 CFR 4.114, Schedule of Ratings for the Digestive System, specifically under diagnostic code 7323. Disability evaluations range from 10% to 100%, based on factors such as:

• frequency of flare-ups
• severity of symptoms
• impact on daily life and health

Claiming Ulcerative Colitis Caused by PFAS

Although the VA doesn't currently classify UC as a presumptive condition linked with PFAS exposure, each claim must be supported by individual medical evidence demonstrating a direct link between service-related exposure and the condition. Research is ongoing for possible associations between PFAS exposure and:

• immune system effects
• chronic inflammation
• autoimmune conditions

When veterans file a claim, documenting exposure history can still be important. PFAS exposure history includes:

• duty locations
• firefighting roles
• deployment records

Medical providers may also consider PFAS exposure in a nexus opinion when evaluating possible service connection. Those veterans whose UC prevents them from sustaining stable, gainful employment may qualify for total disability based on Individual Unemployability (TDIU) through VA. Eligibility depends on the severity of UC affecting:

• work capacity
• daily functioning
• overall health

Especially when UC occurs alongside other service-connected conditions, these impacts become relevant. You can start your claim here. After filing, you will need to submit supporting documents such as medical records and service records. The VA may also schedule a C&P exam to assess the severity before making a decision on the veteran's rating and eligibility for compensation, including possible TDIU in more severe cases.

Assisting Veterans with AFFF Compensation Claims

Since the Navy developed AFFF in the 1960s, it has quickly become widely used in military firefighting and training. With science advancing with proof on how repeated exposure to AFFF may have caused serious long-term health problems in personnel handling it, veterans shouldn't wait to schedule health check-ups.

If you were regularly exposed to AFFF and are experiencing symptoms of UC, or believe your condition may be connected to in-service AFFF exposure, it's important to explore your legal options, as you may qualify for compensation under the 2024 ACT. We can connect you with legal specialists who can explain your rights and assist you with filing an AFFF claim.