Military firefighters trained and responded with AFFF — the PFAS-based foam now at the center of the largest environmental lawsuit in the country — and breathed combustion products on every call.
The error is jumping straight from “used foam” to a specific disease. The record should document the foam use and training frequency, then let a clinician connect it to the diagnosis.
Firefighters are the clearest example of a veteran who may have two separate matters at once: a VA disability claim for service connection, and a separate PFAS lawsuit against the foam manufacturers. The two are decided in different systems and do not cancel each other out.
Related duties that carry the same exposure
A single job code hides the tasks that actually put you in contact with toxins. Count every one of these you performed.
AFFF application, training burns, and system testing
Structural and aircraft-crash fire response
Fuel and hazardous-material response
Apparatus-bay work in diesel exhaust
Exposure to station water where PFAS entered the supply
What these exposures can cost you
PFAS are called “forever chemicals” because they do not break down — in the environment or in the body. Every foam training burn and live response added to a body burden that persists for years, and research links PFAS to kidney and testicular cancer, thyroid disease, ulcerative colitis, high cholesterol, and immune effects. On top of that, the smoke from each fire carried its own respiratory and cancer risk.
Because PFAS accumulate and their diseases develop slowly, a firefighter can carry an elevated risk for decades after the last call. The cost is often a serious, treatable-but-life-altering cancer or chronic condition years down the line. Documenting foam-training frequency and any contaminated station water now protects both a VA claim and, separately, a place in the ongoing PFAS litigation described below.
Watch this
VA Benefits: Toxic Exposure Update
A plain-English overview from the U.S. Department of Veterans Affairs on toxic-exposure benefits and the PACT Act.
Now that you have seen what this job can cost you, here is how the exposure maps to a VA claim — and how to act on it below.
Turn this into a claim
Three questions decide almost every toxic-exposure claim. Here is how to answer them for your service — and how to get help doing it.
Do I qualify?
Almost every toxic-exposure claim comes down to three things — and you generally need all three.
A current diagnosis — a condition a doctor has actually documented, not just symptoms you live with.
An in-service exposure — proof your service put you in contact with the hazard: your MOS, the duties you performed, and your locations and dates.
A link between the two — either a PACT Act presumption that connects them for you, or a medical nexus opinion stating your service at least as likely as not caused the condition.
How to file your claim
You can start today, and filing does not require a lawyer. The path looks like this.
File an Intent to File first — it locks in your effective date and can protect up to a year of back pay while you gather evidence.
Pull your records — service treatment and personnel records, your ILER, any TERA memo, and private medical records for your diagnosis.
Submit VA Form 21-526EZ — online at VA.gov, by mail, or in person, with your evidence and a statement describing your exposure.
Prepare for the C&P exam — know your history cold, and if the exam is inadequate you can challenge it rather than accept a denial.
Want someone to do this with you?
You do not have to figure this out alone. Albert Thombs is a VA-accredited claims agent (#45147) who works the case directly with you.
Free case review — we look at your service, your diagnosis, and whether a presumption or a facts-found theory fits.
No upfront fee — on a first-time claim there is no charge to you.
Fees only if you win an appeal — any fee is capped by law and paid only from past-due benefits actually recovered, never out of pocket.
Each agent below is only compensable if the record shows the source and route. Match every one to what you actually did, where, and for how long.
AFFF / PFAS foam
What it is: Aqueous film-forming foam (AFFF) is the PFAS-based firefighting foam kept for fuel fires. PFAS are the “forever chemicals” that do not break down in the environment or the body.
Where it came from: Training, live response, and system testing
How it harms you: Every training burn, live response, and system test added to a PFAS body burden that persists for years. NASEM found sufficient evidence associating PFAS with kidney cancer and dyslipidemia, and suggestive evidence for testicular cancer, thyroid disease, and ulcerative colitis — so document foam-training frequency, the exposure that also underlies the parallel PFAS litigation.
Why it matters: Linked to kidney, testicular, and thyroid cancer, thyroid disease, and ulcerative colitis; the central firefighter exposure.
Combustion products and smoke
What it is: Every structural and aircraft-crash fire produced a smoke plume of combustion products — soot, hydrocarbons, and toxic gases — that firefighters breathed on each call.
Where it came from: Every structural and crash fire
How it harms you: The fine particulate travels deep into the small airways and into the bloodstream, and combustion smoke carries respiratory-disease and cancer risk. The dose is a function of how many calls you ran, so document call volume and years on apparatus, not just the title “firefighter.”
Why it matters: Respiratory disease and cancer concern; document call volume.
Jet and vehicle fuels
What it is: Crash and vehicle response put firefighters in direct contact with spilled jet and vehicle fuels — kerosene-based and gasoline hydrocarbons containing benzene.
Where it came from: Crash and vehicle response
How it harms you: Fuel reaches you as vapor and as raw product on skin and gear at the scene, adding benzene — a recognized blood-cancer agent — to the smoke exposure. Note the fuel-response calls so this hydrocarbon load is documented alongside the combustion products.
Why it matters: Adds benzene to the exposure load.
Diesel exhaust
What it is: Apparatus bays filled with the exhaust of trucks started and idled indoors, and the firehouse crew lived in that air between calls.
Where it came from: Apparatus bays and running trucks
How it harms you: Diesel exhaust is classified as carcinogenic to humans, and its particulate is a chronic inhalation exposure in an enclosed bay — a daily background dose on top of the fire calls themselves. Document the bay conditions and how trucks were run and vented.
Why it matters: Chronic particulate in the firehouse.
PFAS-contaminated base water
What it is: On installations where AFFF was used and tested, the PFAS foam seeped into the ground and reached the drinking-water supply firefighters and their families used.
Where it came from: Foam that reached the drinking-water supply
How it harms you: This is a second, involuntary PFAS route — ingestion through the water rather than skin and inhalation on the fireground — compounding the body burden. Where base water testing documents it, it adds objective proof and a second pathway to the claim.
Why it matters: Some installations have documented PFAS in the water system.
The overlooked exposure
Noise & hearing
Tinnitus and hearing loss are the two most common service-connected disabilities at the VA — and the easiest to overlook, because the damage is silent and builds over years. If this job put you around jet engines, weapons, or heavy machinery, hearing belongs in your claim.
Noise level on this job
Moderate to high — apparatus, station alarms, and sirens.
Where the noise came from
Fire-apparatus engines and pumpsStation alerting alarms and sirensSaws, extrication tools, and blowersAircraft crash-response flight-line noise
What it can cause
Tinnitus — constant ringing, buzzing, or hissing
Sensorineural (permanent) hearing loss
Trouble following speech in a noisy room
Evidence that proves it
Enlistment vs. separation audiograms — compared side by side for a threshold shift
Firehouse assignment, crash-crew, and incident records
Hearing-conservation program enrollment and annual audiograms
Buddy statements about ringing ears and asking people to repeat themselves
Firefighting and crash-response work generally rates a moderate-to-high probability of hazardous noise on VA's Duty MOS Noise Exposure Listing. Tinnitus is established largely on your own credible report; hearing loss must be confirmed by a VA audiogram that meets the measurement threshold.
Symptoms to watch for
These exposures can surface as everyday complaints long before anyone connects them to service. Knowing the warning signs helps you get screened early and get them documented in your record.
Every group below has its own full page — the complete warning-sign list, the signs that should not wait, the tests to ask for by name, and the words to say on the phone.Or jump straight to how to get an appointment
These are common warning signs, not a diagnosis. Only a clinician can evaluate them — but if any sound familiar, raise them at your next visit and ask that they be noted alongside your exposure history.
Turn this page into an appointment
How to get seen about this
Reading a symptom list changes nothing on its own. A dated note in your medical record does — for your health first, and years later for a claim. Below is every route to an appointment, the phrase that gets your exposure history written down, and the numbers to dial. Nothing on this page is a diagnosis, and none of it replaces your doctor.
Some things do not wait for a scheduler
Chest pain or pressure lasting more than a few minutes, or chest pain with sweating, nausea, or pain spreading to the jaw or arm
Sudden trouble breathing, or breathlessness while sitting still
Face droop, weakness or numbness on one side, slurred speech, or sudden confusion
Coughing up or vomiting blood, or bleeding that will not stop
A first seizure, or fainting you cannot explain
Call 911 or go to the nearest emergency room. Do not wait to reach a VA facility first, and do not drive yourself. Tell VA as soon as you can afterward — VA asks to be notified within 72 hours of emergency care received in the community — and keep every discharge paper and bill.
Call your VA medical center
Fastest
Calling your own VA facility is the quickest way to get an appointment. VA Health Connect gives you round-the-clock phone access to a scheduler, a nurse, and in many regions a provider.
Do not know your facility's number? Call MyVA411 at 800-698-2411, any hour, and ask to be connected to your VA medical center's scheduling line.
Say you are an established patient if you already have a primary care provider, and ask for the next available appointment with that provider.
If nothing is available soon, ask to be added to the cancellation list and ask whether a nurse can advise in the meantime.
Call VET-HOME — VA's exposure team
Exposure-specific
833-633-8846, Monday to Friday, 9:00 a.m. to 7:30 p.m. ET. VET-HOME stands for Veterans Exposure Team — Health Outcomes Military Exposures, and it exists for exactly this conversation.
Say: I want a military environmental exposure assessment. The intake center schedules you with a clinician specially trained in military environmental exposures — by telehealth, so it does not matter how far you live from a medical center. Any veteran enrolled in VA health care, anywhere in the United States or its territories, can use it.
The clinician documents your exposure history, answers exposure-related questions, and recommends follow-up. If labs, imaging, breathing tests, or a specialty consult are needed, they say so. Afterward VA mails you a letter with your results, what they mean, and the recommendations.
Two limits, so you are not surprised: VET-HOME clinicians do not prescribe medication and do not complete disability claim forms. What they produce is a dated VA record of your exposure history — which is the piece most claims are missing.
They also handle the environmental health registry evaluations, and those do not require VA health-care enrollment. If you would rather be seen in person, ask for the environmental health coordinator at your own facility instead — the list is further down this site's Talk To Your Doctor page.
Schedule online or message your care team
Sign in on VA.gov to schedule or request many appointments yourself. What you can book online depends on your facility and the type of care.
You can also send your care team a secure message through My HealtheVet. Use it for non-urgent things — replies typically take up to three business days.
Secure messaging is not for anything urgent. If you need an answer today, call instead.
Locked out or cannot find the option? The My HealtheVet help desk is 877-327-0022.
Not enrolled in VA health care yet
Call the VA Health Benefits Hotline at 877-222-8387, Monday to Friday, 8:00 a.m. to 8:00 p.m. ET, and say you want to enroll in VA health care.
Enrollment is what unlocks VA primary care and the toxic exposure screening. Under the PACT Act many veterans who were turned away years ago are now eligible, so do not assume an old answer still applies.
Enrolling does not mean giving up your own doctor. Plenty of veterans keep a civilian provider and use VA alongside it.
Enrolling in health care is separate from filing a disability claim. One does not require the other.
You see a civilian or private doctor
Ask the front desk for the next available appointment and tell them why: a symptom that has lasted weeks, plus chemical and airborne exposure during military service.
Bring this page, or write the exposures and years on one sheet of paper. Hand it over and ask for it to be scanned into your chart.
A community provider can order tests, refer you, and write your exposure history down — all of which helps. What they cannot do is VA's toxic exposure screening, which only happens inside VA's own record system.
Ask for a copy of the visit note and every result. Those copies are yours, and they are what a claim is eventually built from.
If you are in crisis right now
24/7
Dial 988 and press 1, or text 838255. The Veterans Crisis Line is staffed around the clock.
You do not need to be enrolled in VA health care, and you do not need a service-connected rating, to use it.
You can also start a confidential chat from VA's crisis line website, or ask any VA staff member to walk you to someone.
Ask for your toxic exposure screening
The PACT Act requires VA to offer this to every veteran enrolled in VA health care. It takes about five to ten minutes, and it is the cheapest way to get your exposure history into VA's own record in VA's own words.
What it is
A short set of questions asking whether you believe you were exposed to open burn pits and other airborne hazards, Agent Orange, radiation, Gulf War-related hazards, or contaminated water at Camp Lejeune.
Who can get it
Every veteran enrolled in VA health care. If you are not enrolled yet, enrollment comes first — call 877-222-8387.
How often
An initial screening, then at least once every five years. If you answer that you do not know whether you were exposed, VA schedules you again a year later.
How to get one
It is often done during a primary care or specialty visit — but you can ask for it sooner. Ask your primary care team directly, or ask your facility for its Toxic Exposure Screening Navigator by name.
What it is not
It is not an exam for any specific illness, and it is not part of the disability claims process. It is optional, and declining it does not affect your health care or your benefits.
Why bother
It creates a dated VA record that you raised military exposure. Years later, that entry is evidence that the concern predated the diagnosis.
A civilian or community provider cannot perform this screening — it lives inside VA's own health record. If you only see a private doctor, that is a reason to enroll in VA health care as well.
The burn pit registry: you are probably already in it
Since August 1, 2024, VA and the Defense Department enroll eligible veterans and service members in the Airborne Hazards and Open Burn Pit Registry automatically, from deployment records. For most people there is nothing to sign up for.
Automatic enrollment covers service between August 2, 1990 and August 31, 2021 in the listed operations and locations — Desert Shield, Desert Storm, Iraqi Freedom, Enduring Freedom and New Dawn, the Southwest Asia theater, Egypt, Afghanistan, Djibouti, Jordan, Lebanon, Syria, Uzbekistan, Yemen, and the associated airspace and waters.
You do not need to have been knowingly exposed, and you do not need any current health problem, to be included.
If you enrolled yourself before the redesign, your enrollment carried over. There is nothing to redo.
To check your status, contact the Environmental Health Coordinator at your VA facility.
The registry holds deployment and demographic data only. No medical information is stored in it.
Participation is optional and you can opt out. Being in the registry is not required to file a claim, and it does not affect your eligibility for care or benefits either way.
Being in the registry is not evidence of exposure on its own, and it is not a claim. Treat it as a research tool, and do not let anyone tell you a claim depends on it.
What to take with you
A one-page list of the chemicals and hazards you worked around, with the years and the base or ship
Your job title and MOS or rating, written the way the military wrote it
The symptoms that brought you in, and roughly when each one started
Any breathing tests, blood work, or imaging you already have, including from civilian doctors
A short list of what you want out of the visit — usually: document the exposure, order these tests, refer me
Someone who has watched the change in you, if memory or breathing is the concern
Write firefighting & crash response at the top of that sheet, in the words the military used for it.
Before you leave, and afterward
Ask for a copy of the visit note before you leave, and actually read it.
Check that your exposure history is in the note. If it is missing, say so and ask for it to be added — politely, but ask.
Get a copy of every test result, including the numbers, not just the word normal.
Keep your own folder. Paper you hold is worth more than paper you assume exists somewhere.
If a symptom persists after a normal test, go back. A normal result rules out some things, not everything.
The numbers, in one place
VET-HOME — VA's exposure team
833-633-8846
Monday to Friday, 9:00 a.m. to 7:30 p.m. ET
The number to call about a military environmental exposure specifically. VET-HOME books a free telehealth evaluation with a clinician trained in military exposures, and that clinician writes your exposure history into your VA record. Say you want a military environmental exposure assessment.
MyVA411 — VA main line
800-698-2411
24 hours a day, 7 days a week
The one number to call if you do not know who to call. Ask to be put through to your VA medical center's scheduling line, or press 0 for a person.
VA Health Benefits Hotline
877-222-8387
Monday to Friday, 8:00 a.m. to 8:00 p.m. ET
Enrolling in VA health care, health-care eligibility, VA medical bills, and community care billing.
Veterans Crisis Line
988, then press 1
24 hours a day, 7 days a week
Any crisis, and you do not need to be enrolled in VA health care to use it. You can also text 838255.
My HealtheVet help desk
877-327-0022
Monday to Friday
Trouble signing in, secure messaging, or online scheduling.
VA Benefits Hotline
800-827-1000
Monday to Friday, 8:00 a.m. to 9:00 p.m. ET
Claims, ratings, and back pay — the benefits side rather than the medical side.
TTY
711
Relay service
If you are deaf or hard of hearing.
These are VA's own published lines. If a number ever gives you a runaround, MyVA411 at 800-698-2411 will transfer you — it is staffed every hour of every day.
Conditions linked to these exposures
These are the diagnoses most often argued from this job. Open the evidence file for the medical studies, examiner shortcuts, and what a sound opinion must do.
None of these becomes a claim until a clinician writes it down. If a name on this list matches what you are already living with, get it evaluated and get the exposure history into the note.
Establish call volume and station history — the exposure math that shows how often you faced smoke and foam, not just that you were a firefighter.
Foam-training and system-test records
Document repeated, hands-on AFFF contact, the specific exposure that drives both the PFAS cancers and the parallel litigation.
Base water-testing records for PFAS
Tie station or housing water to a documented source, adding a second, involuntary route of PFAS exposure backed by testing.
Buddy statements on foam use
Corroborate the training and response frequency that logs rarely quantify — first-hand proof of routine foam contact.
Airborne Hazards / exposure registry entries
Create a dated VA record of the reported exposure and begin your symptom timeline on paper.
A medical nexus opinion
A clinician linking the diagnosis to the documented PFAS or smoke exposure — the reasoned connection the VA requires when no blanket presumption applies.
The records to demand for this claim
Most exposure claims are decided on records the veteran never sees — and lost on the ones quietly missing from the file. Chase down all four below before you file, then read them yourself line by line.
The DoD–VA exposure database
Individual Longitudinal Exposure Record (ILER)
ILER is the joint DoD–VA system that compiles what the government already believes about your occupational and environmental exposures. VA raters and examiners pull it up to decide whether your job "really" exposed you — so a thin or blank ILER can quietly sink a claim before you ever see it.
How to get it: Request your own ILER report through VA / VHA — ask your VA provider or the environmental health coordinator at your VA medical center, or raise it with your representative. Get the actual report, read it line by line, and treat it as a draft, not gospel.
A missing or empty ILER entry is NOT proof you were not exposed — it means the database is incomplete, which is common. Never let an examiner treat "ILER is negative" as the end of the story; rebut it with your duty description, buddy statements, and unit records.
Toxic Exposure Risk Activity finding
TERA memorandum
A TERA memo is the VA’s formal finding that your service involved a Toxic Exposure Risk Activity. Under the PACT Act, when you have a current disability plus TERA evidence and the file is otherwise short of proof, VA is supposed to obtain a medical exam and opinion — which makes the TERA memo one of the most powerful pieces of paper in the file.
How to get it: VA is generally responsible for developing the TERA determination — but it is frequently missing from the electronic claims file, based only on your MOS, or simply wrong. Ask in writing whether a TERA memo was completed, request a copy, and if it is absent or MOS-only, submit your specific duties and locations and ask that it be corrected.
TERA conceded is NOT the same as a nexus conceded. VA can grant TERA and still deny the claim for "no link." You still need the medical opinion — but a correct TERA memo is what forces VA’s duty to get that exam in the first place.
STRs + OMPF / personnel file
Service Treatment & personnel records
Your Service Treatment Records (STRs) hold the in-service complaints, sick-call visits, and exams; your personnel file (OMPF) proves where you were and what you did. Together they anchor both the exposure and any early symptoms — and gaps in them are where claims are lost.
How to get it: Request complete copies (not summaries) through the VA claims process, the National Archives (NPRC), or milConnect. Read them page by page, list what is missing, and fill the holes with buddy statements, unit records, and your own dated timeline.
Do not assume the VA already has everything. Records are routinely incomplete or were never scanned into the electronic file. A missing sick-call entry is a hole to fill with lay evidence — not proof the symptom never happened.
What VA actually relied on
The complete electronic claims file (C-file)
The C-file is everything VA used to decide your claim — the ILER pull, any TERA memo, the exam, and every record on file. Requesting it is the only way to see exactly what evidence VA had, what it was missing, and where a denial went wrong.
How to get it: Request your C-file from VA (a Privacy Act / FOIA request, or through your representative). When it arrives, compare it against this checklist: is the ILER there, is a correct TERA memo there, are your STRs complete, and did the examiner actually address your documented exposure?
Most veterans never look at their own C-file — so they never learn the claim was decided on an incomplete record. If a document above is missing or wrong, that omission itself is often the strongest ground for a Supplemental Claim or appeal.
Test any presumption first — it is the shortest path. If none applies, the claim becomes a facts-found / direct case that needs a documented exposure and a medical nexus. Every rating and deadline below is an estimate; confirm the current status for your service.
Deployed fire response may trigger PACT airborne-hazard provisions for certain conditions — confirm your dates and the current diagnosis list.
PFAS-specific VA presumptions are limited, so most PFAS claims are facts-found and need a documented source, pathway, and nexus. Always test any applicable presumption first.
Lawsuits & class actions vs. your VA claim
A VA disability claim is not a lawsuit. Some of these exposures also support a separate mass tort or trust claim against a manufacturer — a different system you can pursue at the same time. Here is how that maps to this job.
Military firefighters are at the center of the AFFF litigation — the largest environmental mass tort in the country. Thousands of personal-injury cases are consolidated in a federal multidistrict litigation (MDL 2873) in South Carolina against foam manufacturers such as 3M, DuPont/Chemours, and Tyco — not the military, which the Feres doctrine bars you from suing. The cases center on kidney cancer, testicular cancer, and thyroid disease from PFAS "forever chemicals" in the foam. 3M and DuPont have announced multibillion-dollar settlements with public water utilities, while the individual personal-injury claims proceed separately and are still being worked up. This track is completely independent of your VA claim: a manufacturer settlement does not reduce VA disability compensation, and you can pursue both at once. Eligibility and filing deadlines vary by state and injury and change over time, so if AFFF applies to you, confirm the current status with a products-liability attorney — separate from the VA work an accredited agent handles.
Note
The VA claim runs in parallel
A firefighter can genuinely have two separate matters running at once: a VA disability claim for service connection, decided by the VA on the facts-found or presumptive rules above, and a PFAS personal-injury claim against the foam makers, decided in federal court. They are judged in different systems under different rules, and neither blocks or reduces the other — VA compensation is not offset by a manufacturer settlement, and filing with the VA does not waive the lawsuit or vice versa. The practical takeaway: document your foam-training frequency and any contaminated station water now, because the same evidence supports both, and pursue the VA claim on its own timeline regardless of where the litigation stands.
You do not have to build this claim alone.
An accredited representative can order the missing records, name the legal theory that fits, and hold the VA to the evidence.
Albert Thombs · VA-accredited claims agent #45147
Who can help you file
Your VA disability claim is not a lawsuit, and there is no class action to “join.” It is an administrative claim decided by the VA — filing one does not require an attorney.
You can prepare it at no cost through a Veterans Service Organization, or with a VA-accredited claims agent who works the case directly with you. Albert Thombs is a VA-accredited claims agent (#45147).
On a first-time claim there is no fee to you. By law any fee is limited to work on an appeal of a denied or under-rated claim, is capped, and is paid only from past-due benefits actually recovered — never out of your pocket.
Build this profile into a claim the VA cannot wave off.
Bring your unit, every location, and every task above. As a VA-accredited claims agent, Albert can name the legal theory that fits, order the missing service and medical records, and build the exposure and nexus evidence into a claim the VA has to address. The case review is free.
