Gulf War Illness Update
Though ailments affiliated with the 1991 Persian Gulf War receive less attention today, research is still being conducted, treatment is being offered and some compensation is available.
By Randi Law
"I am having problems and they have been worsening since my time spent in the Gulf," reads a letter from former Sgt. Art Hickey, posted on www.Desert-Storm.com a decade after the war. "As I write this letter, I am hardly able to swallow. My tongue has some kind of virus that VA doctors can't identify. My eyes water, I'm sensitive to light, my joints are aching, I'm bitter, angry, depressed, I gasp for breath, I'm fatigued and I'm out of my wits end.
"I have cysts on my arms and legs, and also forming sores, headaches, chronic upper respiratory problems and I feel like I am losing control. The pain I experience is excruciating … I was taught to endure pain via military, but I can only take so much … I have been led to believe I was imagining all of this … For if this is in my mind, please help me remove it so I can live and press on."
Nearly 30% of the 1991 war's vets may have experienced one or more of the symptoms described by Hickey.
It has been more than 16 years now since veterans returning home from the Persian Gulf War began reporting symptoms of a mysterious illness or illnesses. Reports of a wide array of health problems believed to be associated with service there began circulating throughout the armed forces, prompting Congress to take action.
In 1994, the Persian Gulf War Veterans Benefits Act (P.L. 103-446) allowed the veterans to receive compensation from VA for an "undiagnosed illness" for the first time in the department's history.
Four years later, in 1998, the Persian Gulf War Veterans Act (P.L. 105-277) and theVeterans Programs Enhancement Act (P.L. 105-368) required, among other things, the secretary of veterans affairs to contract with the National Academy of Sciences (NAS). NAS's Institute of Medicine (IOM) was to review and evaluate literature regarding connections between illness and exposure to toxic agents. Furthermore, its conclusions would form the basis for authorizing cost-free health care services.
Between 1994 and 2003, three federal agencies expended a combined total of $316 million on 256 studies. In 2005, a St. Louis VA Medical Center-Washington University study concluded that more than 28% of Persian Gulf War vets suffered from what researchers called Chronic Multisymptom Illness (CMI).
In September 2006, the IOM released its newest and most controversial findings regarding Gulf War illnesses, and its final installment of Gulf War and Health, a series of congressionally mandated studies on the health of Gulf War veterans.
Though it said no syndrome exists, the IOM did reveal that 29% of the vets experienced multiple symptoms of different ailments.
The committee investigated potential adverse health effects from exposure to sarin nerve gas, depleted uranium, anthrax, pyridostigmine bromide and the botulinum vaccine.
Differing from past IOM studies, this work summarized the current health of those who were deployed to the Persian Gulf in 1990-1991.
The committee, chaired by Dr. Lynn Goldman of Johns Hopkins Bloomberg School of Public Health, was composed of researchers . .select. . ed by the IOM because of "their expertise, their independence and open-mindedness about this issue."
After reviewing nearly 10,000 pieces of literature, witness statements and expert reviews, they found 4,000 potentially relevant cases. Of those, 850 were chosen as the focus for epidemiological studies.
These cases were further broken down into two categories: primary and secondary. Primary studies provided information about specific health effects; secondary supplied background. The focus was on how these studies related to each other.
"Veterans of the first Gulf War report significantly more symptoms of illness than soldiers of the same period who were not deployed," concluded the report. But "studies have found no cluster of symptoms that constitute a syndrome unique to Gulf War veterans. However, evidence shows that service in the Persian Gulf during the 1990-1991 conflict places veterans at increased risk for developing anxiety disorders, depression, and substance abuse."
Though conclusions drawn from the panel did not confirm the existence of a "Gulf War Syndrome (GWS)," it is evident that a constellation of illnesses exists —now known as medically unexplained symptoms (MUS) among some doctors and scientists.
Many veterans groups were dismayed with the findings. "We know this already," said Paul Davidson, . .exec. . utive director of the National Gulf War Resource Center, to The Veteran (Vietnam Veterans of America). "The report is presented in such a way that seems ready-made for misunderstanding and confusion about the true nature of GWS."
Lack of data and limitations could have played a part in not identifying a specific syndrome. According to the IOM report, many of the studies have "limitations that hinder accurate assessment of veterans health status." Pre-deployment health screenings and exams were often vague or incomplete, leaving them unable to provide a baseline needed to draw further conclusions in regard to long-term health.
Reliance on self-reports and what is referred to as "recalled bias" could have also been a factor, believe some observers.
Furthermore, the investigation occurred over a brief period of time, limiting the opportunity to detect long- latency health outcomes, and to observe symptom duration.
Compensation & Care
As Gerald Manar, deputy director of VFW's National Veterans Service, points out, "An undiagnosed illness is not the same as 'Gulf War Illness or Syndrome.' The IOM study failed to find a single new disability, or a common collection of symptoms, which could be related to the Gulf War experience.
"However, qualifying veterans can still receive benefits if they have a diagnosis of chronic fatigue syndrome, fibromylagia, irritable bowel syndrome or a disability which cannot be diagnosed."
According to the Veterans Benefits Administration (VBA), of the 696,841 troops who served in the 1991 war zone, 14,895 had processed compensation claims for undiagnosed illnesses as of February 2007. Of those processed, some 3,733, or 25%, were granted service connection.
A first step to care is to enroll in the Gulf War Medical Exam Program and complete the free medical check-up. Neither a current illness nor VA enrollment is required. Nearly 100,000 vets have done so to date.
"The proactive approach by the VA in identifying, qualifying and treating Gulf War veterans is a step in the right direction," says Jim Willis, director of the Oregon Department of Veterans Affairs. "I would encourage all Gulf War veterans to seek the medical assistance they need and to register with the VA as soon as possible."
The presumptive period for granting compensation expires Dec. 31, 2011.
Over a five-year period, the University of Texas Southwestern Medical Center could spend up to $75 million on related research. The federal grants will allow the center's Gulf War Research Area to conduct and manage projects. Also, there is an advanced brain-imaging facility there. The university center collaborates with the Dallas VA Medical Center.
Moreover, $10 million will be spent on a survey of 10,000 vets regarding symptoms and to study the brains of hundreds who are currently suffering from various ailments.
"The quest for treatment and compensation for the mysterious illnesses afflicting a significant portion of Persian Gulf War vets has been long and difficult," says Bill Bradshaw, director of VFW's National Veterans Service. "But VFW is in it for the long haul until the medical questions are satisfactorily answered."
More information for Gulf War veterans is available at www.va.gov/gulfwar, or call the VA Gulf War Helpline at 1-800-PGW-VETS (1-800-749-8387).
Also, the Gulf War Review newsletter can be found at www.VA.gov/environagents.
Potential Signs of Undiagnosed Illnesses:
• Unexplained Dermatological Signs or Disorders
• Muscle Pain
• Joint Pain
• Neurological Signs and Symptoms
• Neuropsychological Signs or Symptoms
• Symptoms or Signs Involving the Upper or Lower Respiratory System
• Sleep Disturbances
• Gastrointestinal Signs or Symptoms
• Abnormal Weight Loss
• Menstrual Disorders