TRUTHOUT: Gulf War Veterans: The VA Takes Important First Steps

Written by Paul Sullivan and Anthony Hardie

(t r u t h o u t | Op-Ed)  -  Last week, the US Department of Veterans Affairs (VA) officially recognized several diseases as linked with deployment to the 1991 Gulf War.

As Gulf War veterans, we applaud the VA's proposed new regulations that streamline access to disability benefits for Gulf War, Iraq war and Afghanistan war veterans.

More importantly, the VA's new policy opens access to urgently needed free VA health care for the lingering, disabling health outcomes of these terrible diseases.

The VA's recent decisions were made possible by VA Secretary Eric Shinseki and his Chief of Staff, John Gingrich, a fellow Gulf War veteran. The new regulations, prompted by Gulf War veterans' advocates and the VA's internal Gulf War Veterans Task Force, will impact more than 3.3 million people - the 700,000 veterans of the 1991 Gulf War, the 400,000 veterans deployed to Southwest Asia between 1991 and 2001 plus the 2.2 million who deployed to the wars in Afghanistan and Iraq.

We also applaud the VA's simultaneous decision to expand approval of veterans' disability claims for undiagnosed and ill-defined illnesses which affects at least 25 percent, or up to 210,000, of our Gulf War veterans.

After so many years of struggling with illnesses as well as an unyielding, uncaring VA bureaucracy, we know our fellow Gulf War veterans will be relieved at the VA's change in policy.

As two of a small handful of Gulf War veteran leaders who led and participated in the national effort to pass and implement the "Persian Gulf Veterans Act of 1998," the law that authorized the VA's new regulations, we have waited for these and other changes for 19 years, including more than 11 years after the law passed.

That's why we fought for the bill in 1998, why we continue to fight for new research focused on treatments and why we will continue to fight for more streamlined VA regulations based on known wartime exposures and their known health outcomes.

While we are pleased to see the ice melting at the VA so Gulf War veterans can get the care we sought starting in 1991, we also ask the VA to do more to fix this problem.

For the historical record and for the new VA's leaders, we hope you understand our cautious optimism:

• The VA fought against Gulf Research, health care and benefits legislation in 1994 and 1998.
• After the laws were passed, the VA still fought against implementing them.
• The VA took four years to create the mandated Research Advisory Committee on Gulf War Veterans' Illnesses until caving to fierce Congressional and veteran advocacy.
• The VA managers intentionally refused to notify about 15,000 Gulf War veterans of a 2001 law that expanded access to benefits and health care.
• The VA staff manipulated the scope of the Institute of Medicine scientific research reviews to specifically exclude certain types of studies for consideration for health care and benefits. Specifically, the VA excluded lab animal studies linking depleted uranium (DU) with birth defects and cancer.
• Last year, the VA impeded and then canceled a Congressionally mandated contract for unparalleled Gulf War illness research at the University of Texas Southwestern (UTSW).
• This year, the VA used the Gulf War research funds designated for UTSW to buy an $11 million piece of lab equipment of dubious value to Gulf War veterans.
• The VA staff still fight against critical research about toxic exposures and medical treatments, thus impeding our efforts to obtain health care.

Veterans remain highly dismayed at the VA's quiet denial of health care and benefits based on DU exposure. The VA still uses an obsolete test for DU exposure that is only good for six months after exposure. Yet, the VA tests Gulf War veterans years after exposure, in some cases nearly 20 years later, with the inadequate method. In our view, the VA intentionally creates thousands of potential "false negative" test results.

It is outrageous for the VA to "find" that DU's heavy metal toxicity and radioactive properties do not cause kidney, liver, lymphatic or brain/neurologic conditions, or a host of cancers. The VA still refused to study the most insidious type of DU exposure: inhaled and ingested DU dust. The VA's flawed DU policy leaves us wondering if the VA has fully turned over a new leaf.

Here's what is needed. The VA should expand research to find treatments for Gulf War illness. The VA should amend the new regulations to include veterans of the 1990s war in Somalia, where dozens of our troops returned home with one or more strains of malaria, as well as to veterans of all other overt and covert military deployments, large or small, to all areas where these diseases are endemic.

We believes standards of medical evidence for these illnesses should be relaxed for Special Operations veterans whose only diagnosis may be limited to symptoms observed by a medic within a small unit operating alone in a foreign land.

Finally, we want justice for our Gulf War veterans denied benefits by the VA under the 2001 law. These veterans should be awarded retroactive benefits dating to when the VA improperly denied their war-related disability claims.

If we as a nation are serious about providing justice to our Gulf War veterans, then the new VA has taken a few very positive first steps. In order to prevent future obstruction of health care for veterans returning home from Iraq and Afghanistan, then the military has a legal and moral obligation to immediately shut down the use of burn pits overseas. The VA must also provide medical exams to our all returning troops and begin longitudinal studies.

When our government takes these steps, then we will have more confidence it is truly heading in the correct direction.

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Paul Sullivan served as a cavalry scout in the 1991 Gulf War and is now the executive director of Veterans for Common Sense, a nonprofit advocacy organization. Anthony Hardie served in the Gulf War as part of a liaison team embedded with the multi-national Coalition and is now a member of the VA's Research Advisory Committee and the publisher/editor of the 91outcomes health blog. Both Anthony and Paul are service-disabled Gulf War veterans who have repeatedly testified before Congress and other federal bodies on the health needs of ill Gulf War veterans.

VA: Secretary Shinseki Releases Draft Gulf War Task Force Report

No Fooling: VA Gulf War Task Force Report to be Published April 1st

(WASHINGTON D.C. – VA) – Today, Secretary of Veterans Affairs Eric K. Shinseki announced that the Department’s Gulf War Veterans’ Illnesses Task Force has completed the final draft of a comprehensive report that will redefine how the Department of Veterans Affairs (VA) addresses the concerns of Veterans who deployed during the Gulf War in 1990 and 1991.

“Our mission at VA is to be advocates for Veterans,” said Secretary Shinseki. “This report’s action plans provide a roadmap to transform the care and services we deliver to Gulf War Veterans. We must learn from the past and take the opportunity to anticipate the future needs of our Veterans.”

Notification of the draft written report will be published [March 31st] in the Federal Register, and the draft written report identifies seven areas where VA will improve services for this group of Veterans.

Among these improvements, VA will reconnect with Veterans from the 1990 – 1991 Gulf War, strengthen the training of clinicians and claims processors, and reenergize its research effort. VA will also proactively strengthen partnerships and medical surveillance to address the potential health impacts on Veterans from the environmental exposures on today's battlefields.

Earlier this month, VA published a proposed rule that will enable VA to grant service connection on a presumptive basis for nine specific infectious diseases associated with military service in Southwest Asia after August 2, 1990, or in Afghanistan on or after September 19, 2001. The proposed rule change was based on a recent Institute of Medicine review of the scientific literature, and is a part of VA’s on-going Gulf War studies. This rule, when implemented, will make it easier for Veterans to obtain disability compensation and related healthcare.

The mission of VA’s Gulf War Veterans’ Illnesses Task Force is to identify both gaps in services as well as opportunities to better serve Veterans of the Gulf War. Of the almost 700,000 service members who deployed to Operation Desert Shield in 1990 and Operation Desert Storm in 1991, more than 300,000 have filed disability claims and over 85 percent have been granted service connection for at least one condition.

The Chairman of the Gulf War Veterans’ Illnesses Task Force is John R. Gingrich, Chief of Staff at VA, a retired Army officer who also served during the Gulf War.

“Reaching out to Gulf War Veterans is not only essential to our transformation of VA, for many of us it is also personal,” said Gingrich. “Having commanded troops in the Gulf War, and then knowing that some of these brave men and women have fallen to mysterious illnesses has been both a frustrating and saddening experience. We now have an opportunity to do something about this situation -- with this Task Force, I know that we will improve the care and services these Veterans have earned.”

VA’s Gulf War Veterans’ Illnesses Task Force recommendations build on the excellent work and findings of The Gulf War Veterans Illnesses Advisory Committee, VA Research Advisory Committee on Gulf War Illnesses, the interagency Deployment Health Working Group, and other related sources. Some of the Task Force’s recommendations include:

• Improve data sharing with Department of Defense to notify Veterans of potential exposures, monitor their long-term health and inform them about decisions regarding additional follow up.  
• Improve the delivery of benefits to Veterans with Gulf War-related disabilities by:   
• Reviewing and, if necessary, updating regulations affecting Gulf War Veterans.  
• Expanding training for VBA examiners on how to administer disability claims with multiple known toxin exposure incidents.  
• Improve VA healthcare for Veterans through a new model of interdisciplinary health education and training.  
• Increase number of long-term, Veteran-focused studies of Veterans to enhance the quality of care VA provides.  
• Transition from reactive to proactive medical surveillance to help better manage Veterans’ potential hazardous exposures.  
• Find new treatments for Gulf War Veterans through new research.  
• Enhance outreach to provide information and guidance to Veterans about benefits and services available to them for injuries/illnesses associated with Gulf War service.

As a first step, VA is seeking public comments on the draft written report before final publication.

The public notice will be posted at www.Regulations.gov, and the draft written report will be open for comment for thirty (30) days. Comments may also be submitted via mail as described in the public notice.

In addition, VA recognizes that a great number of Gulf War Veterans use a computer on a daily basis to socialize their issues and concerns, so VA has also created a public discussion board on the seven recommendations at: http://yourgulfwarvoice.uservoice.com/.

To view the report without making recommendations, you may view a copy on VA’s website at http://www1.va.gov/opa/vadocs/gwvi_draft_report.pdf.

BUSPH Researchers' Work on Gulf War Illness Pays Off for Veterans -- Finally

Written by Lisa Chedekel, chedekel@bu.edu

(Boston, Mass - BUSPH)  Sixteen months after a panel of experts issued a landmark report affirming that exposure to toxic chemicals may have affected thousands of veterans of the 1991 Gulf War, the U.S. Department of Veterans Affairs has agreed to re-examine the disability claims of veterans suffering from ailments they blame on their war service.

"This is really a big step," said Roberta White, chair of the BU School of Public Heath's Environmental Health Department and scientific director of the Congressionally-mandated panel known as the Research Advisory Committee (RAC) on Gulf War Veterans' Illnesses. The committee is based at BUSPH.

"It's exciting to do a piece of work and see that people may actually benefit from it. Having been one of the first people to study Gulf War illness -- going back 18 years -- I'm just so thrilled to see this sea change in the way it is being viewed," White said.

Roberta White

In a recent interview with the Associated Press, VA Secretary Eric Shinseki said the decision to re-examine disability claims was part of a "fresh, bold look" his department is taking to help veterans who suffer from what is known as Gulf War illness, and who have long felt the government did little to help them. The VA said it also plans to improve training for clinical staff who work with Gulf War veterans, to make sure they understand the cluster of symptoms that characterize the illness and do not dismiss them, as has happened to many veterans over the years.

In November 2008, the RAC panel of scientists and veterans issued a comprehensive report asserting that Gulf War illness was a "real condition" affecting at least one in four U.S. veterans of the 1991 Gulf War. The group cited numerous studies showing that the condition was linked to exposure to toxic chemicals, including pesticides and pyridostigmine bromide (PB), a drug given to troops to protect against nerve gas. White has done numerous studies on the effects of such exposures on Gulf War veterans.

Former Secretary of Veterans Affairs James Peake sent the RAC report to the National Academy of Sciences' Institute of Medicine (IOM) for review and recommendations. But Peake was replaced soon afterwards by retired Gen. Shinseki, who quickly took an interest in the Gulf War veterans' plight, White said.

White said she and other members of the federal committee have had a number of meetings and conversations with Shinseki's staff -- especially with chief of staff John Gingrich, a retired Army colonel who commanded a field artillery battalion in the 1991 war.

"Ever since [Shinseki] came in, he and his staff have really shown a commitment to Gulf War veterans," she said. She said Gingrich had attended the last RAC meeting "to talk with us about how the VA is trying to change the system."

White said only a small proportion of Gulf War veterans have been approved for disability compensation, so the re-examination of claims will be a major undertaking for the VA.

As many as 175,000 to 210,000 Gulf War veterans are believed to have experienced a pattern of symptoms that include rashes, joint and muscle pain, sleep and gastrointestinal problems, according to the RAC report, which reviewed dozens of studies on veterans.

What caused the symptoms has long been a subject of both inquiry and controversy. Independent scientists have pointed to pesticides and pyridostigmine bromide pills given to troops as probable culprits. The 2008 report noted that since 1994, $340 million has been spent on government research into the illness -- but little has focused on effective treatments.

VA officials said the agency is not planning to give a new benefit to Gulf War veterans, but is making sure that the claims that were submitted were handled properly.

"We're talking about a culture change, that we don't have a single clinician or benefits person saying 'you really don't have Gulf War illness, this is only imaginary' or 'you're really not sick,'" Gingrich told the Associated Press.

A law enacted in 1994 allows the VA to pay compensation to Gulf War veterans with certain chronic disabilities from illnesses the VA could not diagnosis. More than 3,400 Gulf War have qualified for benefits under this category, according to the VA.

The VA says it plans to review how regulations were written, to ensure that veterans received the compensation they were entitled to under the law. The VA then would give veterans the opportunity to have a rejected claim reconsidered.

The VA doesn't have an estimate of the number of veterans who may be affected, but it could be in the thousands.

White, who is associate dean for research at BUSPH, recently was named chair of the Department of Defense's Gulf War Illness Research Program Integration Panel, which will guide the allocation of funds for further research. She has been called on a number of times in recent years to provide testimony to Congress about Gulf War illness.

Last summer, White told a U.S. House Veterans' Affairs subcommittee that just as Iraq and Afghanistan veterans are being diagnosed with post-traumatic stress disorder based largely on self-reported symptoms, so, too, should the physical complaints of veterans of Gulf War veterans be taken seriously.

She said that while diagnostic tests often cannot detect the neuropsychological symptoms of Gulf War illness, years of research have shown that veterans of that conflict who were exposed to chemicals may suffer central nervous system deficits and associated health problems.

"When patients are seen clinically, neuropsychological test results and brain imaging can be interpreted as being normal, even among patients who experience significant health symptoms and functional problems in daily life," White said in her testimony. "The clinical and research evidence suggest that health symptoms complaints in Gulf War veterans should be taken seriously, especially if the veteran has known exposure to neurotoxicants in theater."

VA Recognizes 9 “Presumptive” diseases, Expands Gulf War Illness presumption

At same time, VA denies presumptive connection to depleted uranium exposure

Written by Anthony Hardie, 91outcomes 

(91outcomes.com) The U.S. Department of Veterans Affairs announced today that a proposed rule will make nine rare endemic infectious diseases presumptive for veterans with service in the Persian Gulf theater of operations between August 2, 1990 and a future date not yet determined.

In the related press release and an official notice of rule change in the Federal Register, VA also today announced that the theater is considered to include service in Afghanistan.

Nine Infectious Diseases

The nine infectious diseases approved by VA for presumption for veterans with Persian Gulf War theater exposure, including Afghanistan, include:

• Brucellosis,
• Campylobacter jejuni,
• Coxiella burnetii (Q fever),
• Malaria,
• Mycobacterium tuberculosis,
• Nontyphoid Salmonella,
• Shigella,
• Visceral leishmaniasis, and
• West Nile virus. 

According to VA:

For non-presumptive conditions, a Veteran is required to provide medical evidence that can be used to establish an actual connection between military service and a specific disease. With the proposed rule, a Veteran will only have to show service in Southwest Asia or Afghanistan, and a current diagnosis of one of the nine diseases. 
Comments on the proposed rule will be accepted over the next 60 days.  A final regulation will be published after consideration of all comments received.
The 1998 Persian Gulf War Veterans Act requires the Secretary to review NAS reports that study scientific information and possible associations between illnesses and exposure to toxic agents by Veterans who served in the Persian Gulf War.

According to VA: The [IOM] committee selected nine
infectious diseases that:

(1) Are prevalent in Southwest Asia,
(2) Have been diagnosed among U.S. troops serving there, and
(3) Are known to cause long-term adverse health effects.

Undiagnosed Illness Revision and Expansion

Today’s announcement comes three weeks after VA announced that it would be open to reviewing the claims of Gulf War veterans who have submitted claims for chronic, ill-defined or undiagnosed multi-symptom illness, which has often been termed “Gulf War Syndrome” or “Gulf War Illness.”

That announcement was confirmed by today’s release of the proposed rule change in the Federal Register.
To date, the list of unexplained presumptive conditions has included:

• Fibromyalgia
• Chronic Fatigue Syndrome
• Irritable Bowel Syndrome

VA Chief of Staff John Gingrich, the Obama Administration’s highest ranking Gulf War veteran, announced in late February that these three presumptive conditions were only “examples” of ill-defined or chronic multi-symptom illness, and that VA would be open to reviewing previously denied claims if requested by the veteran.

Unfortunate news headlines read that VA would reopen Gulf War veterans’ claims.  While partially accurate, the veteran must request that the claim be reopened.  Gingrich noted in his public announcement that VA does not have the legal authority to proactively reopen veterans claims.

A VA training letter issued a few weeks earlier to VA claims and medical examiners directed a much broader approach to approving disability claims based on multi-symptom illness, and that the three previous conditions were merely “examples” of undiagnosed illness.

The training letter calls for Undiagnosed Illness claims to be held until the new rule becomes final.

Depleted Uranium (DU)

The latest VA announcement on Gulf War veterans claims comes a week after a March 9, 2010 Federal Register announcement in which VA denied of presumption for a list of diseases that may have been related to exposure to depleted uranium (DU) in the Persian Gulf theater of operations. 

According to VA, “The selected health outcomes were ten types of cancer and several non-malignant diseases or conditions.  With the exception of prostatic and testicular cancers, the health outcomes were selected by the IOM because there are plausible mechanisms of action (for example, lung cancer and respiratory disease were selected because inhaled insoluble uranium oxides lodge in the lung).

The types of cancer VA denied presumption related to DU exposure were:

• Lung cancer,
• Leukemia,
• Lymphoma,
• Bone cancer,
• Renal (kidney) cancer,
• Bladder cancer,
• Brain and other central nervous system cancers,
• Stomach cancer,
• Prostatic cancer, and
• Testicular cancer.

The nonmalignant diseases or conditions VA denied presumption related to DU exposure included:

• Renal (kidney) disease,
• Respiratory disease,
• Neurologic disease, and
• Reproductive and developmental effects.

According to VA, “This determination does not in any way preclude VA from granting service connection for any disease, including those specifically discussed in this notice, nor does it change any existing rights or procedures.”

The VA based its DU denial decision on an Institute of Medicine (IOM) review of scientific studies that concluded that at this time, there is “Inadequate/Insufficient Evidence to Determine Whether an Association Exists.”

This category means that the [scientific] evidence is of insufficient quantity, quality, or consistency to permit a conclusion regarding the existence of an association between exposure to uranium and a specific health outcome in humans. 

IOM concluded that there is inadequate/insufficient evidence to determine whether an association exists between exposure to uranium and each health outcome described in the report because well-conducted studies showed equivocal results, the magnitude or frequency of the health outcome may be so low that it cannot be reliably detected given the sizes of the study populations, and the available studies had limitations that prevented the IOM from reaching clear conclusions about health outcomes.

Gulf War veteran advocates have been critical for many years of the lack of scientific studies related to inhaled or ingested depleted uranium particulate matter, almost certainly a common source of exposure for veterans of the 1991 Persian Gulf War and the 2003 U.S. invasion of Iraq who were at any time in or near military vehicles, buildings, and equipment that have been hit at any time in the past with DU rounds and have not been fully cleaned up.

DU is mildly radioactive and is a heavy metal, that, like lead and mercury, is highly toxic when inhaled or ingested.  Its long-term effects remain a subject of debate.

The DU decision by VA, based on “Inadequate/Insufficient Evidence to Determine Whether an Association Exists” nearly 20 years after the end of the 1991 Persian Gulf War, will likely only serve to continue that debate.

================================
Additional information: 

• Federal Register announcement of VA approval for nine infectious diseases, and new rules for consideration of undiagnosed illnesses: “Presumptions of Service Connection
  for Persian Gulf Service,” March 18, 2010:  https://www.federalregister.gov/articles/2010/03/18/2010-5980/presumptions-of-service-connection-for-persian-gulf-service 
• Federal Register announcement of VA denial of  DU claims: “Determinations Concerning Illnesses Discussed in the Institute of Medicine Report on Gulf War and Health: Updated Literature Review of Depleted Uranium,” March 9, 2010:  http://www.gpo.gov/fdsys/pkg/FR-2010-03-09/pdf/2010-4882.pdf
• VBA Training Letter 10-01, "Adjudicating Claims Based on Service in the Gulf War and Southwest Asia", February 4, 2010:  http://sites.google.com/a/91outcomes.com/docs/home/TL10-01.pdf?attredirects=0&d=1

===================================
Proposed 3.317 Rule Language
The Federal Register announces an intention to Revise § 3.317 to read as follows:

§ 3.317 Compensation for certain disabilities occurring in Persian Gulf veterans.

(a) Compensation for disability due to undiagnosed illness and medically unexplained chronic multisymptom illnesses.
(1) Except as provided in paragraph (a)(7) of this section, VA will pay compensation in accordance with chapter 11 of title 38, United States Code, to a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, provided that such disability:  (i) Became manifest either during active military, naval, or air service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2011; and
(ii) By history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis.
(2)(i) For purposes of this section, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following):
(A) An undiagnosed illness;
(B) The following medically unexplained chronic multisymptom
illnesses that are defined by a cluster of signs or symptoms:
(1) Chronic fatigue syndrome;
(2) Fibromyalgia;
(3) Irritable bowel syndrome; or
(4) Any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness.
(ii) For purposes of this section, the term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained.
(3) For purposes of this section, ‘‘objective indications of chronic disability’’ include both ‘‘signs,’’ in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification.
(4) For purposes of this section, disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest.
(5) A qualifying chronic disability referred to in this section shall be rated using evaluation criteria from part 4 of this chapter for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar.
(6) A qualifying chronic disability referred to in this section shall be considered service connected for purposes of all laws of the United States.
(7) Compensation shall not be paid under this section for a chronic disability:
(i) If there is affirmative evidence that the disability was not incurred during active military, naval, or air service in the Southwest Asia theater of operations; or
(ii) If there is affirmative evidence that the disability was caused by a supervening condition or event that occurred between the veteran’s most recent departure from active duty in the Southwest Asia theater of operations and the onset of the disability; or
(iii) If there is affirmative evidence that the disability is the result of the veteran’s own willful misconduct or the abuse of alcohol or drugs. 

(b) Signs or symptoms of undiagnosed illness and medically unexplained chronic multisymptom illnesses. For the purposes of paragraph (a)(1) of this section, signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multisymptom illness include, but are not limited to:
(1) Fatigue.
(2) Signs or symptoms involving skin.
(3) Headache.
(4) Muscle pain.
(5) Joint pain.
(6) Neurologic signs or symptoms.
(7) Neuropsychological signs or symptoms.
(8) Signs or symptoms involving the respiratory system (upper or lower).
(9) Sleep disturbances.
(10) Gastrointestinal signs or symptoms.
(11) Cardiovascular signs or symptoms.
(12) Abnormal weight loss.
(13) Menstrual disorders.

For Brucellosis, the long-term health outcomes presumed to be connected proposed in the rule are:

• Arthritis.
• Cardiovascular, nervous, and respiratory system infections.
• Chronic meningitis and meningoencephalitis.
• Deafness.
• Demyelinating meningovascular syndromes.
• Episcleritis.

For the eight other infectious diseases listed (Campylobacter jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium tuberculosis, Nontyphoid Salmonella, Shigella, Visceral leishmaniasis, and West Nile virus), the long-term health effects presumed to be connected, as proposed in the rule, are:

• Fatigue, inattention, amnesia, and depression.
• Guillain-Barre´ syndrome.
• Hepatic abnormalities, including granulomatous hepatitis.
• Multifocal choroiditis.
• Myelitis-radiculoneuritis.
• Nummular keratitis.
• Papilledema.
• Optic neuritis.
• Orchioepididymitis and infections of the genitourinary system.
• Sensorineural hearing loss.
• Spondylitis.
• Uveitis.
• Guillain-Barre´ syndrome if manifest within 2 months of the infection.
• Reactive Arthritis if manifest within 3 months of the infection.
• Uveitis if manifest within 1 month of the infection.
• Chronic hepatitis.
• Endocarditis.
• Osteomyelitis.
• post-Q-fever chronic fatigue syndrome.
• Vascular infection.
• Demyelinating polyneuropathy.
• Guillain-Barre´ syndrome.
• Hematologic manifestations (particularly anemia after falciparum malaria and splenic rupture after vivax malaria).
• Immune-complex glomerulonephritis.
• Neurologic disease, neuropsychiatric disease, or both.
• Ophthalmologic manifestations, particularly retinal hemorrhage and scarring.
• Plasmodium falciparum.
• Plasmodium malariae.
• Plasmodium ovale.
• Plasmodium vivax.
• Renal disease, especially nephrotic syndrome.
• Active tuberculosis.
• Long-term adverse health outcomes due to irreversible tissue damage from severe forms of pulmonary and extrapulmonary tuberculosis and active tuberculosis.
• Reactive Arthritis if manifest within 3 months of the infection.
• Hemolytic-uremic syndrome if manifest within 1 month of the infection.
• Reactive Arthritis if manifest within 3 months of the infection.
• Delayed presentation of the acute clinical syndrome.
• Post-kala-azar dermal leishmaniasis if manifest within 2 years of the infection.
• Reactivation of visceral leishmaniasis in the context of future immunosuppression.
• Variable physical, functional, or cognitive disability.

Sanders-Kucinich effort would provide treatments for Gulf War veterans

25 percent of 1991 Gulf War veterans still disabled, suffering from Gulf War Syndrome; Funding would pay for treatment-focused research
(91outcomes.com) - An appropriations initiative in Congress would provide much-needed funding for Gulf War illness, focused on treatments, but needs the support of more members of Congress.
According to the U.S. Department of Veterans Affairs, between 175,000 and 210,000 – or about 25 percent – of the living veterans of the 1991 Gulf War are currently afflicted by a debilitating, chronic, multi-symptom, multi-system disease commonly known as Gulf War Illness or Gulf War Syndrome.
However, due to years of squandered federal efforts wrongly focused on “stress” as the culprit, the first real focus on treatments for Gulf War illness caused by the Gulf War’s toxic soup of chemicals only began just three years ago, with $5 million in federal funding for a new treatment-focused effort within the the U.S. Department of Defense at the Ft. Detrick, Maryland-based Congressionally Directed Medical Research Program (CDMRP).
The effort to provide $25 million in long overdue Gulf War illness treatment funding  is being led in the U.S. House of Representatives by Rep. Dennis Kucinich (D-Ohio), and in the U.S. Senate by Senator Bernie Sanders (I-Vermont).
By contrast, PTSD and Traumatic Brain Injury (TBI) research  at CDMRP were funded at $150 million each in a recent year.
In November 2008, the Congressionally chartered U.S. Department of Veterans Affairs Research Advisory Committee (RAC) on Gulf War Veterans’ Illnesses identified some of the most probable causes of Gulf War illness, said treatment is almost certainly possible, and called for funding at $40 million to help find relief for the one-quarter of veterans of the 1991 Gulf War still suffering from the war’s toxic after-effects.
More promising news was released last month at a presentation at the VA headquarters in Washington, DC, with damaged and dysfunctional brain cells playing a key role in the complexities of Gulf War Syndrome.  [Read the Full article here]
And then earlier this month, scientists provided compelling brain images documenting Gulf War illness dysfunction.  [Read the full article].
And last week in Dallas, where some of the most promising research is currently being conducted, the Dallas Morning News called for funding to continue, citing a piece in Science News in which Richard Briggs, one of the researchers, says, "In the last two years we have learned more about Gulf War Illness than we did in the previous 15."
Won’t you please take just a moment to drop an email or make a call to your Member of Congress to request they sign onto the “Sanders/Kucinich letters” to help fund the discovery of medical treatments for suffering Gulf War veterans?
Supporters should immediately contact their Congressional representative and both of their U.S. Senators to request that they sign on to the Sanders/Kucinich letters supporting FY2011 Gulf War illness treatments research.
Don’t know who represents you in Congress?  Use this handy tool:  https://writerep.house.gov. 
Below is the text of the Kucinich House letter to the other members of Congress, who typically will sign on if requested by one of their constituents who lives in the state or district they represent.
And, according to Senator Sanders’ staff, this request is currently supported by this impressive list of the following organizations:

1. Air Force Association (AFA)
2. American Legion
3. AMVETS
4. Association of the United States Army (AUSA)
5. Association of the United States Navy (AUSN)
6. Blinded Veterans Association (BVA)
7. Disabled American Veterans (DAV)
8. Enlisted Association of the National Guard of the United States (EANGUS)
9. Fleet Reserve Association (FRA)
10. Military Officers Association of America (MOAA)
11. National Association of State Directors of Veterans Affairs (NASDVA)
12. National Association for Uniformed Service (NAUS)
13. National Guard Association of the United States (NGAUS)
14. National Gulf War Resource Center (NGWRC)
15. National Vietnam and Gulf War Veterans Coalition
16. Paralyzed Veterans of America (PVA)
17. Reserve Officers Association (ROA)
18. The Retired Enlisted Association (TREA)
19. U.S. Coast Guard Chief Petty Officers Association (USCGCPOA)
20. Veterans for Common Sense (VCS)
21. Veterans of Foreign Wars of the United States (VFW)
22. Veterans of Modern Warfare (VMW)
23. Vietnam Veterans of America (VVA)

Thank you for your support and assistance for the veterans of the 1991 Gulf War.
--Anthony Hardie, 91outcomes Publisher/Editor, member of the RAC, and totally disabled Gulf War veteran.
=======================
Dear Colleague:
We invite you to join us in supporting research into Gulf War Veterans Illnesses by signing a letter to the Defense Appropriations Subcommittee requesting $25 million for fiscal year 2011. This request has the endorsement of the American Legion, Veterans of Foreign Wars, Paralyzed Veterans of America, Iraq and Afghanistan Veterans of America, the National Vietnam and Gulf War Vets Coalition, the Fleet Reserves Association, the Reserve Enlisted Association, Vietnam Veterans of America, Disabled American Veterans and the Enlisted Association of the National Guard of the United States.
Last month, Secretary of Veterans Affairs Eric Shinseki indicated that the VA intends to revisit the rejected claims of Gulf War veterans who have attempted to access treatment for the illnesses linked to their service. But there is still no effective treatment for Gulf War Illnesses. The research program’s tremendous successes are creating growing excitement among scientists in the health research community because of the potential to not only help veterans, but so many others who suffer from similar illnesses. GWI researcher Richard Briggs said, “In the last two years we have learned more about Gulf War Illness than we did in the previous 15.”
Research has shown that Gulf War veterans suffer from ALS, or Lou Gehrig’s disease, at double the rate of their non-deployed peers. Additionally, the 2008 report from the Research Advisory Committee on Gulf War Veterans Illnesses (RAC) stated that “Gulf War illness is real, that it is the result of neurotoxic exposures during Gulf War deployment, and that few veterans have recovered or substantially improved with time.”
The 2008 report also recommended that Congress appropriate $40 million for the program, “an amount commensurate with the scope of the problem.” We propose to continue this important work with $25 million in FY11.

March 16th: Anniversary of Iraqi Chemical Warfare Agent Attacks at Halbja

Halabja poison gas attack

From Wikipedia, the free encyclopedia

Halabja poison gas attack

Part of Iran-Iraq War Operation Zafar 7

Aftermath of the Halabja chemical attack

Date
March 16 - March 17, 1988

The Halabja poison gas attack (Kurdish: Kîmyabarana Helebce) was a genocide massacre that took place on March 16, 1988, during the closing days of the Iran-Iraq War, when chemical weapons were used by the Iraqi government forces in the Kurdish town of Halabja in Iraqi Kurdistan. The attack quickly killed thousands of people (around 5,000 dead) and injured around 11,000, most of them civilians;^[1][2] thousands more died of complications, diseases, and birth defects in the years after the attack.^[3] The incident, which has been officially defined as an act of genocide against the Kurdish people in Iraq,^[4] is the largest chemical weapons attack directed against a civilian-populated area in history.^[5]

The Halabja genocide has been recognized as a separate event from the Anfal Genocide that was also conducted against the Kurdish people by the Iraqi regime under Saddam Hussein.^[6] The Iraqi High Criminal Court recognized the Halabja massacre as genocide on March 1, 2010, which decision was welcomed by the Kurdistan Regional Government. ^[7]

 

Background

Main articles: Al-Anfal Campaign and Operation Zafar 7

It was an event that is historically separate from the Operation Anfal (the 1986-1989 campaign conducted by Saddam Hussein's regime's in order to terrorize the Kurdish rural population and end the peshmerga rebellions by brutal means), as the Iranian troops allied to the rebels were also involved in the Halabja events. Nevertheless, the victims of the tragedy are often included in accounting the deaths attributable to the Anfal campaign, which was characterised by the widespread and indiscriminate use of chemical weapons by Iraq.^[8]

Chemical attack

The five-hour attack began early in the evening of March 16, 1988, following a series of indiscriminate conventional (rocket and napalm) attacks, when Iraqi MiG and Mirage aircraft began dropping chemical bombs on Halabja's residential areas, far from the besieged Iraqi army base on the outskirts of the town. According to regional Kurdish rebel commanders, Iraqi aircraft conducted up to 14 bombing sorties of seven to eight planes each; helicopters coordinating the operation were also seen. Eyewitnesses have told of clouds of smoke billowing upward "white, black and then yellow"', rising as a column about 150 feet (46 meters) in the air.^[1] Survivors said the gas at first scented with the smell of sweet apples;^[9] they said people died in a number of ways, suggesting a combination of toxic chemicals (some of the victims "just dropped dead" while others "died of laughing"; while still others took a few minutes to die, first "burning and blistering" or coughing up green vomit).^[10] It is believed that Iraqi forces used multiple chemical agents during the attack, including mustard gas and the nerve agents sarin, soman, tabun and VX;^[11] some sources have also pointed to the blood agent hydrogen cyanide (most of the wounded taken to hospitals in the Iranian capital Tehran were suffering from mustard gas exposure).^[1]

Medical and genetic consequences

Long-term medical effects included permanent blindness, disfigurement, respiratory, digestive, and neurological disorders, leukemia, lymphoma, and colon, breast, lung, skin, and other cancers, increased miscarriages and infertility and severe congenital disorders and other birth defects.^[16] Many survivors suffered from mental disorders. Some of those who survived the attack or were apparently injured only lightly at the time, later developed medical problems stemming from the chemicals, and there are increasing fears that the attack may be having a lasting genetic impact on the Kurdish population.^[17]

Aftermath

Saddam Hussein's government officially blamed Iran for the attack. The international response at the time was muted and the United States even suggested Iran was responsible.^[13] The United States, who, at the time, were allies of Iraq in their war with Iran, said the images could not be verified to be the responsibility of Iraq.

Ali Hasan al-Majid ("Chemical Ali") was condemned to death by hanging by an Iraqi court in January 2010, after being found guilty of orchestrating the Halabja massacre. Majid was first sentenced to hang in 2007 for his role in a 1988 military campaign against ethnic Kurds, codenamed Operation Anfal; in 2008 he also twice received a death sentence for his crimes against the Iraqi Shia Muslims, in particular for his role in crushing the 1991 uprisings in southern Iraq and his involvement in the 1999 killings in the Sadr City (then Saddam City) district of Baghdad. He was executed on January 25, 2010.^[23]

International sources for technology and chemical precursors

The know-how and material for developing chemical weapons were obtained by Saddam's regime from foreign firms.^[24] The largest suppliers of precursors for chemical weapons production were in Singapore (4,515 tons), the Netherlands (4,261 tons), Egypt (2,400 tons), India (2,343 tons), and West Germany (1,027 tons). One Indian company, Exomet Plastics (now part of EPC Industrie Ltd.) sent 2,292 tons of precursor chemicals to Iraq. The Kim Al-Khaleej firm, located in Singapore and affiliated to United Arab Emirates, supplied more than 4,500 tons of VX, sarin, and mustard gas precursors and production equipment to Iraq.^[25]

The provision of chemical precursors from United States companies to Iraq was enabled by a Ronald Reagan administration policy that removed Iraq from the State Department's list of State Sponsors of Terrorism. Leaked portions of Iraq's "Full, Final and Complete" disclosure of the sources for its weapons programs shows that thiodiglycol, a substance needed to manufacture mustard gas, was among the chemical precursors provided to Iraq from US companies such as Alcolac International and Phillips. Both companies have since undergone reorganization and Phillips, once a subsidiary of Phillips Petroleum is now part of ConocoPhillips, an American oil and discount fossil fuel company, while Alcolac International has since dissolved and reformed as Alcolac Inc.^[26]

VCS Recommendations to Fix VA

VCS Recommendations to Fix VA

House Veterans’ Affairs Committee, “Claims Summit”

March 18, 2010

Veterans for Common Sense (VCS) offers the following five recommendations to fix the enormous backlog of one million veterans’ disability compensation and pension claims now under review at the Veterans Benefits Administration (VBA) and Board of Veterans Appeals (BVA), two sub-agencies within the Department of Veterans Affairs (VA).

VCS applauds the efforts of Chairman Bob Filner and the House Veterans’ Affairs Committee for addressing this important issue. VCS thanks and offers to work with VA Secretary Eric Shinseki as he fixes both VBA and BVA this year.

1. Improve Transparency. Before substantive reform can begin, VCS urges VA to reveal the serious depth and scope of the claims crisis at VBA and BVA. VA leaders must admit the disability claim backlog is one million. VA leaders must also admit it takes five to six months to process a veteran’s original disability claim, and another four or five years to decide a veteran’s appealed disability claim.

2. New Leaders. VCS urges VA Secretary Shinseki to hire a new team of VBA and VBA leaders and then move them from 1800 G Street to 810 Vermont Avenue so they work closely with other top VA leaders to create a veteran-focused claim system.

3. Maintain Current System while Designing New System. VCS urges VBA and BVA leaders to take a two-track approach to reform. First, VA must maintain the current system so it doesn’t collapse under the influx of additional claims due to new regulations for Agent Orange-related conditions, post-traumatic stress disorder, and Gulf War illness. Second, VA leaders must simultaneously design an entirely new claim processing system using new technology such as the lifetime service record currently under development. Any new system should be automated using a one-page claim form and have a detailed timeline to eliminate the backlog. VCS urges VBA to place more VBA claims adjudication staff at VA medical facilities in order to provide friendly face-to-face assistance as well as to streamline appointments for claim examinations.

4. Expand Legal Representation. VCS urges Congress to allow veterans to retain competent, certified legal representation at the initial claim level at VBA.

5. Hire Our Veterans. VCS urges VBA and BVA to hire more veterans, especially our disabled veterans. More than one-in-five of our returning Iraq and Afghanistan war veterans are unemployed. VCS opposes outsourcing VA’s claims processing.

Dallas Morning News: Why Gulf War Illness Research Must Continue

9:11 AM Fri, Mar 12, 2010 | Permalink
Written by Jim Mitchell/Editorial Writer

  Bio |  E-mail  | Suggest a blog topic

As I've mentioned before, I'm really disappointed that the Veterans Affairs pulled the plug on UT Southwestern's research into the nature and causes of Gulf War illnesss. Vets deserve better.

But as the research is winding down, we're learning more about UTSW's advances, thanks in part to brain imaging. We're learning that something different and troubling is going on in the brains of Gulf War vets. In this piece in Science News Richard Briggs, one of the UTSW researchers, says, "In the last two years we have learned more about Gulf War Illness than we did in the previous 15."

I don't understand all of the details, but that is a job for the researchers -- to spend countless waking hours conducting meaningful research. They need to be greenlighted. And when the UTSW research ends, I'm not sure who will pick up the ball and run with it.

But I know this much. It must continue --and continue in good faith -- somewhere.

Gulf War Research Funding Pre-Announcement Released

The pre-announcement for the availability of funding for Gulf War illness research has been announced recently by DOD’s Office of Congressionally Directed Medical Research Programs (CDMRP).  This is a competitive, peer-reviewed program, open to researchers at all levels.  Identified funding priorities include studies focused on identifying treatments for Gulf War illness (GWI), improved definition and diagnosis, and improved understanding of GWI pathobiology and symptoms.  

The pre-funding announcement was posted on CDMRP’s website:  http://cdmrp.army.mil/funding/gwirp.htm and was recently listed.

Studies will be funded under four mechanisms.  All require pre-applications to be submitted and an invitation to submit a full proposal. The dates of submission have not been released yet but we will update you when they are announced. A synopsis of the different funding mechanism requirements and funding amounts can be found here:  http://cdmrp.army.mil/pubs/press/2010/10gwirppreann.htm. 

91outcomes will have additional postings regarding this program as they become available.

Please contact the agency contacts listed in the announcements if you have questions.

--------------------

Special Thanks for this announcement to Kimberly Sullivan, Ph.D., Scientific Coordinator, Research Advisory Committee on Gulf War Veterans' Illnesses, and Boston University School of Public Health Department of Environmental Health.

VA Publicizes Ongoing Research for Gulf War Veterans

The VA’s Environmental Epidemiology Service (EES) conducts original research studies on the health of Veterans, including research on potential exposures to environmental hazards during military service.

EES also maintains databases and registries of Veterans’ exposures and health care utilization, which provide unique data for much of the research.

Learn about upcoming and ongoing research studies on:

 

Longitudinal Health Study of Gulf War Era Veterans

Investigators: Han Kang, Dr.P.H.; Clare Mahan, Ph.D.; Seth Eisen, M.D.; Charles Engel, Jr., M.D., M.P.H.

This is a follow-up study of 30,000 Veterans (15,000 Gulf War Veterans and 15,000 non-Gulf War military personnel) who were in service during 1990-1991. It is one of the largest scientific research studies ever undertaken on the health of Veterans. The goal is to find out how the health of Gulf War Veterans changes over time and if it is better, worse, or the same as non-Gulf War Veterans ten or more years after the war. To achieve this goal, researchers mailed survey questionnaires, conducted telephone interviews, and reviewed medical records.

Specific areas under study are chronic medical conditions, PTSD and other psychological conditions, functional status, mortality, general health perceptions, health care utilization, and VA disability compensation between the two Veteran groups. Research findings from this study are currently being compiled and published in scientific journals, and presented to the scientific community.

 

Estimates of Cancer Prevalence in Gulf Veterans Using State Registries

Han Kang, Dr.P.H.; Clare Mahan, Ph.D.; Paul Levine, M.D.; Samuel Simmens, Ph.D.; Heather Young, Ph.D.; Jessica Maillard, M.P.H.

Although there were relatively few combat casualties in the 1990-1991 Gulf War, many Veterans were subjected to a wide variety of natural and man-made environmental exposures, some of which are considered potential human carcinogens. Because of concerns about increased cancer risks among these Veterans, Congress asked VA to address the question of potential cancer risk among Gulf War Veterans.

Researchers are evaluating the hypothesis that 1990-1991 Gulf War Veterans are at an increased risk of developing specific cancers compared to non-Gulf War Veterans. The objectives of the study are

• to assess and compare the prevalence, distribution, and characteristics of cancer among approximately 620,000 Gulf War Veterans to 750,000 non-Gulf War Veterans; and
• to assess demographic, military, and in-theater exposure characteristics associated with the cancer.

Gulf War and non-Gulf War Veterans with a diagnosis of cancer from 1991 to 2003 are being identified through record linkage of the Veterans’ database with files supplied by state cancer registries. This study will produce information with adequate statistical power to address the question on whether or not there is an excess cancer risk associated with the 1990-1991 Gulf War.

 

Post War Mortality from Neurologic Diseases in Gulf War Veterans

Investigators: Han Kang, Dr.P.H.; Shannon Boyer, M.P.H.; Tim Bullman, M.S.; Mitchell Wallin, M.D., M.P.H.

We investigated the risk of post-war mortality from neurological disease among 620,000 Gulf War Veterans and 750,000 non-Gulf War Veterans. Gulf War Veterans may be at increased risk for adverse health outcomes, including neurological disorders, as a result of their Gulf War service. Specifically, there is concern that Gulf War Veterans may be at increased risk for amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, or brain cancer. These risks may be related to potentially hazardous environmental exposures during the war, such as oil well fire smoke, chemical and biological warfare agents, prophylactic agents against chemical and biological warfare, multiple vaccinations, depleted uranium, pesticides, and endemic infectious diseases.

Since our last follow-up in 1997, there have been few changes in mortality rates among Gulf War and non-Gulf Veterans. Controlling for oil well fire smoke exposure, Army Gulf War Veterans who were potentially exposed to nerve agents at Khamisiyah had a higher mortality rate from brain cancer compared to Army Veterans who were not considered exposed. The risk of death due to motor vehicle accidents is still higher among female Gulf War Veterans compared to female non-Gulf War Veterans, though no longer statistically significant among male Gulf War Veterans.

VCS Asks Congress to Release CIA's Gulf War Chemical Exposure Documents

This excellent letter/article written by VCS, and published at www.VeteransForCommonSense.org.

----------------------------------------

VCS sent this letter to Senator Dianne Feinstein so she is aware of our efforts to determine the facts about our Gulf War chemical exposures.

March 9, 2010

The Honorable Dianne Feinstein
Chair, Select Committee on Intelligence
United States Senate
331 Senate Hart Building
Washington, DC 20510

Dear Senator Feinstein:

Veterans for Common Sense urges you to please retain Section 348 of H.R. 2701 of the Fiscal Year 2010 Intelligence Authorization Act during the conference with the House of Representatives.  This vital section requires a declassification review of Central Intelligence Agency records that are pertinent to the health problems being suffered by as many as 175,000 of my fellow Gulf War veterans.  We want to know why we are ill so we can get treatment.

Between 1991 and 1996, the Department of Defense and the CIA denied any Iraqi chemical agents had been detected.  In June 1996, as a result of pressure from two CIA analysts and a handful of Gulf War veterans (including me), the CIA announced it had discovered intelligence records revealing as many as 145,000 of us were exposed to low levels of Iraqi agents.

In 1998, the CIA made an admission in a report, “Special Assessment: Allegations Regarding the Handling of Information Concerning the Possible Exposure of United States Armed Forces to Chemical Weapons During the Persian Gulf War” --

[The U.S. Government has] identified more than 1.5 million documents as a result of the new electronic and office searches. But the task force does not plan to review each of these documents to determine which are relevant and process those documents for declassification and release.

VCS asks the Senate join the House and retain Section 348 so these documents are reviewed.  After 19 years of waiting, our ill Gulf War veterans deserve to know the facts about our exposures so we may receive medical treatments and benefits.

Sincerely,
Paul Sullivan
Executive Director

Scientists offer compelling images of Gulf War Illness

Depicting brain damage, they distinguish between a trio of syndromes

This excellent article written By Janet Raloff, published at Science News.

Healthy brain (left) shows response to pain from heat on the forearm. Different regions (right) respond to that heat in vets with Gulf War syndrome two.   -- UT Southwestern Med. Ctr.  Enlarge Image

(SALT LAKE CITY) - Nearly two decades after vets began returning from the Middle East complaining of Gulf War Syndrome, the federal government has yet to formally accept that their vague jumble of symptoms constitutes a legitimate illness. Here, at the Society of Toxicology annual meeting, yesterday, researchers rolled out a host of brain images – various types of magnetic-resonance scans and brain-wave measurements – that they say graphically and unambiguously depict Gulf War Syndrome.

Or syndromes. Because Robert Haley of the University of Texas Southwestern Medical Center in Dallas and the research team he heads have identified three discrete subtypes. Each is characterized by a different suite of symptoms. And the new imaging linked each illness with a distinct – and different – series of abnormalities in the brain.

Men with the same symptoms exhibited similar brain changes, features starkly different from healthy vets their age who had served in the same battalions. (That said, a few vets’ symptoms seemed to encompass more than one syndrome. And in such instances, imaging confirmed their brains showed impairments that extended beyond those associated with a single syndrome.)

Since the early 1990s, some 175,000 U.S. troops have returned from service in the first Gulf War reporting a host of vague complaints, notes Richard Briggs, a physical chemist at UT Southwestern involved in the new imaging. Their symptoms ranged from mental confusion, difficulty concentrating, attacks of sudden vertigo and intense uncontrollable mood swings to extreme fatigue and sometimes numbness – or the opposite, constant body pain.

With funding from the Departments of Defense and Veterans Affairs, Haley has assembled a team of roughly 140 researchers. Many work with patients. Others are developing new animal, biochemical and genetic studies to identify the biological perturbations underlying Gulf War Illness. But the vast majority – some two-thirds of these scientists – are now involved in brain imaging.

As a result of these studies, Briggs says, “In the last two years we have learned more about Gulf War Illness than we did in the previous 15.”

What’s emerged is evidence to suggest “that there are three major syndromes responsible for Gulf War Illness,” he says. They appear loosely linked to at least three different types of agents to which many troops were exposed: sarin nerve gas, a nerve gas antidote (pyridostigmine bromide) that presented its own risks and military-grade pesticides to prevent illness from sand flies and other noxious pests. But Briggs acknowledges that no one knows for sure which combination of agents or environmental conditions might have conspired to trigger Gulf War illness.

What is clear, he says, is that “our data now clearly show, beyond a shadow of a doubt, that there are brain abnormalities – physiological differences – between ill veterans and normal ones.” And from the new scans, “we can tell the ill veterans from the well veterans. And we can distinguish syndromes one, two and three from each other.”

The new neuroimaging on a subset of 57 Gulf War vets was completed eight months ago. Yesterday’s presentations represent an unveiling of the complex statistical analyses of data gleaned from those functional MRI scans (or fMRIs), brain-wave recordings, and other magnetic resonance tools.

Some testing employed old-style technologies. For instance, about a dozen years ago, Haley’s team performed magnetic resonance spectroscopy, also known as MRS, to study the chemical composition of various regions in the brains of Gulf War vets. And these tests uncovered the first solid indicators that there were physiological abnormalities in men complaining of Gulf War Illness. Such as a perturbation in the ratio of two chemicals active in the brain’s basal ganglia: n-acetyl aspartate (or NAA) and creatine.

Don’t know what that means? I didn’t either. So Briggs explained.

“The basal ganglia is sort of the switching system of the brain. It’s where a lot of communication between the left and right hemispheres occurs.” Because it crosses the midbrain region, he says, “it’s heavily involved in a lot of these decisionmaking and attention/inhibition networks” – processing centers that, if messed up, could explain many symptoms reported by sick vets.

NAA is a biomarker of healthy nerve cells. So any decrease is a bad sign. The concentration of creatine, which comprises the fuel for brain activities, tends to remain constant, Briggs says, so “it’s often used as an internal standard” against which to compare things like NAA.

The Gulf War syndromes are each associated with a roughly 10 percent lower than normal NAA-to-creatine ratio in the left and right basal ganglia, Briggs says – “an indicator of either sick or dead neurons.”

After Haley’s team initially published evidence in the late ‘90s of the diminished NAA-to-creatine ratio in sick vets, two other labs confirmed this characteristic MRS feature in sick Gulf War veterans, Briggs notes. More recently, when one of those labs failed to reconfirm those changes during a followup study, the UT Southwestern team began to wonder whether it had erred the first time it had conducted the pioneering tests. Or whether the sick vets had simply gotten well over the past 10 years.

“Our new follow-up [MRS] tests now show our initial findings were right,” Haley says – “and that the soldiers haven’t gotten better with time.”

Many of scans that his team unveiled here at SOT rely on a technology – fMRI – that was not available in the late ‘90s. So it provides new evidence of what sets sick vets apart.

This technology allows researchers to identify which areas are active as the brain works. Haley’s multi-center team designed a series of fMRI tests that required subjects to look at threatening pictures of a battlefield, or imagine the theme behind two words to come up with a third (“desert” and “humps” might be the clues given to suggest “camel”), or to learn words and recall faces.

In healthy veterans, appropriate parts of the brain lit up as they thought, reasoned, viewed – even experienced extremes of temperature. But in men suffering from Gulf War Illness, Haley says, “a different part would often light up as their brain attempted to work around its damage.”

Affected areas of the brain in each test varied. The thalamus, for example, is involved in attention and inhibition, Briggs explains. “It is activated differently in syndrome two versus controls,” he notes. Not surprisingly, people with that particular syndrome have problems with those traits. The researchers also correlated what combinations of areas in the brain respond in concert during particular tasks. And sometimes, the collection of brain locales that lit up in sick vets differed markedly from those in healthy vets (see images above).

The background volume of blood flowing through the brain also varied substantially in sick vets, Haley notes, “which suggests decreased [brain] function.” But even more importantly, blood flow varied in unpredictable ways when the sick Gulf War veterans were administered a drug meant to stimulate parts of the brain susceptible to chemical damage, such as nerve-gas-type agents.

In healthy vets and those suffering from syndrome one, blood flow to affected regions of the brain diminished, although not comparably; the drop in syndrome-one vets was about five times that in the healthy men. But among individuals suffering from Gulf War syndromes two and three, blood flow inappropriately spiked after administration of the drug.

Other tests probed for faults in the integrity of the circuitry connecting deep gray matter – where the brain performs unconscious calculations and processing – with the layer of white matter that performs conscious reasoning. In vets with syndrome two, the most seriously ill of the groups, a special form of scans showed signs that the insulating sheath covering the “wires” connecting the gray and white-matter regions was seriously impaired.

Concludes Briggs: “This tells us very clearly that in the syndrome two’s – unlike either of the other syndromes, or the controls – their wiring is flawed.”

The panoply of quantitative changes being revealed by brain imaging “is demystifying Gulf War Syndrome,” says Haley. Indeed, before long, he predicts, “we’re going to come up with tests whereby doctors can diagnose affected vets.” And one day, he hopes, the information emerging from these images may actually point toward treatments.