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."