In 1991, as part of Operation Desert Storm, former U.S. Army Spc. Candy Lovett arrived in Kuwait a healthy 29-year-old eager to serve her country. Two decades later, she's accumulated a stack of medical records over five feet high -- none of which relates to injuries inflicted by bullets or shrapnel.
"It's just been one thing after another," said the veteran, who now resides in Miami and whose ailments run the gamut from lung disease and sleep apnea to, most recently, terminal breast cancer. "At one point," she said, "I was on over 50 pills."
Former Air Force Tech. Sgt. Tim Wymore, who was deployed to Iraq in 2004, suffers from an array of health problems that mirror Lovett's. "Everyone has the same things," said Wymore, who has inexplicably shed 40 pounds in the last few months. "It's just weird."
Wymore and Lovett -- and countless others who served in Iraq, Afghanistan and elsewhere in the desert region over the past three decades -- have struggled to understand this, but they share one nagging conviction: These ailments are tied to service in a war zone.
Their suspicions -- long rebuffed by insurance companies -- are now getting support from some doctors and environmental health researchers, who suspect that American soldiers are being unnecessarily exposed to heavily contaminated environments while serving overseas. Even when not engaged directly in combat, they say, servicemen and women -- typically without protective masks or other simple precautions -- live and work amid clouds of Middle Eastern dust laden with toxic metals, bacteria and viruses, and surrounded by plumes of smoke rising from burn pits, a common U.S. military practice of burning feces, plastic bottles and other solid waste in open pits, often with jet fuel.
Research published in December 2012 raises the possibility that in some instances, soldiers may have been exposed to airborne cocktails that included low levels of adeadly chemical warfare agent, the nerve gas sarin, which wafted hundreds of miles from U.S.-bombed Iraqi facilities.
"I knew something strange was happening," said Dr. Anthony Szema, who recalled returning from summer vacation a few years ago to find that his typically older, overweight clientele had been eclipsed by throngs of apparently sturdy 20- to 25-year-old non-smokers wearing uniforms. His subsequent investigation concluded that new asthma diagnoses among Long Island, N.Y.-based forces were far more common among soldiers who deployed to war zones than those who had stayed state-side.
"There are lots of dangers of war," said Szema, an assistant professor at Stony Brook University School of Medicine. "But at least some of them are preventable."
Still, connecting any particular exposure to a disease is extremely difficult, and federal officials suggest it is too early to jump to conclusions.
"There is concern that there could be long-term effects" of dust and burn pit exposures, said Dr. Paul Ciminera, director of the Post-9/11 Era Environmental Health Program at the U.S. Dept. of Veterans Affairs. "Right now, there is insufficient evidence."
That's slowly changing.
Dr. Cecile Rose, director of the occupational and environmental medicine clinic at National Jewish Health, said that while investigation of these exposures are in their infancy, she is seeing a number of returning troops who suffer from respiratory diseases -- virtually all of whom say they experienced substantial exposure to dust storms and burn pits while overseas.
"The more we do this," she said, "the more compelling it is that there is a problem."
SOURCES OF ILLS
A thin crust of sand naturally covers the Middle Eastern desert landscape. But once that protective layer is crushed, say, by a tank or caravan, the fine grains are vulnerable to being swept up into the air. Research has found that military activity can raise the likelihood of dust storms five-fold, and that the annual number of dust storms has been on the rise in the Middle East since the Gulf War.
Navy Capt. Mark Lyles, chair of health and security studies at the U.S. Naval War College's Center for Naval Warfare Studies, speaking as a private citizen, speculated that the smoking gun for many of the diagnosed and undiagnosed diseases may well be this ubiquitous dust, which can linger in the air for days after a dust storm and gets continuously kicked up by boots, wheels and gusts of wind.
The microscopic dust particles can be "great delivery vehicles" for toxins, Lyles said, because they "bind to everything" yet are small enough to sneak past the body's natural defenses into the lungs and other tissues.
With high temperatures and low humidity, a soldier tends to breathe through the mouth rather than the nose, especially when wearing heavy armor and exercising. "That opens the door for larger particles to penetrate deeper into the lungs," explained Lyles.
"If you're riding behind a vehicle or lying on the ground or just following someone on foot," Lyles added, "the exposure level goes way up -- let alone any wind pick-up or dust storm."
"There was no escape," Wymore said, recalling how the air conditioning units inside his quarters let smoke seep inside. (Tim Wymore)
In samples of Middle East dust, Lyles has identified aluminum, lead and other metals that have been linked to conditions affecting the neurological, respiratory and cardiovascular systems. Lyles has also found what he considers "significant levels" of bacteria, fungi and viruses in the dust particles.
Szema, too, is finding metals including titanium in biopsies of veterans' lungs and in samples of Middle Eastern dust. "And the dust is sharp," he said, comparing it to asbestos. Mice exposed to the dust as part of Szema's research developed lung inflammation and suppressed T cells, key soldiers in the immune system's invader-fighting arsenal. He is testing a novel drug that he believes will protect the body from these effects.
"It would not surprise me at all if we identify organisms associated with illnesses found in various personnel," said Dale Griffin of the U.S. Geological Survey, who has also worked on analyzing dust samples.
Others are more skeptical.
"It's to be expected that veterans link what they see, smell, taste and feel to diseases. Our job is to identify and quantify what is going on," added Dr. Michael R. Peterson, a post-deployment health consultant with the U.S. Department of Veterans Affairs.
"But science changes," Dr. Bernard Rosof, on the board of directors at Huntington Hospital in N.Y., told HuffPost. "And we can't negate the possibility that we might find something in the future."
'UNEXPLAINED, BUT VERY REAL'
In early January, a subcommittee of the Institute of Medicine's Committee on Gulf War and Health published a report suggesting that chronic multisymptom illness, a broadened definition of what has commonly been called Gulf War illness or syndrome, may be affecting soldiers returning from Iraq and Afghanistan -- in addition to one in every three veterans of the 1991 conflict.
"We are beginning to see similar complaints," said Rosof, chair of the subcommittee. "We can't yet say that it meets the level of what we've seen with the Gulf War, but we have every expectation that it will."
Chronic multisymptom illness was defined by the Institute of Medicine committee to include medically unexplained symptoms in at least two of six categories: fatigue, mood and cognition issues, musculoskeletal problems, gastrointestinal problems, respiratory difficulties and neurologic issues that last for at least six months.
The committee concluded that there is no standard treatment approach for these veterans, and that the cause or causes of chronic multisymptom illness may never be found.
"What they are suffering from is medically unexplained, but very real," added Rosof. "We need to give it the attention it deserves."
It's not yet clear whether the new report will push the VA to broaden the group of veterans who qualify for Gulf War benefits to include those who've served in more recent conflicts. The VA held its first meeting to respond to the IOM report on Jan. 30. "There are no recommendations and the group cannot comment on the expansion and its effect on benefits at this time," Meagan Lutz, a spokesperson for the VA, told The Huffington Post.
Sometimes, however, doctors do succeed in pegging some of a soldier's symptoms to an illness.
The diagnosis that stands out most to Rose in her practice at National Jewish Health is an extremely rare, incurable and progressive lung disease called constrictive bronchiolitis, often misdiagnosed as asthma. The disease, which narrows the airways with inflammation or scarring, has been associated with organ transplants, viral infections and certain conditions such as rheumatoid arthritis. It's also been linked to exposure to toxic fumes. Other researchers are seeing cases as well.
The asthma medication Szema prescribed to his growing number of patients wasn't doing the trick for half of them. And in a study published in 2011 in the New England Journal of Medicine, Dr. Robert Miller found that of 49 previously healthy soldiers with unexplained asthma-like symptoms, 38 had biopsy samples showing constrictive bronchiolitis. The disease shares symptoms with asthma yet doesn't respond to asthma treatment -- or any treatments, for that matter. Severe cases require lung transplants.
A biopsy is generally needed to get a definitive diagnosis of the disease. And the diagnosis, said Miller, can significantly raise a veteran's disability rating -- a key to securing a lifetime of health benefits. He added that many veterans with the condition can't hold down a job and depend on those benefits.
"A lot of these people are significantly disabled," said Miller, a lung specialist at Vanderbilt University Medical Center. "They get short of breath climbing one flight of stairs. They can't play with their kids."
Yet Miller said that military doctors don't typically perform these biopsies. And the Army, he added, has made it difficult for patients to seek his help.
Cynthia O. Smith, a spokeswoman with the Department of Defense, said that there is "no specific effort to stop referrals of soldiers with respiratory conditions from going to Vanderbilt University Medical Center or any other civilian medical facility," but added that the department "has a duty to our taxpayers to care for our soldiers within our military health system."
One of those soldiers is former Army Capt. Leroy Torres, who spent four years in the Middle East before being laid low -- and forced into early retirement before he turned 40 this past fall -- by a complement of respiratory, cardiovascular, neurological and gastrointestinal issues. After two years of shuttling from doctor to doctor, Torres was finally diagnosed by Miller in 2010 with constrictive bronchiolitis.
"I'm the father of three kids, and I struggled to get benefits," Torres said, though he added that he knows other soldiers who have it worse. "My good friend is on four liters of oxygen, 24 hours a day," Torres said.
Asked about his service in the Middle East, Torres immediately recalls his time in Iraq between 2007 and 2008 -- and the clouds of thick smoke and wind-blown powdery dust in which he trained. "It was just nasty, dirty," he said. "But we figured someone was looking out for us, so we just didn't think about it."
Government and academic researchers are continuing the look for answers. Federal legislation passed in January requires the secretary of Defense to "issue guidance to the military departments and appropriate defense agencies regarding environmental exposures on military installations."
Smith noted that Congress is asking the Department of Defense to develop tools such as devices that soldiers can affix to their uniforms to detect and measure chemical, biological or radiological agents, and to identify markers that can be measured in soldiers' blood to determine levels of exposure.
New legislation also opens a Department of Veterans Affairs burn pit registry to track the medical history of those exposed.
"Just because we haven't found anything, that doesn't mean there's nothing out there," said Lyles. He added his belief that it was a "mistake" to limit the registry to burn pit exposures, and that it should be broadened to include things like desert dust.
Meanwhile, as the institute was working on their report, Dr. Robert Haley of the University of Texas Southwestern was in the process of unveiling new evidence of the role of plumes of nerve gas in the illnesses of several thousand veterans of the first Gulf War.
In a study published in December, Haley described how weather conditions during a January 1991 bombing raid on an Iraqi ammunition facility propelled a sarin gas plume more than 350 miles, exposing U.S. troops to low levels of the gas over the next several days. Arguments against a nerve gas link with Gulf War illness had generally rested on the proposition that nerve gas could not carry that far, and on the lack of casualties -- in particular, there were no known deaths on the ground in between the bombed facilities and U.S. military bases.
But Haley found evidence that the chemical fallout traveled hundreds of miles atop a protective boundary layer of air before dispersing and descending on the troops at lower concentrations.
Sarin gas is a close chemical cousin of organophosphate insecticides, disrupting normal muscle and gland function in a similar, albeit more potent, way. However, according the the U.S. Centers for Disease Control and Prevention's website, nerve agents -- unlike some organophosphates -- have not been linked with neurological problems lasting more than one to two weeks after exposure.
"In the past, dogma has been that if it's not enough to kill you, it won't hurt you," said Haley. "But now we know that's not true. Low-levels of nerve agents are dangerous."
In a separate study, Haley showed that the more often a soldier heard nerve gas alarms on a base, the more likely that soldier would be to suffer later from the chronic symptoms of Gulf War illness. As he explained, nerve gas alarms often went off after a sonic boom or scud missile explosion -- things that could mix layers of air.
When asked about the new studies, Smith pointed to investigations by the Presidential Advisory Committee on Gulf War Veterans' Illnesses in 1997 and the Senate Veterans Affairs Committee in 2000. Both studies, she said, found the "sarin gas cloud claims" unviable.
Anthony Hardie, a Gulf War Army special ops veteran, remembers hearing those nerve gas alarms. He also remembers an oil well fire, breathing dirty air and taking anti-nerve agent pills -- which some studies have previously associated with Gulf War illness.
"I had about as many exposures as a Gulf War veteran could have," said Hardie, now an advocate on Gulf War and other veterans' issues since being forced into retirement with chronic multisymptom illness.
While Hardie doesn't believe that there is one single culprit behind veterans' illnesses during any Gulf War era, he said he does think that Haley is "on to something." He also thinks that, should Haley be right, it could have "profound implications for homeland security."
"Think about what could happen in Syria," Hardie suggested, referring to the widespread concern that Syria has one of the largest chemical weapon stockpiles in the world. "A plume of toxins could drift and cause long-term health effects in tens, hundreds, even thousands of people."
'AKIN TO FRIENDLY FIRE'
Question 14 of the Post-Deployment Health Assessment that former U.S. Marine Sgt. Tom Sullivan filled out in March 2005 asked about his frequency of environmental exposures while serving overseas. In boxes next to sand dust, smoke from burning trash, tent heater smoke and pesticide-treated uniforms, the returning Marine marked "often."
"My brother's docs never looked at that for any explanation for his illnesses," said Dan Sullivan, noting the chronic widespread pain, swelling and severe inflammatory bowel issues that Tom later suffered. Instead, unable to point a finger at what was causing his body to deteriorate, Dan recalled, his brother's physicians referred him to psychiatric counseling. He even received art therapy in the last months of his life.
"It seems pretty clear that almost all of it could be explained by various toxic exposures," said Dan. "The sad thing about it, Tom died not knowing that. And he died thinking that he was alone."
After Tom's death in February of 2009, Dan recalled how he and his parents began running across other veterans with "strikingly similar illnesses." They went on to found the nonprofit Sergeant Sullivan Center in an effort to raise awareness, research and education on the complicated plight of sick soldiers returning from the Middle East.
Alice Daniel has been on a similar mission herself, working with efforts such as theTragedy Assistance Program for Survivors. She said her son Austin came home in September 2005 from Camp Victory, Iraq, "without a scratch." The Army staff sergeant got sick three years later. And in September 2009, at the age of 33, he died, leaving behind a 27-year-old wife and 22-month-old daughter.
"I love the military. I consider this akin to friendly fire. Things happen during war. But we need to figure out how to stop this from happening, just as we try to avoid friendly fire," said Daniel, who is hopeful about the opening of the burn pit registry. "We can't do research until we have people."
For now, burn pits continue to be used, although to a lesser extent, according to Smith of the Department of Defense. She said that there are no requirements that soldiers use regular respiratory protection, with the exception of individuals engaged in certain occupations. But she added that the DoD and the VA "have taken a number of steps to assess whether exposures to these agents pose a long-term health risk to our service members and veterans."
The situation is more straightforward to some sick veterans. "We were inhaling all that crap," said Lovett. "A lot of us are dying off. And they are doing the same things in the newer wars that they were doing in the Gulf War."
Former Air Force Tech. Sgt. Tim Wymore made frequent truck trips to a burn pit on base, and recalled the "unbelievable" smell and taste. (Tim Wymore)
While Lovett said it never dawned on her to ask for a mask, Wymore remembered stopping by an equipment facility on base one particularly dirty day.
"I asked if they had any masks and they said no," Wymore recalled. "Then I asked if I could use the gas mask with my chem-suit. They said no, that the filters cost too much to replace."
Wymore has been diagnosed with constrictive bronchiolitis, among a number of other problems that he couldn't fully list in an interview. "Every morning I throw up film from my stomach," he said. "And they don't know what is causing it."
"To be honest, I'd rather have had an arm or leg blown off," added Wymore. "At least then I'd know what was wrong with me."
CORRECTION: A previous version of this article incorrectly referenced Dr. Anthony Szema's title as "associate professor"; he is an assistant professor.
This story appears in Issue 37 of our weekly iPad magazine, Huffington, in the iTunes App store, available Friday, Feb. 21.