Wednesday, April 5, 2017

U.S. House Members resoundingly call for continuation of Gulf War Illness treatment research funding


(91outcomes.com - April 5, 2017) -- Nearly one-fifth of the Members of the U.S. House of Representatives this week resoundingly called for continuation of federally funded Gulf War Illness treatment research.  The effort came at the request of Gulf War veterans, supported by ten veterans service organizations and led by Veterans for Common Sense.  

In an April 3 "Dear Colleague" letter co-led by Rep. Jack Bergman, LtGen, USMC (Ret.) (R-MI) and Rep. Gregorio Sablan (D-MP) to the House Appropriations Committee, Subcommittee on Defense, eighty-three (83) cosigners requested Fiscal Year 2018 funding to continue the Gulf War Illness Research Program (GWIRP), part of the Congressionally Directed Medical Research Program (CDMRP) funded under the U.S. Department of Defense health program.

The GWIRP is a unique treatment development medical research program initiated by Congress in FY06 to support medical research of exceptional scientific merit related to the deployment health effects of the 1991 Gulf War (Operation Desert Storm).  

Among the cosigners this year were Rep. Phil Roe, M.D. (R-MI) and Rep. Tim Walz, CSM, ARNG (Ret.) (D-MN), Chairman and Ranking Member, respectively, of the House Veterans' Affairs Committee (HVAC).  Roe and Walz co-led recent prior years' efforts to renew the program.  

A parallel effort is being led in the U.S. Senate by U.S. Senator Tammy Baldwin (D-WI).  

The full list of House cosigners is here, and the cosigned House letter is below.

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NEED AND SUPPORT FOR THE GWIRP

Landmark reports by the National Academy of Sciences’ Institute of Medicine (IOM)[i] (pp. 10, 260-64) and the Congressionally-mandated VA Research Advisory Committee (RAC) on Gulf War Veterans’ Illnesses[ii] (pp. 1, 4, 5, 13, 78, 83) emphasize that “effective treatments, cures, and, it is hoped, preventions for GWI can likely be found,” “…through a concerted national effort and rigorous scientific input.” 2 (p. 10)   In addition, important discoveries made by the GWIRP may also help protect current and future U.S. military service members at risk of similar toxic exposures. (RAC, pp. 1, 4, 5, 13, 78, 83; IOM, pp. 10, 260-64.)

ABOUT GULF WAR ILLNESS (GWI)
GWI is characterized by multiple, diverse symptoms that typically include chronic headache, widespread pain, cognitive difficulties, debilitating fatigue, gastrointestinal problems, respiratory symptoms, sleep problems, and other abnormalities that could not be explained by established medical diagnoses or standard laboratory tests. The population of Veterans affected by GWI is a subset of the nearly 700,000 U.S. Warfighters who served during the 1990-1991 Gulf War. Studies indicate that approximately 25-32% of Gulf War Veterans continue to experience symptoms associated with their deployment.”1  “Scientific research . . . supports and further substantiates . . . that Gulf War illness is a serious physical disease, affecting at least 175,000 veterans of the 1990-1991 Gulf War, that resulted from hazardous exposures in the Gulf War theater.”3 (p.1)
Studies and surveys reviewed in the most recent (2014) RAC report indicated an elevated prevalence of Lou Gehrig’s disease (ALS)3(pp.23-25) and elevated rates of diagnosed migraines, seizures, gastrointestinal conditions, respiratory conditions and skin disorders among Gulf War veterans, and doubled brain cancer3(pp.23-26) death rates among veterans potentially exposed to chemical warfare agents detonated at an Iraqi munitions complex at Khamisiyah, Iraq.  


-Anthony Hardie,
91outcomes.com




CITATIONS:
[1] Gulf War Illness Research Program (GWIRP) website, Congressionally Directed Medical Research Program (CDMRP), U.S. Army Medical Research and Materiel Command, U.S Department of Defense (DoD): http://cdmrp.army.mil/gwirp
[2] Institute of Medicine (IOM), National Academy of Sciences, “Gulf War and Health, Volume 8: Update of Health Effects of Serving in the Gulf War,” Washington, DC: The National Academies Press, 2010. www.nap.edu/catalog/12835/gulf-war-and-health-volume-8-update-of-health-effects
[3] Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), U.S. Department of Veterans Affairs, “Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations, 2009-2013.” Washington, D.C.: U.S. Government Printing Office, May 2014.
[i] Institute of Medicine (IOM), National Academy of Sciences, “Gulf War and Health, Volume 8: Update of Health Effects of Serving in the Gulf War,” Washington, DC: The National Academies Press, 2010. www.nap.edu/catalog/12835/gulf-war-and-health-volume-8-update-of-health-effects
[ii] Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), U.S. Department of Veterans Affairs, “Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations, 2009-2013.” Washington, D.C.: U.S. Government Printing Office, May 2014. www.va.gov/RAC-GWVI/RACReport2014Final.pdf


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INJUSTICE: Why Some Gulf War Veterans are Eligible for the Gulf War medal but not VA's Gulf War Benefits


(91outcomes.com - April 5, 2017) -- For years, there has been confusion surrounding the differences between the Persian Gulf war geographic areas for receipt of the Southwest Asia Service Medal (SWASM) and for purposes of VA benefits.  


It has long been rumored that some Gulf War veterans who qualified for the Persian Gulf War service medal (SWASM) don't qualify for VA Gulf war benefits because their service was in Turkey, Syria, Jordan, Egypt, with Patriot missile crews and other U.S. forces and these countries' airspace and territorial waters. 


Despite that fact that both the medal and VA's Gulf War benefits are based on service in the same war, it is true that each have different geographic areas to qualify, and that some Gulf War veterans are eligible for the medal but not Gulf War-related VA benefits.  



VA Benefits for Persian Gulf War Veterans


Authority to determine the geographic areas of the Southwest Theatre of Operations for the purposes of VA benefits was granted in 1994 law, which specified that the Secretary of Veterans Affairs would determine the geographic area by regulation.  Sec. 106 of the Veterans Benefits Improvement Act of 1994 (PL 103-446) specified:


"(b) The Secretary [of Veterans Affairs] shall prescribe by regulation the period Regulations, of time following service in the Southwest Asia theater of operations during the Persian Gulf War that the Secretary determines is appropriate for presumption of service connection for purposes of this section. The Secretary's determination of such period of time shall be made following a review of any available credible medical or scientific evidence and the historical treatment afforded disabilities for which manifestation periods have been established and shall take into account other pertinent circumstances regarding the experiences of veterans of the Persian Gulf War. "
(c)(1) The Secretary shall prescribe regulations to carry out this section. "
(2) Those regulations shall include the following: "
(A) A description of the period and geographical area or areas of military service in connection with which compensation under this section may be paid. "
(B) A description of the illnesses for which compensation under this section may be paid. "
(C) A description of any relevant medical characteristic (such as a latency period) associated with each such illness. "
(d) A disability for which compensation under this subchapter is payable shall be considered to be service connected for purposes of all other laws of the United States. "
(e) For purposes of this section, the term 'Persian Gulf veteran' means a veteran who served on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War.".

To fulfill its regulatory obligations under the 1994 law, including defining the geographic area for Gulf War veterans’ claims, the VA proposed the following, subject to a 30-day public comment period, in Federal Register Volume 59, Number 235 (Thursday, December 8, 1994), FR Doc No: 94-30133:  

“In response to the needs and concerns of Persian Gulf veterans, Congress enacted the ``Persian Gulf War Veterans' Benefits Act,'' Title I of the ``Veterans' Benefits Improvements Act of 1994,'' Public Law 103-446. That statute added a new section 1117 to title 38, United  States Code, authorizing the Secretary of Veterans Affairs to  compensate any Persian Gulf veteran suffering from a chronic disability  resulting from an undiagnosed illness or combination of undiagnosed  illnesses that became manifest either during active duty in the  Southwest Asia theater of operations during the Persian Gulf War or to  a degree of 10 percent or more within a presumptive period, as  determined by the Secretary, following service in the Southwest Asia  theater of operations during the Persian Gulf War. The statute directs that VA's implementing regulations should address: (1) The nature, period, and geographical areas of military service in connection with which compensation may be paid; (2) the illnesses for which compensation may be paid; and (3) any relevant medical characteristic associated with each such illness. The statute further provides that a disability for which compensation is payable under Sec. 1117 shall be considered service connected for the purposes of all laws of the United States.”
...
We propose to define Southwest Asia theater of operations to include Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. This definition follows Executive Order 12744 of January 21, 1991, in which President Bush designated the combat zone of the Persian Gulf War.”

An executive order by then-President George H.W. Bush, governing the Persian Gulf War theatre of operations, designated the combat zone area on which this VA regulation is based.  “Executive Order 12744—Designation of Arabian Peninsula Areas, Airspace, and Adjacent Waters as a Combat Zone,” dated January 21, 1991, specified:

By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 112 of the Internal Revenue Code of 1986 I hereby designate, for purposes of that section, the following locations, including the airspace above such locations, as an area in which Armed Forces of the United States are and have been engaged in combat:
--the Persian Gulf
--the Red Sea
--the Gulf of Oman
--that portion of the Arabian Sea that lies north of 10 degrees north latitude and west of 68 degrees east longitude
--the Gulf of Aden
--the total land areas of Iraq, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, and the United Arab Emirates.
For the purposes of this order, the date of the commencing of combatant activities in such zone is hereby designated as January 17, 1991.
The VA's proposed rule was made final as announced in the Federal Register [Federal Register Volume 60, Number 23 (Friday, February 3, 1995), Rules and Regulations, Pages 6660-6666, FR Doc No: 95-2764, with an effective date of November 2, 1994, the effective date of Title I of the “Veterans' Benefits Improvements Act of 1994,” Public Law 103-446 [38 U.S.C. 501(a))].   

The geographic area for VA benefits was thus codified in regulation by VA, where it remains unchanged ever since, at 38 CFR 3.317: 
 
 “(d) For purposes of this section:
    (1) the term ``Persian Gulf veteran'' means a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War.
    (2) the Southwest Asia theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations.”


Southwest Asia Service Medal for Persian Gulf War Veterans

The award of the Southwest Asia Service Medal (SWASM) comes from a second Persian Gulf war -related executive order by then-President Bush in March 1991, which broadly defined the geographic area of eligibility.  Department of Defense regulations for the medal added greater specificity.  
 
This second executive order governing the Persian Gulf War theatre of operations was specifically to authorize the Southwest Asia Service Medal and generally authorized a broader geographic area.  Executive Order 12754—Establishing the Southwest Asia Service Medal,” dated March 12, 1991, stated:  

By the authority vested in me as President by the Constitution and the laws of the United States of America, including my authority as Commander in Chief of the Armed Forces of the United States, it is hereby ordered as follows:
Section 1. There is established, with suitable appurtenances, the Southwest Asia Service Medal. It may be awarded to members of the Armed Forces of the United States who participated in military operations in Southwest Asia or in the surrounding contiguous waters or air space on or after August 2, 1990, and before a terminal date to be prescribed by the Secretary of Defense.
Sec. 2. The Southwest Asia Service Medal may be awarded posthumously to any person covered by, and under the circumstances described in, section 1 of this order.
Sec. 3. The Secretaries of the Military Departments, with the approval of the Secretary of Defense, and the Secretary of Transportation with respect to the Coast Guard when it is not operating as a service in the Navy, are directed to prescribe uniform regulations governing the award and wearing of the Southwest Asia Service Medal.

The award of the Southwest Asia Service Medal (SWASM) is governed by federal regulation, 32 CFR 578.27, based on that second Persian Gulf War executive order; its second paragraph includes additional geographic areas beyond those for which the VA extends its Persian Gulf War benefits:  
 
32 CFR § 578.27 Southwest Asia Service Medal. 
(a) The Southwest Asia Service Medal (SWASM) was established by Executive Order 12754, March 12, 1991. It is awarded to all members of the Armed Forces of the United States serving in Southwest Asia and contiguous waters or airspace thereover, on or after August 2, 1990 to November 30, 1995. Southwest Asia and contiguous waters, as used herein, is defined as an area which includes the Persian Gulf, Red Sea, Gulf of Oman, Gulf of Aden, that portion of the Arabian Sea that lies north of 10 degrees N. latitude and west of 68 degrees E. longitude, as well as the total land areas of Iraq, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, and United Arab Emirates.
(b) Members of the Armed Forces of the United States serving in Israel, Egypt, Turkey, Syria, and Jordan (including the airspace and territorial waters) between January 17, 1991 and April 11, 1991, will also be eligible for this award. Members serving in these countries must have been under the command and control of U.S. Central Command or directly supporting military operations in the combat theater.


Some Persian Gulf War Veterans remain ineligible for VA benefits

Thus, Persian Gulf War veterans who served in Israel, Egypt, Turkey, Syria, and Jordan (including their airspace and territorial waters) are eligible for the definitive Gulf War medal -- the Southwest Asia Service Medal (SWASM) -- but not for VA's Gulf War benefits, which exclude these veterans from qualifying for Gulf War-specific benefits.  

It remains unclear why neither Congress nor VA have ever updated the VA's more narrow geographic definition of the Persian Gulf War theatre of operations to provide equal benefits to these "other" Gulf War veterans.

This puts some Gulf War veterans in the bizarre position of being authorized the Southwest Asia Service Medal for their Persian Gulf War service but simultaneously being ineligible for Persian Gulf War benefits from the VA. 

-Anthony Hardie
91outcomes.com 


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SOURCES:

Tuesday, April 4, 2017

Changes in Mitochondrial, Immune, and Inflammatory Pathways following Gulf War agent exposures

(91outcomes.com - April 4, 2017) - Newly published study results by researchers at the Roskamp Institute in Sarasota, Fla, have found changes in mitochondrial, immune, and inflammatory pathways following Gulf War agent exposures in an animal model relevant to Gulf War Illness.

In the publication authored by Dr. Zuchra Zakirova and a team of Roskamp researchers, led by Dr.'s Ghaniyah Ait-Ghezala and Fiona Crawford, conclude that these discoveries may lead to potential targets for therapeutic intervention.

The study was funded by the Gulf War Illness Research Program (GWIRP), part of the Congressionally Directed Medical Research Program (CDMRP) funded by Congress under the Defense health program (GW100076).

Dr. Ait-Ghezala has recently been awarded a follow-on research grant to identify treatment strategies, which if successful could then be expedited to human trials (GW160107, "Treatment Strategies in a Mouse Model of Chronic Gulf War Illness").

Another Roskamp researcher, Dr. Laila Abdullah, has begun a related GWIRP-funded study, "Identification of Lipid Biomarkers of Inflammation and Metabolic Disturbances in GWI" (GW150056).

Crawford, President and CEO of the Roskamp Institute, serves on the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RAC).

-Anthony Hardie, 91outcomes.com


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SOURCE:  PubMed, by Dr.'s Zuchra Zakirova, Fiona Crawford, Ghaniyah Ait-Ghezala, et al (Roskamp Institute), published in Proteomics Clinical Applications, March 28, 2107 (ePub ahead of print)

ARCHIVED ABSTRACT:

 2017 Mar 28. doi: 10.1002/prca.201600190. [Epub ahead of print]

Complementary proteomic approaches reveal mitochondrial dysfunction, immune and inflammatory dysregulation in a mouse model of gulf war illness.

Abstract

PURPOSE: 

Long term consequences of combined pyridostigmine bromide and permethrin exposure in C57BL6/J mice using a well characterized mouse model of exposure to these Gulf War (GW) agents were explored at the protein level.

EXPERIMENTAL DESIGN: 

We used orthogonal proteomic approaches to identify pathways that are chronically impacted in the mouse CNS due to semi-acute GW agent exposure early in life. These analyses were performed on soluble and membrane-bound protein fractions from brain samples using two orthogonal isotopic labeling LC-MS/MS proteomic approaches - stable isotope dimethyl labeling and isobaric tags for relative and absolute quantitation.

RESULTS: 

The use of these approaches allowed for greater coverage of proteins than was possible by either one alone and revealed both distinct and overlapping datasets. This combined analysis identified changes in several mitochondrial, as well as immune and inflammatory pathways after GW agent exposure.

CONCLUSIONS AND CLINICAL RELEVANCE: 

The work discussed here provides insight into GW-agent exposure dependent mechanisms that adversely affect mitochondrial function and immune and inflammatory regulation. Collectively, our work identified key pathways which were chronically impacted in the mouse CNS following acute GW agent exposure, this may lead to the identification of potential targets for therapeutic intervention in the future. Long term consequences of combined pyridostigmine bromide and permethrin exposure in C57BL6/J mice using a well characterized mouse model of exposure to these Gulf War agents were explored at the protein level. Expanding on earlier work, we used orthogonal proteomic approaches to identify pathways that are chronically impacted in the mouse CNS due to semi-acute GW agent exposure early in life. These analyses were performed on soluble and membrane-bound protein fractions from brain samples using two orthogonal isotopic labeling LC-MS/MS proteomic approaches - stable isotope dimethyl labeling (SIDL) and isobaric tags for relative and absolute quantitation (iTRAQ). The use of these approaches allowed for greater coverage of proteins than was possible by either one alone and revealed both distinct and overlapping datasets. This combined analysis identified changes in several mitochondrial, as well as immune and inflammatory pathways after GW agent exposure. The work discussed here provides insight into GW-agent exposure dependent mechanisms that adversely affect mitochondrial function and immune and inflammatory regulation at five months post exposure to PB+PER. This article is protected by copyright. All rights reserved.

KEYWORDS: 

Gulf War; SIDL; iTRAQ; mitochondrial dysfunction; tandem mass spectrometry
PMID:
 
28371386
 
DOI:
 
10.1002/prca.201600190