IOM to Release 8th Report in Gulf War and Health Series this Week

Veterans groups skeptical of earlier reports, citing  biased VA contracting

Written by Anthony Hardie, Publisher/Editor

(91outcomes.com) This week, the Institute of Medicine (IOM), part of the National Academy of Sciences, will release the first of two parts of its eighth report in its “Gulf War and Health” series, Update of Health Effects of Serving in the Gulf War. 

The IOM has conducted the series of studies -- mandated by the Persian Gulf War Veterans Act of 1998 and modeled after Agent Orange legislation -- to examine the scientific and medical literature on the potential health effects of veterans’ 1991 Gulf War exposures. 

However, most of IOM’s previous Gulf War reports have come under fire from veterans groups and the powerful, congressionally-chartered Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI), which have called the reports biased against veterans because they have led to very few presumptive conditions for veterans of the 1991 Gulf War. 

Veterans groups and the RAC-GWVI have faulted U.S. Department of Veterans Affairs contracting authorities rather than IOM scientists, noting that IOM study committees have been contractually forced by VA authorities to specifically exclude considering critically important animal and other types of studies that are key to studying health outcomes of exposures to toxic substances present in the Gulf War. 

The IOM reports are used by the VA to determine presumptive conditions for service-connected disability compensation and health care for the conditions.

Last month, VA Secretary Eric Shinseki used IOM study results to presumptively connect long-term health effects associated with nine rare infectious diseases endemic to the Persian Gulf region. 

Shinseki also announced a rewrite of the rules related to Gulf War veterans’ illnesses to help with disability and health care claims by the 175,000 to 210,000 of the 697,000 veterans of the war believed to be affected by chronic multi-symptom illness.

IOM has conducted several previous public meetings related to the new report, as the committee has met to deliberate on published studies relevant to the issues at hand.

The IOM will host a public briefing on the new report on Friday, April 9, 2010, from 1:00 to 2:00 p.m. (Eastern Time).  The briefing will be held in Room 700 in the National Academies Keck Center, 500 5th Street NW, Washington, DC. The building is located about one block from the Judiciary Square Metro station.

Information regarding the project can be found on the National Academies website at: http://www8.nationalacademies.org/cp/projectview.aspx?key=49036. If you are interested in attending, please email Joe Goodman (jgoodman@nas.edu)  as space is limited.  If you cannot attend in person and would like to listen to the briefing via telephone, please respond via email; a call-in number will be sent the week of the briefing to those who wish to listen. 

According to Committee staff, this briefing is related to the release of the committee’s initial report (first phase of a two-phase study). A second report is scheduled to be completed and released in about 30 months, and will go more in-depth into the readjustment issues identified in the initial report.

Previous reports in the IOM Gulf War and Health series have included:

1.  Gulf War and Health: Volume 1.  Depleted Uranium, Sarin, Pyridostigmine Bromide, and Vaccines, January 1, 2000. 

This first study by IOM reviewed the scientific literature on depleted uranium, chemical warfare agents (sarin and cyclosarin), pyridostigmine bromide, and vaccines (anthrax and botulinum toxoid)

2.  Gulf War and Health Volume 2. Insecticides and Solvents, Feb 18, 2003. 

This report provides a comprehensive assessment of the available scientific literature on potential health effects of exposure to certain biological, chemical, and environmental agents associated with the Gulf War. In this second study, the committee evaluated the published, peer-reviewed literature on exposure to insecticides and solvents thought to have been present during the 1990-1991 war.

Because little information exists on actual exposure levels a critical factor when assessing health effects the committee could not draw specific conclusions about the health problems of Gulf War veterans. However, the study found some evidence, although usually limited, to link specific long-term health outcomes with exposure to certain insecticides and solvents.

3.  Gulf War and Health: Volume 3.  Fuels, Combustion Products, and Propellants.  Released 2005. 

This volume evaluates the long-term, human health effects associated with exposure to selected environmental agents, pollutants, and synthetic chemical compounds believed to have been present during the Gulf War. The committee specifically evaluated the literature on hydrogen sulfide, combustion products, hydrazine and red fuming nitric acid. Both the epidemiologic and toxicologic literature were reviewed.

4.  Gulf War and Health: Volume 4.   Health Effects of Serving in the Gulf War, Released: September 12, 2006. 

This report differs from the previous work of IOM in that it summarizes in one place the current status of health effects in veterans deployed to the Persian Gulf irrespective of exposure information.  The charge to this IOM committee was to review, evaluate, and summarize peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans. 

The committee found that although veterans of the first Gulf War report significantly more symptoms of illness than soldiers of the same period who were not deployed, studies have found no cluster of symptoms that constitute a syndrome unique to Gulf War veterans. 

The committee did find evidence that suggests there may be an elevated rate of the rare disorder amyotrophic lateral sclerosis (ALS) among Gulf War veterans. However, there does not appear to be an increase in mortality and hospitalizations among Gulf War veterans. Evidence regarding rates of testicular cancer, brain cancer, and certain birth defects among Gulf War veterans is inconsistent and the committee recommended further surveillance for those health outcomes.

5.  Gulf War and Health: Volume 5.  Infectious Disease.  Released: November 3, 2006. 

This report reviewed long-term adverse human health effects associated with selected infectious diseases pertinent to Gulf War veterans.  The infectious diseases include, but are not limited to, diseases caused by pathogenic Escherichia coli, shigellosis, leishmaniasis, and sandfly fever.

6.  Gulf War and Health: Volume 6.  Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress, Released: November 15, 2007.   

This study comprehensively reviewed, evaluated, and summarized the peer-reviewed scientific and medical literature regarding the association between stress and long-term adverse health effects in Gulf War veterans, specifically the physiologic, psychologic, and psychosocial effects of stress.

The study was not limited to veterans of the 1991 Gulf War but also is applicable to veterans of Operation Iraqi Freedom and Operation Enduring Freedom.

7.  Gulf War and Health: Volume 7. Long-term Consequences of Traumatic Brain Injury, Released:  December 3, 2008. 

This report assesses the possible long-term health outcomes of traumatic brain injury (TBI), detailing numerous outcomes that might be associated with mild, moderate, and severe injuries. These include: neurologic, endocrine, psychologic outcomes, in addition to problems with social functioning. 

Recommendations are provided for study of blast injuries and the report suggests methods of data-gathering for future research to improve our understanding of blast injuries which ultimately would improve veteran care.

 

Additional IOM reports relevant to Gulf War veterans:

Gulf War Veterans: Treating Symptoms and Syndromes, Released: July 26, 2001

Potential health consequences of service in the Gulf War have been a concern since U.S. troops returned home. Research and investigations to date indicate there is no single illness or syndrome common to all ill veterans. Questions have arisen as to whether there are effective treatments for the problems ill veterans are experiencing, and whether these veterans are receiving appropriate care.

In response to Section 105 of this legislation, the Department of Veterans Affairs asked the Institute of Medicine to convene a committee that would:

• Identify and describe approaches for assessing treatment effectiveness;
• Identify illnesses and conditions among veterans of the Gulf War, using data obtained from the VA and the DoD Gulf War Registries, as well as information in published articles; and
• For these identified conditions and illnesses, identify validated models of treatment (to the extent that such treatments exist), or identify new approaches, theories, or research on management of patients with these conditions if validated treatments models are not available.

The congressional legislation specifically requested that the Academy study address undiagnosed illnesses as well as any other chronic illness deemed to warrant review. 

Gulf War and Health: Updated Literature Review of Sarin Released: August 20, 2004

In a report released in 2000, the IOM revealed that exposure to the chemical warfare agent sarin can cause short-term symptoms such as severe cramping, difficulty breathing, twitching, pinpoint pupils and heavy sweating. However, there was not enough evidence to draw conclusions as to whether long-term health effects are associated with low-dose exposures.

In response to veterans' ongoing concerns and recent publications in the literature, IOM updated its 2000 report. In the report, Gulf War and Health: Updated Literature Review of Sarin, the committee concluded that there is still not enough evidence to determine whether exposure to low doses of sarin are associated with long-term health problems.

Gulf War and Health: Updated Literature Review of Depleted Uranium, Released: July 30, 2008.

In this most recent report, the committee concluded that there is still not enough evidence to determine whether exposure to depleted uranium is associated with long-term health problems.

Epidemiologic Studies of Veterans Exposed to Depleted Uranium: Feasibility and Design Issues, Released: July 30, 2008.

Depleted uranium, a component of some weapons systems, has been in use by the U.S. military since the 1991 Gulf War. Military personnel have been exposed to depleted uranium as the result of friendly fire incidents, cleanup and salvage operations, and proximity to burning depleted uranium-containing tanks and ammunition. Under a Congressional mandate, the Department of Defense sought guidance from the Institute of Medicine in evaluating the feasibility and design of an epidemiologic study that would assess health outcomes of exposure to depleted uranium.

The study committee examined several options to study health outcomes of depleted uranium exposure in military and veteran populations and concluded that it would be difficult to design a study to comprehensively assess depleted uranium-related health outcomes with currently available data. The committee further concluded that the option most likely to obtain useful information about depleted uranium-related health outcomes would be a prospective cohort study if future military operations involve exposure to depleted uranium.

The book contains recommendations aimed at improving future epidemiologic studies and identifying current active-duty military personnel and veterans with potential DU exposure.

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Background:  The Persian Gulf War Veterans Act of 1998, Public Law 105-277, title XVI, 112 Stat. 2681-742 through 2681-749 (codified at 38 U.S.C. 1118), and the Veterans Programs Enhancement Act of 1998, Public Law 105-368,112 Stat. 3315, previously directed the Secretary to seek to enter into an agreement with the NAS IOM to review and evaluate the scientific literature regarding associations between illness and exposure to specific toxic agents, environmental or wartime hazards, or preventive medicines or vaccines to which service members may have been exposed during service in the Southwest Asia theater of operations during the Persian Gulf War.

6 Simple Ways to Improve Symptoms of Fibromyalgia, a condition common in Gulf War veterans

Written by January W. Payne, U.S. News & World Report.

Fibromyalgia affects about 2 percent of the U.S. population--more women than men--and often, those who have the condition are afraid to exercise because they fear worsening their symptoms. But experts say that regular physical activity actually helps fibromyalgia sufferers. The problem? The condition's hallmarks--widespread body pain and fatigue--make it tough to work out. So how can people with fibromyalgia be encouraged to exercise without fear of making their pain and fatigue worse? A new study shows that taking small steps can help improve pain and functioning of those with fibromyalgia, as long as it's done in moderation.

[Read A New Fibromyalgia Remedy: Antiviral Drugs.]

The goal of the new study, published Monday in Arthritis Research & Therapy, was to "see if we can get [people with fibromyalgia] to be more active throughout the day," says Kevin Fontaine, associate professor of medicine in the division of rheumatology at the Johns Hopkins University School of Medicine. "The goal is to get them to accumulate 30 minutes of activity most days of the week," which can be accomplished in two-to-three-minute increments over the course of the day. The study's 84 participants were randomized to a "lifestyle physical activity" group or to a control group. Those in the lifestyle group--who, for example, were encouraged to walk more and take the steps instead of the elevator--increased their average daily steps by 54 percent by the end of the study and reported improvements in physical functioning and less pain. "Even if they just walk to their mailbox, that's better than doing nothing," Fontaine says. "If they do a little bit, they realize that they can manage the pain."

Still, because fibromyalgia symptoms can vary from day to day, each individual has to know his or her own limitations. "People have good days and bad days, and on good days, they tend to overdo it," Fontaine says. "So if you're having a bad day, try to do a little bit, and if you're having a good day, don't do too much."

[Quiz: How bad is your pain?]

Fontaine says that anyone with fibromyalgia can make the small daily lifestyle changes that the study showed can help. He recommends the following six activities to get started, done at a pace intense enough to make you breathe heavily but not so much so that you can't hold a conversation:

Buy a pedometer, and walk more. Walking is a total body exercise, and you can moderate the pace and control the intensity, Fontaine says. Wearing a pedometer allows you to easily monitor your progress.

[Read: We're Born to Walk.]

Move about while watching TV. Raise your arms over your head, or move them from side to side, Fontaine advises. Or sit in a chair and lift your legs one at a time at the knee. Other options: Make circles with your arms for a minute or two while sitting in a chair. The goal is "even on your worst day, try at the end of the day to say to yourself, 'I did something,' " he says.

Take the steps. If you work in an office building, take the steps instead of the elevator once or twice a day, adjusting your routine based on what's easier for your body. For example, if you find going up the steps to be easier than going down, take the steps up and the elevator down, he says. "Stairs are one of the more intense daily lifestyle activities," and you can build up your tolerance over time, walking two to three flights after several weeks even if you can't tackle one flight at the beginning, Fontaine says.

Do yardwork or garden. But make adjustments to fit your needs. That means if your back tends to bother you, consider sitting on a bench while gardening rather than bending over while standing up. Also, "if you have a big yard and you can't do your whole yard at once, just spend five minutes using the mower" at a time, Fontaine suggests. "One of the problems is that people spend the whole day doing yardwork, and then they have a flare-up for the next few days," he says, so instead of doing four hours of outside work at one time, break the task up into pieces--say, 20 minutes at a time three or four times per week until the work is completed.

Do housework--and make it fun. Turn on music while you vacuum or clean so you move a bit quicker while you work. "Whatever activity you're doing, think of a way to make it a little bit more taxing than it would be otherwise," advises Fontaine.

Finally, if you'd like to step up your routine a bit but don't feel ready for joint-pounding exercise, consider water or aqua exercise. Warm water can be especially therapeutic, Fontaine says. A 2008 study published in Archives of Physical Medicine and Rehabilitation found that exercise in a warm pool three times a week for 16 weeks improved many fibromyalgia symptoms in a group of previously unfit women.

[Read Aquatic Exercises May Ease Fibromyalgia.]

Short Bursts of Physical Activity May Reduce Chronic Pain Symptoms

Written by Laurie Barclay, MD, Freelance writer and reviewer, Medscape, LLC

(Medscape) — Short bursts of physical activity in a lifestyle physical activity (LPA) intervention may reduce fibromyalgia (FM) symptoms and improve physical function, according to the results of a randomized trial reported online in the March 29 issue of Arthritis Research & Therapy.

"Fibromyalgia is estimated to occur in 2% of the U.S. general population, affecting about eight times more women than men," said lead author Kevin R. Fontaine, PhD, from Johns Hopkins University School of Medicine, in Baltimore, Maryland, in a news release. "Although exercise has been shown to be beneficial, the symptoms often create obstacles that deter many from exercising consistently enough to derive benefits."

The goal of this study was to assess the effects in 84 minimally active adults with FM of accumulating at least 30 minutes of self-selected LPA on perceived physical function, pain, fatigue, body mass index, depression, tenderness, and the 6-minute walk test. Participants were assigned to either LPA or a FM education control (FME) group receiving information and support.

In the LPA intervention, participants were taught to perform LPA intense enough to cause heavy breathing without preventing conversation. Suitable moderate-intensity physical activities included climbing stairs, gardening, and walking. The goal was to accumulate 30 minutes of self-selected moderate-intensity LPA at 5 to 7 days per week.

A total of 73 (87%) of the 84 participants completed the 12-week trial. Average daily steps in the LPA group increased by 54%. Perceived functional deficits and pain were significantly less in the LPA group vs the FME group (P = .032 and P = .006, respectively). The groups did not differ on 6-minute walk test performance (P = .067), fatigue, depression, body mass index, or tenderness.

"The nature of fibromyalgia's symptoms, the body pain and fatigue, make it hard for people with this malady to participate in traditional exercise," Dr. Fontaine said. "We've shown that LPA can help them to get at least a little more physically active, and that this seems to help improve their symptoms."

Limitations of this study include inability to determine how LPA compares with a traditional no-treatment control group; use of self-reported outcomes; and use of pedometers to assess LPA, which failed to quantify cycling or water exercise. In addition, muscle strength was not measured during the trial, and persons with other comorbid conditions were excluded.

"Accumulating 30 minutes of LPA throughout the day produces clinically relevant changes in perceived physical function and pain in previously minimally active adults with FM," the study authors conclude. "However, the LPA intervention only moved the participants from the sedentary to low physical activity category. This suggests that it is essential to encourage FM patients to increase the duration of their physical activity in ways that do not compromise their ability to sustain the increased level of activity over the intermediate- and long-term."

The National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases supported this study. One of the study authors (Daniel J. Clauw, MD) has acted as a consultant for Pfizer, Lilly, Forest Laboratories, Cypress Biosciences, Pierre Fabre, UCB, and Wyeth, and has received grant support from Pfizer, Cypress Bioscience, and Forest.

Arthr Res Therapy. Published online March 29, 2010

DoD: VA to Intensify Gulf War Illness Outreach, Care

Written by Donna Miles, American Forces Press Service

(WASHINGTON – DoD) – Veterans Affairs Secretary Eric K. Shinseki yesterday announced promising news for veterans of the Persian Gulf War experiencing the broad range of symptoms referred to as Gulf War Illnesses.

Acting on recommendations from a task force he stood up to identify gaps in service, Shinseki said VA plans to reconnect with veterans who deployed during the Gulf War in 1990 and 1991 to ensure they get the best information and care possible.

As part of that outreach, VA’s Gulf War Veterans’ Illnesses Task Force recommended improved data-sharing with the Defense Department to notify veterans of potential exposures, monitor their long-term health and provide additional follow-up.

The task force also recommended that VA strengthen training for clinicians and claims processors so they’re better postured to diagnose, treat and process disability claims related to Gulf War Illnesses, and reenergize its research and medical surveillance efforts.

The task force’s report will redefine how VA addresses the concerns of veterans deployed during the Gulf War, Shinseki said. “Our mission at VA is to be advocates for veterans,” he said. “This report’s action plans provide a roadmap to transform the care and services we deliver to Gulf War veterans.”

The new recommendations come on the tail of a VA proposal announced last month to presume nine specific infectious diseases to be service-connected for anyone who served in Southwest Asia after Aug. 2, 1990, or in Afghanistan after Sept. 18, 2001.

That ruling, once adopted, will impact veterans who deployed to Iraq and Afghanistan. It will relieve those suffering from the designated diseases from the burden of proving their ailments are linked to service in the Persian Gulf or Afghanistan to receive VA health care and disability payments.

The nine diseases are: brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), malaria, Mycobacterium tuberculosis, nontyphoidal Salmonella, Shigella, visceral leishmaniasis (kala-azar) and West Nile virus.

During an interview with American Forces Press Service, Shinseki called the proposed ruling a positive step in taking care of Gulf War veterans suffering numerous symptoms and diagnoses yet to be pinpointed to any specific exposure.

“We can’t historically go back and decide what actually caused [Gulf War Illness],” he said. “We spent $350 million trying to find the cause, and we haven’t arrived at a clear answer.”

Rather than simply waiting for researchers to come up with a cause-and effect solution, Shinseki pressed VA to come up with a plan to compensate affected veterans now.

“My request was, ‘Can we agree that something happened?’” he said. “We have enough evidence here, symptomatically, that something happened. It may be a combination of things. We may never be able to answer exactly what caused this.

“But we can deal with the problem,’ he said. “So let’s take care of people.”

Shinseki took a similar approach to Agent Orange, a defoliant used during the Vietnam War that many veterans blame for causing a variety of illnesses and diseases.

VA previously presumed 12 diseases to be service-connected based on Agent Orange exposure. In October, Shinseki proposed adding three more diseases to the list: hairy-cell leukemia and other B-cell leukemias, Parkinson's disease and ischemic heart disease.

Shinseki said he based his decision on a report by the National Academy of Science's Institute of Medicine citing compelling new evidence of a connection between the three illnesses and Agent Orange exposure.

“That was not an independent decision by the VA,” Shinseki emphasized. “The Institute of Medicine is designated by Congress as the impartial determiner of whether or not there is sufficient evidence to make the decision like the one I made…. And they gave me enough information for me to say, ‘I can see the tie.’ So the decision was made.”

Shinseki, a former Army chief of staff and Vietnam veteran, had long criticized past practices that put the burden on veterans to prove that the variety of illnesses many suffered was linked to Agent Orange exposure. Too often, he said, this created an adversarial relationship between VA and veterans.

“It was important to clearly let the Vietnam veterans know that they have not been forgotten,” he said. “We are dealing with our responsibilities here.”

VA Gulf War Task Force Draft Report available in 91outcomes.com Library

The March 29, 2010 Final Draft Report of the U.S. Department of Veterans Affairs Gulf War Veterans’ Illnesses Task Force is available in the online library of 91outcomes.com.

To read the report:

• Visit the library (File name: VA_Gulf_War_Task_Force_03-29-2010.pdf), or
• View the report online,  or
• Download it. 

Public notice of the Gulf War Veterans’ Illnesses Task Force Draft Written Report has been posted on the Federal Register at: http://www.regulations.gov/search/Regs/home.html#documentDetail?R=0900006480ace153. 

The public will be able to review the notice, download the draft written report, and submit comments for the next 30 days.

The Task Force members reviewed existing literature and consulted with Veterans, Veterans’ advocates, program managers, Gulf War subject matter experts, and other stakeholders in developing the perceptions and recommendations presented. 

General information relating to the Department of Veterans Affairs benefits and services related to the Gulf War may be found at www.publichealth.va.gov/exposures/gulfwar/  or the toll free helpline at: 1-800-749-8387.  You may also submit your ideas on VAs discussion board at: www.yourgulfwarvoice.uservoice.com.

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]