Elevated Cytokines Possibly Connected to Chronic Pain Symptoms

 

This excellent article was written by Frances Lee, and posted at Suite101.com:

Recent studies show that cytokines, chemical messengers that tell other immune cells to activate, grow or die may fuel autoimmune diseases such as fibromyalgia.

For the most part, cytokines benefit the immune system. They aid white blood cells to fight infection, bringing inflammation to an area of a wound to heal it. However, cytokines that go wrong can cause autoimmune diseases. They become elevated to the point where they alter how the immune system works.

Elevated Cytokines Cause Inflammation

Fibromyalgia has not been considered an inflammatory disorder; however, recent studies have shown the connection between the immune system, cytokine inflammation and pain physiology in this condition. Increased levels of certain inflammatory cytokines have been found in serum and skin biopsies of fibromyalgia patients, indicating inflammation of the nervous system or nervous tissue.

Inflammatory cytokines can cause a functional disturbance in the peripheral nervous system, inducing abnormal pain and increased pain sense. Although this inflammation starts within the body's immune system and cannot pass the blood brain barrier, studies have shown a cascade effect. The release of inflammatory cytokines in the body can lead to release of these within the brain and spinal cord.

Clinical Studies Reveal Antioxidants' Role in Reducing Inflammation

The Journal of Neuroscience reported on a study performed with aged control rats to determine whether the antioxidant capacity of food played a role in reducing inflammation in the cerebellum. The rats' cognitive abilities were first measured by electrophysiologic techniques revealing a significant decrease in function and then measured again after adding foods high in ORAC value.

Spirulina and apple, high in ORAC, reversed the levels of inflammatory cytokines in the brain. Cucumber, low in ORAC, had no effect. This study confirmed an important factor not only for brain dysfunction but all autoimmune diseases. There is a direct link to decreased inflammation and a diet rich in antioxidants.

Food That Decrease or Increase Inflammatory Cytokines

"Let your food be your medicine," said Hippocrates. Diet can be very helpful in managing fibromyalgia. Not only are there specific foods to include in your diet, but also foods to avoid. Studies done on those with food intolerances and food sensitivities show a marked increase in inflammatory cytokines.

Avoid or limit foods that increase inflammation such as: wheat, yeast, milk, sugar, peanuts, corn, eggs, citrus, alcohol, caffeine and soy.

Include foods, on a daily basis, that reduce inflammation and strengthen the immune system such as: coldwater fish (salmon, trout, mackerel, sardines, cod, halibut), flax seed, evening primrose oil, borage oil, fresh pineapple, papaya, spinach, blueberries, strawberries and onions.

Additional Studies Behind Inflammatory Cytokines and Fibromyalgia

Studies have shown that lack of sleep, sleep apnea or other sleep problems can also raise cytokine levels. Research suggests that sleep is important to the immune system, fine tuning it to use cytokines, the body's chemical messengers, appropriately. The majority of those who suffer with fibromyalgia also have sleep problems. While some feel this could be the real reason behind fibromyalgia, other doctors feel sleep problems are the result of fibromyalgia. More studies are needed to determine if elevated cytokines come first or are secondary.

Read more at Suite101: A New Study in Fibromyalgia: Elevated Cytokines Possibly Connected to Fibromyalgia Symptoms http://autoimmunedisease.suite101.com/article.cfm/a-new-study-in-fibromyalgia#ixzz0heaGajYz

Read more at Suite101: A New Study in Fibromyalgia: Elevated Cytokines Possibly Connected to Fibromyalgia Symptoms http://autoimmunedisease.suite101.com/article.cfm/a-new-study-in-fibromyalgia#ixzz0heaGhm0z

VA Publishes Employee Training Letter Expanding Reach of Gulf War illness Claims

VA acknowledges “25 percent” of Gulf War veterans are ill; Expands coverage to Afghanistan War veterans

Written by Anthony Hardie, 91outcomes Publisher/Editor

(91outcomes.com) – Coming on the heels of U.S. government recognition of the reality of Gulf War Syndrome and news that VA will reopen thousands of veterans disability claims, the federal VA has published specific new guidance to its employees regarding Gulf War veterans’ claims that should open the door to approval for thousands of veterans previously denied.

Overtly acknowledging that 25 percent of the 697,000 veterans of the 1991 Gulf War suffer from disabling and chronic multi-symptom illness, the highly technical training letter, entitled, "Adjudicating Claims Based on Service in the Gulf War and Southwest Asia,” was issued by VA on February 4, 2010 as part of a broader “culture change” in the agency for veterans of the 1991 Gulf War that includes dramatically modifying the department’s programs and procedures to provide long awaited help for these veterans.

Read last week’s article, “VA cites “Culture Change” for Gulf War veterans.”

The changes to Gulf War veterans’ disability claims were among those publicly announced last week at a meeting of the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ Illnesses by VA Chief of Staff John Gingrich, the Obama Administration’s highest ranking veteran of the 1991 Gulf War.  In his remarks, Gingrich said these issues are, for him, “personal,” noting that as a ground commander during the war, a number of his troops fell ill and have remained disabled since the war.

Since the 1990s, federal law has authorized service-connected disability compensation for Gulf War veterans suffering from “undiagnosed illness” – a gateway determination that also allows for VA health care and other benefits.

Until now, however, VA interpretations of the governing laws have been narrow, with few claims approved for patterns of chronic disability and excluding all but three “ill-defined” conditions that ultimately receive a diagnosis.  Gulf War veteran advocates have publicly expressed their concerns that veterans claims were being denied as “diagnosed” conditions, when in actuality the “diagnoses” were just labels for unexplained symptoms that were part of a larger patter of disability, such as widespread pain, chronic sinusitis, and chronic migraines.  These denials were despite the fact that doctors are trained to diagnose and label conditions and symptoms, as the new training letter explicitly notes and seeks to correct. 

Those three “ill-defined” conditions, which VA has previously allowed to be service-connected under the “undiagnosed illness” laws, are Fibromyalgia (FMS), chronic fatigue syndrome (CFS/ME), and irritable bowel syndrome (IBS).  Even still, this practice has come under fire by Gulf War veteran advocates, who note that only the chronic fatigue syndrome diagnosis can be rated by VA as totally disabling.  The other two, fibromyalgia and irritable bowel syndrome, “max out” at 40 percent and 30 percent disabling, respectively, despite the fact that many Gulf War veterans are severely or even totally disabled by these ill-defined but diagnosed conditions. 

With the new policies announced in the letter, VA clarifies that these three conditions are only “examples,” and not an exhaustive list of allowable ill-defined conditions, as was often seen to be the case in previous rating decisions.

These limitations have led to the denial of most Gulf War veteran claims made under the “undiagnosed illness” category, and have left veterans’ service officers with no other option but to file claims seeking direct service connection for Gulf War veterans’ diagnosed conditions and symptoms – a much more difficult case to prove and exactly the situation that Congressional leaders sought to prevent with the enactment of laws allowing for undiagnosed and ill-defined illness.

The exact numbers of denials are unclear because VA is scrubbing its Gulf War Veteran Information System reports that report the number of Gulf War veterans’ claims received and approved.

According to the VA’s training letter, diagnosed multi-symptom conditions of unexplained origin that feature symptoms including, but not limited to the following list, will qualify under the newly clarified rules:

Chronic multi-symptom illnesses include, but are not limited to: (1) fatigue, (2) signs or symptoms involving skin, (3) headache, (4) muscle pain, (5) joint pain, (6) neurological signs or symptoms, (7) neuropsychological signs or symptoms, (8) signs or symptoms involving the upper or lower respiratory system, (9) sleep disturbances, (10) gastrointestinal signs or symptoms, (11) cardiovascular signs or symptoms, (12) abnormal weight loss, and (13) menstrual disorders.

The new rules further state, “There may be instances where a chronic undiagnosed illness or diagnosed multi-system illness affect distinct body systems. In such a case, a determination should be made that is most consistent with the evidence and most beneficial to the Veteran.”

However, diabetes and multiple sclerosis (MS), which VA states in the letter are of partially explained etiology, are specifically excluded.

The new policy letter, distributed internally to disability claims and medical examiners, seems to add credence to Gingrich’s public comments, which are echoed in the letter’s statement that the changes, “will allow medical examiners more latitude in evaluating disability patterns based on service in Southwest Asia.”

The letter also clarifies that veterans who have served in the Persian Gulf after the 1991 Gulf War will continue to be eligible for service-connection for unexplained or undiagnosed chronic multi-symptom illnesses.  And, the letter notes that VA is expanding the geographic area of service for “UDX” to include veterans with service in Afghanistan, with formal regulations forthcoming.

Gingrich said that veterans previously denied will be sent a letter providing the details of the new rules and information on how to have their claim reopened.  Despite previously misleading headlines, VA will reopen claims, but only if requested by the veteran.

The only bad news in the letter, if it is indeed bad news, is that potentially eligible veterans who have claims currently pending and would be positively affected under the new regulations will see their claims held until the new regulations are formally issued.  According to VA:

“Until the amended regulation becomes final, regional office personnel will be required to hold any claim where the medical evidence shows a disability pattern that is not one of the three currently identified.”

The silver lining of that cloud is that veterans should do much better under the new rules – exactly what Congress originally intended and Gulf War veterans’ advocates have long argued.

=======================

More about the Letter

The letter begins with a “History of Disability Patterns Associated with Gulf War and Southwest Asia Service,” which states, in part that for these veterans, that:

…patterns of chronic debilitating medical symptoms..typically
included some combination of chronic headaches, cognitive difficulties, widespread bodily pain, unexplained fatigue, chronic diarrhea, skin rashes, respiratory problems, and other abnormalities. These symptoms did not correspond easily to recognized categories of diseases and presented a problem for health care diagnoses and treatment procedures, as well as for regional office decision makers attempting to adjudicate claims for disability  compensation.

Because the problem involved a significant percentage of Gulf War Veterans, estimated at 25 percent, [VA] initiated studies seeking to explain these chronic illness patterns.

The report then goes on to describe the types of multi-symptom illness experienced by this 25 percent of Gulf War veterans.

The RAC study indicates that service in Southwest Asia may be associated with disturbances of the brain and central nervous system, including dysfunctions of the autonomic nervous system, neuromuscular system, neuroendocrine system, and sensory systems, as well as the immune system.

The report provides an interpretive history of the laws and regulations related to undiagnosed illness and unexplained chronic-multi-symptom illness in Southewest Asia veterans, and provides detailed technical guidance for VA personnel involved in rating procedures and medical exams.  A clarifying letter to VBA claims examiners in also included.

The letter also notes that while the laws and regulations creating “Undiagnosed Illness” as a presumptive service-connection for veterans of the 1991 Gulf War, they remain in effect to the present and therefore include veterans of current operations in Iraq, as well as in the interim between 1991 and 2003. 

Additionally, the letter notes that VA has interpreted the applicable “Southwest Asia” region to include service in Afghanistan, thereby making an equal playing field for those with post-9/11 service in the region, for whom, according to VA:

…information is accumulating that indicates environmental hazards may also be widespread in the current theater of Gulf War operations and may contribute to the disability patterns typically associated with Southwest Asia service.

The letter states that a regulatory amendment is forthcoming that will make this “inclusive of Afghanistan” interpretation official.

The letter was signed by Brad Mayes, VBA’s director of the Compensation and Pension Service.  Mayes has had an upwardly mobile career with VBA that, among others, included service at Bay Pines, Fla., Ohio, and as assistant director of the VA Regional Office in Milwaukee, Wis. under then-director John Baker.

The letter is dated February 4, 2010, and is available in the 91outcomes document archives.

 

Letters to the Editor: Veterans now face a battle for proper medical care

St. Petersburg Times, Florida

(St. Petersburg, Fla)  - I thank you for printing this story. I am a Desert Storm veteran and actually take 14 different medications a day. The majority of the population does not know of the battle veterans endure after the war. I've been battling the bureaucracy of the Veterans Affairs Department for about six years. I have experienced the same problems dealing with the VA as Wally Heath, who was featured in your story.

I spent two tours in the Persian Gulf in 1990 and 1991, the first being Desert Storm. When the pyridostigmine bromide, better known as BP pills, was issued, the soldiers were given a direct order to take the pills or face an Article 15 (disciplinary action).

During the two deployments to the Persian Gulf, our M8 Chemical Alarms would sound off, only we were told it was from the diesel engines or sand getting in the device. During mid March of 1991 the alarms would continue to sound to the point where the chemical sergeant had us shut all of them down. A couple of times a day I would check, and the M8 would sound in less than 30 seconds.

Upon leaving the location, a couple of my troops and I noticed about a dozen dead goats to the side of the road. There was no sign of trauma, and they had been dead for day or two. There was no infestation of insects, and that side of town was deserted.

Several years ago a letter was sent by the Department of Defense stating that our unit may have been exposed. Four years ago I found out with my own research we had been exposed to sarin gas from the demolition of weapon caches in Iraq.

So many different stories are yet to be told by many veterans. No matter what war or conflict our armed forces have fought in, veterans have faced mental and/or physical problems from each. My fellow veterans and I have placed our lives in harm's way to serve our country, and now that hundreds of thousands of us fall ill, we face an even longer battle trying to obtain the proper compensation, diagnosis and care we deserve.

John Arias, Port Richey

Immune cells of the brain linked to Gulf War Syndrome symptoms

A new theory based on interactions between the immune system and the brain may provide an explanation for the symptoms experienced by veterans suffering from Gulf War Syndrome.

Written by Matthew Hogg, EIR

(Environmental Illness Resource) - According to the theory special brain cells called 'microglia', which are actually a form of macrophage (white blood cell) and part of the body's first line immune defense, become sensitised and persistently release chemicals which affects the firing of neurons in the brain, causing chronic pain and other symptoms.

Following an announcement on February 26th made by the Veterans Affairs Department in the US, scientists from across the country were invited to Washington D.C. by the Federal Advisory Committee on Gulf War Veteran’s Illnesses to present research related to the symptoms and illnesses suffered by veterans, collectively known as Gulf War Syndrome.

It was at this meeting that Dr. Linda Watkins of the University of Colorado reported on her work demonstrating that microglia play a key role in chronic pain and drug addiction. Conventional wisdom is that it it is only the nerve cells (neurons) themselves that cause chronic pain and tolerance to powerful painkilling drugs such as morphine. Dr Watkins explained that the new understanding of how microglia (essentially the same as macrophages found in the bloodstream but fixed in place in the brain) aggravate neurons after an injury by releasing substances that produce excruciating pain, led to the observation that the process may help to explain Gulf War Syndrome.

Gulf War syndrome has much in common with chronic fatigue syndrome (ME/CFS) and fibromyalgia (FMS) and is characterised by a constellation of unexplained symptoms, many neurological, including chronic pain, chronic fatigue, depression, sleep disturbances, poor memory and concentration, chemical sensitivities, as well as digestive disorders and lung problems. A combination of factors are thought to contribute to its development including multiple vaccinations given to soliders prior to deployment (many containing potentially toxic adjuvants such as squalene), psychological stress, and particularly exposure to low-level neurotoxins including sarin gas, drugs such pyridostigmine bromide (PB) given to soldiers to protect them from chemical warfare agents, pesticides used to treat tents, uniforms and vehicles, insect repellents (e.g. DEET), fumes from oil fields set ablaze by retreating Iraqi soldiers, and depleted uranium (DU) used in armour-piercing munitions by the allied forces.

Unlike normal pain, chronic pain does not subside after an injury has healed. The latest research based on the principles of psychoneuroimmunology (the study of the connections between the mind, brain and immune system) shows that chronic pain results from ongoing pathological interactions between the brain and immune system. When we are ill the immune system releases chemicals called 'cytokines' which tell the brain to trigger the 'sickness response', that familiar feeling everyone experiences when coming down with the flu, for example. This response forces us to rest and allow the body to use all available energy to fight the infection. Symptoms associated with the sickness response include painful joints and muscles, profound fatigue, headache, and sensitivity to light and sound - all very similar to the symptoms suffered chronically by veterans suffering from Gulf War Syndrome.

Based on her research on microglia in chronic pain that she presented to the Federal Advisory Committee, Dr. Watkins believes an initial exposure to some stressor such as the numerous chemical toxins present in the Gulf “primes” the microglia in the brain to make them hyper sensitive. Then when a second toxin, infection, injury, or highly stressful situation is experienced, the brain’s immune cells over-react, triggering excessive secretion of the cytokines cause the sickness response. In Gulf War Syndrome, and perhaps chronic fatigue syndrome, fibromyalgia and other unexplained chronic illnesses, it seems the sickness response is not switched off once the body has healed thus leading to chronic symptoms.

In the case of Gulf War veterans, the initial trigger could have been a reaction to vaccines, psychological stress, or exposure to low-level neurotoxins. A second insult could have then been experienced during the war or once the soldiers were back home. Research from various labs on microglia in chronic pain has identified numerous stages in this neuro-immune signaling process that become disrupted. Several drugs have been found to effectively reverse the process in animals and human trials are now getting underway.

It may be that there is also a role for alternative mind-body therapies such as meditation, breathing techniques, acupuncture, and reflexology in aiding healing from Gulf War Syndrome since evidence suggests they also influence interactions between the immune system and brain.

Source: National Institute of Child Health and Human Development

Hilbert Potter, Disabled Kentucky Veteran, Helps Other Amputees Learn To Walk Again

(HUFFINGTON POST) - After machine gun fire claimed Hilbert Potter's leg during Operation Desert Storm, he learned to walk again with the help of a prosthetic leg and a devoted physical therapist. His experience inspired him to want to help other amputees learn to walk, so that their disabilities would not hold them back from leading a normal life.

Potter now works with the Kentucky Orthopedic Rehab team, with which he founded the LEAP program, helping disabled people like himself re-learn to walk.

WATCH: 

Military Research Hazards to Veterans: Lessons Spanning More than Half a Century

Following is a 1994 U.S. Senate report authored by Dr. Diana Zuckerman and published by U.S. Senator John D. Rockefeller, entitled, “IS MILITARY RESEARCH HAZARDOUS TO VETERANS’ HEALTH? LESSONS SPANNING HALF A CENTURY.” 

The full report is available from a link at the bottom of this 91outcomes’ front page.

New VA officials in the Obama Administration should familiarize themselves with this report.  Gulf War veterans have been intimately familiar with it since it was released in 1994, and recognize that their experience has been part of a long history of similar experiences that have continued through to the present time.

Benzene-laden drinking water that still flows into homes at Camp Lejeune, N.C., burn pits that are still being used in Iraq (and probably Afghanistan), and hazardous chemical plant exposures at Qarmat Ali are among just a few of the unaddressed hazardous military exposures of the present era.

Read, and remember.

-Anthony Hardie, 91outcomes Publisher/Editor

================================

Military Human Experimentation Protocol

103d Congress, 2d Session – COMMITTEE PRINT – S. Prt. 103-97

IS MILITARY RESEARCH HAZARDOUS TO VETERANS’ HEALTH? LESSONS
SPANNING HALF A CENTURY

A STAFF REPORT PREPARED FOR THE COMMITTEE ON VETERANS’ AFFAIRS

UNITED STATES SENATE DECEMBER 8, 1994

JOHN D. ROCKEFELLER IV, West Virginia, Chairman

DENNIS DeCONCINI, Arizona
GEORGE J. MITCHELL, Maine
BOB GRAHAM, Florida
DANIEL K. AKAKA, Hawaii
THOMAS A. DASCHLE, South Dakota
BEN NIGHTHORSE CAMPBELL, Colorado
FRANK H. MURKOWSKI, Alaska
STROM THURMOND, South Carolina
ALAN K. SIMPSON, Wyoming
ARLEN SPECTER, Pennsylvania
JAMES M. JEFFORDS, Vermont

Jim Gottlieb, Chief Counsel/Staff Director
John H. Moseman, Minority Staff Director/Chief Counsel
Diana M. Zuckerman, Professional Staff Member
Patricia Olson, Congressional Science Fellow

FOREWORD

U.S. Senate, Committee on Veterans’ Affairs, Washington, DC,
December 8, 1994

During the last few years, the public has become aware of several
examples where U.S. Government researchers intentionally exposed
Americans to potentially dangerous substances without their
knowledge or consent. The Senate Committee on Veterans’ Affairs,
which I have been privileged to chair from 1993-94, has conducted
a comprehensive analysis of the extent to which veterans
participated in such research while they were serving in the U.S.
military. This resulted in two hearings, on May 6, 1994, and
August 5, 1994.

This report, written by the majority staff of the Committee, is
the result of that comprehensive investigation, and is intended
to provide information for future deliberations by the Congress.
The findings and conclusions contained in this report are those
of the majority staff and do not necessarily reflect the views of
the members of the Committee on Veterans’ Affairs.

This report would not have been possible without the dedication
and expertise of Dr. Patricia Olson, who, as a Congressional
Science Fellow, worked tirelessly on this investigation and
report, and the keen intelligence, energy, and commitment of Dr.
Diana Zuckerman, who directed this effort.

John D. Rockefeller IV, Chairman

CONTENTS

I. Introduction

II. Background

*  A. Codes, declarations, and laws governing human
experimentation.
*  B. Mustard gas and lewisite
*  C. Seventh-Day Adventists
*  D. Dugway Proving Ground
*  E. Radiation exposure
*  F. Hallucinogens
*  G. Investigational drugs

III. Findings and conclusions

A. For at least 50 years, DOD has intentionally exposed
military personnel to potentially dangerous substances,
often in secret

B. DOD has repeatedly failed to comply with required ethical
standards when using human subjects in military research
during war or threat of war

C. DOD incorrectly claims that since their goal was
treatment, the use of investigational drugs in the Persian
Gulf War was not research

D. DOD used investigational drugs in the Persian Gulf War in
ways that were not effective

E. DOD did not know whether pyridostigmine bromide would be
safe for use by U.S. troops in the Persian Gulf War

F. When U.S. troops were sent to the Persian Gulf in 1994,
DOD still did not have proof that pyridostigmine bromide
was safe for use as an antidote enhancer

G. Pyridostigmine may be more dangerous in combination with
pesticides and other exposures

H. The safety of the botulism vaccine was not established
prior to the Persian Gulf War

I. Records of anthrax vaccinations are not suitable to
evaluate safety

J. Army regulations exempt informed consent for volunteers
in some types of military research

K. DOD and DVA have repeatedly failed to provide information
and medical followup to those who participate in military
research or are ordered to take investigational drugs

L. The Federal Government has failed to support scientific
studies that provide information about the reproductive
problems experienced by veterans who were intentionally
exposed to potentially dangerous substances

M. The Federal Government has failed to support scientific
studies that provide timely information for compensation
decisions regarding military personnel who were harmed by
various exposures

N. Participation in military research is rarely included in
military medical records, making it impossible to support
a veteran’s claim for service-connected disabilities from
military research

O. DOD has demonstrated a pattern of misrepresenting the
danger of various military exposures that continues today

RESEARCH UPDATE: Mustard Gas linked to Limbal Stem Cell Deficiency

Impression cytology links limbal stem cell deficiency and mustard gas keratopathy

Ophthalmology. 2010;117(2):246-252.

Impression cytology showed varying degrees of limbal stem cell deficiency in patients with chronic or delayed-onset mustard gas keratopathy, a noninflammatory disease of the cornea in the eye, according to a study.

Iraqi forces used mustard gas extensively against Iranian troops during the Iran-Iraq war in the 1980s. More than 100,000 people were exposed to the agent, and an estimated 0.5% will develop complications that adversely affect visual acuity, the study authors said.

Additionally, many veterans of the 1991 Gulf War have long asserted that they were exposed to mustard-lewisite.

"Although there are some reports suggesting progressive [limbal stem cell deficiency] as a contributing factor to corneal manifestations associated with mustard gas, to the best of our knowledge, no study has described the actual pathogenesis of corneal manifestations in patients with mustard gas keratopathy," the authors said.

The prospective, observational case series included 35 eyes of 18 patients. Mean patient age at the time of sampling was 44.5 years; the mean interval between mustard gas exposure and sampling was 20 years.

The identification of goblet cells on the corneal side of ocular surface samples was considered evidence of corneal conjunctivalization and limbal stem cell deficiency. Clinical manifestation of limbal stem cell deficiency was graded as mild, moderate or severe in each quadrant of the cornea.

Study data showed the presence of goblet cells in at least one corneal quadrant in all 35 eyes. In addition, corneal clinical grading was significantly statistically more severe in the nasal and temporal quadrants than in the superior and inferior quadrants (P < .001), according to the study.

Gulf War Veteran with Terminal Non-Hodkin’s Lymphoma Granted VA Benefits after Years of Waiting

Written by by: Alex Diprato, WPRI-TV

(CUMBERLAND, R.I. - WPRI) - A Marine who was diagnosed with terminal cancer, after he fought for our country, has been battling for his health.

After Eyewitness News looked into his story , we've learned the government has agreed to help cover his medical expenses and beyond.

• Read the VA's statement on Belliard's case

Doctors say, Jose Belliard has about 3 years to live. But, a new ruling from the VA or (Veterans Affairs) means Belliard's kids will have insurance and an education when he's no longer here.

Belliard waited two years for the phone call.

"It was something that, I just couldn't believe my ears," he said.

It's the end of a long battle for the Gulf War veteran.

"I was shaking, crying, everything you could imagine."

The Director of the Providence VA called Belliard personally, to tell him that he's been granted full benefits for non-Hodgkins Lymphoma. Belliard said he developed the cancer spreading a chemical on Iraqi prisoners to kill lice.

The VA's decision means his medical costs are covered, and his three children will have an education when he's gone.

"The best gift I can give my kids is a college education. If I would've still been around, I would've been working towards that," said Belliard.

It's a decision that Belliard knew he had to keep fighting for.

• Watch an extended interview with Jose Belliard

"It hasn't been easy but at least I can, I can breathe a little better."

Belliard hopes his case will serve as a wake-up call for how our country treats its veterans.

"It is amazing that someone who serves their country has to wait that long for their family to get relief."
But most of all, he said he enjoys being able to spend time with his family. Now that he's not paying for his cancer treatments on his own.

"My kids don't have to save their allowance to take their father to the movies anymore. I can take them to the movies."

New Suspect In Gulf War Syndrome: Brain Cells

Written by Dr. Douglas Fields, Chief of the Nervous System Development and Plasticity Section, National Institute of Child Health and Human Development

(Washington, D.C. – Huffington Post) -- On February 26, 2010, the Veterans Affairs Department announced that it will re-examine the disability claims of thousands of Persian Gulf War veterans still suffering from the mysterious Gulf War illnesses two decades after the war ended. At a meeting of the Federal Advisory Committee on Gulf War Veteran's Illnesses held yesterday in Washington, D.C., scientists from around the country presented their latest research to committee members searching for clues to this mysterious illness. Early in the meeting a new culprit emerged -- "the other brain" -- the non-electric portion of the brain composed of brain cells called glia.

"This is one of the best explanations I've heard," commented distinguished neuroscientist Floyd Bloom, after a presentation by Dr. Linda Watkins of the University of Colorado speaking about her latest research showing that glial cells, called microglia, are the unsuspected agents in chronic pain and drug addiction.

Previously neurons were thought to be the sole cause of chronic pain and morphine tolerance. However, the new insight into how these "immune cells" of the brain aggravate neurons after an injury by releasing substances that produce excruciating pain, a parallel with Gulf War Syndrome became apparent.

Gulf War syndrome is characterized by a collection of unexplained symptoms, many of them neurological, including chronic pain, chronic fatigue, depression, sleep disturbances, memory loss, as well as gastrointestinal and lung problems. A number of causes have been suspected, including exposure to low-level neurotoxins, including sarin gas, drugs taken to protect soldiers from biological and chemical warfare agents, pesticides used to treat tents and soldier's uniforms stationed in the desert, depleted uranium from munitions, and the toxic mixture of fumes released for a year after the war ended from oil fields set ablaze by the retreating Iraq soldiers. The toxic fumes blotted out the sun at midday for miles.

Many people suffer chronic pain after an injury. Unlike normal pain, chronic pain does not end after the injury heals; in fact it often gets worse. The latest research shows that chronic pain results from an interaction between the immune system and the brain. When we are sick, substances are released by the body that tell the brain to initiate the familiar "sickness response," which we have all experienced, for example when we catch the flu. Profound fatigue, headache, sensitivity to light and sound, and painful joints and muscles, drive us to bed. This sickness response forces us to rest and give the body the opportunity to fight the invading germ. This sounds a lot like the symptoms of many Gulf War veterans.

What Dr. Watkins suspects, based on her research on microglia in chronic pain, is that an initial exposure to some toxin "primes" the microglia in the brain to make them hyper alert. Then when a second infection, injury, or toxin is experienced, the brain's immune cells over-react, releasing too much of the chemical signals that cause the "sickness response", and they do not stop releasing the substances after the body heals. In the case of Gulf War veterans, the "initial trigger" could have been a reaction to an immunization, stress, or exposure to low-level toxins. Later a second insult to the body unleashes a run-away illness. Research from several labs on microglia in chronic pain has identified many steps in this neuro-immune signaling process that become disrupted and researchers have found specific drugs to restore the normal function of these pain circuits, thus ending the chronic pain. Most of this work is in laboratory animals but clinical studies are now under way.

In my overview to the committee on the four major kinds of glial cells in "the other brain", several other ways in which glia could be involved in Gulf War illnesses were recognized. This includes the involvement of glial cells, called astrocytes, in processing toxins in the brain. Parkinson's disease, for example can be caused by astrocytes acting on a foreign substance (a recreational drug), and converting it into a toxin that kills the neurons that die in Parkinson's Disease. Astrocytes also release factors that protect neurons from damage caused by inflammation or oxidation, and they release growth factor proteins that stimulate the growth and repair of neurons.

The latest research on the myelin insulation on nerve fibers in the brain, which is essential for sending electrical signals, is revealing a previously unsuspected role of myelin in cognition and psychiatric illness. Myelin insulation is especially vulnerable to blast injuries and to autoimmune diseases in which the body's immune system attacks the myelin sheath. The myelin sheath is made by a type of glial cell, called an oligodendrocyte. Prevously this insulation was of interest in diseases such as multiple sclerosis, but because the insulation speeds the rate of electrical transmission through nerve fibers (axons), myelin is now understood to have an important role in cognitive function, psychological illness, and learning.

One of the reasons the Gulf War Syndrome may have been so difficult to understand is that glia--the other brain--has itself been such a mystery until recently.

Further reading
The Other Brain http://theotherbrainbook.com
New Culprits in Chronic Pain, Scientific American, November, 2009
http://www.scientificamerican.com/article.cfm?id=new-culprits-in-chronic-pain
White Matter Matters, Scientific American, March, 2008
http://www.scientificamerican.com/article.cfm?id=white-matter-matters

Gulf War Syndrome and TBI: Irresponsible DoD Official Should be Removed

The article below, from last year, is extremely troubling and shows how irresponsible comments by lone military officers unskilled in health issues can have  ripple effect across the country.

TBI and mild Traumatic Brain injury (mTBI) are potentially serious health consequences affecting veterans of blast injuries and other concussions. DoD is doing a better job recently in helping to ensure that troops with blast exposures are sidelined from combat until they have healed.

And with regards to Gulf War Syndreom, VA’s own data have shown that between 175,000 and 210,000 of the 697,000 veterans of the 1991 Gulf War still suffer from debilitating chronic multi-symptoms illness. Hundreds of scientific studies have documented the serious health outcomes affecting these veterans, for whom effective treatments remain elusive.

Other studies have documented excessively high spikes in diagnosed illnesses as well, including various cancers (brain, testicular, lung), ALS (Lou Gehrig’s Disease), and more.

It is a relief to these myriad ill Gulf War veterans and their loved ones that the current VA leadership has set up an effective, internal Gulf War Veterans Task Force to finally address the serious health and benefits issues that have languished unresolved for the veterans of this forgotten war that may have been the most environmentally and occupationally hazardous of any before or since.

It is highly irresponsible that a DoD official would imply that Gulf War Syndrome was and is a public relations problem rooted in mass hysteria, rather than the serious, still unaddressed public health problem that is is.

This official should be reprimanded, and removed from any position of responsibility for health issues of the troops affected by deployment issues and prevented from ever talking to the media again on behalf of DoD.

Our troops and veterans deserve better.  Much better. 

For more information, see http://www.va.gov/GulfWar or http://www.91outcomes.com.

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By Gregg Zoroya, USA TODAY 

(Washington - USA TODAY – March 18, 2008) - For more than two years, the Pentagon delayed screening troops returning from Iraq for mild brain injuries because officials feared veterans would blame vague ailments on the little-understood wound caused by exposure to bomb blasts, says the military's director of medical assessments.

Air Force Col. Kenneth Cox said in an interview that the Pentagon wanted to avoid another controversy such as the so-called Gulf War syndrome. About 10,000 veterans blamed medical conditions from cancer to eczema on their service.

The Pentagon did not acknowledge the syndrome until Congress created a committee to study it in 1998.

For troops who think they may have a condition not designated as war-related, Cox said, often "they're reacting to rumors, things that they've read about or heard about on the Internet or (from) their friends."

That uncertainty, Cox said, means "some individuals will seek a diagnosis from provider to provider to provider." It also makes treating veterans "much more difficult and much more costly," he said.

Asked whether mild traumatic brain injury (TBI) could turn into another Gulf War syndrome, Cox said, "It could."

"That's baloney," says Rep. Bill Pascrell, D-N.J., founder of the Congressional Brain Injury Task Force. "There was no need to delay this."

In a January 2006 report, scientists at the federal Defense and Veteran Brain Injury Center urged that troops be screened for TBI "immediately." The Pentagon will soon require that troops be checked as they come home, according to Cox.

Cox says research shows screening is the most appropriate step.

An Army mental health report last month indicated that 11% of 2,195 soldiers surveyed in Iraq and Afghanistan show signs of mild brain injury, but fewer than half were identified and evaluated in the field.

That's more proof of the need to screen troops as they leave Iraq, says Air Force Lt. Col. Michael Jaffee, a neurologist who heads the brain injury center. Screening includes a series of questions about a soldier's experience and symptoms relating to head injury, such as balance or memory.

About 1.6 million U.S. troops have served in Iraq.

Sen. Patty Murray, D-Wash., says, "Here we are five years into this war, and the Pentagon is just now coming to grips with how to track and treat those … with TBI." Murray is a member of the Senate appropriations subcommittee that oversees spending on veterans issues.

One concern, Cox says, was that mild TBI symptoms often resemble simple problems such as a lack of sleep or stress.

Screening for brain injury is vital to the health of troops in the field, says Staff Sgt. Marcus Brown, 30. He was transferred to Fort Carson, Colo., where the Army has operated a pilot screening program for traumatic brain injury since 2005. There, Brown was screened for brain injury for the first time after serving two tours in Iraq and surviving three IED blasts.

Doctors need to screen soldiers for brain injury as they leave the war zone, Brown says, because "most soldiers, especially NCOs (noncommissioned officers), are not going to show any type of weakness in front of their soldiers."

======================

This article was also reposted at: 

Overseas Civilian Contractors
Post: DoD delayed brain injury scans
URL: http://civiliancontractors.wordpress.com/2010/03/02/dod-delayed-brain-injury-scans/

VA cites “Culture Change” for Gulf War veterans

VA’s new Gulf War Task Force report – which will be open for public review -- will be “a step in the right direction,” says a top official

By Anthony Hardie, 91outcomes Publisher/Editor

(Washington, DC – 91outcomes.com) Chief of Staff John Gingrich of the U.S. Department of Veterans Affairs (VA), the highest ranking Gulf War veteran in the Obama administration, today provided an encouraging view of what he called a major “culture change” in his agency with regards to veterans of the 1991 Gulf War.  The comments were made as part of a public presentation by Gingrich to the Congressionally chartered Research Advisory Committee (RAC) on Gulf War Veterans’ Illnesses at the VA’s offices in Washington, DC.

Following a meeting with members of the RAC last July at which the task force concept was recommended, Gingrich created the VA’s new Gulf War Task Force the next month, and the Task Force’s report is due out shortly.

“I do not see the report as the end, I see it as a step in the right direction,” said Gingrich. “The Task Force isn’t done, and won’t be done until we have worked through as many issues as we can physically work through,” he added.

The report is still in draft form, and is currently being rewritten.

According to one VA official who serves on the Task Force but wished to remain unnamed, “Gingrich has kept the Task Force on a tight timeline,”

Gingrich says he anticipates that the redrafted report will be sent out to the Executive Branch, including DoD and OMB. 

He said he hopes that it will be back to VA within about another week, after which VA will adjust the report based on their concurrence or non-concurrence.

The report will then be made open to public comment for 30 days, and the availability for public comment will be announced in the Federal Register (and then here on 91outcomes).

“This is personal, we have to get this right,” said Gingrich.  “We’re going to do our best to change the culture” at VA.

“I ask that people read the report, understand that it’s a step on the path, and request clarification where it’s need,” said Gingrich.

According to Gingrich, the report will be made public, every recommendation email and call and letter logged, every comment reviewed, and the final report will be published.

When asked about how long before that might be, Gingrich said that given the large amount of expected comment, not sure.

Gingrich explained that part of the report’s contents include recommendations for changes to federal rules regulating veterans’ service-connected disability conditions.

When the three rules are published, Gingrich said VA would go back and inform every veteran who applied for service-connected disability compensation of information on the new rules, which, “should be final very soon,” he said.

Among those changes are examining the current rule dealing with service-connection for multi-symptom symptom illness and whether fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome – currently “presumptive” conditions – are the only conditions that should qualify under that rule.

“We don’t think so, we think they are ‘examples’ of undiagnosed illness,” said Gingrich.

Another rule change will be in the definition of the geographic area of that defines the Gulf War area for Gulf War illness issues, and another will be related to PTSD.

Developing and providing new training materials for doctors, including those in primary care, is another key component of the culture shift documented in the upcoming report.  Other key times Gingrich cited will be:

• Holding seminars on environmental exposures.
• Looking at VA’s benefits laws and rules differently.
• Newsletters, website will be updated.
• Added to performance metrics for VA healthcare facilities.
• Telephone survey of Gulf War veterans.
• Longitudinal studies to track long-term health outcomes.
• Better focus on  female veterans.
• Partnerships, including doing much more with DoD.
• Need to have a transparency of records between DoD and VA health care facilities, including with the VLER (Veteran Lifetime Electronic Record).

Gingrich also said that VA needs to learn from the experiences of Gulf War veterans for veterans of later generations.  “

We need to look at environmental exposures as a whole, not just a slice of individual exposures,” such as burn pits and Camp Lejeune drinking water exposures affecting current veterans, said Gingrich.

Ginrich said, “One of the things that the Secretary [Shinseki] said over and over to me was, ‘Remember, we’re trying to treat veterans, secondarily find out the issues that caused it.  Find a way to help them.’”

“What we don’t want to do is be sitting here in 2020, and someone saying, ‘What about the burn pits, what do we do about it?’”, said Gingrich.

With regards to outreach, Gingrich was surprisingly candid. 

“With Gulf War veterans, I’m not sure the federal government could contact half of them, but we should, 20 years from now, not be able to say that,” he said.

Dr. Lea Steele, past scientific director of the RAC and now at Baylor University, asked whether VA would be allowing for input into the training manual for doctors.  Gingrich agreed to look into it. 

Steele’s concerns about allowing RAC scientists and doctors to have input into the clinical training were echoed by Dr. Kimberly Sullivan, RAC scientific coordinator and scientific faculty at the Boston University School of Public Health.

Dr. James O’Callaghan, chief toxicologist for the U.S. Centers for Disease Control and Prevention (CDC), noted that “there is always a feel-good period,” but expressed concerns that there needs to be sustained effort to make all the necessary changes.

Gingrich said he had spoken on the phone with one ill Gulf War veteran on Wednesday night. 

“I wish I could make you whole.  But I can’t.  But what I can do is everything that is physically, scientifically, humanly possible right now,” said Gingrich.

But he concluded, “This is a long-term situation, that we have the obligation to stand up and do what we can for the veteran, and we have an opportunity right now,” said Gingrich.

Time will tell how successful Gingrich’s efforts are, but at this point, the news is more encouraging for Gulf War veterans than in a long time.

 

War Injury Centers provide Health Assessments, Research to Help Gulf War Veterans

Veterans with unexplained war-related illness, injury can be referred with no cost to the veteran

By Anthony Hardie, 91outcomes Publisher/Editor

(Washington, DC – 91outcomes.com) - In a presentation by Dr. Gudrun Lange, director of the War Related Injury and Illness Study Center (WRIISC) for post-deployment health concerns since 2005, veterans with unexplained war-related illness or injury can be seen by one of the three WRIISC centers around the country at no charge to the veteran.

Previously Dr. Lange served as a researcher at the WRIISC on fibromyalgia, chronic fatigue syndrome (ME/CFS) and Gulf War Syndrome.  Also present were the directors of the other two WRIISC’s, as well as Dr. Michael Petersen of the VA’s Environmental Agents Service.

VA established the WRIISC’s in 2001 in response to deployment-related health concerns of veterans returning from the 1991 Persian Gulf War.  The WRIISC’s were established in three locations, including Palo Alto, Calif., Washington, DC, and East Orange, N.J. 

The WRIISC’s provide research, clinical service, risk communication, and education, as well as comprehensive clinical evaluations, exposure evaluations, and education/outreach.

Health Assessments and Treatment “Roadmap”

The WRIISC’s provide a second opinion resource, addressing the post-deployment health needs of combat veterans from past and future conflicts. 

The WRIISC’s provide consultative clinical assessments to veterans with deployment-related health concerns and illnesses to improve their health related concerns.

The Comprehensive Clinical Evaluation provided by the WRIISC’s is a comprehensive standardized medical evaluation of medically unexplained symptoms for Gulf War veterans and veterans from any era or conflict.  The assessment includes medical evaluation and labs, exposure evaluation, and more.  Treatment recommendations are made.

Participating veterans receive a “roadmap” that focuses on helping the veteran and his or her caregivers to better understand the veteran’s health conditions and what helps or hurts.  To date, more than 420 PGWVs, and 750 other era veterans have been seen at the WRIISC’s.

Travel expenses are covered for veterans participating in an evaluation at the WRIISC’s.

The exposure assessment includes occupational and environmental medicine physicians conducting an exposure evaluations, from birth to the present.  The assessments are also done as a stand alone service to any veteran of any era, including in person or by telephone.  Common wartime exposures are discussed and the WRIISC’s are followed-up, and participating veterans are provided with written documentation that list their exposures.

While the documentation of exposures cannot be used for VA’s service-connected disability compensation, it can be used by the C&P evaluating physicians in their evaluation of the veteran.

Some of the treatments also include alternative therapies, including Yoga and acupuncture, which have been shown to be helpful in chronic pain and other symptoms and conditions.

HOW TO PARTICIPATE:  To participate in a clinical evaluation, the primary care provider or the veteran can call one of the WRIISC’s, or use an electronic form to request the evaluation.

Call the National Coordinator: 1-202-461-1013, use the WRIISC website, at www.WarRelatedIllness.va.gov, or contact the appropriate WRIISC directly:

• For veterans west of the Mississippi -- Palo Alto, Calif.: 1-888-482-4376
• For veterans east of the Mississippi and in the southern portion of U.S. -- Washington, D.C.: 1-800-722-8340
• For veterans east of the Mississippi and in the northern portion of U.S. -- East Orange, N.J.: 1-800-248-8005

Research

Another key role of the WRIISC’s is to conduct medical research that will help improve the health and lives of ill Gulf War veterans and other war veterans.

To date, the WRIISC’s have more than 45 research publications specific to veterans of the 1991 Gulf War, with active research collaborative relations with numerous top research universities. 

“I think the time for a lone researcher, working alone, to figure out Gulf War illness is over,” said Dr. Lange, stressing the need for wide collaborative research efforts to help Gulf War veterans at this point in time, nearly 20 years after the war.

The WRIISC’s research serves to help medical care practitioners nationwide to help Gulf War and other veterans.

She called for veterans organizations to help spread the word about participating in research that will benefit all veterans.  She pointed out that potentially beneficial studies have died in the past because of a sample size of study participants that was too small.

Among the WRIISC’s Gulf War research recently completed or in progress:

• Early life determinants of vulnerability to PB (Weaver).
• Interactions between maternal care, stress and PB (Weaver).
• Cardiovascular hyperactivity and fatiguing illness in Gulf War veterans
• Pain sensitivity in Gulf War veterans with medically unexplained musculoskeletal pain (Cook, UW).
• Motor neuron function of Gulf War veterans with excessive fatigue (Li)
• Functional imaging in Gulf War veterans with unexplained musculoskeletal pain (Cook)
• MRI/PET/CT brain scanning in Gulf War veterans – detection of abnormalities and surveillance for irregular patterns.
• Telemedicine treatments for veterans with Gulf War Illness.
• Predictors of medically unexplained symptoms. (McAndrew).
• Avoiding PTSD relapse through behavioral conditioning .

Studies proposed or planned by the WRIISC’s include:

• Physiological causes of sleep disturbance in Gulf War veterans and implications for treatment.  (Serrador, preparing for CDMRP funding).
• The effectiveness of repetitive transcranial magnetic stimulation (rTMS) for chronic pain in veterans with Gulf War Illness (Ashford)
• Evaluating the implementation of a cognitive rehabilitation program for Gulf War veterans (Hodkiss)
• Complimentary and Alternative medicine: treatment feasibility study for sleep disturbances in Gulf War veterans (Rusiewicz)
• Complimentary and Alternative medicine: Mind/Body Treatment program for veterans with pain, fatigue, and PTSD (Mahoney)
• Brain imaging studies.
• Cutting edge genetic studies.
• Cardiovascular and vestibular (related to the inner ear and balance and dizziness) studies.

RESOURCES:

• WRIISC website: www.WarRelatedIllness.va.gov

 

New structure for VA Research Outlined

Will provide expert advice from Gulf War veterans’ illnesses research community

By Anthony Hardie, 91outcomes Publisher/Editor

(Washington, DC – 91outcomes.com) - In a presentation today before the Congressionally chartered Research Advisory Committee (RAC) on Gulf War Veterans’ Illnesses, Dr. Joel Kupersmith, VA’s chief research and development officer, outlined recent planning efforts to create a new steering committee to guide VA’s clinical research and clinical trials related to veterans of the 1991 Gulf War.

According to Kupersmith, four members of the new steering committee will be nominated by and may be members of the RAC, four will be nominated by the VA’s National Research Advisory Committee (NRAC), and VA will select a chair that could come from either body.  Both bodies have veteran representatives, including five ill Gulf War veterans on the 14-member RAC.

Until now, the VA’s research on Gulf War veterans’ illnesses has been given its direction by the Deployment Health Working Group, which has come under criticism by the RAC for failing to acknowledge the unique chronic multi-symptom illness in Gulf War veterans and for a persistent, excessive focus on the role of stress.

“One of it’s more important functions will be its coordination with Congressionally-mandated programs, like [the RAC],” said Kupersmith about the new steering committee.

Technically, the new steering committee will report to both the RAC and the NRAC.  According to Kupersmith, it’s guidance, “ideally consensus-based,” internally and with VA, will give VA it’s new research direction.

Kupersmith also highlighted the importance of fostering direct researcher-to-researcher interaction, including through telephone meetings and virtual meetings via the Internet and social media, and stated that this is now possible.

Dr. William Goldberg, scientific program manager for VA’s Gulf War research, added that while the program is by law an internal VA program, it is open to non-VA researchers who are willing to take a VA appointment while conducting the research.

“One of the things we have struggled with is how to get the best and the brightest, like those we heard from yesterday, involved in the research,” related to Gulf War veterans’ health,” said Dr. Roberta White, scientific director of the RAC and a senior faculty member in the Boston University’s School of Public Health, referring to presentations to the RAC about the role of glia – key cells in the brain and neurological system – in Gulf War Illness.  She expressed hope that the new structure might help.

“I think the fundamentals of our [scientific research] program are very important, for the veterans and for the country,” said Kupersmith.

 

Hutchison Statement on Veterans Affairs’ Decision to Reconsider Rejected Claims of Gulf War Vets

Calls Decision ‘Vindication’ for Gulf War Veterans

(Washington, DC – PRESS RELEASE ) U.S. Senator Kay Bailey Hutchison released the following statement concerning the Department of Veterans Affairs decision to reconsider the rejected claims of Gulf War veterans:

“Today’s decision by the VA to reconsider the rejected claims of the Gulf War veterans is a long-awaited vindication for those veterans who have suffered unexplained illness as a result of their service during the Gulf War and for those who have advocated on their behalf for benefits, research and treatment. I want to commend the VA for finally recognizing Gulf War Illness in our veterans and for the pro-active approach they will take in the future in dealing with these veterans, funding research and granting benefits to those who may have been exposed. For too long, our veterans have had their health concerns dismissed as ‘imaginary’ or ‘stress-related’ first by the Department of Defense and then by the VA. I commend Secretary Shinseki for doing the right thing.

“It is also a vindication for the medical researchers at UT Southwestern and elsewhere who have worked tirelessly to identify the connection between the exposure to chemicals and toxins our servicemen and women may have experienced during the first Gulf War and the symptoms and illnesses these veterans suffer from today.

“I fought long and hard for funding for Gulf War Illness research, and to get it I had to fight an entrenched bureaucracy that denied the legitimacy of these veterans’ health issues. No one was a bigger ally of mine nor a greater voice in support of these veterans during those battles than Ross Perot, who has been a tireless supporter and advocate for veterans.”

Click here to view related Website: Senator Kay Bailey Hutchison

Secretary Shinseki Announces Gulf War Task Force Report

Comprehensive approach to delivering care and benefits to Veterans

(Washington, DC – VA) - Today, Secretary of Veterans Affairs Eric K. Shinseki announced that the department’s Gulf War Veterans’ Illnesses Task Force has nearly completed a comprehensive report that will redefine how VA addresses the pain and suffering of ill Veterans who deployed during the Gulf War in 1990 and 1991.

“At VA, we advocate for Veterans – it is our overarching philosophy and, in time, it will become our culture,” Secretary Shinseki said. “Every day we must challenge our assumptions to serve our Nation’s Veterans.”

The mission of VA’s Gulf War Task Force is to identify 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, there have been 300,000 Gulf War Veterans with claims decisions, over 85 percent were granted service connection for at least one condition, and over 14 percent were not granted service connection for any condition. 

“We must learn from the past and take the opportunity to anticipate the future needs of our Veterans,” Shinseki said.  “This new approach is the first step in a still unfolding comprehensive plan of how VA will treat and compensate Veterans of the Gulf War era.”

The chairman of the Gulf War Task Force is John R. Gingrich, Chief of Staff at Veterans Affairs and retired Army officer who 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,” Mr. Gingrich said.  “Having commanded troops in Gulf War, and then witness some of them fall to mysterious illnesses has been very difficult to watch. With this Task Force, I am hopeful we can provide these men and women a better quality of life.” 

VA’s Gulf War Task Force recommendations build on the findings from the 2008 VA Research Advisory Committee on Gulf War Illnesses. 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

a.         Reviewing, and if necessary, updating regulations affecting Gulf War Veterans.

b.         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.

 

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VA Gulf War Veterans Illness Task Force

Background Brief 26 February 2010

The Gulf War Veterans Illness Task Force (GWVI-TF) is a leading edge of the Secretary’s vision of transforming the VA into a 21^st century organization. The Task Force represents a bold step forward in how VA considers and addresses the challenges facing not just Veterans of a specific era, but the challenges facing all Veterans. Improving the responsiveness of the VA to the challenges facing the 1990-1991 Gulf War Veterans is a priority that requires innovation and the engagement of all stakeholders, including VA employees, DoD, Congress and Veterans’ Service Organizations (VSOs). This brief summarizes the efforts of the Task Force and the recommendations made in the draft report which was written by an interdisciplinary team of subject matter experts from across multiple work centers within VA. The intended outcome is to take the VA one step closer to the goal of improving services for Gulf War Veterans across the spectrum of care and benefits.

Task Force Mission, Efforts, and Approach

The Task Force was formed in August 2009 to provide a unified and cohesive organizational instrument to address the concerns and needs of Gulf War Veterans, especially those who suffer from unexplained chronic multisystem, or undiagnosed illnesses. From the outset, the VA recognized that this was a complex issue with many people deeply invested in its resolution. We recognized the frustrations that many Veterans and their families experience on a daily basis as they look for answers, and seek benefits.

The Task Force was charged with conducting a comprehensive review of all VA programs and services that serve the Gulf War cohort of Veterans. The Task Force was further charged to identify gaps in services as well as opportunities to better serve this Veteran cohort, and then develop results-oriented recommendations to decisively advance VA’s efforts to address their needs. The Task Force considered a successful mission outcome as a coherent, comprehensive and facts-based action plan, which considers and integrates appropriate viewpoints from stakeholders and subject matter experts.

The Task Force focused its efforts on Veterans who were deployed to the Operation Desert Shield or Operation Desert Storm components of the 1990-1991 Gulf War period. However, as part of the Task Force charge to develop innovative and forward-looking solutions, it identified lessons learned from past practices and policy that can be applied to today’s programs and services supporting the Operation Enduring Freedom/Operation Iraqi Freedom cohort.

The Gulf War is legally defined as beginning on August 2, 1990, and extending through a date to be prescribed by Presidential proclamation or law.  The term "Gulf War Veterans" could refer to all Veterans of conflicts in Southwest Asia during this period, including Veterans of Operation Iraqi Freedom, and subsequent conflicts in this theater. These possibilities informed the recommendations with the view that this report would serve as a foundation for treating the unique wounds of war of the present conflicts.

In order to accomplish these goals, the Task Force was designed as a matrix organization within VA that meets regularly to investigate allegations and perceptions, analyze facts and data, coordinate and review findings and proposals, and collaboratively develop recommendations. The Task Force includes staff from the Office of the Secretary (OSVA), Veterans Heath Administration (VHA), Veterans Benefits Administration (VBA), Office of Public and Intergovernmental Affairs (OPIA), Office of Policy and Planning (OPP), and the Office of Congressional and Legislative Affairs (OCLA). The staff from these offices represented a broad spectrum of subject matter expertise and stakeholder perspectives necessary to ensure success. Members were charged with defining the key areas of review, consulting key experts and relevant stakeholders, and capturing the issues, data, programmatic and performance information necessary to inform their recommendations.

The Task Force draft report reflects an unprecedented VA approach to problem solving. The approach uses an interdisciplinary team of subject matter experts from across multiple horizontal domains of VA, to include direct senior leader participation. The GWVI-TF worked with great speed and agility over several months to develop a comprehensive plan of action consistent with the challenge inherent in Secretary Shinseki’s pledge to all Veterans in his comments before the National Society of the Sons of the American Revolution on 9 January 2010: “At VA, we advocate for Veterans – it is our overarching philosophy and, in time, it will become our culture.”

Task Force Objectives

The draft report’s action plans form an initial roadmap to transform the care and services we deliver to the Gulf War cohort. Execution of these plans will deliver the critical tools for frontline staff to address issues raised by VA and Gulf War Veterans, Veteran Service Organizations, Congressional committees, and other external stakeholders.

Due to significant limitations in the VA’s Gulf War Veterans Information System (GWVIS) and the reports generated from the various data sources used by GWVIS, it is extremely difficult to accurately portray the experiences of the 1990-1991 Gulf War cohort and their respective disability claims or health care issues. That said, this shortfall did not prevent the GWVI-TF from identifying gaps in services as well as opportunities to better serve this Veteran cohort.

The Task Force developed action plans to deliver new and improved tools for VA personnel based on seven core themes:

• Partnerships: Partner with the Department of Defense (DoD) to improve communication and subsequently the care and services VA delivers to Veterans;
• Benefits: Reassess and revise benefit policies as needed and empower and train VA compensation personnel to better secure the benefits Veteran clients have earned;
• Clinician Education and Training: Empower clinical staff to better serve Veteran needs through a new model of interdisciplinary health education and training;
• Ongoing Scientific Reviews: Ensure long-term population-based surveillance efforts for improved care for Veterans;
• Medical Surveillance: Transition from reactive to proactive medical surveillance to identify and better manage possible adverse health outcomes of Veterans’ potential hazardous exposures;
• Research and Development: Strengthen the foundation today for tomorrow’s more comprehensive short and long-term program for research and development; and
• Outreach: Enhance outreach to reconnect VA care, services, information and databases.

These action plans are not meant to be the definitive panacea for caring for Gulf War Veterans. While a starting point, this Veteran-centric care will require continued efforts and vigilance on the part of all stakeholders. Implementing the recommendations in this report will provide VA staff with the means to continue to advocate and care for all Gulf War Veterans.

Task Force Recommendations

The Task Force organized the report around seven themes that drive action plans for the way ahead. The seven theme subjects are summarized below and are: partnerships, benefits, clinician education and training, ongoing scientific reviews and population based surveillance, enhanced medical surveillance of potential hazardous exposure, research and development, and veteran outreach.

Partnerships: Veteran care is profoundly influenced by how well DoD and VA share information and resources in the areas of deployment health surveillance, assessment, follow-up care, health risk communication, and research and development. VA is dependent on DoD to identify environmental hazards and service members who were possibly exposed to those hazards.

VA and DoD already collaborate through the Deployment Health Working Group (DHWG). The draft report proposes to leverage the DHWG as the principal mechanism for VA to receive data on environmental exposures of Service members, but this proposal has not been coordinated yet with the DHWG. Additionally, the report proposes using the DHWG to provide regular progress reports on data sharing efforts to the VA/DoD Health Executive Council.

Benefits: The Task Force received input from Veterans and Veterans' stakeholders concerning the benefits and services targeted to Gulf War Veterans. Specifically, there was concern that some Veterans were continuing to suffer from symptom clusters that could not be attributed to known diseases or disabilities through conventional medical diagnostic testing and that these Veterans were "falling through the cracks" within the current disability compensation scheme.

As a result, the Task Force reviewed the current legislative and regulatory provisions unique to the Gulf War cohort of Veterans. Rule-making is underway to add additional diseases to the list of those subject to the presumption of service connection based on qualifying Gulf War service. Based on evidence provided by the National Academy of Sciences on chronic diseases associated with service in Southwest Asia, additional rules to ensure that Veterans can efficiently access the benefits they’ve earned may also be forthcoming.

To further assist Gulf War Veterans, VBA Compensation and Pension (C&P) Service has developed two training letters designed to inform and instruct regional office personnel on development and adjudication of disability claims based on Southwest Asia service. Training Letter 10-01, titled Adjudicating Claims Based on Service in the Gulf War and Southwest Asia, was released on February 4, 2010. This training letter provides background information on the Gulf War of 1990-1991, and explains the initial 1994 and subsequent 2001 legislation found in Title 38 United States Code, Section 1117, which was a response to the ill-defined disability patterns experienced by returning Gulf War Veterans. It explains the terms “undiagnosed illness” and “medically unexplained chronic multisymptom illness” used in the legislation, and stresses that service connection may be granted for other diagnosed chronic, multisymptom illness in addition to chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, which are identified as examples in the legislation. It also provides step-by-step procedures for procuring supporting evidence and for rating a disability claim based on Southwest Asia service under Section 3.317 of the Code of Federal Regulations. The training letter includes a separate memorandum to be sent with the VA medical examination request so that examiners are informed of the issues related to qualifying chronic disabilities and better able to evaluate a Gulf War Veteran’s disability pattern.

Additional assistance will be provided in Training Letter 10-02, titled Environmental Hazards in Iraq, Afghanistan, and Other Military Installations, which is currently in development and will be coordinated with DoD. This training letter provides regional office personnel with information on environmental hazards associated with Gulf War and Southwest Asia service. It discusses airborne toxic substances resulting from the widespread use of burn pit fires to incinerate a variety of waste materials in Iraq and Afghanistan, as well as hexavalent chromium contamination at the Qarmat Ali water treatment plant in Basrah, Iraq, from April through September 2003.

In addition to Southwest Asia environmental hazards, the training letter will provide details of the contaminated drinking water situation at Camp Lejeune, North Carolina, from the 1950s to the 1980s . The purpose of this information is to alert regional office personnel to the potential for disability claims based on exposure to any of these environmental hazards. The training letter outlines development and rating procedures for such claims and provides “fact sheets” for VA medical examiners that explain each hazard. We will coordinate with DoD to assure that these fact sheets accurately describe the environmental hazards.

Clinician Education and Training: VHA has historically used a series of clinician training programs, titled Veterans Health Initiative (VHI), to prepare clinician staff to treat Veterans. However, the current programs are unwieldy, information is out-of-date, the format is not user-friendly, and process for updating these training programs lacks agility.

In order to address this training deficit, an interdisciplinary team of VA subject matter experts met on December 8 and 9, 2009, to rewrite and reorganize the Gulf War Veterans’ Illnesses training program. This was the first time that such a wide array of policy makers, subject matter experts, and clinicians in the field were brought together to review every facet of a training program. A conference call on December 28, 2009, was held to continue editing the content. A two-day offsite meeting on February 1 and 2, 2010, finalized the content. The training program will be reviewed by the peer review board and undergo the process to ensure it is Section 508 compliant.

And while primary care providers currently do an excellent job of providing patients with work-ups based on symptoms, they do not always have the necessary tools to provide thorough exposure assessments. An initial seminar was developed in August 2009 in conjunction with Mount Sinai Medical Center and the New Jersey War Related Illness and Injury Study Center (WRIISC) to overcome this deficiency.

Lessons learned from prior conflicts, including the 1990-1991 Gulf War, were coupled with the lessons learned at the August 2009 seminar to build more comprehensive training for VA staff. VHA will conduct exportable workshops in exposure evaluation and assessment to update VA clinicians on the unique exposure concerns of returning OEF/OIF Veterans and provide educational and clinical tools for evaluation of exposure risk and the health outcomes relevant to these risks. In addition, in FY 2010, this workshop seminar will be offered as a satellite broadcast available to all VA providers. We will coordinate with DoD on the development of these educational materials.

Ongoing Scientific Reviews: VA recognizes the need to leverage additional resources available to support systematic data collection and review efforts that provide Gulf War Veterans with the highest standard of care.

The VA will continue to support the long-term Institute of Medicine (IOM) scientific reviews of health outcomes related to Veterans’ service in Gulf War combat theaters. VA will seek to improve collaboration with the Centers for Disease Control and Prevention (CDC) to incorporate Veteran-specific data collection and analyses into three major longitudinal health-related national surveys: National Health and Nutrition Examination Survey (NHANES); National Health Interview Survey (NHIS); and National Immunization Survey (NIS). VA has reached out to DoD to discuss such data collection. We will improve collaboration between DoD and the VA to ensure Veteran-specific data collection and analyses are included in the Millennium Cohort Study (MCS).

To prepare for and address future needs, in June 2009 the VA announced the National Health Study for a New Generation of U.S. Veterans to study the health status of 60,000 Veterans who have separated from active duty, Guard, or Reserves, half of whom served in either Iraq or Afghanistan and half who did not. Women Veterans are being oversampled to permit appropriate comparisons.

Medical Surveillance: DoD has discussed with VA events or situations when Service members may have been exposed to hazardous substances during the current conflicts in Iraq and Afghanistan. These possible exposure events include exposure to hexavalent chromium, burn pit smoke, and other contaminants.

A program is being developed for those Veterans who may have been exposed to sodium dichromate while performing duties at Qarmat Ali, Iraq. This model will be used to develop medical surveillance programs for the other exposure events for which medical surveillance is appropriate. We will coordinate with DoD on the development of these medical surveillance programs.

Among Gulf War Veterans, there are known instances where service members were hit by coalition fire and are believed to still have depleted uranium (DU) fragments present in their bodies. The need to monitor the effects of long-term DU exposure still exists. The Depleted Uranium follow-up program was started in 1993 at the Baltimore VA Medical Center (VAMC). This program periodically re-evaluates service members who have known embedded DU fragments. In 2008 the Toxic Embedded Fragment Study Center was established to clinically evaluate all service members with any type of embedded fragment. These programs have been supported by the Division of Biophysical Toxicology at the Armed Forces Institute of Pathology (AFIP). The Joint Pathology Center (JPC), authorized in NDAA 2008, will serve as the new Pathology Reference Center for the federal government providing pathology consultation, education, research, and oversight of the vast Tissue Repository housed at AFIP, which will close in 2011. VA will continue to require the support of the JPC to maintain these vital programs for Veterans with Toxic Embedded Fragments of all kinds.

Research and Development: There has been significant Federal support for research on Gulf War Veterans’ Illnesses that has answered many epidemiological questions and studied a number of potential biological indicators of illness in Gulf War Veterans. Effective treatments and objective diagnostic tests, however, have not yet been fully adopted by the medical community. This is particularly frustrating to Veterans and their families.

VA is committed to conducting a multi-pronged approach that balances the urgency of understanding and finding new diagnostic tests and treatments for ill Veterans of the 1990-1991 Gulf War with the need to do new studies on a national cohort of Gulf War Veterans. Clinical trials are currently underway to examine new therapies for sleep disturbances and gastrointestinal problems and to test the feasibility of performing cognitive behavioral therapy via telephone. Another major focus of VA’s current research portfolio is to identify biomarkers, or biological indicators, that can distinguish ill Gulf War Veterans from their healthier counterparts.

The VA Office of Research and Development (ORD) issued three new Requests for Applications (RFA) on November 10, 2009, which incorporated more than 80 percent of the research recommendations the Research Advisory Committee on Gulf War Veterans’ Illnesses made in their 2008 report. These RFAs will be re-issued twice a year to regularly request submission of new proposals and revisions of previously reviewed, but not funded, applications. In addition, ORD’s long-term plans include the design of a new study of a National cohort of Gulf War Veterans under the auspices of the VA Cooperative Studies Program, which has extensive experience in developing multi-site VA clinical trials and clinical studies. The design of this new study will include a Genome Wide Association Study (GWAS) and other elements, based on evaluation of the existing body of scientific/clinical knowledge about the illnesses affecting Gulf War Veterans.

The VA commitment to providing the highest standard of care led to a decision to not exercise the two option years of the contract with the University of Texas Southwestern Medical Center (UTSW). The decision was based on persistent noncompliance with contract terms and conditions, and numerous performance deficiencies documented by the Office of the Inspector General. Consequently, unobligated funds from the third UTSW contract period will be redirected to other VA-funded Gulf War research projects that are in the same direction as the UTSW research. This includes the VA Medical and Prosthetics Research program which has committed $20 million annually for Gulf War Illnesses research.

Outreach: There is a general lack of engagement on, and knowledge of, the efforts VA is taking to address the issue of Gulf War Veterans’ Illnesses. VA needs to improve the delivery of accurate and timely information about Gulf War related ailments to all stakeholders. In general, VA requires a more robust outreach plan to continuously inform eligible Gulf War Veterans about the full compliment of benefits and services they are entitled to, and to provide more complete information to help obtain and use these benefits and services.

In order to develop this plan, VA will solicit key stakeholders for their ideas and concerns. This feedback will be used to develop a communication strategy that improves the level of knowledge within the Veteran community regarding VA modifications to the rating schedule and presumptions related to the Gulf War Veterans’ Illnesses. Improving open lines of communication is key in improving the VA responsiveness.

Conclusion

The VA team views this report as a foundation upon which we can collectively build iterative future improvements in the care and services VA delivers by leveraging the lessons learned by this Task Force across the full spectrum of all Veteran communities and their families. This requires a sustained commitment to be transparent and accountable for improving the responsiveness of the organization. These priorities encompass how the VA plans to drive the cultural and institutional change needed to transform it into a 21^st century organization.

A centerpiece of transformation is to build a legacy of success and excellence that translates into improved service delivery across the spectrum of benefits and care for Veterans. This requires improving partnerships within VA, with Veterans, with DoD and other external stakeholders. VA looks forward to partnering with all of these groups in implementing the Task Force recommendations and in devising new strategies that shape the future course. In fact, coordination of the draft report is underway with DoD, which will be a major partner in these efforts. To this end, the VA welcomes recommendations and criticisms in the hopes of forming a constructive dialogue that continues to improve services for Veterans.