Tuesday, March 15, 2016

MILITARY.COM -- Lawmaker: Poor Wording in VA Bill Hurt Victims of Gulf War Illness

SOURCE:  Military.com, Bryant Jordan reporting, March 15, 2016

http://www.military.com/daily-news/2016/03/15/lawmaker-poor-wording-va-bill-hurt-victims-gulf-war-illness.html


ARCHIVED ARTICLE:

Lawmaker: Poor Wording in VA Bill Hurt Victims of Gulf War Illness

Oil fire
A lawmaker on Tuesday suggested Congress may have to redraft part of the initial legislation authorizing the Veterans Affairs Department to grant claims compensation to Persian Gulf War veterans suffering from multi-symptom ailments that make up Gulf War Illness.
Responding to testimony showing the VA has denied compensation to more than 90 percent of veterans claiming Gulf War Illness, Rep. Ann McLane Kuster, D-New Hampshire, said it was not Congress' intent to require VA accept an undiagnosed multi-symptom disorder as a condition.
"We created this Catch-22," Kuster said during a joint hearing of the Disability Assistance and Memorial Affairs and Oversight and Investigations subcommittee. "It sounds like an unintended consequence of what we were trying to do to help Gulf War veterans … They had multi-symptoms and we didn't have the science and the words" to properly describe what we wanted VA to do.
Gulf War veterans and advocates say that 90 percent or more Gulf War veterans who apply for compensation for Gulf War Illness are turned down. VA officials say veterans filing claims for Gulf War Illness may still be compensated when a particular symptom or symptoms are diagnosed and service-connected. But the compensation would be for the chronic symptom -- sinusitis or gastritis, for example -- but not for Gulf War Illness.
Congress in 1994 authorized the VA to compensate Gulf War vets suffering from a chronic disability resulting from an undiagnosed -- or combination of undiagnosed illnesses -- linked to service in the Gulf War. But the result, Kuster suggests, is that VA awards claims for Gulf War Illness when symptoms cannot be diagnosed.
She suggested the committee could urge VA Secretary Bob McDonald to move toward a single Disability Benefits Questionnaire tailored for Gulf War Illness claims. There are currently about 70 individual DBQs, according to the VA.
"But we may need to also unravel the Catch-22 we created in our attempt to help Gulf War veterans," she said.
Also during the hearing lawmakers said there is a need to extend the deadline by which Gulf War veterans need file claims for benefits for undiagnosed illnesses.
The deadline period is currently Dec. 31, 2016, and lawmakers want it extended by five years.
David R. McLenachen, VA Deputy Under Secretary for Disability Assistance, told the panels that McDonald has the authority to extend the deadline but was unable to say if that would happen.
But Ron Brown, president of the National Gulf War Resource Center, told Military.com on Tuesday that McDonald already informed him the presumptive date would be pushed back. He said McDonald told him in a letter dated Feb. 9, 2015 that he also was concerned with the "end date" for filing.
"We, once again, plan to use our existing regulatory authorities to extend the presumptive date beyond the current December 31, 2016, deadline," McDonald wrote. "This is consistent with our beliefs, our policy and our past actions."
In 2011 then-VA Secretary Eric Shinseki used the same authority to extend the date -- then about to lapse -- to the end of 2016.
Rick Weidman, Executive Director for Policy and Governmental Affairs for Vietnam Veterans of America, likened the VA's treatment of Gulf War Veterans to that experienced by Vietnam veterans, who were told for years that that chronic health issues were not related to exposure to Agent Orange in Vietnam.
He said VA forces Gulf War veterans to try to link their conditions to the war when "VA knows that you cannot pin down exact cause when you have a multi-toxin environment, which is exactly what you had with the Gulf War."
The VA has relied on work from the Institute of Medicine, or IOM, in deciding how to handle Gulf War Illness, and Weidman said IOM appears predisposed to seeing the illness as psychological.
During a meeting last month the IOM Gulf War panel recommended no further research into Gulf War Illness, said Weidman, who attended the meeting. He said half the member panel, along with the chair, is made up of psychologists and psychiatrists and the other by research scientists.
Weidman said IOM should be conducting an epidemiology study comparing Gulf War veterans in certain military occupational specialties with troops in the same job who did not deploy to the war, as well as civilians with no military background.
Brown said there has been 20 years of studies, though he does not know if one suggested by Weidman has been carried out.
-- Bryant Jordan can be reached at bryant.jordan@military.com. Follow him on Twitter at @bryantjordan.

RELATED TOPICS

Headlines Veteran Benefits Medical Disabilites VA Claims and AppealsDepartment of Veteran Affairs Bryant Jordan


Monday, March 14, 2016

Congressional Hearing to Examine Gulf War Veterans' Claims Denials by VA


SOURCE:  House Veterans' Affairs Committee Press Release, March 14, 2016



ARCHIVED TEXT:


HVAC to Examine VA’S Gulf War Illness Disability Claims Process

WASHINGTON — On Tuesday, March 15, 2016, at 10:30 a.m. in room 334 of the Cannon House Office Building, the House Committee on Veterans’ Affairs Subcommittees on Disability Assistance and Memorial Affairs and Oversight and Investigations will hold an oversight hearing examining VA’s disability claims process for veterans afflicted with Gulf War Illness (GWI).

VA’s own data reveals that at least 80% of Gulf War Illness claims are denied.  The data is specific to undiagnosed illnesses and chronic multisymptom illnesses – both presumptive conditions under current regulation. This data reveals apparent problems in VA’s interpretation of the law with regard to claims processing.  
 
The purpose of this hearing is to evaluate VA’s disability claims process with respect to veterans suffering from Gulf War Illness.

The following event is open to the press:

WHO: Subcommittees on Disability Assistance and Memorial Affairs and Oversight and Investigations
WHEN: 10:30 a.m., Tuesday, March 15, 2016
WHERE: 334 Cannon House Office Building and streaming at veterans.house.gov

WITNESS LIST

Mr. David R. McLenachen
Deputy Under Secretary for Disability Assistance
U.S. Department of Veterans Affairs

Accompanied by

Mr. Bradley Flohr
Senior Advisor, Compensation Service
Veterans Benefits Administration
U.S. Department of Veterans Affairs

Mr. Zachary Hearn
Deputy Director for Claims
Veteran Affairs and Rehabilitation Division
The American Legion

Mr. Aleksandr Morosky
Deputy Director, National Legislative Service
Veterans of Foreign Wars

Mr. Rick Weidman
Executive Director for Policy and Government Affairs
Vietnam Veterans of America

Mr. Richard V. Spataro
Director of Training and Publications
National Veterans Legal Services Program

###

For more news from the House Committee on Veterans’ Affairs, please visit:
Find us on Facebook at: Facebook.com/HouseVetsAffairs or follow us on Twitter at:

Tuesday, March 8, 2016

**URGENT ACTION ALERT** - 5 Minutes to Help the Gulf War Illness treatment research program




ACTION NEEDED:   Ask both your U.S. Senators and your Congressperson in the U.S. House of Representatives to sign onto the "Baldwin" (in the U.S. SENATE) or "Roe-Walz" (in the U.S. HOUSE) "Dear Colleague Letter for FY17 Gulf War Illness CDMRP funding"  

DEADLINE:  Sign-On's must be completed no later than March 14, 2016 (House) and March 15 (Senate).

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(91outcomes.com) - Several members of Congress have launched an important, bipartisan initiative to provide continuation funding for the treatment-focused Gulf War Illness Research Program, part of the Congressionally Directed Medical Research Program (CDMRP) administered by the U.S. Department of Defense under Congressional direction.  

Official estimates show that Gulf War Illness affects between one-fourth and one-third of the veterans of the 1991 Gulf War.   The consensus among Gulf War Illness medical researchers is increasingly clear:  With the a concerted national effort, effective treatments can likely be found.

Led in the U.S. House of Representatives by Congressman Phil Roe, M.D. (R-Tennessee) Congressman Tim Walz (D-Minnesota) and in the U.S. Senate by Senator Tammy Baldwin (D-Wisconsin), the effort seeks continuation funding for the unique, treatment-focused medical research program aimed at improving these veterans' health and lives.  

Information below shows what you can do in just five minutes to support this critically important national effort to help our nation's war veterans on this 25th anniversary of the war.


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STEP-BY STEP, HOW YOU CAN HELP IN JUST 5 MINUTES:

1.  Find your two U.S. Senators and one Congressperson in the U.S. House of Representatives:
    • (U.S. SENATE) Find your two U.S. Senators here (near the top right corner, select your State).  
    • (U.S. HOUSE) Find your Congressman/Congresswoman here (near the top right corner, enter your zip code).  

2.  Call their Washington, DC office [not their office(s) back in their district or home state] , and ask for the legislative staff person who handles Defense Appropriations.  
    • If you get their voicemail, leave a detailed voicemail with your specific request (below).


3.  State your name and that you are a constituent, and very briefly (in 1 or 2 sentences at most) state your connection to Gulf War Illness
    • [For example:  "I'm among the one-in-three veterans of the 1991 Gulf War suffering from Gulf War Illness".  
    • Or, "I'm the wife/husband/son/daughter/parent of a Gulf War veteran suffering from Gulf War Illness."
    • Or, "I'm one of many other veterans besides those who served in the Gulf War and I'm also suffering from a chronic multi-system illness like Gulf War Illness."
    • Etc.


4.  State that there is a "Dear Colleague" letter that you are specifically requesting the Congressman/Congresswoman sign onto.  


5.  Provide the name of the "Dear Colleague" letter (there is no bill number -- this is a request to get funding into a bill -- specifically the FY17 Defense Appropriations Act): 
  • (U.S. SENATE)  The "Baldwin Dear Colleague letter for treatment-focused FY17 Gulf War Illness Research Program continuation funding."   
  • (U.S. HOUSE)  The "Roe-Walz Dear Colleague Letter for treatment-focused FY17 Gulf War Illness Research Program continuation funding."  



6.  State that this is continuation funding for a successful, treatment-focused program and there have been many cosigners every year.



7.  State the sign-on deadline (this is a hard deadline)March 14, 2016 (U.S. House) or March 15, 2016 (U.S. Senate).  The Senator or Congressman/Congresswoman will likely want to support the one-fourth to one-third of Gulf War veterans and others suffering from Gulf War Illness.  

Staff contacts, in case they ask are:  Sen. Tammy Baldwin (Jeremy Steslicki); Rep. Phil Roe (Alex Large); Rep. Tim Walz (Chris Bennett).


8.  Ask if you can email the staffer with a short one-pager about the program.  This is very important.  Then right away, email them the link to this document:  

https://www.scribd.com/doc/303204670/About-the-Gulf-War-Illness-CDMRP-Feb-2016


9.  Ask that the staff person follow-up with you to let you know the Senator's or Congressman's/Congresswoman's decision.


10.  Thank the staff person for their time.


AFTER YOUR CALL:

If they say they will sign on, post a comment below this post with the name of the Senator or Congressperson and the name of the staffer and that they will or will not sign on.  

Follow-up in 2-3 days to find out the status, if you haven't heard back.


TIPS:
  • Be polite
  • Be pleasant
  • Be urgent
  • Be respectful
  • Be convincing
  • Be brief
  • Be SPECIFIC with the REQUEST:  Sign onto the "Baldwin" (U.S. SENATE) or "Roe-Walz" (U.S. HOUSE) "Dear Colleague Letter for FY17 Gulf War Illness CDMRP funding"  
  • Do not argue with, get angry with, or threaten the staffer in any way.  


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



FREQUENTLY ASKED QUESTIONS (FAQ's)




WHAT IS THE GOAL?




The overall goal of the program is to find effective treatments for the officially estimated quarter-of-a million veterans of the 1991 Gulf War and others who are still suffering from the debilitating effects of Gulf War Illness.



These veterans were directly impacted by a veritable toxic soup of hazardous exposures during the short but intense war, and the best efforts our nation can provide to assist them.  




WHAT CAN I DO TO HELP? 


You can email, call, or electronically message your two U.S. Senators who represent you and your state in the U.S. Senate and your Congressman or Congresswoman who represents you in the U.S. House of Representatives.  



See above for "10 quick and easy steps" to make your request.  



Many Members of Congress have an option to submit your comments from a quick form right on their webpage.



WHO IS LEADING THIS FUNDING EFFORT IN CONGRESS?

In the United States Senate, U.S. Senator Tammy Baldwin (D-Wisconsin) is leading the bipartisan effort for the Senate.  

In the U.S. House of Representatives, Rep. Phil Roe, M.D. (R-Tennessee) and Rep. Tim Walz (D-Minnesota) are co-leading the bipartisan effort for the House.




AT WHAT LEVEL SHOULD THE FUNDING BE SUPPORTED, AND WHY?



The effort is to support the treatment-focused Gulf War Illness CDMRP.  Their effort is calling for House Members to support this important program by signing onto a "Dear Colleague" letter requesting adequate continuation funding for this successful, unique, and important program.  




WHO SUPPORTS THIS PROGRAM?


The program is supported by the nation's leading Veterans Service Organizations, including:  the American LegionAMVETS; Association of the U.S. Navy (AUSN); Burnpits360; Disabled American Veterans (DAV); Lung Cancer Alliance; National Gulf War Resource Center (NGWRC); National Vietnam & Gulf War Veterans Coalition (NVGWVC); Paralyzed Veterans of America (PVA); Sergeant Sullivan CircleToxic Wounds Task Force; Veterans for Common Sense (VCS); Veterans of Foreign Wars (VFW); Vietnam Veterans of America (VVA). 
The FY15 Independent Budget Veterans Service Organizations (IBVSO’s, composed of AMVETS, DAV, PVA, VFW, and 53 other organizations that serve veterans) stated that the GWI CDMRP, “has made great strides in the short time it has been operating.” (pp. 126-27)




WHEN SHOULD I CALL MY SENATORS'/CONGRESSPERSON'S OFFICE?




Right away.  The deadline is fast approaching. 





WHEN IS THE DEADLINE? 


The sign-on deadline for Congresspersons in the U.S. House of Representatives to sign-on is March 14, 2016, and for Senators in the U.S. Senate it is March 15, 2016.  Typically, their offices need one or more days to secure approval to sign-on.  




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ADDITIONAL QUESTIONS



WHERE CAN I LEARN MORE ABOUT THE GULF WAR ILLNESS RESEARCH PROGRAM?



The Congressionally Directed Medical Research Program (CDMRP), a Congressionally directed activity funded under the U.S. Department of Defense, has a comprehensive website on the GWI program at:  http://cdmrp.army.mil/gwirp .  The CDMRP also publishes an overview of the program in its GWIRP program booklet.  


Veterans for Common Sense (VCS), a leading national veterans' education and advocacy organization, has published the following two documents about the Gulf War Illness Research Program:


WHEN IS THE NEXT FUNDING AVAILABILITY FOR GULF WAR ILLNESS TREATMENT RESEARCH FUNDS?


The Congressionally Directed Medical Research Program, which is administered by the U.S. Department of Defense (U.S. Army Medical Research and Materiel Command) provides information for prospective researchers, including how to apply.

Funding announcements are typically made in the late Spring of each year, but timing may vary quite a bit from year to year, depending upon Congressional appropriations.  


WHAT IS RECENT RESEARCH SAYING ABOUT GULF WAR ILLNESS?

Recent research shows that chemical exposures are causally associated with Gulf War Illness.  Psychiatric causes have been ruled out.  


This paper reviews the recent medical literature on the health of 1991 Gulf War veterans, focusing particularly on the central nervous system and on effects of Gulf War toxicant exposures:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724528/pdf/nihms746360.pdf





WHAT DOES THE "DEAR COLLEAGUE" LETTER ACTUALLY SAY?  


****THIS IS THE "DEAR COLLEAGUE" LETTER THE SENATORS ARE SIGNING ONTO.  THE HOUSE LETTER IS VERY SIMILAR****

March 16, 2016
The Honorable Thad Cochran, Chairman
The Honorable Richard J. Durbin, Ranking Member
Subcommittee on Defense
Committee on Appropriations
Washington, DC 20510 

Dear Chairman Cochran and Ranking Member Durbin:
Thank you for your continued support for the Gulf War Illness Research Program (GWIRP) within the Department of Defense (DOD) Congressionally Directed Medical Research Programs (CDMRP), including the $20 million provided to the program by Congress for Fiscal Year (FY) 2016. As your Committee begins work on the FY 2017 DOD Appropriations Bill, we are writing to provide a program update and to request that you include the funding necessary to continue the GWIRP’s successful work on behalf of Gulf War veterans.
We have made strides in the fight against Gulf War Illness, but many challenges remain. Since the 2008 report of the congressionally-mandated Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC) and the 2010 report of the Institute of Medicine (IOM), science has shown that Gulf War Illness is a physical condition—likely caused by toxic exposures—affecting between one-quarter and one-third of the nearly 700,000 veterans who served. The most recent RAC update in 2014 affirmed these conclusions, and a 2016 IOM update “found little evidence to warrant changes to the conclusions made by the [2010 IOM] committee . . .” Common symptoms include “some combination of widespread pain, headache, persistent problems with memory and thinking, fatigue, breathing problems, stomach and intestinal symptoms, and skin abnormalities.” Studies also have found an elevated incidence of Lou Gehrig’s disease (ALS) among Gulf War veterans as well as significantly elevated rates of death due to brain cancer among those who were most exposed to the release of nerve gas by the destruction of the Khamisiyah Iraqi arms depot.
The positive news is that treatment research has increased significantly since 2008, particularly reflecting the work of the GWIRP at CDMRP, and that early results represent encouraging steps toward achieving the 2010 IOM treatment goals “to speed the development of effective treatments, cures, and, it is hoped, preventions.” Indeed, the GWIRP has served as a model of how to conduct treatment-oriented research to address a challenging illness and is succeeding where earlier programs failed. By Congressional design, the program is narrowly focused on identifying treatments and diagnostic markers. Its highly competitive, peer-reviewed process is open to all researchers, whereas U.S. Department of Veterans Affairs (VA) research is restricted to VA staff, few of whom have expertise in this rapidly-evolving, cutting-edge area.
GWIRP-funded studies have found treatments—like CoQ10, acupuncture, carnosine, and xylitol/saline nasal irrigation—that help alleviate some GWI symptoms, and ongoing evaluations of treatments include off-the-shelf medications and alternative therapies for which there is a rationale for GWI symptom relief. Other studies by multisite, multidisciplinary teams are focused on identifying treatments to attack the underlying disease and are showing great promise, finding that even low-dose chemical warfare agent and/or pesticide exposure leads to the following findings, among others: persistent brain changes associated with GWI; evidence of a GWI chronic central nervous system inflammatory state; a potential explanation of GWI immunological dysfunction; inflammation and immune dysfunction in GWI after exercise challenge; evidence suggesting small fiber peripheral neuropathy in a subset of GWI veterans; lipid dysfunction following GWI exposures; and persistent changes in axonal transport in the brain. Some of the new pilot studies of treatments approved in 2015 include: vagus nerve stimulation; D-Cycloserine; anatabine; liposomal glutathione and curcumin; and a “mitochondrial cocktail” extending the benefits of CoQ10. New research to identify underlying disease mechanisms and biomarkers includes: studies of novel autoantibody serum and cerebrospinal fluid biomarkers; microtubule abnormalities; neurovascular and autonomic dysfunction; brain autoimmune dysfunction; muscle mitochondrial assessment; and an objective blood test from stimulated gene expression. In addition to improving the health of Gulf War veterans, these important discoveries also will help protect current and future American servicemembers who could be at risk of toxic exposures.
Recognizing the program’s progress, the most recent RAC report recommends that “Congress should maintain its funding to support the effective treatment-oriented [GWIRP].” We agree and respectfully request that you provide the necessary resources to continue this vital and effective program in the FY17 DOD Appropriations Bill. Furthermore, it is critical to the program’s success and accountability that it remains a stand-alone program within CDMRP, rather than combined with other diseases.
Thank you for your consideration of our request, which is supported by the American Legion, Veterans of Foreign Wars, Disabled American Veterans, Paralyzed Veterans of American, AMVETS, Vietnam Veterans of America, National Vietnam and Gulf War Veterans Coalition, the National Gulf War Resource Center, and Veterans for Common Sense.
Sincerely,
________________________
Tammy Baldwin
United States Senator
********

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--Anthony Hardie, 91outcomes.com Author and Gulf War veteran advocate.



Friday, March 4, 2016

Army "Celebrates" Gulf War 25th Anniversary without Fanfare or Publicity



From: USARMY Pentagon HQDA SECARMY Mailbox Under Secretary
Sent: Friday, March 04, 2016 10:55 AM
Subject: Great Anniversary!

Army Team,

Today we're celebrating the 25th Anniversary of the end of the Persian Gulf War - where a joint and combined coalition led by the United States Army expelled Saddam Hussein’s Army, then the world's fourth largest Army, out of Kuwait.  Army heroes like Generals Colin Powell, "Stormin" Norman Schwarzkopf, and Barry McCaffery led our men and women valiantly. For the first time, the world witnessed American prowess in advanced ground combat and our interoperability of air, sea, and land forces, live on their televisions.

Our victory came with a solemn cost – 383 American servicemembers lost their lives to liberate Kuwait.  While memories fade and time marches on, we must never forget America's leadership that galvanized support of our allies and freed millions of Kuwaitis from tyranny.

Today, all of you on the Army team - our Soldiers, Civilians, & Families - stand tall in keeping up our proud traditions.  Like those that fought in Desert Storm, we are also in a defining moment for our Army as we continue to fight the longest wars in American history in Iraq & Afghanistan. Thank you--you make us proud every day.

Army Strong! Soldier for Life!
-Patrick



Patrick J. Murphy
Acting Secretary of the Army

Thursday, March 3, 2016

More Gulf War Veterans Have Brain Deterioration than Previously Shown, says New Study

(91outcomes.com) - An even larger number of Gulf War veterans exposed to Gulf War chemical warfare agents have brain deterioration than previously thought, accordingly to the results of a newly published research study.

In an early study, Dr. Lindo Chao and her research team found evidence of, "reduced cortical gray matter (GM), white matter (WM), and hippocampal volume," in veterans of the 1991 Gulf War who were among those exposed to low-level nerve agents following demolitions of chemical-laden munitions shortly following the end of the war.  

In her team's new study published on February 23, 2016 in the peer-reviewed medical journal, Neurotoxicology, Chao reports that veterans who report having merely heard chemical alarms sounding have similar degenerative changes in their brains.  

According Chao's news study, "The current findings suggest that exposure to substances that triggered those chemical alarms during the Gulf War likely had adverse neuroanatomical effects."

-A.H.


****


SOURCE: PubMed

http://www.ncbi.nlm.nih.gov/pubmed/26920621


ABSTRACT:

 2016 Feb 23;53:246-256. doi: 10.1016/j.neuro.2016.02.009. [Epub ahead of print]

Associations between the self-reported frequency of hearing chemical alarms in theater and regional brain volume in Gulf War Veterans.

Abstract

BACKGROUND: 

We previously reported evidence of reduced cortical gray matter (GM), white matter (WM), and hippocampal volume in Gulf War (GW) veterans with predicted exposure to low-levels of nerve agent according to the 2000 Khamisiyah plume model analysis. Because there is suggestive evidence that other nerve agent exposures may have occurred during the Gulf War, we examined the association between the self-reported frequency of hearing chemical alarms sound during deployment in the Gulf War and regional brain volume in GW veterans.

METHODS: 

Ninety consecutive GW veterans (15 female, mean age: 52±8years) participating in a VA-funded study underwent structural magnetic resonance imaging (MRI) on a 3T scanner. Freesurfer (version 5.1) was used to obtain regional measures of cortical GM, WM, hippocampal, and insula volume. Multiple linear regression was used to determine the association between the self-reported frequencies of hearing chemical alarms during the Gulf War and regional brain volume.

RESULTS: 

There was an inverse association between the self-reported frequency of hearing chemical alarms sound and total cortical GM (adjusted p=0.007), even after accounting for potentially confounding demographic and clinical variables, the veterans' current health status, and other concurrent deployment-related exposures that were correlated with hearing chemical alarms. Post-hoc analyses extended the inverse relationship between the frequency of hearing chemical alarms to GM volume in the frontal (adjusted p=0.02), parietal (adjusted p=0.01), and occipital (adjusted p=0.001) lobes. In contrast, regional brain volumes were not significantly associated with predicted exposure to the Khamisiyah plume or with Gulf War Illness status defined by the Kansas or Centers for Disease Control and Prevention criteria.

CONCLUSIONS: 

Many veterans reported hearing chemical alarms sound during the Gulf War. The current findings suggest that exposure to substances that triggered those chemical alarms during the Gulf War likely had adverse neuroanatomical effects.
Published by Elsevier B.V.

KEYWORDS: 

Brain imaging; Cerebral volume; Chemical warfare agents; Gulf War veterans
PMID:
 
26920621
 
[PubMed - as supplied by publisher]