Another Breakthrough on Gulf War Syndrome: IOM Report Confirmed Two Decades of Gulf War Veterans’ Statements

By Camilla Louise Lyngsby, Columbia University SIPA

This summer marked the 20th Anniversary of the [buildup to the 1991] Gulf War, yet many veterans of that conflict continue to grow sicker.

[An April 2010] report released by the Institute of Medicine now provides additional scientific evidence to back up veterans’ claims that Gulf War illnesses exist, and are associated with their deployment.

Still, the soldiers who served the nation from 1990-1991 have not been getting the health care, treatment and disability benefits they needed and earned.

Just before the beginning of this semester, this reporter attended a congressional hearing on the issue.

Donald Overton, Executive Director for Veterans of Modern Warfare who served in the Gulf War, receives benefits for his blindness because it’s irrefutable, but not for his debilitating symptoms of Gulf War Syndrome.

“While some may view my injuries as devastating, particularly my blindness, I consistently contend I am one of the fortunate warriors that served during this conflict,” said Overton. “My conditions unlike those of so many of my battle buddies, could not be refuted by the Veterans Benefits Administration, thus affording me access to VA healthcare and benefits program.”

Of the 696,842 service members who served in the war, about 250,000 veterans suffer from the multi-symptom illness also, known as Gulf War Syndrome.

This is the same government that placed them in harm’s way that is now unwilling to fulfill its obligations to protect them. Many of the soldiers who served in the conflict were wounded in the line of duty and suffering from a range of physical disabilities including Chronic Fatigue Syndrome, Fibromyalgia which is the most common arthritis-related illness  and Irritable Bowel Syndrome. According to the Veterans of Modern Warfare, “We believe that these presumptions are appropriate and consistent with countless peer-reviewed scientific studies that have concluded that these conditions and symptom sets have high, unusual prevalence among veterans of the 1990 – 1991 Gulf War.”

Gulf War veterans are heading down that same path as the Vietnam War veterans exposed to the herbicide Agent Orange, and who were denied disability compensation benefits for decades.

Soon after the Gulf War, veterans started to contact the American Legion Service Officers complaining about health issues stemming from their service in the country or upon their return from Southwest Asia. “The symptoms were wide-ranging, but fatigue, joint pain, skin rashes, memory loss appeared to be met with a common diagnosis ─ “It is all in your head,” or “It is stress-related,” by both the Department of Defense and Department of Veterans Affairs (VA) health care professionals, said Ian de Planque, Deputy Director of Veterans Affairs and Rehabilitation Commission, American Legion.  We even learned of biases within the health care profession that found undiagnosed illness as simply a desire for disability compensation.”

It’s unclear how to treat Gulf War Syndrome, a cluster of symptoms that doesn’t fit into current medical concepts of disease. There is now scientific consensus that Gulf War illness is real. And being sick is a fundamental reality to the veterans suffering from the war illnesses.

In order to be effective, Dr. Stephen Hauser, the medical doctor and chairman of the most recent Institute of Medicine panel on Gulf War illness research suggested that, large scale research models are needed much like government-sponsored programs that are performed in the same manner as a national effort to eradicate polio or government research efforts to eliminate HIV/AIDS.

Chairman James Binns of the Research Advisory Committee on Gulf War Veterans’ Illnesses said it is essential “to employ the best in American science, run by people who go to bed at night and wake up in the morning thinking about this problem, [but] this country is not doing that.”

Congressional members routinely ask if the VA has adequate funding to carry out its obligations, and the VA’s response is always that it has sufficient funds. However, the Government Accountability Office (GAO) has accused the VA of underestimating funding needs.

Since 2009, Secretary of Veterans Affairs Eric K. Shinseki and his Gulf War  Veterans Illness Task Force was charged with reexamining the disability claims of thousands of veterans. But, some skeptics say that problems remain at the VA. Paul Sullivan of the advocacy group Veterans for Common Sense said, “If VA Secretary Shinseki won’t fix VA’s Research Office, then Congress must intervene and place Gulf War research outside of their area of responsibility.”

In November 2005, $75 million was appropriated for Gulf War illness research at the University of Texas Southwestern Medical Center. However In 2010, the VA cancelled the research program and is in the process of launching a new program. But apparently the VA staff is still funding research focused on “stress,” as shown in a VA most recent announcement of $2.8 million for research widely criticized by Gulf War veterans.

To this day, the trail remains cold. There have been many speculations and disagreements about the causes of the Gulf War Syndrome and the health issues faced by thousands of soldiers. Some causes considered include soldiers’ exposure to depleted uranium, chemical weapons, environmental hazards, anthrax vaccines given to deployed soldiers and infectious diseases. But many of these potential sources have been debunked. To date, research on the exposure to depleted uranium has not been launched.  [Editor’s Note:  substantial research has been conducted on DU, and found that inhaled and ingested DU are of substantial human health concern, including DNA and RNA changes that may result in long latency cancers.]

The Gulf War Syndrome and related diseases are not unique to the U.S. Many coalition soldiers reported illnesses upon their return home. In particularly German and British soldiers are suffering from Gulf War illnesses. They are waiting for the U.S. to spearhead an investigation and research into what has caused them to be sick upon return from the war zone and to why they are suffering from undiagnosed ailments and medically unexplained chronic illnesses. But the key difference is that Germany and the UK are providing medical treatment and disability benefits. Unlike the United States, these countries are taking care of their own.

The Veterans of Modern Warfare is urging Congress to enact legislation to remove all sunset provisions so health care and benefits last for the for the lifetime of every Gulf War veteran and every surviving beneficiary. Gulf War veterans have pointed to the complexity of accessing benefits and gaining permission to the Veterans Health Administration.

Chairman Charles Cragin, Advisory Committee on Gulf War Veterans said, “Consider for a moment that all of the fine men and women were considered in excellent health and ‘deployable’ when they went to war and shortly after their return home, the veterans began complaining of feeling ill and seeking help. These veterans were not engaged in a massive, national conspiracy to defraud the government. Rather they were sick. The ‘Process’ became a wall rather than a door.”

In 2009, the VA Task Force was responsible for conducting a comprehensive review of all VA programs and services that serve the Gulf War cohort of veterans. “Due to significant limitations in VA’s Gulf War Veterans Information System and the GWVIS reports generated from the various data sources used by the information system, 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,” said Chief of Staff John Gingrich, U.S. Department of Veterans Affairs.  That said, Gingrich continued, “This shortfall did not prevent the Task Force from identifying gaps in services as well as opportunities to better serve this veteran cohort.”

The Gulf War Veterans Information System was corrupted. To date, the issues with this data system have not been addressed, said Cragin during the hearing, “If you don’t have good data, you can’t make good decisions.”

Still, remarkably, the veterans don’t regret their service.

“The most revealing comment we have heard from the ill Gulf War veterans that we have talked to,” said Ian de Planque,  “was their answer to one simple question, “If you had it all to do over again and your unit was deployed to the Persian Gulf, would you go?”

The answer was unanimous ─ ‘Absolutely!’

These young men and women did not fail us ─ We as a nation have failed them.”

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Camilla Louise Lyngsby is a second year Master of International Affairs student and SIPA News Editor for Communiqué

VA Announces New Task Force to Address IOM Report Recommendations

Written by Anthony Hardie

(91outcomes.com) - VA has formed a task force to address an April 9, 2010 Institute of Medicine (IOM) report on Gulf War Veterans’ illnesses that found associations between deployment to the 1990 - 1991 Gulf War and specific health problems. .  The new VA task force is reviewing the Institute of Medicine Report on Gulf War and Health and will make recommendations for VA action to VA Secretary Eric Shinseki.

The Persian Gulf War Veterans Act of 1998, enacted through the work of Gulf War veteran activists, directs VA to contract with IOM for the study of exposures and ailments potentially linked to service in 1991 Gulf War. 

VA’s review of IOM reports of new associations with wartime service generally result in expanded presumptions for service connected disability benefits and can result in new focuses in VA health care. 

In 2008, IOM began to review, evaluate, and summarize the literature on health outcomes noted in its 2006 report that seemed to appear at higher occurrence in Gulf War-deployed Veterans than non-deployed Gulf War Veterans. Also, IOM reviewed studies on cause-specific mortality in Gulf War Veterans and examined the literature to identify any emerging health outcomes.

In the April 2010 report, IOM found the following associations between deployment to the 1991 Gulf War and specific health outcomes:

• Sufficient evidence of a causal relationship: PTSD, as might be expected from any combat experiences.  Rates of PTSD are much lower for veterans of the 1991 Gulf War than for other wars, and IOM found the percentage of Gulf War veterans with PTSD to be far lower than that with chronic multisymptom illness.
• Sufficient evidence of an association:
• Chronic Multisymptom illness (CMI).  IOM noted that this affects 250,000 veterans of the 1991 Gulf War and could not be attributed to any known psychiatric condition.  CMI is more popularly known as Gulf War Illness (GWI) or Gulf War Syndrome. 
• Gastrointestinal symptoms consistent with functional gastrointestinal disorders such as irritable bowel disease (IBS)
• Anxiety disorders and other psychiatric disorders. These disorders persist for at least 10 years.   It is well established that depression and anxiety are common in people with chronic illness.  A recent 91outcomes.com article showed that depression is often diagnosed before diagnosis of the real underlying disease.
• Substance abuse, particularly alcohol abuse.
• Limited/suggestive evidence of an association:
• Fibromyalgia and chronic widespread pain
• Amyotrophic lateral sclerosis (ALS).  ALS has been termed by involved scientists as a true “outbreak”, which peaked in 1995.  Scientists are monitoring whether there may be other future peaks.
• Sexual difficulties
• Death due to causes such as car accidents in the early years after deployment

Of the conditions found by IOM to be associated with 1991 Gulf War service, currently only fibromyalgia (FM) and irritable bowel syndrome (IBS) are presumptive for service-connected disability claims for veterans of the 1991 Gulf War.  While claims for chronic multi-symptom illness, called “undiagnosed or ill-defined illness” by VA, are also presumptive, VA has come under severe criticism for its high claims denial rates in this area. 

Another task force, chaired by VA Chief of Staff John Gingrich, is currently reviewing this and other related matters.

The report calls for a substantial commitment to improve identification and treatment of multisymptom illness in Gulf War veterans.

According to IOM, the path forward should include continued monitoring of Gulf War veterans and development of better medical care for those with persistent, unexplained symptoms.  IOM said that researchers should undertake studies comparing genetic variations and other differences in veterans experiencing multisymptom illness and asymptomatic veterans. 

According to IOM, it is likely that multisymptom illness results from the interactions between environmental exposures and genes, and genetics may predispose some individuals to illness, the committee noted.  IOM noted that there are sufficient numbers of veterans to conduct meaningful comparisons given that nearly 700,000 U.S. personnel were deployed to the region and more than 250,000 of them suffer from persistant, unexplained symptoms. 

IOM stated that a consortium involving the U.S. Department of Veterans Affairs, U.S. Department of Defense, and National Institutes of Health could coordinate this effort and contribute the necessary resources.

From the IOM:  About Us

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.

Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

The Institute of Medicine serves as adviser to the nation to improve health.

The IOM asks and answers the nation’s most pressing questions about health and health care. Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely. Each year, more than 2,000 individuals, members, and nonmembers volunteer their time, knowledge, and expertise to advance the nation’s health through the work of the IOM.

Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations. While our expert, consensus committees are vital to our advisory role, the IOM also convenes a series of forums, roundtables, and standing committees, as well as other activities, to facilitate discussion, discovery, and critical, cross-disciplinary thinking.

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The U.S. Department of Veterans Affairs and the Institute of Medicine contributed to this story.

DoD, Michael Kilpatrick, spin IOM’s report into focus primarily on psychiatric issues

Written by Anthony Hardie

(91outcomes.com) – In a new article by the U.S. Department of Defense, the latest findings by the Institute of Medicine (IOM) related to Gulf War veterans’ illnesses are twisted or outright ignored, focusing on psychiatric conditions including at least one not even named in the IOM press release while nearly ignoring the very real physical health issues that IOM noted affect more than one-third of Gulf War veterans.

“The excess of unexplained medical symptoms reported by deployed Gulf War veterans cannot be reliably ascribed to any known psychiatric disorder,” said the Institute of Medicine in its comprehensive scientific review last month, which also said that 250,000 veterans of the 1991 Gulf War suffer from chronic multisymptom illness.  This debilitating health condition affecting one third of Gulf War veterans is more commonly called Gulf War Illness or Gulf War Syndrome.

However, the DoD article misses many of the health conditions linked by IOM to Gulf War service, and reorders those it does list to put the psychiatric conditions first. 

For many years, Gulf War veterans have complained about federal government spin that left them without needed health care for the underlying conditions causing their chronic, multiple symptoms. 

This latest DoD release is likely to be met with anger by Gulf War veterans.

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The IOM report press release and link to the full report is located at:  http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12835

Comments can be posted to the DoD article, located at:  http://www.health.mil/blog/10-05-20/Institute_of_Medicine_Releases_Gulf_War_Illness_Report.aspx

The comments feature on the DoD webpage is monitored.  Two comments left earlier today have yet to show on the DoD website, one of which was as follows:

Shame on you, DoD, for twisting IOM's release into yet one more story that focuses on psychiatric issues (PTSD affects roughly 10-11%) when the real story about more than 250,000 Gulf War veterans is elsewhere.

IOM's own release listed the causal condition first, as they always do. Of course war causes PTSD in some veterans; that's hardly news.

IOM's release then went on with the following: "and is also associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; substance abuse, particularly alcoholism; and psychiatric problems such as anxiety disorder."

Finally, IOM stated the conditions for which there is some evidence of links to the Gulf War: "There is some evidence that service during the conflict is linked to fibromyalgia and chronic widespread pain, amyotrophic lateral sclerosis, sexual difficulties, and death due to causes such as car accidents in the early years after deployment."

In this press release, those of you responsible at DoD were utterly irresponsible, including reversing the order of the conditions listed by IOM by their order of strength, and omitting quite of few of them entirely.

Scientists briefing the VA believe they have found causes, and believe that effective treatments can be developed that might improve the health and lives of ill Gulf War veterans. THAT brings real hope to Gulf War veterans; this DoD press release is just more spin by the same people like Michael Kilpatrick, who have been denying Gulf War veterans even THAT piece of mind for far too long.

Kilpatrick seems to have missed the IOM's own release, which said, in part:

"The report calls for a substantial commitment to improve identification and treatment of multisymptom illness in Gulf War veterans. The path forward should include continued monitoring of Gulf War veterans and development of better medical care for those with persistent, unexplained symptoms. Researchers should undertake studies comparing genetic variations and other differences in veterans experiencing multisymptom illness and asymptomatic veterans. It is likely that multisymptom illness results from the interactions between environmental exposures and genes, and genetics may predispose some individuals to illness, the committee noted. There are sufficient numbers of veterans to conduct meaningful comparisons given that nearly 700,000 U.S. personnel were deployed to the region and more than 250,000 of them suffer from persistant, unexplained symptoms. A consortium involving the U.S. Department of Veterans Affairs, U.S. Department of Defense, and National Institutes of Health could coordinate this effort and contribute the necessary resources."

"The committee concluded that multisymptom illness is linked to Gulf War service, based on the availability of a number of good-quality surveys documenting increased reporting and occurrence of multiple, unexplained symptoms among veterans from several countries that sent troops, including the United Kingdom and Australia. "

"Veterans who continue to suffer from these symptoms deserve the very best that modern science and medicine can offer to speed the development of effective treatments, cures, and -- we hope -- prevention. Our report suggests a path forward to accomplish this goal, and we believe that through a concerted national effort and rigorous scientific input, answers can be found.""

How much longer do veterans have to wait before people like Kilpatrick -- who has long been focused on "stress" as a cause of hundreds of thousands of Gulf War veterans' illness -- are finally removed by the new Administration?

And, it’s pretty disingenuous to lay out all those big numbers of studies and their cost without breaking them down. For example: How many of those studies have been focused on stress and psychiatric issues as what's wrong with Gulf War veterans?100? 200? 300? More? Yet, despite the constant, heavy focus on stress and psychiatric causes by DoD of the past and, apparently, the present, the results are clear in the IOM report’s words, which you at DoD chose to omit: “The excess of unexplained medical symptoms reported by deployed Gulf War veterans cannot be reliably ascribed to any known psychiatric disorder.”

And, how many of that large number of expensive studies have been focused on PB pills and pesticides? Not many, right? How about on reversing the damage? None, right?

How many studies have surveyed veterans of the Gulf War to ask them specifically which chemical warfare agents they believe they were exposed to, and the basis of that belief? None, right?

How about ALS studies that have led to effective new treatments? Sadly, more than 70 years after Lou Gehrig died of the disease, there ‘s only one, and it only prolongs life with ALS by a handful of months.

Of those studies, Mr. Kilpatrick, exactly how many have focused on inhaled or ingested Depleted Uranium dust? Any?

VA's new leadership is taking Gulf War Illness issues in the right direction, and are a shining light and a beacon of hope. Despite the fact that it's now nearly 20 years since the Gulf War, better late than never. And now, it's high time for DoD to get it right, too.

Come on, DoD -- there's real work to do. Our disabled Gulf War veterans deserve no less, and future generations of troops will depend on us finding effective treatments -- and prevention -- TODAY.

NEWS FROM…

CHAIRMAN BOB FILNER

HOUSE COMMITTEE ON VETERANS’ AFFAIRS

VA Unresponsive to Questions, Needs of Gulf War Veterans

Washington, D.C. – On Tuesday, May 19, 2009, the House Veterans’ Affairs Oversight and Investigations Subcommittee, led by Chairman Harry Mitchell (D-AZ), conducted the first of a series of hearings on Gulf War Illness research. The hearing provided a review of the history of the research that has been conducted on Gulf War Illness, examined the methodology used by the Department of Veterans Affairs (VA) to determine possible exposure to toxins and pesticides, and focused on the ongoing challenges veterans face as a result of their service in Operations Desert Shield and Desert Storm.

“It has been almost 19 years since the United States deployed some 700,000 service members to the Gulf in support of Operations Desert Shield and Desert Storm,” said Chairman Mitchell. “When these troops returned home, some reported symptoms that were believed to be related to their service. Still today, these same veterans are looking for answers about proper medical treatment and the benefits that they bravely earned. While we hear about numerous studies and millions of dollars spent on Gulf War Illness research, many questions remain unanswered. Today, we will attempt to establish an understanding of the research that has been conducted – and the actions that have been taken – in relation to Gulf War Illness.”

According to Congressional testimony, VA had concerns that returning veterans might have certain unique health problems including respiratory effects from exposure to the intense oil fire smoke even before the 1991 Gulf War cease-fire. During the summer of 1993, U.S. troops’ exposure to chemical warfare (CW) agents first became an issue. The Department of Defense (DoD) and the Central Intelligence Agency (CIA) concluded that no troops had been exposed for two reasons: there were no forward-deployed CW agent munitions, and plumes of CW agents released from the bombing that destroyed the chemical facilities could not have reached the troops. This conclusion was maintained until June 1996, when DoD publicly acknowledged that U.S. troops had destroyed stockpiles of chemical munitions at Khamisiyah after the war.

In 1998, Congress passed legislation, the Persian Gulf War Veterans Act of 1998 and the Veterans Programs Enhancement Act of 1998, which directed the VA Secretary to seek to enter into an agreement with the National Academy of Sciences (NAS) to review and evaluate the available scientific evidence regarding associations between illnesses and exposure to toxic agents, environmental or wartime hazards, or preventive medicines or vaccines to which service members may have been exposed during service in the Persian Gulf during the Persian Gulf War. Congress directed the NAS to identify agents, hazards, medicines, and vaccines to which service members may have been exposed during the Persian Gulf War.

Between January 1, 2000 and September 12, 2006, NAS issued four reports on health effects of various toxins, chemical warfare agents, and insecticides. Each report concluded that the available evidence did not warrant a presumption of service connection for any disease discussed in the report. The fifth report, released October 16, 2006, reviewed published, peer-reviewed scientific and medical literature on long-term health effects from infectious diseases associated with Southwest Asia. VA is currently drafting a proposed rule to establish presumptive service connection for nine infectious diseases discussed in the report and providing guidance regarding long-term health effects associated with those diseases. It was determined, however, that the scientific evidence in the report does not warrant a presumption of service connection for any illnesses caused by these diseases or agents.

Veterans raised a number of concerns at the hearing, mostly based on lack of information, outreach, and resources available from the VA. Veterans reported frustration that there is no formal Gulf War I Registry, no service-connected benefits for maladies, inadequate research to determine the cause of illness, no formal recognition by the VA of Gulf War Illness, and a lack of epidemiological tools in use to further track effects of Operation Desert Storm and Operation Desert Shield.

Recommendations from witnesses included increasing the VA research budget, formal recognition by DoD and VA of Gulf War Illness, access to disability benefits, and an end to the perceived secrecy that surrounds research findings, treatments, and new information. Also discussed was the immediate need to implement an electronic medical health record that fully incorporates the veteran’s military record. Rick Weidman of Vietnam Veterans of America testified,

“VA needs to move quickly to modify the Computerized Patient Records System (CPRS) or VISTA, to incorporate a military history that will include branch of service, periods of service, places assigned and when, military occupational specialties, and notes on what happened to the individual that may be of note. This also needs to be searchable on a nationwide basis, so that if an individual has an unusual medical condition, then the physician can search and find out if others who served in their unit at the same time have the same or similar conditions. This would be an invaluable epidemiologic tool that could/would point VA in the direction of where there needs to be research that is directed where there are obviously problems. You may ask why they never did this before? Well, we have come to the inescapable conclusion that they never did it because they did not want the information. As the cost to make this change to the CPRS is really minimal, we can come up with no other explanation that makes any sense whatsoever.”

“If Gulf War veterans have been harmed by their service to their country, we must ensure they are taken care of through presumptive service connection for that illness,” said Bob Filner (D-CA), Chairman of the House Committee on Veterans’ Affairs. “I support President Obama’s call to develop joint electronic medical records that contain military records. Not only is this information sharing between the DoD and VA imperative to more accurately treat maladies and service connected injuries, it will allow the VA to refocus its efforts and direct care to its wounded warriors. It is time for the VA to compassionately and immediately serve its clients.”

Subsequent hearings on this issue will take a multi-level view of the methodology and conclusions of Gulf War Illness research, how the review of information was compiled, and why certain methods were employed.

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Mustard Gas and Lewisite - Symptoms of WWII "Volunteers" Used in Experiments Similar to Many Gulf War Veterans'

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) -- The Institute of Medicine (IOM), part of the National Academies of Science, published an extensive series of medical reviews on deployment health of our veterans of the U.S. Armed Forces.

Among those is one from IOM's series on WWII veterans, published shortly after the 1991 Gulf War, entitled, "The Health Effects of Mustard Gas and Lewisite: Veterans at Risk," (1993).

For many Americans, this would seem like the stuff of science fiction.

However, it's not necessarily so for veterans of the 1991 Gulf War and other veterans affected by chemical warfare agent exposures followed by decades of official denial.

For the 60,000 "human subjects in this chemical defense research program," (IOM, 1993) one can only imagine how it must have felt for these once-young veterans to have suffered a lifetime of serious health effects, including those from the following list demonstrated as being caused by Lewisite and Lewisite-Mustard exposures -- and probably many more:

• Respiratory cancers (nasopharyngeal, laryngeal, lung)
• Skin cancer
• Pigmentation abnormalities of the skin
• Chronic skin ulceration and scar formation
• Leukemia (typically acute nonlymphocytic type, nitrogen mustard)
• Chronic respiratory diseases (also Lewisite) (asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease COPD), chronic laryngitis)
• Recurrent corneal ulcerative disease
• Delayed recurrent keratitis of the eye
• Chronic conjunctivitis
• Bone marrow depression and (resulting) immunosuppression
• Psychological disorders (mood disorders, anxiety disorders (including traumatic stress disorder), other traumatic stress disorder responses (These may result from traumatic or stressful features of the exposure experience, not a toxic effect of the agents)
• Sexual dysfunction (scrotal or penile scarring may prevent or inhibit normal sexual activity)

According to the IOM summary:


World War II (WWII) has been called “the unfought chemical war.” Both sides had produced millions of tons of chemical weapons and had made massive preparations for their use, yet the weapons were never used. These preparations included the establishment of secret research programs to develop better weapons and better methods of protecting against those weapons.

In the United States, some of this research was focused on the development of protective clothing and skin ointments, which could prevent or lesson the
severe blistering effects of mustard agents (sulfur and nitrogen mustard) and
Lewisite (an arsenic-containing agent).

By the time the war ended, over 60,0000 U.S. servicemen had been used as human subjects in this chemical defense research program, in a wide range of exposures from mild to quite severe.

All those undergoing the latter exposure. and some undergoing the former were told at the time that they should never reveal the nature of the experiments. Almost to a man, they kept this secret for the next 40 years.

Public attention was drawn to these experiments when some of the WWII human subjects began to seek compensation from the Department of Veterans Affairs (VA) for health problems that they believed were caused by their exposures to mustard agents or Lewisite.

Resolution of these cases was complicated by a lack of records documenting individual participation in the experiments, and uncertainty as to which health problems were in fact the result of these exposures.

In June 1991 [just over three months after the end of the 1991 Persian Gulf War] the VA announced guidelines for the handling of these cases, including the loosening of normal requirements for documenting individual participation in the experiments, and the identification of seven diseases to be considered as caused by mustard agents or Lewisite.

In addition, the VA requested that the Institute of Medicine (IOM) convene a committee to assess the strength of association between exposure to these agents and the development of specific diseases. The committee was also charged with identifying the gaps in the literature, and making recommendations as to closing them.

IOM made the following general conclusions:

• The lack of follow-up health assessments of the human subjects in the WWII gas chamber and field tests severely diminished the amount and quality of information that could be applied in the assessment of long-term health consequences of exposure to mustard agents and Lewisite.
• The levels of exposure to mustard agents and Lewisite may have been much higher than inferred in the summaries of the gas chamber and field tests.
• There were no epidemiologic studies done of mustard-agent exposed U.S. chemical weapons productions workers, war gas handlers and trainers, or combat casualties from WWII.

The lack of follow-up of exposed WWII veteran "volunteers," the identified possibility that levels of exposure may have been higher, and the lack of epidemiological studies on those exposed are troubling. Yet, decades later, responsible federal officials at DOD and VA failed in these same areas with veterans of the 1991 Gulf War.

The timing of the 1993 publication of this material is of note -- nearly 50 years after the fact, but just two years after the Gulf War, the veterans of which had already begun to complain of mysterious symptoms.

Mass exposures of Gulf War troops to sarin and cyclosarin have already been proven with the Khamisiyah incident in which a bunker complex filled with chemical munitions was detonated, resulting in a chemical plume that drifted over a wide swath of troop areas for at least three days. Lesser known is the fact that mustard blister agent was also present at Khamisiyah, the Iraqi munitions storage facility where U.S. Gulf War troops' demolitions at the end of the war included munitions containing sarin nerve agent.

Given that the Iraqi military had forward deployed mustard to Khamisiyah, and given the history of Iraq's offensive use of mustard, lewisite, and mustard-lewisite mixtures during the Iran-Iraq war, it should be assumed that Gulf War troops were exposed to mustard and/or lewisite vapors -- which would certainly explain many Gulf War veterans' commonly reported symptoms.

In fact, DOD admitted to "one" mustard gas exposures in a 1997 press release, entitled, "Mustard Gas Exposure Likely, report finds." And IOM noted that Gulf War veterans who were Khamisiyah "witnesses" were highly likely to report that they recalled several symptoms of mustard agent exposure, including coarse voice, rash, and blisters.

Meanwhile, IOM noted the Presidential Advisory Commission's 1996 finding that:

Two other storage sites in central Iraq, Muhammadiyat and Al Muthanna, sustained damage from air attacks during the Gulf War. Munitions containing 2.9 metric tons of sarin–cyclosarin and 1.5 metric tons of mustard gas were damaged at Muhammadiyat, and munitions containing 16.8 metric tons of sarin–cyclosarin were damaged at Al Muthanna (PAC 1996a).

It is time for Congress to conclude that Gulf War troops were exposed to not only sarin and cyclosarin, DU, and the full range of pesticides and PB pills, but also mustard and lewisite blister agents -- and to provide presumptive service-connection to ensure VA healthcare for the range of known health outcomes from these exposures.