Gulf War Illness 25 Years Later

It’s been a quarter of a century since troops served in the 1991 Persian Gulf War. Today, VA estimates as many as 210,000 suffer from an undiagnosed constellation of diseases that vary in name. But researchers continue to work to find answers. Here is an update.

The United States deployed almost 700,000 troops to Southwest Asia after Iraq invaded Kuwait in 1990. When veterans returned home, a significant number began reporting a variety of medical symptoms. What would eventually become known as Gulf War Illness, or more commonly, syndrome, affects as many as 30% of Persian Gulf War veterans.

Twenty-five years later, symptoms include a multitude of unexplained, chronic conditions such as fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders and memory problems.

An independent scientific committee tasked by VA with producing a single definition of these combined maladies was unable to do so. The panel suggested that VA officially refer to them as Gulf War Illness instead of “chronic multisymptom illness.” Nonetheless, VA officially retains this cumbersome label.

Theories as to what may have caused these illnesses range from vaccinations, oil well fires, pesticides, chemical or biological weapons to environmental exposure. To date, VA recognizes four categories of conditions potentially eligible for compensation.

• Chronic Fatigue Syndrome—“a condition of long-term and severe fatigue that is not relieved by rest and is not directly caused by other conditions,” according to VA.

• Fibromyalgia—widespread muscle pain. Other symptoms may include insomnia, morning stiffness, headaches and memory loss.

• Functional gastrointestinal disorders—a group of conditions marked by chronic or recurrent symptoms related to any part of the gastrointestinal tract. Examples include irritable bowel syndrome (IBS), functional dyspepsia (indigestion) and functional abdominal pain syndrome.

• Undiagnosed illnesses—symptoms may include but are not limited to: abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headaches, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders and sleep disturbances.

VA presumes that certain chronic, unexplained symptoms existing for six months or more are related to Gulf War service without regard to cause. According to VA, the illnesses must have been evident during active duty in the Southwest Asia theater of operations or by Dec. 31, 2016, and be at least 10% disabling to qualify for compensation.

To assess your risks, it is important to register with VA. The Gulf War Registry and Airborne Hazards & Open Burn Pit Registry c an h elp y ou d o so. Furthermore, subscribing to the Gulf War Review will keep you updated on the latest developments. See the resources at the end of this article. Dependents and survivors also may be eligible for benefits.

Research funding has varied through the years. VA funding for FY2014 was $9.7 million, up 22% from the year before but down 25% from its peak of $13 million in 2006. A combined total of $504 million in federal funds were devoted to Gulf War health research between 1994 and 2014, including $150 million for VA alone, according to the VA Gulf War Research Strategic Plan. VA’s Office of Public Health (OPH) focuses on epidemiology and surveillance while the Office of Research and Development (ORD) concentrates on hypothesis-driven studies. The goal is to improve diagnosis and treatment for Persian Gulf veterans.

To that end, here are some studies designed to come up with answers. They were mostly directed by the 2012 strategic plan for Gulf War research.

• Glutamine pathway bowel disease— researchers at Ohio State University and the Cincinnati VA Medical Center discovered a part of ribonucleic acid (RNA) that blocks a gene that makes glutamine. Glutamine is an amino acid that keeps the colon healthy. And while it’s already found in many digestive supplements, this research could lead to increased glutamine production in the body. This could greatly benefit Persian Gulf veterans diagnosed with irritable bowel syndrome.

• Multiple sclerosis—“A VA team compared the clinical and military histories of nearly 700,000 deployed and 1.8 million non-deployed personnel from the Gulf War era to look for trends in multiple sclerosis and other diseases that cause deterioration of the myelin sheath that insulates nerves and allows them to function,” according to VA. “The study found no correlation between Gulf War deployment and multiple sclerosis risk.”

• Biomarkers—Minneapolis VA researchers are working on ways to better diagnose and define illnesses associated with Gulf service. Attempting to distinguish it from other conditions that could share similar symptoms, they identified abnormalities in a protein found in Gulf vets’ blood that starts the coagulation process. Also found were elevated platelets and C-reactive protein in chronically ill Gulf vets.

• Brain cells—in North Carolina at the Durham VA Medical Center and Duke University researchers used rats in a 2013 study and found exposure to chemicals such as pyridostigmine bromide (an anti-nerve agent pill), permethrin and DEET (commonly used to repel insects) caused mood swings and memory loss.

Adding stress on the animals worsened the problems, and researchers were able to identify changes in the brain that appeared to be responsible for the functional decline and loss of specific neurons.

Researchers further determined that treatment focused on brain cell regeneration and inflammation reduction may help Persian Gulf War veterans.

• Sleep—in New York, at the Northport VA, researchers found that 96% of Persian Gulf War veterans with Gulf War Illness who participated in the study experienced breathing problems while they slept. Only 36% of veterans without the condition had breathing problems while they slept.

Researchers discovered that continuous positive airway pressure therapy (CPAP) helped with breathing and sleep problems. It lessened pain and fatigue, and improved thinking, sleep quality and general health.

• Effects of depleted uranium—VA researchers found no significant evidence of clinically important changes to veterans’ bones and kidneys in a 2011 study by the Baltimore VA Medical Center and the University of Maryland.

Studying 35 veterans who had been exposed to depleted uranium (found in armor-piercing rounds, typically in anti-tank weapons), researchers found that, while they had higher-than-normal levels of uranium in their urine, there were no clinical abnormalities.

• Brain changes—San Francisco VA researchers used MRI tests to confirm reports of brain differences in veterans with suspected exposure to low levels of sarin and cyclosarin (nerve agents) compared to those who were not exposed. A follow-up study in 2014, found differences in the area of the brain crucial for learning and memory.

• Mitochondria—VA and Rutgers University researchers found that veterans with Gulf War Illness have damaged mitochondria, the part of the cell where respiration and energy production occur.

“The more we know about the type of (damage) and the more we can characterize the mitochondrial damage in these veterans, the better we can treat them,” said Michael Falvo, the study’s senior researcher and a faculty member of the VA War Related Illness and Injury Study Center in Orange, N.J., in a September Stars and Stripes interview.

“The symptoms are so diverse and vary so much person to person that that’s been a challenging piece.” Falvo added that “while the study could help find better treatment, it was unlikely to uncover the root cause.”

• Cancer—A July 2014 Institute of Medicine—now the National Academy of Medicine (NAM)—study found insufficient evidence exists to link brain cancer, lung cancer and migraine headaches to service in the 1991 Persian Gulf War.

“[NAM] stated that there ‘is no consistent evidence of a higher overall incidence of cancer in veterans who were deployed to the Gulf War than in non-deployed veterans,’” wrote Robert Jesse, VA’s former acting undersecretary for health, to Rep. Timothy Walz (D-Minn.). Walz had pushed VA to qualify these as presumptive conditions for compensation.

Although the rate of brain cancer deaths was twice as high for those veterans exposed to sarin gas compared to those who weren’t, VA said the number of deaths was too low to be conclusive.

Likewise, lung cancer death rates were 15% higher for Gulf vets who deployed versus those who did not. But that statistic was deemed “inconclusive” because IOM could not determine how many of the troops smoked.

“It is cruel that science and medicine takes too long to conduct the research and accumulate the evidence necessary to make these determinations [for benefits],” said Carlos Fuentes, VFW’s senior legislative associate. “That is why VFW has continued to push Congress to fully fund the [Department of Defense] Gulf War Illnesses Research Program, which funds important peer-reviewed research on Gulf War Illness.”

A VFW resolution related to Gulf War vets was approved at the 116th National Convention in Pittsburgh last July.

Toxic Exposures (Res. 619) urges Congress to invest adequate resources to study, diagnose and treat conditions and illnesses associated with toxic exposures. It calls for Congress to ensure VA extends presumptive service connection to veterans suffering from any conditions or illnesses found to be associated with exposure to toxic substances in the line of duty.

“The NAM is currently conducting a long overdue systemic review of the body of medical research regarding the health effects associated with Gulf War service,” Fuentes said. “This project will be completed sometime in 2016 and has the potential of determining whether additional presumptive conditions are needed for Gulf War veterans.

“VFW will continue to monitor this project and will work to ensure the NAM committee charged with carrying out this task remains impartial and focused on evaluating the evidence objectively.”

• Number of veterans who served in the Southwest Asia Theater of Operations from Aug. 2, 1990 through July 31, 1991: 696,842

• Number denied for GWI but service-connected for diagnosed conditions: 46,248

• Total amount spent on research studies: $504 million in federal funds between 1994 and 2014, including $150 million by VA.

• Gulflink—Office of the Assistant for Gulf War Illness: www.gulflink.osd.mil/