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Gulf War and Health: Volume 2. Insecticides and Solvents |
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Gulf War Advisory Committee Meeting, Feb. 2009
N. Gale Reid, USAF, Ret (E-5)
Gulf War Advisory Members and Veterans:
My name is N. Gale Reid, Air Force, Retired, E-5. I am a veteran of the Gulf War in 1991. I worked as an aerovac medic assigned to a 2E (Second Echelon) Mobile Aeromedical Staging Facility (MASF) with AFRES, 37AEG, Mac Dill AFB (Tampa, FL) near Al Jubayl, Saudi Arabia during the Gulf War. Our mission was to transport and triage casualties for care to either the nearest surgical facility (Fleet Hospital 5) or back to facilities behind lines, to Europe, or to the US. I arrived in Riyadh, Saudi Arabia in January 1991 sick from adverse side effects after taking the anti-malarial tablets and was hospitalized for 3 days.
I spent nearly 13 years in the military in the Reserve and Guard forces, while simultaneously working Federal Civil Service. I was activated to the Gulf War in 1991. I was in prime condition (health wise) before my deployment, but soon spiraled downward upon my return. My declining health from exposures in the Gulf War caused me to lose my jobs and my marriage. I was working at a VA facility in my civilian job before my health gave out completely in 1994, after collapsing on the PT field during an annual run with my Reserve unit in Alaska. I had never failed a PT course nor was ever "out-of-regulation" during my entire career up till that time.
While employed as a civilian at the VA in Alaska, I encountered blatant ridicule and an attempted reprimand from my own supervisor for taking sick leave while trying to obtain physical and mental evaluations for my exposures and conditions. Fortunately for me, there were some good folks working there in positions of authority who helped me, but I can tell you first-hand there are some very ignorant and uncaring people working there as well. I'm afraid many (if not, most) of my fellow veterans are still encountering the same bad treatment and inadequate evaluations I did just over fifteen years ago in other VAs throughout the nation.
Some can give thanks that there weren't many casualties during the war, but that depends on who you talk to and where they were. Sadly, DoD and the media portrayed it as a small, insignificant war with tolerable losses. It took years for DoD to even admit we were exposed to anything after the bombing of Khamisiyah. Then when it did, they, the CIA, and the Institute of Medicine (IOM) played down the effects of environmental toxins and bad vaccines on our soldiers before even researching all the resources available to them (i.e. private research).
The IOM still holds closed-door meetings, accounting to no one what reports they use for their findings used in advising the VA on how to examine and treat veterans who have been exposed to environmental toxins and bad lots of vaccines (mainly anthrax). They have chosen to ignore the 2001 FDA report on the deplorable conditions founds at the anthrax producing company, Michigan Department of Public Health/Bioport, now known as Emergent Solutions, in which Bioport lost its license:
http://www.fda.gov/ohrms/dockets/dailys/04/mar04/031904/80n-0208-ref0001-16-Tab-09-01-vol126.pdf
“A proper recategorization of anthrax vaccine adsorbed as Category XI, and the revocation of BioPort’s license in accordance with 21 C.F.R. 6 130.12 and the Food, Drug and Cosmetics Act is the decisive regulatory action that will ‘protect the public health.”
I also find it utterly repulsive that the IOM makes blind decisions regarding the healthcare of Gulf War Veterans based on incomplete and sanitized information from DoD, then sells their findings online as well:
http://books.nap.edu/catalog/10628.html
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Gulf War and Health: Volume 2. Insecticides and Solvents |
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I represent just one of thousands of sick Gulf War Veterans who have been forced into physical and financial hardship just trying to prove my conditions were caused by the exposures from the war. I've watched how the VA criteria for service-connection has slowly changed over the years as more conditions have been added and recognized as a result of toxic exposures. Only in recent years has Multiple Sclerosis and ALS been recognized as a service-connected condition, in light of doctors' inability to "rule it out". Normally, a doctor is required to "rule out" conditions that may be affecting a patient, however, the IOM initially ruled out MS and other conditions such as Parkinson's Disease, brain cancer, and heart disease for service-connection in Gulf War Veterans without even considering the research available in the private peer-reviews because DoD has dictated to them and the medical community how to do their own business. We now need to focus on our Parkinson’s Disease Gulf War Veterans: (http://www.gulfwarvets.com/ubb/ultimatebb.php?ubb=get_topic;f=12;t=000033).
Gulf War Veterans have followed the research and reports of exposures and their effects on troops long before the IOM was asked to do "peer reviews" for these conditions in 1998. Initial reports from the CIA of exposures were questionable at best when the CIA reported they obtained their information from "foreign sources and DoD" in the 1995 Shays Congressional Hearings. As Christopher Shays told the agent from the CIA, 'it was the most unintelligent intelligence report he had ever seen'. Unfortunately, the information in those initial reports were (and still are being) used in recent research because there was no one challenging their data and sources at the time. Information on air particulate matter wasn’t even gathered until FIVE MONTHS AFTER the soldiers were exposed to the smoke from the oil well fires. Because there was no data available for research during the war, the DoD, CIA, and IOM chose to use the data obtained 5 months after the war to report their findings. OF COURSE the air is going to be far less toxic 5 months later! Since then, the information on those reports regarding the effects of the fires have changed on numerous occasions, with different plots of how the plumes of smoke blanketed the area and the number of troops exposed. (Example: http://www.iom.edu/file.asp?id=8896 and http://www.iom.edu/file.asp?id=8893 )
The IOM even admits to having "scant information" on the effects of these exposures on Gulf War Veterans (see below), however the Gulf War and Health Staff refused to look at the 2004 RAC Report which documents the critical information on exposures needed to consider the effects on the soldiers who were exposed:
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11180
(Excerpt)
"Because scant information exists on actual exposure levels experienced by individual service members -- a critical factor when assessing health effects -- the committee could not draw specific conclusions about Gulf War veterans' chances of developing lung cancer or any other health problems as a result of exposures. No systematic monitoring of air contamination from oil-well fires was conducted in the Persian Gulf region until May 1991, and this monitoring did not measure levels of contamination produced by other combustion sources, such as heaters or engines. Moreover, no data are available that would allow comparisons between levels of exposure to air contaminants during the Gulf War and exposures to similar contaminants in civilian occupational and environmental settings."
It appears to me the IOM will do only what they are "tasked" to do-- no more, no less; and they make no promises as to whether they will do anything else:
"While the committee might have that information as background it is not part of the committee's task."
And
"The committee might recommend approaches for studies that will provide answers about the health of current Gulf War veterans, as well as for those involved in future deployments."
Someone needs to review their "statement of task" to include something more definitive and productive in its objectives and goals! How about using the information it has from the RAC and Gulf War Advisory Committee in achieving a more complete review/study of "deployment-related illnesses among Gulf War veterans that might not be fully appreciated"?
None of these people at IOM have never had to personally navigate the treatment and claims maze, so they have no appreciation of what the impact is on the veterans it serves when facts are ignored, resulting in incomplete and inaccurate evaluations. Perhaps, if they had to be exposed to the toxic environments we were, then to return to a government and medical community for treatment that denied they were exposed to anything, and then merely pointed them in the direction of MHC (Mental Health Clinic), instead of examining them for neurological effects... They MIGHT be more inclined to study the facts a little deeper!
Meanwhile, sick veterans continue to seek help in their care and claims at VAs where healthcare providers know little-to-nothing in how to refer the veteran for thorough examinations of their symptoms and conditions (because of a lack of reviews and reports from IOM) as a result of their exposures, or document their records accurately for smooth claims process. When VA healthcare providers have little guidance in examining and treating Gulf War Veterans, they cannot document records adequately and the veteran has nothing in his/her records to submit for favorable claims awards. When medical records are void of documentation, the veteran is met with certain denial of adequate care and benefits.
Healthcare providers can help veterans only if and when they have been given complete information from those who advise the VA (the IOM). This information must contain ALL data that could lead to a better understanding of the effects of multiple exposures to a toxic environment. If the IOM concedes that it has insufficient information report on its findings of the Gulf War exposures, it can only be seen as irresponsible if the IOM does not ask for and seek more information in its peer reviews. The RAC has handed them the critical information needed in making a more comprehensive and complete review of more recent and accurate information on those exposures in 2004 and the IOM has chosen to ignore this without even considering the consequences of their actions on the veterans depending on their findings.
Monetary benefits are only half of the concern when it comes to advising the VA with peer reviews that are current, complete, and accurate. More often than not, veterans are evaluated as having PTSD, depression, or other mental disorders when neurological effects of toxic exposures are ignored. This can only be summed up as “malpractice” when more diagnostic testing is indicated and isn’t included in the healthcare protocol to rule out the possibilities of brain damage from environmental exposures.
Although the VHA Handbook 1303.2 (formerly, VA Policy manual, M-10) for Gulf War Vets is put out by the Environmental Agents Service, few VA healthcare providers even know the EAS exists! In fact, even though every VA is mandated to have this office and service, I found none existed in Alabama until about five years ago when I asked to have a couple of other of my conditions evaluated by the EAS here in Montgomery. Once the Gulf War Coordinator’s office was closed here, Gulf War Veterans were virtually swept under the rug and forgotten about.
Because it is easier to treat and diagnose veterans for PTSD and other mental conditions, and because there is little recognized research and reports to guide healthcare providers, the neurological and physiological effects of toxic environmental exposures (to include unsafe vaccines) are neglected, thus jeopardizing Gulf War Veterans' already fragile health conditions.
http://www1.va.gov/gulfwar/docs/RiskFactor2.doc
“A total of 169 Gulf War veterans submitted 24-hour urine samples for determination of urinary uranium concentration. Possible DU exposure was determined from 30 separate questionnaire items condensed into 19 distinct exposure scenarios. Twelve individuals (7.1 percent) had urine uranium levels in the high range, and 157 (92.9 percent) had low level. A second test for six of the twelve (the other six dropped out of the study) found three of these individuals in the low range.
The exposures scenarios of the high and low urinary uranium groups were similar, with the presence of retained shrapnel being the only predictor of high uranium levels. The researchers concluded that the study results emphasized the unlikely occurrence of an elevated urine uranium result and consequently any uranium-related health effects in the absence of retained DU metal fragments in the veterans.“
This can hardly be considered adequate“research” when only a small fragment of the GW Vets were ever tested for DU exposure. It is hardly fair to the rest of the GW Veteran population (over 700,000 who deployed) to gather data from only 169 veterans to make determinations on the overall effects of DU exposures. I urge everyone to please view the DVD, Beyond Treason, I have brought for each of you. You will see and hear testimonies from several GW Vets who deployed to the AOR during the Gulf War. One very important testimony on DU comes from Maj Doug Rokke, who was put in charge of DU cleanup during the war.
Gulf War Veterans were once the most physically healthy, strongest sector of our society; required by the military to stay fit for the most physically demanding jobs. Military personnel spend a great deal of time dedicated to building strong bodies and stamina—far more than its civilian counterparts. The IOM needs to stop comparing their health conditions to that of the ‘average’ civilian population in its research studies.
If anyone is listening and cares, I plead with you to "do the right thing" by the veterans who have served bravely and faithfully when their country called. Quit forcing them into poverty and worsening health because their conditions haven't been thoroughly evaluated and considered for service-connection or research by the IOM and VA. Expand the research, resources, and care that are desperately needed in order to adequately treat and care for ALL the soldiers who have already served and those now serving in toxic environments. Initiate an outreach campaign to reach every single Gulf War Veteran to provide them the more thorough evaluations as is performed in the WRIISCs. Until every veteran has been found and thoroughly evaluated can we say that research is thorough, complete and adequate.
Sincerely,
N. Gale Reid
Gale Reid
For the
Gulf War Advisory Committee
Findings:
1. Gulf War Veterans are not being directed to the EAS for Gulf War Registries within the VA. Thus, these veterans are not obtaining the evaluations and documentation they need for adequate healthcare and also supporting a disability claim for their conditions from serving in the Gulf War.
2. VA doctors and employees are not even familiar with the VA/EAS to direct veterans for these needed evaluations. I personally had to go through several offices (including the C&P office) of the Central Alabama HCS (VISN #7) before anyone could get an appointment for me to have conditions that weren’t included in my initial exam. C&P didn’t know, and so they referred me to the VARO building. The only reason I even knew what to ask for is because I worked in the VA Clinic in Alaska and had been through the process before. One gentleman from the Montgomery VA/RO was called from his “upstairs office” (because no one else in the RO knew who or how to) to help in making my follow-up appointment for my additional conditions. One of the clerks working behind the desk at the VARO was a Gulf War Veteran and when I asked him if he had ever been through the Gulf War Registry, he said, “No” and that he wasn’t even aware there was one! I seemed to be the first and only Gulf War Vet requesting an evaluation in the EAS in a very long time. This indicates to me that Gulf War Veterans in this region are being completely ignored and overlooked for the evaluations and care they need.
3. I have had to provide VA healthcare providers a hard copy of the VHA Handbook 1303.2 to show them the VA authorization that allows them to test for Gulf War conditions. In the past 16 years of walking through the process of obtaining care for these conditions, I have had only two doctors willing and interested in learning what was in the VHA Handbook 1303.2 (previously, known as the publication M-10). Most of the other doctors were offended and too embarrassed to admit they didn’t know about it. I changed doctors twice because they were too prideful and lazy to familiarize themselves with Gulf War issues.
4. Gulf War Registry evaluations have changed over the years, as well as the criteria included in them and the associated VA publications. Gulf War Veterans who registered in the early years received a very brief evaluation according to a 2-page VHA Directive 10-94-058, July 11, 1994. At this period of time, myself and other Gulf War Veterans were being evaluated for “Gulf War Illness”, instead of “Gulf War Illnesses” (plural) in which case the criteria changed drastically allowing more recent claims from Gulf War exposures to be rated for individual presumptive conditions, instead of just one rating for “Gulf War Illness”. The 2-page VHA Directive 10-94-058 changed to the VA M-10 publication which consisted of approximately 150 pages. The VA M-10 publication then changed to the current VHA Handbook 1303.2, now only approximately 38 pages long.
5. PTSD was too quickly diagnosed in the early years before Gulf War Registry exams included testing and x-rays for brain damage. I was diagnosed with PTSD, as well, without first evaluating me for brain damage. An MRI later on (in 1994) revealed “mild, diffuse brain atrophy”. Veterans who were assessed for PTSD without ruling out neurological problems in the early years need to be assessed again to include neurological testing.
Recommendations:
1. Ensure every VA/VHA/VBA facility, every doctor, and every VA employee is briefed on Gulf War issues annually and knows where to direct Gulf War Veterans when they come into the VA.
2. Make sure every VA/VHA/VBA facility has adequate VA publications/library and that every employee is provided with hard copy EAS publications regarding toxic exposures (including Gulf War, Agent Orange, etc.) Possibly, include list of EAS Coordinators in VHA Handbook 1303.2 for Gulf War Veterans as well as in the standard “Federal Benefits for Veterans and Dependents”, http://www1.va.gov/opa/vadocs/fedben.pdf .
3. Outreach to veterans - Provide an option in the VA automated telephone message system for toxic-exposed veterans to be routed directly to that VA/EAS office.
4. Provide more specific, detailed authorization to Primary Care Physicians so they can provide more comprehensive care and testing for conditions that may be associated with Gulf War exposures. At present, many PCPs are reluctant to involve themselves in testing for and diagnosing conditions that haven’t been rated as “service-connected”. I have spoken with a couple of physicians that have confided that they fear retribution or risk of losing their jobs if they involve themselves in Gulf War issues.
5. Recommend establishing a reporting system from every VA/EAS on the number of Gulf War Registry evaluations performed each month to the RAC.
6. Obtain totals of Gulf War Veterans that have been through the Gulf War Registry in each VHA each year since 1993 to the RAC. This will indicate just how many Gulf War Veterans that have been evaluated and what kind of evaluation they had.
7. Provide a bed/housing through the Domiciliary (if space is available) for veterans coming in from distant locations for these meetings with the GW Advisory Committee.
8. Suggest legal and monetary remedies sought from the IOM for all proceeds and profit generated from its sales from publications on Gulf War Veteran Research to be set aside for a Gulf War Veteran Benevolence Fund (or something comparable). This money would be used to help out veterans who have been deprived of adequate pre- and post-deployment evaluations that precluded them from obtaining the medical documentation in their records needed to support their claims.
