PurpleheartOklahoma (scroll down)

Gulf War Vets hazmat exposure and exams
What kinds of hazards may Gulf War veterans have been
exposed to?

According to the Department of Defense (DOD) the approximately 690,000 American servicemen and women who served in the Gulf War may have been exposed to many hazards such as:
oil and other petrochemical agents
smoke from the sabotage of Kuwaiti oil wells by retreating Iraqi forces
Leishmaniasis (Sand flies)
pyridostigmine bromide, malaria prophylaxis, and other prophylactic drug treatments
depleted Uranium (DU)
inoculations (Anthrax, botulism, etc.)
pesticides
diesel and jet fuels and other petrochemicals and solvents
chemical Agent Resistant Compound (CARC) paint
chemical and/or biological warfare agents
contaminated food and water obtained in the Persian Gulf
air pollutants (carbon monoxide, sulfur oxide, hydrocarbons, particulate matter, and nitrogen oxide)
psychological stressors

What is unique about examinations of Gulf War veterans?
Gulf War veterans may claim, and require an examination for, any condition resulting from a disease or injury that was incurred in or aggravated by military service, as other veterans do. In such cases, the regional office may request an examination of one or more specific conditions, e.g., residuals of a knee injury, and will refer to the appropriate worksheet(s) . However, what is unique about Gulf War veterans is that some veterans will need instead, or in addition, a comprehensive examination that will allow the examiner to distinguish between a clearly diagnosable condition (like asthma) and an “undiagnosed illness” (like a cough that cannot be attributed to a specific diagnosis). An undiagnosed illness is established when findings are present that cannot be attributed to a known, clearly defined diagnosis, after all likely diagnostic possibilities for such abnormalities have been ruled out. Examiners should follow the worksheet titled “Guidelines for Disability Examination in Gulf War Veterans,” which provides detailed instructions for examinations in Gulf War veterans.
20.3 What are the some signs and symptoms that may be manifestations of undiagnosed illnesses in Gulf War veterans? (38 CFR 3.317)
fatigue
signs or symptoms involving the skin
headache, muscle pain, joint pain
neurologic signs and symptoms
neuropsychological signs and symptoms
signs or symptoms involving the respiratory system (upper or lower)
sleep disturbances
gastrointestinal signs or symptoms
cardiovascular signs or symptoms
abnormal weight loss
menstrual disorders

Veteran Information Network 

http://www.veteraninformationnetwork.net/

Veterans of Southwest Asia

http://groups. yahoo.com/ group/Vets- of-SWA/

Disabled Veteran help desk (not a part of the DAV)

http://groups. yahoo.com/ group/Disabled- Vet-help- desk/

Persian Gulf War Vets Rules change
Rules Liberalized for Veterans with Undiagnosed Illnesses
Application Window Extended for Five Years
 

WASHINGTON – Veterans of the Persian Gulf War with undiagnosed illnesses have an additional five years to qualify for benefits from the Department of Veterans Affairs.

“Not all the wounds of war are fully understood,” said Secretary of Veterans Affairs Eric K. Shinseki. “When there is uncertainty about the connection between a medical problem and military service, Veterans are entitled to the benefit of the doubt.”

A recent change in VA regulations affects Veterans of the conflict in Southwest Asia.  Many have attributed a range of undiagnosed or poorly understood medical problems to their military services.  Chemical weapons, environmental hazards and vaccinations are among the possible causes.

Under long-standing VA rules, any undiagnosed illnesses used to establish eligibility for VA benefits must become apparent by Dec. 31, 2011.  The new change pushes the date back to Dec. 31, 2016.

Veterans or survivors who believe they qualify for these benefits should contact VA at 1-800-827-1000.

Further information about undiagnosed illnesses is available online at www.publichealth.va.gov/exposures/gulfwar and www.publichealth.va.gov/exposures

Interim VA ruling Gulf War Amendment

 [Federal Register Volume 76, Number 250 (Thursday, December 29, 2011)]
[Rules and Regulations]
[Pages 81834-81836]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-33222]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 3
RIN 2900-AO09
Extension of Statutory Period for Compensation for Certain Disabilities Due to Undiagnosed Illnesses and Medically Unexplained Chronic Multi-Symptom Illnesses
AGENCY: Department of Veterans Affairs.
ACTION: Interim final rule.
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SUMMARY: The Department of Veterans Affairs (VA) is issuing this interim final rule to amend its adjudication regulation regarding compensation for disabilities suffered by veterans who served in the Southwest Asia Theater of Operations during the Persian Gulf War. This amendment is necessary to extend the period during which disabilities associated with undiagnosed illnesses and medically unexplained chronic multi-symptom illnesses must become manifest in order for a veteran to be eligible for compensation.
DATES: Effective Date: This interim final rule is effective December 29, 2011. Comments must be received by VA on or before February 27, 2012.
ADDRESSES: Written comments may be submitted through www.Regulations.gov; by mail or hand-delivery to Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Ave. NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026. (This is not a toll-free number). Comments should indicate that they are submitted in response to ``RIN 2900-AO09--Extension of Statutory Period for Compensation for Certain Disabilities Due to Undiagnosed Illnesses and Medically Unexplained Chronic Multi-Symptom Illnesses.'' Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday (except holidays). Please call (202) 461-4902 for an appointment. (This is not a toll-free number). In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at www.Regulations.gov.
FOR FURTHER INFORMATION CONTACT: Nancy Copeland, Consultant, Regulations Staff (211D), Compensation and Pension Service, Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420, (202) 461-9428. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: In response to the needs and concerns of veterans who served in the Southwest Asia theater of operations during the Persian Gulf War, Congress enacted the Persian Gulf War Veterans' Benefits Act, Title I of the Veterans' Benefits Improvement Act of 1994, Public Law 103-446, which was codified at 38 U.S.C. 1117. This law provided authority for the Secretary of Veterans Affairs (Secretary) to compensate Gulf War veterans with a chronic disability resulting from an undiagnosed illness that became manifest either during service on active duty in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of ten percent or more disabling during a presumptive period determined by the Secretary.
Public Law 103-446 directed the Secretary to prescribe by regulation the period of time, following service in the Southwest Asia theater of operations, determined to be appropriate for the 2

manifestation of an illness warranting payment of compensation. It further directed that the Secretary's determination of a presumptive period be made only following a review of any credible medical or scientific evidence and the historical treatment afforded disabilities for which manifestation periods have been established, taking into account other pertinent circumstances regarding the experiences of veterans of the Persian Gulf War.
To implement 38 U.S.C. 1117, VA published a final rule to add 38 CFR 3.317, which established the framework for the Secretary to pay compensation under the authority granted by the Persian Gulf War Veterans' Benefits Act. See 60 FR 6660, February 3, 1995. As part of that rulemaking, VA established a 2 year, post-Gulf War service presumptive period based primarily on the historical treatment of disabilities for which manifestation periods have been established and pertinent facts known regarding service in the Southwest Asia theater of operations during the Persian Gulf War. VA determined that there was little or no scientific or medical evidence, at that time, useful in
determining an appropriate presumptive period for undiagnosed illnesses.
Due to the continuing lack of medical and scientific evidence about the nature and cause of the illnesses suffered by Gulf War veterans and the inadequacy of a designated presumptive period for undiagnosed illnesses, the Secretary established December 31, 2001, as the date by
which an undiagnosed illness must become manifest for purposes of claims based on service in the Southwest Asia theater of operations during the Persian Gulf War. In 2001, VA further extended the period from December 31, 2001, to December 31, 2006.
In December 2001, section 202(a) of Public Law 107-103 amended 38 U.S.C. 1117 by revising the term ``chronic disability'' to include the following (or any combination of the following): (a) An undiagnosed illness; (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs and symptoms; or (c) any diagnosed illness that the Secretary determines warrants a
presumption of service connection. The revised term ``qualifying chronic disability,'' has broadened the scope of those health outcomes the Secretary may include under the presumption of service connection. Under 38 U.S.C. 1117, a chronic disability must still occur during service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of ten percent or more disabling during the prescribed presumptive period following such service. VA amended 38 CFR 3.317 to reflect these changes. See 68 FR 34539, June 10, 2003.
As required by Public Law 105-277, the National Academy of Sciences (NAS) conducts ongoing review, evaluation, and summarization of the scientific and medical literature for peer review regarding the possible association between service in the Southwest Asia theater of operations and long-term adverse health effects. Due to the inconclusive nature of the scientific and medical evidence concerning the manifestation period for the subject illnesses, in December 2007, VA published a final rule to further extend the manifestation period from December 31, 2006 (previously extended), to December 31, 2011. See 72 FR 68507-01. Additionally, on October 13, 2010, Congress enacted section 806 of Public Law 111-275, which directed NAS to continue to review, evaluate, and summarize scientific and medical literature associated with Persian Gulf War service and broadly expanded the time frame for NAS to complete this research, since military operations in the Southwest Asia Theater of Operations continue, including Operation Iraqi Freedom, and no end date for the Gulf War has been established by Congress. See 38 U.S.C. 101(33).
In a report published in 2010 titled Gulf War and Health, Volume 8: Update of Health Effects of Serving in the Gulf War, NAS evaluated the available scientific and medical literature regarding the prevalence of chronic multi-symptom illnesses in Gulf War veterans. Consistent with its prior findings, NAS concluded, based on multiple studies, that there is sufficient evidence of an association between deployment to the Gulf War and chronic multi-symptom illness. NAS analyzed two follow-up studies that surveyed veterans who served in the Gulf War in 1991 in order to determine whether the increased prevalence of chronic multi-symptom illness persisted several years after such service. One study, conducted 10 years after the 1991 Gulf War, involved conducting detailed examinations and medical histories of veterans deployed to the Gulf War and non-deployed veterans of the same era. The study found that, 10 years after the 1991 Gulf War, chronic multi-symptom illness was nearly twice as prevalent in veterans deployed to the Gulf War
(present in 28.9 percent of such veterans) than in the non-deployed veterans (15.8 percent). The study found that the prevalence of chronic multi-symptom illness decreased gradually over time, 3

but remained significantly elevated 10 years after service. The other follow-up study involved a 2005 survey of veterans deployed to the 1991 Gulf War and their non-deployed counterparts of that era. That study found that 36.5 percent of the deployed veterans reported experiencing symptoms of chronic multi-symptom illness in 2005, compared to 11.7 percent of the
non-deployed veterans. While this report is limited in that it is based on self-reports, the results are statistically significant and are consistent with the other follow-up report.
The currently available scientific and medical literature thus suggests that, while the prevalence of chronic multi-symptom illness may decrease over time following deployment to the Gulf War, the prevalence remains significantly elevated among deployed veterans more than a decade after deployment. At present, there is not a sufficient basis to identify the point, if any, at which the increased risk of chronic multi-symptom illness may abate. Further follow-up studies may
provide additional information relevant to this issue in the future.
Section 501(a) of Title 38, United States Code, provides that the Secretary of Veterans Affairs ``[h]as authority to prescribe all rules and regulations which are necessary or appropriate to carry out the laws administered by the Department and are consistent with those laws.'' Because scientific uncertainty remains as to the cause of illnesses suffered by Persian Gulf War veterans and the time period in which such veterans have an increased risk of chronic multi-symptom
illness, and because scientific studies and NAS reviews are ongoing, in order to ensure that benefits established by Congress are fairly administered, VA is further amending 38 CFR 3.317 to extend the evaluation period from December 31, 2011, to December 31, 2016.
Administrative Procedures Act
The Secretary of Veterans Affairs finds that there is good cause under the provisions of 5 U.S.C. 553(b)(3)(B) to publish this rule without prior opportunity for public comment. Absent extension of the sunset date in the current regulation, VA's authority to provide benefits in new claims for qualifying chronic disability in Gulf War veterans will lapse on December 31, 2011. A lapse of such authority would have significant adverse impact on veterans disabled due to such disabilities. To avoid such impact, VA is issuing this rule as an interim final rule. However, VA invites public comments on this interim final rule and will fully consider and address any comments received.
Paperwork Reduction Act
This document contains no provisions constituting a new collection of information under the Paperwork Reduction Act (44 U.S.C. 3501-3521).
Regulatory Flexibility Act
The Secretary hereby certifies that this rule will not have a significant economic impact on a substantial number of small entities as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-612. This rule would not affect any small entities. Only VA beneficiaries could be directly affected. Therefore, pursuant to 5 U.S.C. 605(b), this rule is exempt from the initial and final
regulatory flexibility analysis requirements of sections 603 and 604.
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563 direct agencies to assess the costs and benefits of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, and other advantages; distributive impacts; and equity). Executive Order 13563 (Improving Regulation and Regulatory Review) emphasizes the importance of quantifying both costs and benefits, reducing costs, harmonizing rules, and promoting flexibility. Executive Order 12866 (Regulatory Planning and Review) defines a ``significant regulatory action,'' which requires review by the Office of Management and Budget (OMB), as ``any regulatory action that is likely to result in a rule that may: (1) Have an annual effect on the economy of $100 million or more or adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities; (2) Create a serious inconsistency or otherwise interfere with an action taken or planned by another agency; (3) Materially alter the budgetary impact of entitlements, grants, user fees, or loan programs or the rights and obligations of recipients thereof; or (4) Raise novel legal or policy issues arising out of legal mandates, the President's priorities, or the principles set forth in this Executive Order.''
The economic, interagency, budgetary, legal, and policy implications of this rule have been examined and it has been determined to be a significant regulatory action under Executive Order 12866.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 1532, that agencies prepare an assessment of anticipated costs and benefits before issuing any rule that may result in the expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any year. This rule would have no such effect on State, local, and tribal governments, or on the private sector.
Catalog of Federal Domestic Assistance Numbers and Titles
The Catalog of Federal Domestic Assistance program numbers and titles for this rule are: 64.109, Veterans
Compensation for Service-Connected Disability.
Signing Authority
The Secretary of Veterans Affairs, or designee, approved this document and authorized the undersigned to sign and submit the document to the Office of the Federal Register for publication electronically as an official document of the Department of Veterans Affairs. John R. Gingrich, Chief of Staff, Department of Veterans Affairs, approved this document on November 28, 2011, for publication.
List of Subjects in 38 CFR Part 3
Administrative practice and procedure, Claims, Disability benefits, Health care, Pensions, Radioactive materials, Veterans, Vietnam.
Dated: December 22, 2011.
Robert C. McFetridge, Director of Regulation Policy and Management, Office of the General Counsel, Department of Veterans Affairs.
For the reasons set out in the preamble, VA amends 38 CFR part 3 as follows:
PART 3--ADJUDICATION
1. The authority citation for part 3, subpart A continues to read as follows:
Authority: 38 U.S.C. 501(a), unless otherwise noted.
Sec. 3.317 [Amended]
2. In Sec. 3.317, paragraph (a)(1)(i), remove the date ``December 31, 2011'' and add, in its place, ``December 31, 2016''.
[FR Doc. 2011-33222 Filed 12-28-11; 8:45 am]
BILLING CODE 8320-01-P

Draft Gulf War Task Force Report Is Released
Report Redefines How Care and Services Are Provided
to Gulf War Veterans

WASHINGTON – Today, Secretary of Veterans Affairs Eric K. Shinseki announced that the Department’s Gulf War Veterans’ Illnesses Task Force has completed the draft of a comprehensive report that will outline how the Department of Veterans Affairs (VA) addresses the concerns of Veterans who deployed during the Gulf War in 1990 and 1991.

“This report provides a roadmap for our continued enhancements in our care and services we provide to Gulf War Veterans,” said Shinseki. “We will be applying lessons learned from this report to Veterans of all eras.”

Notification of the draft written report is published in the Federal Register, and the draft written report addresses seven areas where VA provides services for this group of Veterans.

Over the past year, the task force has examined, evaluated, designated and adjusted the initial roadmap outlined in last year’s report. VA has designated steps to improve care and services to Gulf War I Veterans and these improvements are becoming a part of our culture and operations.

This year’s report focuses on improvements in the delivery of health care for Gulf War Veterans. One of the most substantial additions is modifications to clinical care models used for Gulf War Veterans, which is the most critical point of service VA provides. There are better linkages between specialty knowledge and services at the basic point of care. Clinical research and development is significantly contributing new concepts and methods to clinical practice and clinical education throughout VA.

Two new positions were established in the Office of Research and Development for deployment and Desert Shield and Desert Storm health-related issues. Both positions have been filled and are enhancing research efforts for Gulf War Veterans and will continue to do so in the coming years.

VA is also strengthening partnerships and medical surveillance to address the potential health impacts on Veterans from the environmental exposures on today's battlefield. Additionally, VA continues to use social media to improve communication with Gulf War Veterans.

The Chairman of the Gulf War Veterans’ Illnesses Task Force is John R. Gingrich, chief of staff at VA, a retired Army officer who also served in the Gulf War.

“To ensure we are tracking the needs of our Veterans, we want to get feedback from Gulf War Veterans on this draft report,” said Gingrich. “Their feedback is critical to our efforts to understand and serve their specific needs. Therefore, we hope they take advantage of one of the different opportunities to provide feedback that we have created for them.”

As a first step, VA is seeking public comments on the draft written report before final publication. The public notice and instructions for how to submit electronic and comments via postal mail will be posted at www.regulations.gov, and the draft written report will be open for comment for 30 days. In addition, VA recognizes that a great number of Gulf War Veterans use the Internet on a daily basis to share their ideas and concerns, so VA has also created a public discussion board on the seven recommendations at: http://vagulfwartaskforce.uservoice.com/. To view the report without making recommendations, please visit VA’s website at http://www.va.gov/opa/publications/Draft_2011_GWVI-TF_Report.pdf.

Gulf War Syndrome Is Brain Damage Caused By Nerve Gas
Not Psychological Issues, UT Southwestern Study Proves
By Brantley Hargrove Thu., Sep. 15 2011 at 12:48 PM
 
There's no denying it now: Gulf War Syndrome, characterized by memory loss, lack of concentration, neuropathic pain and depression, is a physiological illness, not a psychological one.
A UT Southwestern study, published in the journal Radiology, used a specialized MRI that specifically measures blood flow in the brain and detected marked abnormalities in the brains of those with Gulf War Syndrome. Not only have those abnormalities persisted for 20 years, but in some cases they've worsened.
The findings mark a significant advancement in our understanding of the syndrome, which was for years written off by the Defense Department and the Department of Veterans Affairs as a form of combat stress rather than an objectively diagnosable injury. Dr. Robert Haley, chief epidemiologist at UT Southwestern, and a cadre of clinicians and researchers, have struggled with the government for some 18 years for research funding and to have the syndrome recognized as a legitimate war injury caused by chronic exposure to minimal amounts of sarin gas.
"This was really one of the first techniques to show an objective picture of whether there's really brain damage or not," Haley tells Unfair Park.
In this study, Haley used a neurotransmitter called acetylcholine, which mimics nerve gas and acts to slow the heart rate and blood flow to the brain, making you groggy. For those with receptors damaged by nerve gas, they don't become groggy at all. In fact, sometimes it has the opposite effect. By administering the neurotransmitter and projecting radio waves into the carotid artery, Haley used a kind of MRI to measure blood flow in response. Veterans afflicted with Gulf War Syndrome didn't respond normally by showing decreases in blood flow to the brain you'd expect.
It's no surprise, then, that many of them report sleep difficulties as well. Approximately 20 percent of the population has a weak form of a gene that protects nerve receptors from sarin gas, Haley says. As a result of this study, it's likely no coincidence that at least 25 percent of veterans who were deployed in Iraq are thought to have the syndrome, according to a VA report.
Because of Haley's work, we now know brain damage is involved. But which specific brain cells, and what's wrong with them? Until we understand the underlying pathology, Haley says, we can't treat them. "We're shooting in the dark," he said, referring to potential treatments. "So far, nobody's guessed right.
"But the research is really going to come to a head in the next six to 12 months."
http://blogs.dallasobserver.com/unfairpark/2011/09/gulf_war_syndrome_is_brain_dam.php
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Hippocampal Dysfunction in Gulf War Veterans
Investigation Hippocampal Dysfunction in Gulf War Veterans:

1 Purpose: To determine, with arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging and physostigmine challenge, if abnormal hippocampal blood flow in ill Gulf War veterans persists 11 years after initial testing with single photon emission computed tomography and nearly 20 years after the 1991 Gulf War.
Materials and Methods: The local institutional review board approved this HIPAA-compliant study. Veterans were screened for contraindications and gave written informed consent before the study. In a semiblinded retrospective protocol, veterans in three Gulf War illness groups—syndrome 1 (impaired cognition), syndrome 2 (confusion-ataxia), and syndrome 3 (central neuropathic pain)—and a control group received intravenous infusions of saline in an initial session and physostigmine in a second session, 48 hours later. Each infusion was followed by measurement of hippocampal regional cerebral blood flow (rCBF) with pulsed ASL. A mixed-
2 Effects linear model adjusted for age was used to test for differences in rCBF after the cholinergic challenge across the four groups.
Results: Physostigmine significantly decreased hippocampal rCBF in control subjects (P < .0005) and veterans with syndrome 1 (P < .05) but significantly increased hippocampal rCBF in veterans with syndrome 2 (P < .005) and veterans with syndrome 3 (P < .002). The abnormal increase in rCBF was found to have progressed to the left hippocampus of the veterans with syndrome 2 and to both hippocampi of the veterans with syndrome 3.
Conclusion: Chronic hippocampal perfusion dysfunction persists or worsens in veterans with certain Gulf War syndromes. ASL MR imaging examination of hippocampal rCBF in a cholinergic challenge experiment may be useful as a diagnostic test for this condition.
© RSNA, 2011
Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101715/-/DC1
Footnotes
? Received September 10, 2010; revision requested October 20; revision received April 8, 2011; accepted April 22; final version accepted May 27.
? Funding: This research was supported by the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research (grant UL1RR024982).
? Supported by Indefinite Delivery Indefinite Quantity contract VA549-P-0027, awarded and administered by the Department of Veterans Affairs Medical Center, Dallas, Tex, and by the U.S. Army Medical Research and Materiel Command, grant number DAMD17-01-1-0741. The content does not necessarily reflect the position or the policy of the Federal government or the sponsoring agencies, and no official endorsement should be inferred.
Abbreviations:
ASL = arterial spin labeling
MP-RAGE = magnetization-prepared rapid acquisition gradient echo
PTSD = posttraumatic stress disorder
rCBF = regional cerebral blood flow
ROI = region of interest
http://radiology.rsna.org/content/early/2011/08/17/radiol.11101715.abstract