10 years later, Gulf War illness remains unresolved

The controversial issue has divided veterans and the Pentagon

ATLANTA (CNN) -- In the aftermath of the Gulf War, one of the most charged issues to emerge has been the cause of illnesses suffered by Gulf War veterans. Despite much research, the debate surrounding the issue is as heated as it was when it first surfaced. The Pentagon says it cannot link the various symptoms to any one cause and veterans groups maintain the Pentagon is stonewalling the issue.

As many as 100,000 of the 700,000 troops who served during Operation Desert Storm and Operation Desert Shield in 1990 and 1991 have reported symptoms ranging from chronic fatigue, muscle and joint pain, memory loss, balance disturbances, sleep disorders, depression, chronic diarrhea and concentration problems.

In Britain, 6,000 of the 31,000 who served suffer from similar symptoms and 300 of the 25,000 French veterans who went to the Gulf have asked for pensions related to the illnesses. The French government in September agreed to study the problem.

The most recent U.S. government report on the issue, a 90-page report released in December 2000 by a presidential panel, repeated the main theme of all Pentagon findings so far: "To date, research has not validated any specific cause of these illnesses." It said research must continue.

That finding has frustrated veteran groups and contributed to suspicions of a cover-up. Patrick Eddington, the executive director of the National Gulf War Resource Center (NGWRC), says the government is avoiding the problem and trying to disprove that the illnesses are linked to the Gulf War.

"They don't want to find the problem," he said. "They don't want to address it."

The panel's report came to a different conclusion. It concluded that the Defense Department has "worked diligently to fulfill the president's directive to 'leave no stone unturned' in investigating possible causes" for the variety of illnesses.

It also found the department "made no effort to deliberately withhold information," an allegation among critics who believe the Pentagon is hiding data about Iraqi chemical warfare agents or other toxins veterans may have been exposed to while serving.

But one of the board's seven members, immunologist Dr. Vinh Cam, disagreed with the report and wrote a three-page dissent. Cam charged that the board -- composed largely of retired military officers -- lacked independence from the Pentagon office it was overseeing, the Office of the Special Assistant for Gulf War Illnesses (OSAGWI).

"At times (the board) acted more like an extension of OSAGWI," Cam wrote in her dissenting letter.

Government labels stress a 'primary cause of illness'

An estimated $300 million has been spent and scores of studies have looked into such possible culprits as Iraq's chemical and biological weapons, service members' vaccinations, oil well fires, anti-nerve agent tablets taken by troops, desert sand and stress, according to the panel's report.

"The board concludes that stress is likely a primary cause of illness in at least some Gulf War veterans," the report said.

Cam's dissent to the board's report, however, said the board it had no authority to suggest that stress be studied further as a possible cause. Non-governmental researchers also have disputed stress as a possible cause.

Eddington says the Pentagon is pushing stress as a cause and has avoided studying treatments for the illnesses, instead focusing on the cause.

The reason, Eddington says, is because it would be expensive to treat. It's difficult to estimate how many service members would be treated, he said, but no matter how many, the expense would not be "budget neutral" for the Defense Department.

But to Eddington, the cost of treating a veteran's illness is the duty of the nation to bear. "Are we going to take care of our veterans or are we going to waste our money on a Star Wars defense system?," he said.

Charges of a cover-up

The vagueness of the illnesses and the inability to find a cause led some veterans to charge the Pentagon was involved in a cover-up, which it vigorously denied.

Many of the vets had long suspected their illnesses were caused by exposure to Iraqi chemical or biological weapons. But there was never any proof, and the Defense Department vehemently denied that troops had ever come in contact with toxic weapons.

Research into the problem focused on other risk factors -- infectious diseases, pesticides, smoke and particulates from oil well fires, and vaccines and pills given to troops as antidotes for possible chemical and biological agents.

But in 1996, the Pentagon revealed that thousands of U.S. troops may have been exposed to low-level doses of the debilitating nerve gas sarin when they destroyed a sprawling Iraqi ammunition depot at Kamisiyah in 1991.

In 1997, the Central Intelligence Agency (CIA) admitted that it had done a poor job dealing with the information that could have given U.S. troops warnings about the Khamisiyah site.

Robert Walpole of the CIA said the agency initially was reluctant to share some of its most sensitive data with other top government officials. The agency also did not perform a thorough enough search when it was trying to compile lists of known or suspected chemical weapons in Iraq.

"If you're looking for an apology ... I'll give that apology," Walpole said in 1997. "We should have gotten it out sooner."

The Khamisiyah revelation was followed by an October 1996 report by a panel from the highly-regarded Institute of Medicine that said the U.S. military was too preoccupied with its war mission in the Persian Gulf to prepare for the potential medical aftermath. The panel's report concluded that the absence of uniform health records for all troops who served in the war had impeded research efforts.

The lack of records also was cited in National Institute of Medicine study released in September 2000. The study attempted to find a link between the veterans' health problems and the drugs, chemicals and vaccines that veterans were exposed to during the Gulf War but failed for a lack of evidence.

"We'd like to give veterans and their families definitive answers, but the evidence simply is not strong enough," said Dr. Harold C. Sox Jr. when the report was released last September.

Is 'Balkans Syndrome' related?

The panel of experts also found limited, suggestive evidence that there is no link between exposure to dust or rubble from exploded shells made of depleted uranium and kidney disease or -- at low-exposure levels -- lung cancer.

The idea of depleted uranium causing at least some of the health problems is getting more attention with the emergence of what is being called "Balkans Syndrome." At least 17 soldiers from European armies have died of cancer, 15 of them from leukemia, since being deployed on peacekeeping missions in Bosnia and Kosovo.

The deaths have caused an uproar in Europe, and some of their governments believe the illnesses may lie in the NATO ammunition used against Serbian armor and artillery positions in both regions.

The U.S., Britain and NATO headquarters cite extensive scientific research by the World Health Organization, among others, to assert that there's no link between depleted-uranium ammunition and the illnesses that killed the European peacekeepers. But the U.S. issued a warning on the dangers of depleted-uranium debris to all NATO armies joining the peacekeeping mission in 1999.

Depleted uranium is used in ammunition because its high ratio of mass to bulk allows it to pierce the heavy armor of tanks. It is a by-product of nuclear power stations and it carries fairly low doses of radiation, but if directly ingested, inhaled or absorbed through cuts, it does pose some risk of cancer and other ailments.

Depleted uranium is a by-product of the process for converting natural uranium into the enriched form used in nuclear weapons and reactors. The uranium remaining from the process is 40 percent less radioactive than natural uranium but still is a toxic heavy metal.

In the National Institute of Medicine's committee's review of depleted uranium, the committee concluded, "There is limited/suggestive evidence of no association between exposure to uranium and clinically significant [kidney] dysfunction."

Dr. David Case, a member of the Defense Department's environmental and occupational exposure team, says the health risks from its radioactivity are slight compared to the heavy metal toxicity risk.

"Exposure to depleted uranium can cause kidney problems because of its heavy metal toxicity," Case said. "The exposure that could cause radiation-related health problems is thousands of times more than the exposure that could cause heavy metal toxicity symptoms."

But the concerns over the uranium remain. Eddington says he has been "inundated with phone calls" about the uranium issue.

Outside research finds different results

Veterans groups like the NGWRC also cite private researchers, who, they say, have found better evidence of Gulf War illness, including researchers at the University of Texas Southwestern Medical Center at Dallas.

Researchers there concluded that some Gulf War veterans are suffering from three primary syndromes indicating brain and nerve damage caused by wartime exposure to combinations of low-level nerve agents and other common chemicals.

The UT researchers conducted a series of studies on a U.S. Navy Reserve construction battalion and identified what they said are three different syndromes. One is characterized by thought, memory and sleep difficulties while another involves more severe thought problems plus confusion and imbalance. The third one is characterized by sore joints and muscles and tingling or numbness in the hands and feet.

The researchers reported that they traced the symptoms to flea collars, insect repellant and anti-nerve gas pills, as well as exposure to chemical nerve agents. The UT reports said the syndromes are variants of a rare disorder called organophosphate-induced delayed polyneuropathy, which is caused by exposure to certain chemicals that inhibit cholinesterase, an enzyme important to nervous system function.

The lead researcher, Dr. Robert Haley, also has disputed the government's stress theory of Gulf War syndrome and findings of no difference in mortality, hospitalization and birth defects between Gulf War-deployed and nondeployed military populations. Haley is continuing his research.

Another recent study commissioned by the Kansas Commission on Veterans Affairs found that among 1,548 veterans who served in the Gulf War and 482 veterans who served elsewhere, 42 percent of the Gulf veterans who served in Iraq or Kuwait had chronic symptoms associated with the illness.

The lowest rate of illness in the study was found in veterans who served primarily on ships during the war, suggesting that proximity to the battlefield could be a risk factor in developing symptoms associated with Gulf War illness. The study was published in the November 15, 2000, issue of the American Journal of Epidemiology.

The government is continuing to research the issue and veterans groups will maintain a close watch on the research and the Pentagon.

"I'm not going to say there was a cover-up," says Steve Smithson of the American Legion veterans' group. "But ... 10 years later we still don't know any more, and in the meantime people out there are sick."

The Associated Press contributed to this report, which was written by CNN.com writer Douglas S. Wood.