A. Discussion

This investigation has sought to determine whether a chemical warfare agent caused blisters to the right arm of a United States Marine in post-Gulf War Saudi Arabia. In arriving at an assessment, our investigation relied on:

The physical evidence from this investigation consisted mostly of photographs of the corporal’s blisters and scars. These blisters healed when medical personnel applied a treatment regimen of Daikin’s solution and Benadryl´┐Ż . The injury was corroborated by the corporal’s medical record, interviews with the medical specialists who made entries in the corporal’s medical record, and testimony of the corporal’s immediate chain of command.

The corporal’s initial visit to the Kibrit battalion aid station was not recorded and medical entries in the corporal’s medical record did little to establish the cause of the blisters. The corporal himself at first discounted that his blisters were caused by a chemical warfare agent, mostly because he experienced no immediate chemical warfare agent exposure symptoms while working for hours with the enemy equipment and he knows of no injuries sustained by others from the incident. Again, the possibility of chemical warfare agent exposure was suggested by the corporal’s crewmates and eventually raised by the medical personnel who treated him at Al Jubayl. However, these medical personnel could not be certain about the cause of the blisters; a chemical warfare agent injury was one possibility that they suggested. Their concern was treatment, whatever the cause.

Our concern has been to determine whether a chemical warfare agent caused the corporals blisters. Without spectrum analysis tapes showing the Fox detections made while testing the Iraqi EPW equipment, and without other such evidence to support the reported positive CAM readings, and unable to find the staff sergeant who handled the EPW equipment, we have not been able to make a definitive assessment. We have, however, based our assessment on:

Lewisite produces pain or irritation seconds to minutes after contact and is extremely irritating to the nose and lower airways, causing individuals exposed to it to seek immediate protection.[97] The corporal experienced no such symptoms while handling the EPW equipment and working around the reddish dust he noticed. He stated that he knows of no one else in the immediate area that day that experienced any effects.[98] His blisters were only on his right arm and not in a pattern consistent with that expected from a dusty chemical warfare agent.[99] Mustard could have produced blisters, but it also would have resulted in irritation of the eyes within an hour or so of exposure.[100]  More importantly, in a 1999 interview, the corporal indicated that he only had positive readings for lewisite.[101] Lewisite exists as a liquid or a vapor,[102] so the red dust could not have been lewisite. The United Nations Special Commission in Iraq reported that their inspectors found no lewisite in their inspections of Iraq’s production and storage facilities.[103]

Two different accounts from the corporal confuse the impact of the M258 kit on the blistering. He stated, in 1999, that he had wiped his arm with chemical warfare agent decontamination kit wipes and then washed his arms with bleach and water.[104] However, more recently, he remembers that he did not use the decontamination kit until the next morning, after the first blister had appeared, and left the decontamination solutions on his arm for several hours before showering.[105]

The corporal’s officer in charge, the I MEF NBC officer, thought the blisters noteworthy enough to photograph. However, he initiated no operational records to corroborate the time or nature of the injury. He did not initiate any investigation to determine a cause of the corporal’s blisters and, apparently did not consider this to be an NBC incident because he filed no NBC report following the incident or during the medical treatment in theater to alert others to a potential hazard in the area.

The evidence from this investigation was presented to six physicians for evaluation´┐Ż two chemical warfare agent casualty treatment experts and four dermatologists. The two chemical warfare agent casualty treatment experts interviewed the corporal together at Camp Pendleton in November 1997. Following that interview, one chemical warfare agent casualty treatment expert ruled out lewisite or mustard as the cause but did not offer any medical alternatives.[106] The second physician who interviewed the corporal indicated that he could not rule out chemical warfare agent exposure as a cause but thought, "it was possible, but unlikely."[107]

The dermatologists’ reviews of the information and photographs of the injury and, in one case, an examination of the corporal were not conclusive. One dermatologist discounted mustard agent as the cause of the lesions and offered several other possibilities for the injury, none of which were chemical warfare agents.[108] Another dermatologist did not believe mustard agent caused the blisters because of the pattern they formed. However, she stated the pattern did not look like any contact dermatitis she had seen in her experience and suggested insect bites could have caused the blisters. Again, there was no suggestion that a chemical warfare agent caused the injury.[109] A third dermatologist stated it was likely that the corporal was exposed to one or more chemical warfare agents. The doctor based his opinion on the statements of the corporal and the members of the medical community who had originally seen and treated him. However, the Marine’s health record does not reflect a definite cause of his injury.[110] After interviewing and examining the corporal in 1998, a fourth dermatologist stated that such blisters could be caused by a number of things to include a blister agent or a burn. He added that the pattern of the lesions and the appearance of new ones much later made it unlikely that a one-time exposure to a chemical warfare agent would be the cause of the injury, but he was unable to give a definitive cause.[111]

As part of our final review, a biochemist at the Defense Intelligence Agency, knowledgeable in industrial hygiene and chemical decontamination issues, reviewed the case narrative and medical assessments. He suggested that the corporal’s decontamination procedures (use of the bleach and water solution and the decontamination kit) might have been the cause of the blisters.[112]

B. Conclusion

We have little hard evidence for this case and conclusions are complicated by difficulties remembering details with the passage of time. Some data support a possible exposure. The Fox MM-1 apparently alarmed. The corporal definitely developed blisters. One nurse who saw the injuries documented in the corporal’s medical records the possibility of a blister agent as the cause of the injury. One of the dermatologists opined that exposure to a blister agent likely caused the injury. However, most of what we have learned supports a different conclusion. There were no chemical warfare agent exposure effects experienced at the EPW holding area—no pain, no eye problems, nothing attributable to chemical warfare agent effects. No one else reported similar problems despite their proximity to the EPW equipment. Although the Fox alerted for lewisite, there is no evidence that Iraq ever had or employed this agent. There were no operational or medical reports of chemical warfare agent presence or exposure. All but one of the physicians and biochemists who reviewed this case agreed that it was unlikely that chemical warfare agents caused the Marine’s injury. Based on the corporal’s 1999 testimony, the combination of bleach and water and the M258 kit might be a plausible explanation for the blisters, but his later recollection that he used the M258 kit after a blister had already appeared would make it difficult to find a definite explanation. Consequently, we are unable to attribute a cause to the blisters, but we assess that it is unlikely that they were caused by chemical warfare agent exposure.

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