Case narratives, information papers, and environmental exposure reports are the main products of OSAGWI. Case narratives are reports on the investigations into possible exposures to chemical and biological agents. Information papers provide background material such as the strengths and limitations of chemical alarms and detection equipment which helps veterans understand the findings reported in the case narratives. As of the fall of 2000, OSAGWI had published 24 case narratives and 9 information papers. These are available on the Internet at www.gulflink.health.mil.
Considerable attention has been paid to the possible exposure of Gulf War veterans to chemical and biological agents; however, other adverse exposures could also have impacted their health. Therefore, OSAGWI initiated a number of environmental exposure reports to focus on hazards veterans may have encountered. These reports address the possible exposure of U.S. troops to such substances as depleted uranium (DU), oil well fires, and pesticides. These studies differ significantly from the work on specific chemical warfare incidents. They are not designed to assess the likelihood of exposure to a specific agent at a specific place and time, but rather to provide a more general understanding of the hazards faced by our forces. Six environmental exposure reports had been published by the fall of 2000.
To complement OSAGWIs investigation of the Gulf War exposures, and to assess the possible health risk impacts of a number of other factors, RAND prepared reports on the existing scientific literature on other possible causes of illnesses among Gulf War veterans: infectious diseases, pyridostigmine bromide, immunizations, stress, chemical and biological warfare agents, oil well fires, depleted uranium, and pesticides.
The events surrounding the release of low-levels of sarin and cyclosarin at Khamisiyah, and the issue concerning the possible health effects of the military use of depleted uranium are two of the most important investigations conducted by OSAGWI.
The events surrounding Khamisiyah dominated the activities of OSAGWI in 1997. Their inquiry focused on what had happened at Khamisiyah and why it had taken so long for DoD and the CIA to realize chemical munitions had been destroyed there in March 1991.
In June 1996, when DoD announced that it was likely that U.S. troops had unknowingly destroyed chemical nerve agent-filled rockets at Khamisiyah, it raised the questions of who was potentially exposed and to what level they may have been exposed. In order to reduce uncertainties, DoD and the CIA undertook extensive testing at the Armys Dugway Proving Grounds in Utah to determine the effects of destroying stacks of chemical-filled 122-mm rockets in an open pit. The location and movement of troops in the Khamisiyah demolition area at the time of the demolition were researched from classified and unclassified sources. By combining the results of these efforts, estimates were developed showing the units that were most likely exposed. In July of 1997, OSAGWI and VA notified the individuals in those units that:
Since the time of the initial notification, there is still "inadequate/insufficient" evidence that these possible low-level exposures caused any immediate poisoning effects or can be linked with the health complaints of veterans. This was documented in the September 2000, IOM Report on Gulf War and Health: Volume 1. An independent report by the Army Inspector General substantiated published reports concerning the events that took place at Khamisiyah. In addition, OSAGWI and the CIA issued seven reports on Khamisiyah, the last one in December 2000.
For this last report, numerous in-depth conferences with Gulf War operations officers were held to improve the accuracy of unit location and the personnel database. OSAGWI also submitted the analysis of the potential exposure area to a rigorous independent scientific peer review, involving experts in weather, weather modeling and atmospheric physics from academia and the National Oceanographic and Atmospheric Administration. Additionally, new information from the U.S. intelligence community and DoDs chemical defense community increased understanding of the chemical warfare agents released. Those efforts culminated in improvements to the 1997 modeling effort that included:
It should be noted that many Gulf War veterans with symptoms of undiagnosed illnesses were not positioned anywhere near the low concentrations of nerve agent released at Khamisiyah.
Depleted Uranium (DU)
Depleted uranium became an important concern when claims arose that the battlefield was contaminated by DU, possibly causing some of the symptoms experienced by Gulf War veterans. OSAGWIs report on DU culminated nearly two years of investigation and analysis involving hundreds of interviews with veterans, reviews of scientific literature, discussions with scientists in the fields of health physics, nuclear medicine, and occupational health, and consultations with Government and civilian agencies. The report highlighted VAs follow-up on veterans who had confirmed exposures to DU during the Gulf War. VA continues to monitor the health of these soldiers, and in 1998, began offering a 24-hour urine test for DU to veterans with concerns about possible DU exposure.
The report acknowledges that some U.S. soldiers were exposed to DU through inhalation or ingestion of fumes and dust. Approximately 100 veterans were exposed to DU fragments and particles when their armored vehicles were damaged in friendly-fire incidents. It also identifies training lapses for troops operating in environments where DU was present, and some lessons learned to be implemented for future deployments.
Several organizations reviewed the limited existing medical literature on DU and the much more voluminous literature on natural uranium. A sample includes:
The NIH, 1994 Journal of the American Medical Association: "Uranium, a heavy metal, causes kidney damage and when inhaled can accumulate in the lungs, but no pulmonary toxicity has been reported. The symptoms reported among the Persian Gulf veterans do not appear to be related to the heavy metal uranium."
The PAC, 1996 Final Report: "It is unlikely that health effects reported by Gulf War veterans today are the result of exposure to DU during the Gulf War."
The General Accounting Office report of March 2000: This report noted that reviews by RAND and the Agency for Toxic Substances and Disease Registry concluded, "current evidence suggests that radiation from inhaled or ingested depleted uranium is an unlikely health hazard."
The Presidential Special Oversight Boards Interim and Final Reports agree that while DU can pose a chemical toxicity and radiological hazard under specific conditions, " the Board believes that after review of the available evidence to date, exposure to DU is unlikely to be the cause of the unexplained illnesses affecting Gulf War veterans." The recent IOM Report on Gulf War and Health: Volume 1 also provides strong support for these conclusions on DU.
Other Narratives and Information Papers
In addition to the Khamisiyah report, OSAGWI published several case narratives on reported exposures to U.S. Marines as they moved throughout the battlefield around Kuwait City. OSAGWI also investigated a suspected chemical agent detection at a Kuwaiti girls school, and other suspected detections by Czech and French forces. In all cases, chemical agent detection devices had produced initial false-positive readings in the presence of substances other than chemical warfare agents.
A case of particular interest involved a reported exposure of a soldier to liquid mustard chemical warfare agent that occurred in March 1991. The investigation of this incident resulted in a case narrative published in 1997. After a soldier received burns on his arm following entry into enemy bunker complexes, doctors concluded that those injuries were most likely caused by exposure to mustard agent. Later analyses of physical evidence, as described in a report in October 2000, were unable to confirm the exposure.
OSAGWI also produced nine information papers on such topics as chemical protection equipment, inhibited red fuming nitric acid, Iraqs scud missiles, and medical record-keeping. All are available for review on the Internet at www.gulflink.health.mil.
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