Master Sgt. Darryl Sterling tosses trash into a burn pit in Iraq in 2008. Image: Julianne Showalter/Air Force
In a nation of booming health costs, most focus is placed on aging Baby Boomers. But there's another huge group facing a health crisis that's underfunded and still not full understood: the 175,000 to 250,000 Gulf War veterans suffering from Chronic Multisymptom Illness (CMI), more commonly known as Gulf War Syndrome. That number may soon balloon. According to a new report from the federal Institute of Medicine, some of the 2.9 million veterans of the most recent wars in Iraq and Afghanistan have started to display CMI symptoms.
The key paragraph from a brief (PDF) on the IoM's report:
In addition to the 1991 Gulf War veterans, the committee refers to two other groups of Gulf War veterans: Iraq War veterans and Afghanistan War veterans. As of September 2011, 2.6 million U.S. military personnel had been deployed to the Iraq or Afghanistan war theaters. These troops included more women than the 1991 conflict, are comprised of more National Guard and reserves, have been exposed to more hostile fire and improvised explosives, and have served longer deployments. Many symptoms reported by Iraq and Afghanistan war veterans, including headaches, chronic pain, disrupted sleep, fatigue, and attention and memory problems, overlap with symptoms experienced by 1991 Gulf War veterans.
The report drives home a fact that's long dogged those affected by Gulf War Syndrome: There's no single ailment indicative of the condition, which means there's no single course of treatment for CMI. Additionally, because CMI encompasses such a wide range of ailments, which can include symptoms that may overlap with other battlefield-induced health issues like PTSD, there isn't a medical consensus as to what specifically caused (and causes) CMI.
That's left many veterans battling to prove that their ailments are battlefield-related in order to receive medical benefits. If CMI is also occurring in Iraq and Afghanistan veterans, which the IoM reports shows, the nation's military and veteran's affairs organizations have a growing health problem on their hands. And CMI encompassing more than one set of symptoms doesn't give those agencies an excuse to deny assistance, as the IoM notes:
There is no single description of the stresses endured by U.S. military personnel deployed to the 1991 Gulf War and to the wars in Iraq and Afghanistan. They are personal and many. While the cause or causes of the many symptoms experienced by veterans who have CMI remain unknown, this lack of clarity does not undermine the legitimacy of veterans’ reports of symptoms.
That means dealing with CMI can't be solved by simply implementing a specific treatment plan nationwide. Because CMI now encompasses such a broad range of conditions, outreach and health programs need to be designed to create personalized assessment and treatment plans.
"Based on the voluminous evidence we reviewed, our committee cannot recommend using one universal therapy to manage the health of veterans with chronic multisymptom illness, and we reject a 'one size fits all' treatment approach," said committee chair Bernard M. Rosof in a statement. "Instead, we endorse individualized health care management plans as the best approach for treating this very real, highly diverse condition."
The IoM report comes about a month after a blockbuster report by Tuite and Haley that showed evidence that more Gulf War veterans were exposed to the neurotoxin sarin gas than previously assessed by the military, and that such exposure led to a number of CMI symptoms. That on its own is a hugely contentious issue, and one that the Pentagon officially does not agree with. But if veterans of the Iraq and Afghanistans wars, which did not see sarin gas use in significant quantities, also are beginning to display CMI conditions, that means CMI is a more complex set of conditions than it's often portrayed.
The IoM found that brain injuries, whether from blunt force trauma or concussive force from being near explosives, were prevalent among veterans of the most recent wars, as well as PTSD-like symptoms. Additionally, those veterans also showed high rates of respiratory illnesses, which is also common with Gulf War vets.
According to the IoM, respiratory illnesses are partly due to trash-burning in the field–Stars and Stripes notes that some burn pits can go through 240 tons of waste a day. But airborne bacteria and heavy-metals are also to blame. That opens up another can of worms for CMI advocates, as the military's heavy use of depleted uranium in the Gulf War has been heavily debated as a cause of some CMI symptoms. Heavy metals include a lot more than just DU, but veterans fighting and living on the same battlefields as the last war face the possiblity of exposure to DU that persists in the ground.
The takeaway from the IoM's long study is pretty straightforward: CMI encompasses far too broad a range of symptoms for regulators and officials to try to create a specific set of guidelines for treatment, and doing so means a number of veterans will be blocked from effective health treatment. The solution is more complicated, especially as the medical problems afflicting Iraq and Afghanistan veterans continues to be assessed. But it's a matter of beaurocracy versus medicine: Officials cannot operate under the assumption that there is a single set of CMI symptoms, and that others are somehow fake. Instead, for the sake of our veteran's health, officials need to develop comprehensive plans that offer doctors the freedom to assess individuals on a case-by-case basis and prescribe treatments accordingly.