2023 Fall GAPNA Newsletter Volume 42 Number 3

Gulf War Veteran and Toxic Exposure

How Can Healthcare Providers Be of Assistance?

By Ronnita Usher, APRN, FNP-BC, FNP-C, GS-C

Ronnita Usher, APRN, FNP-BC, FNP-C, GS-C

Ronnita Usher, APRN, FNP-BC, FNP-C, GS-C

A Gulf War Veteran is anyone who served on active duty from August 2, 1990, to the present. Over 650,000 service members served in Operation Desert Shield and Desert Storm. During the Gulf War, the demographic characteristics included older veterans, almost 7% of women, and approximately 17% from the National Guard and Reserve units. After wartime, some soldiers began to report health problems believed to be connected to their service (National Library of Medicine, 1999; War Related Illness and Injury Study Center, 2022).

In August of 1990, U.S. soldiers were deployed to Kuwait. Additionally, a coalition of 41 countries went into battle with almost one million soldiers, including the United States. U.S. casualties were low compared to other wars, but exposure to a number of stressors remained high. Some of the stressors that U.S. soldiers were exposed to were chemicals, such as oil fire smoke, diesel and jet fuel, insect repellants, depleted uranium, anthrax and botulinum vaccines, and pyridostigmine bromide pills. Environmental exposures included sand, extreme heat, exposure to dead and mutilated bodies, and being in an unfamiliar character region. Finally, they were exposed to combat-related stressors such as (the Air Standards Coordinating Committee) Scud missile attacks, multiple chemical alarms, and repeated deployments to conflict (National Library of Medicine, 1999).

Reported symptoms and problems during the Gulf War included fatigue, mood disturbances, cognitive impairment, muscle and joint pain, shortness of breath, and skin rash. As a result of these reports, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) worked closely together to develop programs to examine Gulf War veterans and treat their illnesses (National Library of Medicine, 1999; War Related Illness and Injury Study Center, 2022). Veterans who served during the Gulf War period are encouraged to seek guidance from the VA or DoD related to symptoms and or problems during wartime.

Presumptive conditions for Gulf War Veterans include chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders, cardiovascular symptoms, muscle and joint pain, headaches, and chronic multi-symptom illness. Infection diseases considered presumptive within one year of separation are brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), malaria, nontyphoid salmonella, shigella, and West Nile virus. Mycobacterium tuberculosis and visceral leishmaniasis are presumptive infectious diseases at any time after separation (War Related Illness and Injury Study Center, 2022).

Open burn pits are open bits that include chemicals, paint, medical and human waste, metal and aluminum cans, munitions and unexploded ordnance, petroleum and lubricant products, plastics, rubber, wood, and food waste (U.S Department of Veterans Affairs, n.d.b).

Burn pit exposures are presumptive conditions including brain cancer, gastrointestinal cancer, glioblastoma, head cancer, lymphatic cancer, lymphoma, melanoma, neck cancer, pancreatic cancer, reproductive cancer, squamous cell carcinoma (SCC) of the larynx and trachea, adenocarcinoma, salivary gland-type tumors, adenosquamous carcinoma of the lung, large cell carcinoma of the lung, salivary gland-type tumors of the lung, sarcomatoid carcinoma of the lung, typical and atypical carcinoid of the lung, asthma diagnosed after service, chronic bronchitis, chronic obstructive pulmonary disease (COPD), chronic rhinitis, chronic sinusitis, constrictive bronchiolitis or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease (ILD), pleuritis, pulmonary fibrosis, and sarcoidosis (U.S. Department of Veterans Affairs, n.d.a).

The Gulf War Registry, formally known as the Persian Gulf Registry, is a database that serves as the basis for future medical surveillance. The VA lead registry contains medical data of Gulf War veterans. The registry addresses questions about the possible future effects of exposure to pollutants and environmental agents. (National Library of Medicine, 1999). Exposure and presumptive conditions can be determined during the Gulf War registry exam, which is free to eligible veterans.

The DoD has a similar program called the Comprehensive Clinical Evaluation Program (CCEP). It provides a thorough clinical evaluation for the diagnosis of health problems of those veterans who served during the Gulf War. The CCEP assesses war-related- conditions, streamlines access to care, provides clinical diagnoses, and provides an extensive treatment plan. Together the VA and DoD work to coordinate care for those soldiers who served in the Gulf. Both programs are voluntary through the VA and the DoD (National Library of Medicine, 1999). As a result of the growing number of reported exposures, President Biden signed the PACT Act, which expands healthcare and benefits for veterans and their spouses.

The Promise to Address Comprehensive Toxic Act (PACT) Act is an expansion of benefits and services for toxic-exposed veterans. It will ensure veterans can receive quality health screenings related to potential toxic exposures and establishes a new process for evaluating and determining the presumption of exposure and service connection for various chronic conditions. It removes the need for certain veterans and their survivors to prove service connection if they are diagnosed with one of 23 specific conditions. Lastly, it also provides critical resources to VA to allow access to care and timely benefits for all eligible veterans (The White House, 2022).

So, what can non-VA or non-DoD healthcare providers do to assist those who served our country during the Gulf War?

  • VA recommends all providers caring for veterans outside of the VA by way of the Community Care Network contract complete training on the TRAIN LEARNING Network, which is a publicly available training site (The White House, 2022). https://www.va.gov/COMMUNITYCARE/docs/providers/VHA_TRAIN.pdf
  • Additionally, the VA encourages non-VA providers to use the Exposure Ed App to help provide information on side effects from exposure during military service (The White House, 2022). https://mobile.va.gov/app/exposure-ed
  • Non-VA providers should ask about the veteran’s military and deployment history
  • Specific locations and times of deployment and possible exposure
  • Recommend further evaluation with an environmental health clinic or expert in occupational and environmental exposures through the VA or DoD (National Library of Medicine, 1999; War Related Illness and Injury Study Center, 2022; The White House, 2022).

Ronnita Usher, APRN, FNP-BC, FNP-C, GS-C

References