A. Background

1. Incident Report

In February 1998, investigators from the predecessor of the Office of the Special Assistant for Gulf War Illnesses, Medical Readiness, and Military Deployments interviewed Navy doctors and medical personnel about various issues. During these interviews, two nurses and one member of Fleet Hospital 15's administrative staff described an incident that occurred at the hospital in Al Jubayl, Saudi Arabia, in early March 1991.

According to a nurse on duty at the time of the incident, approximately 15 to 20 Marines from the 2d Reconnaissance Battalion appeared at the hospital seeking treatment for what she thought doctors diagnosed as symptoms of chemical warfare agent exposure. According to the nurse, hospital personnel admitted seven of these Marines for treatment and had to place one on an intubator due to severe respiratory ailments.[2] The assistant chief of the hospital's Casualty Receiving Area and another nurse, both on duty at the time, made similar statements to our investigators regarding the treatment of these Marines.[3] None of these three persons treated these Marines; however, one thought this incident was so significant that he photocopied the casualty receiving records, retained them, and later provided us those records for this investigation.

2. The 2d Reconnaissance Battalion

a. Organization

In December 1990 the 2d Reconnaissance Battalion, 2d Marine Division (MARDIV), Fleet Marine Force Atlantic deployed to the Persian Gulf as an operational component of the I Marine Expeditionary Force. The battalion's subordinate commands included a Headquarters Company and Companies B, C, and D (Company A was detached before January 1991). These companies’ personnel divided into 29 reconnaissance teams, of which 24 were motorized with 48 high-mobility multi-purpose wheeled vehicles (HMMWVs).[4] This narrative covers activities that occurred between February 4, 1991 and March 17, 1991.

The Marines involved in this investigation belonged to teams of Company B, which consisted of the company commander and three reconnaissance platoons. The reconnaissance platoons’ teams consisted of a team leader and five to seven Marines.[5] Six Marines from Company B reported experiencing the blisters we investigated. Figure 2 illustrates those Marines’ position in the company's chain of command.

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Figure 2. 2d Reconnaissance Battalion organization

b. Mission

The 2d Reconnaissance Battalion supported the 2d MARDIV by conducting reconnaissance and surveillance of the areas forward of Coalition defensive positions. The battalion’s task was to identify enemy units south of the breaching sites and gaps or weaknesses in enemy defenses in those areas.[6] They accomplished this task by establishing observation posts along Kuwait's border and conducting reconnaissance patrols in that vicinity.

B. Sequence of Events

We primarily used veterans’ accounts, supported where possible by documented evidence, such as watch logs, unit chronologies, and Gulf War histories to develop this chronology. Figure 3 graphically depicts the time-line of these events.

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Figure 3. Timeline of events

1. Pre-Ground War Activities

On January 29, 1991, Iraq's units probed across the Saudi Arabian border three times, once in the 2d MARDIV's area of responsibility. This prompted the division commander to move the 6th Marine Regiment forward to provide a defensive front for the 2d MARDIV. At this time Company B was detached from the 2d Reconnaissance Battalion to support the 6th Marines, which they did by establishing listening and observation posts four kilometers south of Kuwait’s border. On February 4, 1991, the observation posts moved forward two kilometers to a man-made berm parallel to Kuwait’s border that concealed them from observers north of the position. Five days later, the 8th Marines relieved the 6th Marines. Company B remained in position (Figure 4).[7]

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Figure 4. Observation post locations on February 10, 1991

a. Symptoms Develop (February 4-14, 1991)

Between February 4 and 14, 1991, six Marines from Company B reported developing what they have described as bumps, blisters, or sores on their hands, ears, and necks. These Marines were from different teams and different platoons, and were assigned to different observation posts. Five Marines were from the 1st Platoon: one from the first reconnaissance team, one from the second, and three from the third reconnaissance team. The sixth Marine to report experiencing these symptoms was 3d Platoon's commander.[8]

The possibility of biological or chemical warfare was heavily emphasized during the Gulf War—Coalition forces expected Iraq’s forces to initiate chemical warfare.[9] Because of this expectation, the proximity of Company B's listening and observation posts to Iraq’s forces, and the obvious concern blisters result from some types of chemical warfare agent exposure, the company commander instructed these Marines to seek medical attention.[10]

At a rear area command post, corpsmen and various medical personnel examined the Marines. No one could diagnose a cause, but several speculated the blisters formed because of something the Marines contacted while digging in the sand at the berm. Because of the threat of chemical attack, someone tested the Marines and their equipment for chemical contamination with a chemical agent monitor (CAM), a portable, hand-held device capable of detecting blister or nerve agent contamination on personnel, equipment, and elements of the surrounding environment (Figure 5 and Tab E). The CAM alerted for the presence of chemical warfare agent on one Marine's glove, so field medical personnel prepared the Marines for decontamination procedures. However, after the operator cleared the CAM and retested the glove, there was no alert. The CAM operator decided the alert had been a false detection and decontamination procedures were unnecessary.[11]

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Figure 5. A chemical agent monitor

b. 8th Marines Regimental Aid Station (February 14, 1991)

Because the command post medical staff was unable to determine a cause for the blisters, the Marines traveled farther back to the 1st Battalion, 8th Marine Regiment’s battalion aid station. Medical personnel again examined the Marines but could not diagnose a cause. The Marines stayed overnight, showered, and the next morning continued further back to a larger aid station operated by the 8th Marine Regiment.[12]

At the regimental aid station, medical personnel inspected the blisters. At least one Marine remembered having one of the blisters opened for closer inspection and cleaning. Further inspection of the blisters prompted one unidentified individual to speculate the lesions could be the result of leishmaniasis, a parasitic disease spread by the bite of infected sandflies. This Marine recalled that medical personnel dismissed this explanation due to the absence of any other symptoms commonly associated with this condition, such as fever, fatigue, and abdominal discomfort.[13]

The Marines returned to duty. They were not incapacitated and their symptoms in no way hindered them from performing their daily tasks. Medical personnel had not diagnosed the blisters’ cause and advised only frequent daily hand-washing to treat the blisters. After approximately three to five weeks of daily washing, the blisters healed with no further complications.[14]

Little documentation describes the treatment of these injuries. In fact, after thoroughly searching medical records, unit histories, and watch logs, we could find only one reference to this incident. A 9:15 AM entry on February 14, 1991, in the 2d Reconnaissance Battalion's Watch Officer Log reads:

MSG [message] Received from "B" Co. 1.) Still maning [sic] OP [observation posts] F + D 2.) They have 6 people w/ blisters on hands and are being looked at by 8th MAR M.O. [medical officer] 3.) They wanted to know the status of their HMMWV alternator 4.) They also requested that LCPL [redacted] out of Combat Replacement Co return to BN [battalion].[15]

Company B rejoined the 2d Reconnaissance Battalion on February 18, 1991, as the unit prepared for the ground offensive.[16]

2. Ground War Activities (February 24-26, 1991)

The 2d Reconnaissance Battalion moved through the minefield breaching lane behind the 6th Marines on February 24, 1991, after which the battalion supported the 2d Battalion, 4th Marine Regiment during the final assault from Phase Line Horse to Phase Line Bear (Figure 6), providing navigational support and additional firepower with HMMWV-mounted machine guns.[17] All the Marines who experienced the reported symptoms were with the unit at this time and participated in these events unhindered by any ailments.[18]

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Figure 6. Movement of the 2d Reconnaissance Battalion on February 26, 1991

3. Fleet Hospital 15 (March 11-17, 1991)

Between March 11 and 17, 1991, approximately one month after field medical personnel examined the Marines at the 8th Marines' regimental aid station, doctors at Fleet Hospital 15 in Al Jubayl treated three Marines from Company B, including the 1st platoon commander, for symptoms attributed to respiratory ailments, and another for a broken jaw. According to the hospital's admission logs, these were the only instances between February 10 and March 21, 1991, that anyone from the 2d Reconnaissance Battalion was admitted to this hospital. Two of the casualties eventually were medically evacuated.[19]

One of the Marines in the group treated for respiratory ailments in March was a corporal from 1st Platoon's third reconnaissance team who had developed blisters before the ground campaign. On this Marine's hand where the blisters were healing were minor scars. When doctors asked about them, the Marine recounted his treatment at the 8th Marines' aid station. It may have been unclear to hospital staff what caused the blisters, but doctors did not find the scars severe enough to require any treatment. Fleet Hospital 15 personnel later reported the treatment of these 2d Reconnaissance Battalion Marines to our office as a nuclear, biological, or chemical (NBC) incident. When questioned, both the Marine corporal and the 1st Platoon commander stated they went to Fleet Hospital 15 in March 1991 for treatment of respiratory ailments they associated with inhaling oil well fire smoke, not chemical warfare agent exposure or the blisters that developed before the ground war.[20]

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