One prominent hypothesis about illnesses among Gulf War veterans is that some of the reported symptoms are the result of exposure to chemical warfare agents. During and after the Gulf War, some veterans reported that they had been exposed to chemical warfare agents. To investigate these incidents, and to assess the likelihood that chemical warfare agents were present in the Gulf, the Department of Defense developed a methodology for investigation and validation based on work done by the United Nations and the international community. The criteria include:
While the methodology (Tab C) used to investigate suspected chemical warfare agent incidents is based on these protocols, the passage of time since the Gulf War makes it difficult to obtain certain types of documentary evidence, and physical evidence was often not collected at the time of an event. Therefore, we cannot apply a rigid template to all incidents, and each investigation must be tailored to its unique circumstances. Accordingly, we designed our methodology to provide a thorough, investigative process to define the circumstances of each incident and to determine what happened. Alarms alone are not considered to be certain evidence of chemical warfare agent presence, nor is a single observation sufficient to validate the presence of a chemical warfare agent.
After following our methodology and accumulating anecdotal, documentary, and physical evidence; and after interviewing witnesses and key servicemembers; and after analyzing the results of all available information, the investigator assesses the validity of the presence of chemical warfare agents on the battlefield. Because information from various sources may be contradictory, we have developed an assessment scale (Figure 1) ranging from Definitely Not to Definitely, with intermediate assessments of Unlikely, Indeterminate, and Likely. This assessment is tentative, based on facts available as of the date of the report publication; each case is reassessed over time based on new information and feedback.
Figure 1. Assessment of Chemical Warfare Agent Presence
The standard for making the assessment is based on common sense: Do the available facts lead a reasonable person to conclude that chemical warfare agents were or were not present? When insufficient information is available, the assessment is Indeterminate until more evidence can be found.
Two weeks after the Gulf War cease-fire on February 28, 1991, a US Marine corporal at Kibrit, Saudi Arabia, developed blisters on his right forearm. The Marine stated that on the day he sustained the injury, March 12, 1991, he and the commander of his XM93 Fox Nuclear, Biological, and Chemical Reconnaissance Vehicle were on a routine training mission demonstrating the capabilities of the vehicle to Marines in the Kibrit area. At one demonstration sitean enemy prisoner of war holding areaa Marine staff sergeant asked for their assistance. According to the corporal, the staff sergeant had tested some captured Iraqi personal field equipment with a chemical agent monitor and had received a positive indication of a chemical warfare agent. The corporal, assisted by the staff sergeant, tested the captured equipment with the Fox vehicle's chemical agent analysis system. The corporal reported that the Fox vehicle's MM-1 mobile mass spectrometer indicated the possible presence of the chemical warfare agent lewisite on some of the equipment. However, since none of the enemy prisoners of war or Marines in the area were exhibiting symptoms consistent with exposure to this chemical warfare agent, the corporal and the staff sergeant did not send an incident report and continued to test additional enemy equipment for several hours. Before leaving the enemy prisoner of war holding area, the corporal washed up. According to the corporal's account during interviews in 1998 and 1999, he wiped his right forearm with a chemically-treated wipe contained in his personal skin decontamination kit and then washed both hands and arms in a bleach and water solution. Some hours later, the corporal experienced severe skin irritation on his right forearm. However, in January 2000, after reviewing a draft of this document, he revised the order and timing of his use of bleach and water and the personal decontamination kit. What did not change was his account of the discomfort and irritation that followed and the subsequent medical treatment.
The morning after his work with the captured equipment, the corporal noticed a quarter-sized blister in the middle of an irritated area on his right forearm. A corpsman treated the corporal at a battalion aid station. On March 15, 1991, three days after the irritation reportedly began, the corporal went to the US Navy medical battalion at Al Jubayl, Saudi Arabia. By this time, more blisters had formed on the corporals right forearm. The medical staff at Al Jubayl treated the blisters with a bleach solution applied to a gauze dressing and they prescribed an oral antihistamine to further reduce itching. The corporal had a follow-up examination on March 18, 1991. He continued the treatment of bleach solution on a gauze bandage and he continued to take the antihistamine. A physician at the medical battalion in Al Jubayl recommended that the corporal see a dermatologist at the Balboa Naval Medical Center in San Diego, California, as soon as he returned to the United States.
The corporal was reassigned to Yuma, Arizona, and arrived there on April 10, 1991. He received treatment in San Diego on May 21, 1991, where the medical staff continued the bleach solution and oral antihistamine treatment and took photographs of the corporals scarred forearm. The corporal said he sought no additional medical treatment for the blisters that eventually cleared up within six months. The corporal said a blister did form for a short time in the same area in May 1992.
This investigation was initiated to determine if a chemical warfare agent caused the blisters on the Marine corporals right forearm. We concentrated on determining how the corporal was injured, the medical treatment of the injury, and the opinions of various medical experts. We have consulted members of the medical staffs, including dermatologists, who treated the corporal in 1991, and with chemical warfare specialists to determine if a chemical warfare agent could have caused the injury.
Medical doctors familiar with the study and treatment of chemical warfare agent injuries provided our office with their opinions about the corporal's blisters, as did four dermatologists. Based on the evidence, including photographs of the pattern of blisters on the corporal's arm, these medical experts generally believe it is unlikely a chemical warfare agent caused the blisters. Because there are many possible causes for the blisters, the experts could not, with absolute certainty, rule out the possibility of a chemical warfare agent injury.
However, neither the corporal nor anyone else working with the corporal that day, or in the area, experienced any immediate effects of chemical warfare agent exposure or put on chemical warfare protective clothing. The blisters occurred only on the corporal's right arm and there were no chemical warfare agent injury reports from either the corporals chain of command or the medical community at Kibrit in March 1991. Therefore, we assess that the possibility a chemical warfare agent caused the corporals blisters is unlikely.
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