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 D) 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; 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 we do not expect to always have conclusive evidence, 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 our best judgment, 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 site—an enemy prisoner of war holding area—a Marine staff sergeant asked for their assistance in testing some captured Iraqi personal field equipment for the presence of chemical warfare agent. According to the corporal, the staff sergeant had tested this equipment with a chemical agent monitor and 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 exhibited 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 himself with a bleach and water solution. According to the corporal's account during an interview in 1999, he cleaned his right forearm with wipes from his personal decontamination kit before he washed both hands and arms in a bleach and water solution. In 2000, after reviewing a draft of this narrative, the corporal corrected his account to reflect that he washed both hands and arms in a bleach and water solution while at the enemy prisoner of war holding area, and did not wipe his forearm with the wipe from the decontamination kit until the following morning.
After cleaning his arm, the corporal left the prisoner of war holding area with the Fox vehicle commander and returned to his quarters. That evening, the corporal experienced severe skin irritation on his right forearm. The morning after his work with the captured equipment, the corporal noticed a blister about the size of a quarter in the middle of an irritated area on his right forearm. A corpsman (medic) 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 corporal’s right forearm. The medical staff at Al Jubayl treated the blisters with a bleach solution applied to a gauze dressing and prescribed an oral antihistamine to 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 corporal’s 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.
We initiated this investigation to determine if a chemical warfare agent caused the blisters on the Marine corporal’s right forearm. We sought to determine the cause of the corporal’s injury, the medical treatment of the injury, and the opinions of various medical experts. We interviewed members of the medical staffs, including dermatologists, who treated the corporal in 1991. We also interviewed chemical warfare specialists to determine if a chemical warfare agent could have caused the injury.
Medical doctors familiar with the treatment of chemical warfare agent injuries provided us with their opinions about the cause of 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 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.
Except for the corporal, no one in the area reported any effects of chemical warfare agent exposure. There were no chemical warfare agent injury reports from either the corporal’s chain of command or the medical community at Kibrit in March 1991. Because there were no chemical warfare agent exposure effects experienced at the EPW holding area and no one else reported similar problems despite their proximity to the EPW equipment; the Fox alerted for lewisite when there is no evidence that Iraq ever had or employed this agent, and the symptoms were inconsistent with lewisite exposure; there were no operational or medical reports of chemical warfare agent presence or exposure; and the medical and subject matter experts doubted the injury resulted from chemical warfare agent exposure, we assess that it is unlikely that a chemical warfare agent caused the corporal’s blisters.
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