DoD reassesses Gulf War soldier's exposure to mustard agent
WASHINGTON, October 26, 2000 (GulfLINK) - The Department of Defense issued today the updated version of its case narrative, "Reported Mustard Exposure Operation Desert Storm." In the latest report, investigators from the Office of the Special Assistant for Gulf War Illnesses re-assessed a soldier's exposure to mustard agent as "indeterminate." This differs from the original, interim report released in 1997, which determined that exposure to liquid mustard agent was "likely." The indeterminate assessment is based upon the conflicts between key pieces of physical evidence.
"Although we have changed our assessment from likely to indeterminate, it does not change the fact that a soldier was injured while on duty," said Bernard Rostker, the special assistant for Gulf War illnesses. "However, we are less sure of what caused the injury."
The report updates the investigation of events involving then-U.S. Army
Pfc. David A. Fisher who was diagnosed as having been exposed to liquid mustard chemical warfare agent while exploring enemy bunkers along the Kuwait-Iraq border.
Both the General Accounting Office and Presidential Special Oversight Board agreed with the 1997 initial overall assessment as presented, but indicated that additional investigation was needed to explain inconsistencies. After further inquiry, investigators determined that the physical evidence collected in the incident was too contradictory to decide the issue either way. The updated case narrative incorporates additional information obtained from Fisher, medical personnel, chemical warfare agent experts and other soldiers involved in the search-and-destroy mission with Fisher.
On March 1, 1991, Fisher's unit conducted a search-and-destroy mission for enemy ordnance located in bunkers along the Kuwait-Iraq border. Fisher reports that he searched more than 30 bunkers during a three-day period ending March 1, 1991. Several hours later, while on early morning guard duty, he noticed redness on his upper left arm, possibly caused, he believed, by a spider bite. Later that morning he noted blisters on his arm. The medic at the morning sick call initially diagnosed the blistering as a possible heater burn. Fisher was told to return for the afternoon sick call. When he returned, there were additional blisters on his arm. The medics re-examined the arm and suspected a chemical warfare agent injury. Fisher was treated for possible blister agent exposure.
A Fox Nuclear, Biological, Chemical Surveillance Vehicle was used to test the coveralls Fisher wore during the bunker searches. The Fox alarmed for phosgene oxime, thiophosgene, lewisite and sulfur mustard, but the MM-1 mobile mass spectrometer operator could not obtain a spectrum analysis for any of these chemical warfare agents. Sample patches of the coverall material were collected and sent forward with the vehicle analysis results.
Based on the preliminary diagnosis of possible blister agent exposure and the Fox alarms to mustard agent on his coveralls, 3rd Armored Division officials notified VII Corps headquarters of the suspected chemical injury. Two Fox vehicles were dispatched to search the area where it was believed Fisher had been exposed. After a two-hour search, one Fox vehicle reportedly alarmed for slight mustard contamination in a bunker located in the area where Fisher's unit had operated on March 1, but no evidence of this alert was found. The second Fox did not detect any chemical warfare agent. Intelligence assessments and United Nations Special Committee on Iraq (UNSCOM) findings were that Iraq did not deploy chemical warfare agents south of Khamisiyah. Although there was some speculation that the contamination resulted from weapons storage during the Iran-Iraq War, the bunkers in this area did not exist until 1990.
Meanwhile, Fisher was transported to the next higher echelon medical facility at the 45th Support Battalion. There the senior medical officer confirmed the diagnosis of blister agent exposure, photographed the injury, treated Fisher with a topical antibiotic and dressed the injury. Fisher returned to his unit in full duty status.
Col. Michael Dunn, a physician and medical expert on chemical warfare injuries examined and interviewed Fisher. Dunn also interviewed the medics at the unit aid station. Even though it was medically possible that Fisher's injury could have been caused through means other than chemical warfare agents - Dunn did not believe this was the case.
Dunn assessed Fisher's injury as a chemical warfare agent injury citing a number of reasons. The eight-hour, delayed onset of symptoms from the time of suspected exposure to the formation of blisters is consistent with mustard agent. The appearance of the injury, though not extensive, was consistent with blister agent injuries. U.S. forces had been briefed that there was a high probability for the presence of Iraq's chemical weapons on the battlefield. Fisher was forced to squeeze his way through one bunker making contact with many surfaces thereby soiling his clothing and equipment. Mustard agent is extremely persistent, meaning harmful contamination could have remained in the bunker for an extended length of time before Fisher made contact.
The injury itself appeared consistent with exposure to mustard agent, though the small extent of the injury and absence of any other medical complications indicated a fairly limited exposure. Dunn reported that Fisher felt fine except for mild local pain at the injury site. More serious exposures can result in damage to the respiratory tract, vomiting, diarrhea, and burns or blisters to the eyes, mucous membranes, lungs and skin. Other than the four small blisters on his left arm, Fisher showed no other symptoms. In a post-war interview, Fisher reported that he also had scars on one leg from blisters, but these were not noted at the time of the injury or in his medical records.
Dunn also secured a urine specimen to be tested for the presence of thiodiglycol, a mustard breakdown product. A positive test result would support the argument for mustard exposure. The urine sample was transported to the U.S. Army Medical Research Institute of Chemical Defense, Aberdeen, Md., for analysis. The sample tested negative for the presence of thiodiglycol, indicating no exposure to mustard. Dunn believes it is possible to obtain a negative test result if the original exposure was at a very low level, which would be consistent with the limited blistering Fisher experienced. However, without the positive urinalysis, there is no way to be certain that the blisters were caused by mustard agent exposure.
The 1997 case narrative included reports of a second urinalysis that was reportedly performed in-theater and produced positive results for the mustard breakdown product. The unsubstantiated reports of the second test were in error. Interviews with Dunn, the VII Corps Chemical Officer, the 3rd Armored Division surgeon, and the non-commissioned officer-in-charge of the 4-8th Cavalry aid station confirmed no second urinalysis was conducted.
A second Fox test of Fisher's coveralls was ordered to confirm the original MM-1 readings. However, the coveralls had by that time been buried as contaminated waste. The Fox company still had Fisher's flak vest and two Fox vehicles were used to analyze it. Both vehicles' MM-1 alarmed for mustard and lewisite, but the company commander reported that they were unable to obtain a spectrum printout of mustard because of high concentrations of fat, oil or wax contaminants. The entire analysis process was videotaped.
After testing, the flak vest, the company commander's protective gear and Fox sampling wheels used during the test were packaged with Fisher's flak jacket and coverall cloth samples and sent to division chemical office. Three Fox test printouts - the original coveralls test and the two flaks vest tests - were sent. Investigators were able to obtain two of the reports. Theses didn't confirm the presence of any chemical warfare agent.
The videotape showing the MM-1 screen indicates a MM-1 spectrometer interpreted the sample contained sulfur mustard. A subject-matter expert at the Chemical and Biological Defense Command reviewed the video in 1993 and based on that evidence believed it showed a correct mustard detection. However, in 2000, detailed analysis of the videotape revealed that several ions necessary for mustard were missing from the sample. All other Fox results were negative for the mustard spectrum. The CIA and Defense Intelligence Agency doubt mustard caused the blisters and do not regard the Fox MM-1 spectrum as a valid indication of mustard agent exposure.
On one hand, the characteristic nature of the blister injury itself; the Fox vehicle alarms during testing of the coveralls, flak vest and a suspected bunker; expert evaluation by medical and chemical warfare injury experts; and the videotape appear to indicate mustard exposure. However, the lack of a chemical warfare agent sample and a confirming spectrum analyses from the Fox vehicles, negative urinalysis, negative test results of the flak vest at stateside test facilities, and failure to positively identify a contaminated bunker leave open enough questions to make this assessment indeterminate.
"There are just too many questions that remain for us to conclude that Fisher was exposed to mustard agent," concluded Rostker.
Veterans with new or additional information should call the veterans' hotline at (800) 497-6261. This case narrative, along with all other reports released by the special assistant's office, is available on the GulfLINK website.