Neurologic Damage in Gulf War Syndrome

Finally. Now there is clear evidence that the symptoms associated with Gulf War Syndrome (sometimes called CMI or chronic multisystem illness) have a biological basis. Recent studies have revealed that veterans of the Persian Gulf War who have been complaining of chronic fatigue, muscle and joint pain, gastrointestinal symptoms, problems of cognition and depression) have areas of their brains that have atrophied (become smaller) and that their physical response to pain and exercise is different from that of control patients. The cause of this condition is not known, but it is strongly suspected that exposure to nerve gas that was released when we destroyed Saddam Hussein's chemical weapon stockpile is the culprit. Other suspected causes include infectious agents, vaccines, and exposure to other toxins - especially when waste is burned to dispose of it. That is why CMI is sometimes called "burn pit" disease.
     Many CMI symptoms are similar to other medical conditions that do not have an obvious cause; these include fibromyalgia and chronic fatigue syndrome. It is interesting that when physicians are faced with treating debilitating symptoms that have no obvious cause, there is a tendency to blame the patient's psyche. The medical euphemism used by doctors is to describe the patient as suffering from a "functional disorder." Without saying so, the doctor is suggesting that the illness is a "function" of the patient's inability to deal with his or her symptoms. It would be more accurate to say the patient has a condition of "undetermined etiology or cause" because the lack of clear diagnosis is often a consequence of the physician's inability to figure out what is causing the symptoms.
     Another commonly used term is "idiopathic" which literally means that the illness is caused by itself. Calling a condition idiopathic sounds more academic than admitting that we are clueless about what causes it. The difference between idiopathic and functional is that idiopathic illnesses are accepted as having a real or organic basis. Not so with functional illnesses where the physician believes it is more likely than not that the cause resides somewhere "in the patient's head." There can be a real dilemma sorting out which symptoms are psychological and which are organic because patients who have chronic symptoms - especially pain -  tend to become anxious or depressed because of the illness.  This is called somatopsychic illness; when anxiety and depression cause physical symptoms or make them worse, the condition is referred to as psychosomatic.
     Even though many physicians still believe that Gulf War Syndrome is a functional illness brought on by exposure to the stress of combat, to its credit, the Veterans Administration has granted benefits to most Gulf War veterans who have filed for disability because of these symptoms.  The military has been tracking patients with MSI using a voluntary registry, but it is probable that many veterans who would be eligible for benefits are not receiving them.

     As discussed in a previous post, 80 percent of veterans receive their healthcare from sources outside of the VHA, but most civilian physicians do not routinely take a Military Health History to determine whether their patients ever served in the military. Similarly, without a prompt, most veterans do not tell their doctors if they served, when and where they were stationed, and if they were exposed to known toxic substances. Without this information, a civilian physician would be unlikely to make the correct diagnosis of Gulf War Syndrome in a symptomatic patient. It is imperative that all patients be asked these questions and that their responses be entered into their electronic medical records. Veterans also need to be proactive and tell their physicians where and when they served  even when physicians did not ask for this information.