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As benefits administrators, officials and politicians argue the worthiness of studies on Gulf War syndrome, researchers say they have no doubts that they've found the root of the problem.
And they have advice for as many as 300,000 troops exposed to small doses of sarin in 1991: Don't use bug spray, don't smoke and don't drink alcohol.
"Don't do anything that would aggravate a normal, healthy body," said Mohamed Abou-Donia, a neurobiology scientist at Duke University who conducted two studies for the Army.
Research released in early May showed that 13 soldiers exposed to small amounts of sarin gas in the 1991 Gulf War had 5 percent less white brain matter connective tissue than soldiers who had not been exposed. A complementary report showed that 140 soldiers who were exposed had the fine motor skills of someone 20 years older what researchers called a "direct correlation" to exposure.
The data was the work of Roberta White, chairwoman of the Department of Environmental Health at Boston University School of Public Health.
Her study was noteworthy because it was funded by the Veterans Affairs and Defense departments, and used Pentagon data to triangulate the locations of troops who were in the path of a huge sarin plume unleashed when U.S. forces destroyed an Iraqi chemical weapons dump in Khamisiyah in March 1991. The study also used new technology to look at troops' brains.
Of the 700,000 service members who served in Desert Storm, 100,000 have reported mysterious symptoms. Until recently, each study commissioned by the VA and Pentagon concluded the problems were caused by stress and had no physical cause.
"We've been asking for this for so long," said Denise Nichols, a Gulf War veteran who spends much of her time fighting for more information. "It's not surprising to me. It's what I would expect."
Nichols, like the other veterans, has heart palpitations, a cough, nose bleeds, joint aches, spine pain, twitching in her legs and leg pain. She also reacts to strong chemical smells with coughing so heavy she can't breathe, she said.
The issue surged to the fore in a Senate hearing Wednesday as Sen. Patty Murray, D-Wash., asked if the VA would send out letters to veterans who may have been affected, as they did to 100,000 troops at higher risk of brain cancer because of sarin exposure.
Murray called the study a "great example" of how recent research can provide guidelines for care. It seems easy enough: If a soldier complains of Gulf War syndrome, why not check him out with an MRI?
She called the study's findings "overwhelming," but noted that the VA's response, once again, was merely: "We're going to study this.
"They were told, ‘It's all in your head, you're making it up.' Now there is a study that provides a direct link. They deserve to know the answer," Murray said.
Sen. Bernie Sanders, I-Vt., called the research "profound."
"We started out by denying there was any problem," he said. "It shows that many soldiers may have suffered brain damage."
Dr. Gerald Cross, acting principal deputy undersecretary for health at the Veterans Health Administration, agreed with Murray that troops deserve answers.
But Cross said Sanders' description of the findings "is different from how I read it." Cross called the findings of White's research a "slight anatomical variation."
The debate over this issue goes back 16 years to when U.S. forces blew up the chemical munitions dump in Khamsiyah and released a plume of sarin gas to which thousands of U.S. troops were exposed something the Pentagon denied until 1997.
As more research was done, and as veterans systematically sought details through the Freedom of Information Act, scientists showed Desert Storm vets exposed to sarin were at higher risk for brain cancer. And the veterans eventually showed the Pentagon knew that as many as 300,000 service members had breathed in small doses of the toxic fumes.
Paul Sullivan, of Veterans for Common Sense, said he filed FOIA requests in 1994, and then helped ensure research was made public that showed veterans were not making up their illnesses.
Eventually, 10 years after the Gulf War, the Research Advisory Committee on Gulf War Veterans' Illnesses was created by Congress. It held meetings to determine what needed to be done, to review research, and to fund further research outside the VA and Defense Department, Sullivan said.
"That's why, in the last few years, you've seen all the sarin, depleted uranium and pyridostigmine bromide research," Sullivan said. "It's a bittersweet victory because people waited so long."
To date, he said, no one has contradicted that research. As such, Sullivan said he thinks every Gulf War veteran should automatically be presumed to have been exposed to sarin.
In 1999, working on behalf of the Rand Corp., Beatrice Golomb, professor of internal medicine at the University of California, San Diego School of Medicine, reviewed every study she could find on the issue. She said it was the first time anyone had pulled all that research together.
Golomb said she found a link between symptoms of Gulf War veterans and their exposure to sarin, pyridostigmine bromide (PB) and bug repellent, all of which overstimulate muscles by inhibiting acetylcholinesterase, a chemical that signals muscles to stop moving. The tongue, being a big muscle, eventually cuts off a person's ability to breathe if it is overstimulated.
In the case of the bug repellent, the ill effects are aimed at the bug, not the person wearing the repellent.
In large enough amounts, PB is harmful, but in small doses it acts to prevent nerve agents from overstimulating muscles, and the effects of PB itself are temporary and reversible.
Exposure to sarin alone would be problematic enough. But for Gulf War veterans, exposure to sarin as well as PB and/or bug repellent may have been what ushered in Gulf War syndrome.
Abou-Donia's research showed the combination of nerve agents, PB, bug spray and stress could cause any of those chemicals as well as any lurking viruses to cross the blood-brain barrier, causing other problems. He said he has no doubt there are other long-term effects of low doses of sarin on other body systems, citing chronic fatigue, muscle weakness and fibromyalgia as symptoms.
White's work came in the wake of animal research that showed persistent central nervous system effects and acetylcholinesterase inhibition following exposure to sarin at levels too low to produce clinically observable symptoms.
The use of PB among troops, and PB's potential role in Gulf War syndrome in combination with other substances, also has been scrutinized.
PB slows the effects of nerve agents, giving troops more time to self-administer antidotes. Research has shown PB offers troops a better chance of survival against the nerve agent soman, rather than sarin, because soman works much quicker than sarin.
Golomb's research showed that just before the Gulf War, the U.S. government knew Iraqi leader Saddam Hussein had sarin in his arsenal, but had no evidence he possessed soman.
As such, she said "there was no benefit" to giving troops PB to increase their survival odds in the event of a sarin attack as long as they had access to the antidote, she said.
Yet according to the Pentagon, about 250,000 troops were given PB during the Gulf War.
Golomb said the U.S. military changed its PB policy because of the report she did for Rand and is not dispensing it to troops in the current war in Iraq.
John Rash, who did research on PB for the Pentagon in the late 1970s and early 1980s, was charged with ensuring people could react with their antidotes quickly enough to prevent nerve gas poisoning.
Rash's research looked at the long-term effects of PB in combination with sarin and soman on rats. At first, he said, the filaments separating muscle cells "turned to soup." But within days, the membranes reappeared and the rats seemed to have recovered.
"That's what made the Army particularly like our study," he said.
But he said he didn't look at how the drug would affect any other body system. And, he said, he knew the combination of stress and drugs could cause the agents to cross the blood-brain barrier.
Rash said his study was never published because the U.S. military didn't necessarily want to publicize the results during the Cold War era. But he said it will come out within the next two years.
A human study in 1997 showed subtle deficits in short-term memory and attention, a slight elevation of hospitalization for circulatory diseases, and a twofold increase in brain cancer deaths more than four years after exposure.
To Abou-Donia, the connection became clear after terrorists hit a Tokyo subway with sarin in 1995. Hospital workers who were never in the subway but who worked with sickened passengers came down with the same symptoms reported by Gulf War vets.
"At last they can have peace of mind because they know what it was, most likely," he said.
But, he said, there isn't much that can be done now although he cautioned Gulf War vets not to use insecticide.
"It's kind of too late to do much of anything," he said. "But the body has many redundant systems. Usually, if the damage is small, other neurons will take over. As time goes by, people will adapt."
A list of units exposed to sarin in the 1991 Gulf War is http://www.gulflink.osd.mil/forces_in_hazard_00.htm">online.
http://www.militarytimes.com/forum/showthread.php?t=1559242">Study: Sarin at root of Gulf War syndrome