Fall 1996 Edition

National Gulf War Resource Center, Inc.
1224 M Street NW Washington, DC 20005
(202) 628-2700 ext. 162 Fax: (202) 628-6997
Email: Charles@gulfwar.org
HomePage: www.gulfwar.org/Resource_Center/

The National Gulf War Resource Center, Inc. is a non-profit organization founded in June 1995 to support the activities of grassroots groups assisting individuals who have suffered the health effects of the Persian Gulf War.

Table of Contents

What is Gulf War Syndrome?

Known Exposures

Who Has Gulf War Syndrome?

Symptoms and Treatments

Congressional & Federal Actions

VA Programs and Actions

Filing VA Disability Claims

DoD Programs and Actions

Counseling and P.T.S.D

Social Security Admin. Programs

Litigation Against Chemical Companies

Resources or Where to Get Help

Selected References

Self-Help Guide Credits

What is Gulf War Syndrome?

In the years since the end of the war a great deal of research and investigation has been devoted to this question. At this point, we can offer some general possibilities and answers. Gulf War Syndrome (GWS) is probably not a single, new illness or disorder. Rather, GWS is most likely a collection of different illnesses with similar symptoms. This has caused confusion and has made it difficult for researchers to come up with a case definition. Often, in order to define an illness, it is necessary to look first at known exposures, which include: chemical and biological weapons, depleted uranium, experimental drugs and vaccines, environmental toxins, and endemic infectious diseases.

The medical definition of a syndrome is a combination signs or symptoms that form a distinct clinical picture indicative of a particular disorder. In the medical sense, GWS may be a misnomer. However, the NGWRC has adopted the GWS moniker because it is an accurate and distinctive social description. Veterans do have a core set of symptoms. In one study, over 80% show a constellation of 11 signs or symptoms. GWS also is descriptive of the time and place that most people became ill. The war, and the adverse exposures it brought, is the precipitating factor and this is highlighted by the GWS name. Finally, ill veterans and civilians are experiencing a similar lack of adequate clinical examination, treatment, compensation, and compassion. This highlights the prevalent social syndrome that exists.

As of March 1996 approximately 80,000 veterans had officially registered as ill subsequent to the war and many spouses, children, and civilians are ill as well. The Departments of Defense (DoD) and Veterans Affairs (VA) claim that they have been doing all they can to help those that are ill. However, it has not been our experience that they have been very effective in educating, diagnosing, treating, or compensating those who are ill. Thus, the purpose of this Guide is to collect and present information we believe may be helpful to those that are ill. It is our intent to provide the information and tools necessary so that those who are ill can effectively educate and advocate for better medical care, comprehensive research and appropriate compensation for themselves and their families.

Known Exposures

Chemical And Biological Weapons

Nerve Agents: Sarin, Soman, Tabun Blister Agents: Mustard Gas, Lewisite Biological Agents: Anthrax, Brucellosis, and Possible Viral or DNA-Altered Organisms

Within days of the end of the fighting, the Department of Defense reported on March 7, 1991 that Iraq's forces had failed to get chemical weapons to the front, and that no chemical weapons were used or found in the Kuwait Theater of Operations. Within a year, this became the categorical stance by the DoD, who attempted to discredit any reports to the contrary.

Many knowledgeable sources question this assumption. Numerous veterans, including NBC team members, have testified before congressional committees over the last several years that their chemical alarms repeatedly went off, often at the same time these units were subjected to SCUD missile attacks. The DoD has explained these incidents by stating that the alarms were set off in error by smoke and diesel fumes. However, the alarms did not go off before the start of the air war on 17 Jan 91, despite the ongoing presence of smoke and diesel fumes. Further, the Senate Banking Committee released a report in 1994 which documented the fact that the alarms will only go off when chemical concentrations reach levels over one thousand times the amount needed to harm human beings.

Far more evidence has come to light over the last several years that prove chemical weapons were present, detected and confirmed in the Persian Gulf theater of war by various coalition governments, including the United States. These documents also prove the U.S. government had knowlege that some people in the Gulf had either acute or long-term, low level exposures to chemical and biological weapons agents.

The documents cited above were obtained by many members of the NGWRC, including James Tuite, III, former staff member for the Senate Banking Committee, Paul Sullivan, Chair of NGWRCs Research Committee, and the Gulf War Veterans of Georgia. They have written and filed numerous FOIA (Freedom of Information Act) requests in the last few years and have received voluminous piles of documents from various units present in the Gulf. Some of the documents they have acquired are the NBC Logs of Central Command. They show quite clearly the DoD knowledge of multiple chemical incidents and exposures during the conflict.

Former Senator Reigle (D-Michigan) sent some equipment brought back from the Persian Gulf by veterans to Lawrence Livermore Laboratories. This equipment was tested for possible chemical and biological agent contamination. Positive findings were reported. The DoD has subsequently been forced to admit at least one incident in which members of the Armys 37th Engineer Battalion may have been exposed to sarin and mustard agents during the demolition of an Iraqi bunker complex at Kamishiyah depot between March 4-7, 1991. Many more such incidents may come to light in the coming months and years - making questionable previous DoD statements on the matter of chemical and biological exposures.

Experimental Drugs And Vaccines

In December 1990 the Food and Drug Administration agreed to issue a waiver to the Department of Defense allowing the military to issue experimental drugs and vaccines to U.S. personnel in the Gulf without first obtaining informed consent for use of those drugs. This waiver is still in effect for U.S. troops in combat situations, and has been recently challenged by NGWRC and other consumer and advocacy groups. Though U.S. law and the Nuremburg Code require informed consent from the patient, the military did not explain possible side effects or obtain informed consent. The three main drugs and vaccines are listed below.

Many soldiers were threatened with court martial if they refused these immunizations, while others were held down and forcibly injected. Vaccines usually were not noted in immunization records nor in the medical record of service members. Some medical staff report that they were given orders not to annotate records and to destroy medical records during and after the war.

Pyridostigmine Bromide

This was the most widely used drug. It was used as a nerve agent pre-treatment drug and came as a small white pill in blister packets. Approved for use in cases of a neurological disorder known as myasthenia gravis, the drug has never been tested or approved for use on normal populations. In the few limited tests conducted prior to the war by the DoD, women, smokers, and anyone who might be at all sensitive to the drug were screened out. Despite this screening, adverse effects were widely noted.

Pre-treatment with PB is only effective in relation to exposure to soman; it actually increases adverse effects to exposures to sarin.

Anthrax Vaccine

This vaccine has been tested and approved for limited use by the Food and Drug Administration (FDA). It was administered to approximately 150,000 troops in the Gulf region. It is not known if it is safe for pregnant woman or their offspring.

Botulinum Toxoid Vaccine

This vaccine is not approved by the FDA and must be administered by an IND (Investigational New Drug) waiver by the FDA. Approximately eight thousand service members were given this vaccine, or approximately 1% of the troops in the Gulf region. Most were given one or two shots, not enough to provide protection against botulism according to the Centers for Disease Control (CDC). Though considered safe by the CDC when given as instructed, the DoD did not follow these guidelines. The vaccine used was up to twenty years old and it is not known if it was still safe or effective.

Depleted Uranium (DU) Munitions

Depleted uranium is the highly toxic, radioactive by-product of the uranium enrichment process. Although it is normally stored in a radioactive waste repository, DU is used in munitions because of its extreme density, pyrophoric properties, and cheap availability.

DU is used in the armor of M1A1 and M1A2 tanks, and as armor-piercing rounds fired by tanks, the Bradley Fighting Vehicle, the A-10 aircraft, and the Navys Phalanx weapons system. DU munitions were used for the first time in combat during Desert Storm, and are credited with the destruction of approximately 1,400 Iraqi tanks, as well as other equipment.

When a DU penetrator impacts a hard target, up to 70% of the round burns up, scattering uranium dust in and around the target. If this uranium dust is ingested or inhaled, the health effects can include kidney problems, cancers, neurological problems, and repoductive problems.

Prolonged exposure to DU armor and/or penetrators is dangerous, but DU poses the greatest risk to those who: Breathe smoke or dust from a burning vehicle hit by DU rounds; Climb on or enter a vehicle hit by DU rounds; Breathe smoke or dust from a fire involving DU armor and/or rounds, such as the July 1991 fire at Doha, Kuwait, or; Were in a friendly fire incident involving DU rounds. Other methods of exposure include medical treatment of people injured by DU munitions, and recovery of vehicles stuck by DU rounds.

The standard VA and DoD Persian Gulf medical exams do not include testing for DU exposure. In order to get tested for exposure to DU, your local VA or DoD physician must contact the DU Program at the VAMC in Baltimore, MD (Kate McFall, Coordinator, 1-800-815-7533). For more information about DU, contact the Depleted Uranium Citizens Network of the Military Toxics Project. Their address and phone number is in the Health & Research Organizations area of the Resources section of this Guide.

Environmental Exposures

It has been said that during the war the Persian Gulf region was one of the most environmentally toxic places in history. Those located in the Persian Gulf were exposed to a wide variety of toxic substances in varying degrees. Many of these substances, including gases containing nitrogen oxides, sulfur dioxide, and organic carbon and metal particulates, were contained in the oil well fires.

One area that has received study from several sources is the interaction between the PB pills given troops and exposure to various insecticides, such as DEET. It has been shown in several research efforts that the toxicity of either agent alone is not so great as when used in combination. When combined a synergistic effect takes place and the toxicity of each increases up to 10 times. This means that ingesting the PB pills and using DEET can be far more hazardous than use either one alone.

Other exposures include the spraying of diesel fuel to reduce dust, diesel fumes from stoves inside tents, the spraying and liberal use of pesticides, fumes from CARC (chemical agent resistant coating) paint, and others.

Leishmaniasis and Endemic Diseases

Leishmaniasis is a parasitic infection borne by sand fleas in Southwest Asia. The disease can have extremely long dormancy periods, and manifests with non-specific symptoms such as chronic fatigue and rashes. Thus, it can be difficult to diagnose and treat. It can also be fatal if not diagnosed and treated properly. We dont know how common this infection is among those who served in the Gulf. There is no easy non-invasive diagnostic test, so the number of diagnosed cases is probably far lower than the actual incidence. Many physicians are not aware that the type of leishmaniasis typically borne by veterans of the Gulf region is unusual and needs specialized testing only performed by the Centers for Disease Control (CDC). There has been only one known case of sexual transmission of leishmaniasis.

Other diseases endemic to the area include brucellosis and cholera. To date, we know of no Gulf veterans diagnosed with either disease.

Who Has Gulf War Syndrome?

Veterans

Not all veterans who served in the Persian Gulf War are ill. Of the 697,000 U.S. troops who served in the war, approximately 108,000 are on a Registry and, of these, 80,000 are symptomatic. As of February 1996, about 80,000 are on the VA Registry, with 80% symptomatic, and 28,800 are on the DoD Registry, with 85% symptomatic. According to a VFW survey, only about half of ill gulf vets have turned to the VA or DoD for registration and treatment, the rest seeking private medical care. Therefore the numbers of ill may well be significantly higher than reported by the Registries. Veterans from Great Britain, Canada, Australia, Czechoslovakia, France, and other coalition countries are also ill.

Civilian Participants

Civilians who were present in the Persian Gulf area during the war had many of the same exposures as military personnel to chemical, biological, and radiation contamination, endemic infectious diseases, and other toxic materials. Civilian participants include media personnel, DoD contractors, Red Cross workers, and Iraqi and Kuwaiti civilians living in the area.

Civilian Non-Participants

Civilian non-participants were not present in the theater of war. However, they worked in direct, close contact, both during and after the war, with either military personnel or military equipment used in the war. Therefore, they may have been exposed to infectious diseases or chemically or biologically contaminated personnel or equipment.

Reported ill civilian non-participants include those who cleaned and repaired returned tanks and airplanes, repackaged used returned parachutes, sorted, cleaned, repaired and painted returned equipment, removed clothing and equipment from the evacuated injured and dead, and/or boarded returned ships. Air stewards who ferried the troops back from the war and medical personnel who treated the ill and injured are sick as well.

The governmental response to these ill civilian non-participants has been non-existent. Although some may be eligible for workmans compensation, proof that exposure occurred through contact with contaminated personnel or equipment is difficult to prove without scientific studies, and none are being planned by the government. Medical care and compensation from the government or involved corporations seems to be unavailable for civilian non-participants.

Families & Close Living Contacts

One survey of approximately 1,200 ill veterans performed by Senator Reigles staff found that 77% of spouses, 68% of children born after the war, and 25% of the children born before the war are either experiencing similar symptoms to those of the ill veterans or have birth defects. A survey of 10,051 ill veterans performed by Operation Desert Shield / Desert Storm Association found that 51% of spouses were ill and 22% of children. While not scientific studies these surveys seem to show a widespread incidence of illness among family members of ill veterans.

Possible exposure sources for families and close contacts include both traditional sources, such as infectious diseases, as well as exposure to equipment contaminated by chemical or biological warfare agents. Soldiers generally brought home equipment, such as uniforms, gas masks, sand samples, ect., without the equipment having been through any type of decontamination procedures - even general washing. Equipment was generally not collected, confiscated or examined by either military or civilian sources.

Female spouses have reported a high rate of miscarriages, menstrual and reproductive problems, and burning semen during sexual intercourse. The Association of Birth Defect Children (ABDC) provides information, resources and a registry of children with birth defects possibly related to their parents service in the Gulf. See the Health & Research Organizations area of the Resources section of this Guide. Others reporting problems include siblings, parents, fiances, housemates and others in close contact with ill veterans.

A small number of spouses are receiving health care from the DoD, mainly the spouses of active-duty veterans. In April 1996 the VA began a limited, poorly funded study to provide registry exams, without follow-up treatment, to spouses and children of registered, ill veterans. Otherwise, there is little to no health care, and no compensation, for the family members and close contacts of ill veterans.

A recommendation has been made to include ill spouses, children, and family members on separate, supplemental VA claims. An ill veteran will file a claim for themselves, and then file an additional claim on behalf of the ill family member. Any compensation for family members will be routinely denied, however, by filing you establish an initial claim date. If VA regulations ever change, for instance, as they may regarding the relationship between spina bifida in children and their parents exposure to Agent Orange, you will already have an established claim. As well, filing a claim for family members will put the VA on notice about the extent of ill family members.

Communicability and Blood Ban

After the completion of the Gulf War a ban on all blood donations from veterans was initiated to protect the American public from exposure to a variety of new and old infectious diseases. In 1993, the National Association of Blood Banks (NABB) lifted the ban, saying that a public health threat no longer existed.

Since that time, there has been no consensus on the widespread communicability of illnesses related to the Gulf War. However, leishmaniasis has an extremely long latency period with no symptoms and some evidence exists for possible viral infections. In 1994 the National Institutes of Health recommended an investigation of reestablishment of the blood ban. Other medical researchers have found specific primary and opportunistic infections prevalent among Gulf veterans and recommend that veterans not donate blood or body organs.

Currently, the NGWRC, the American Legion, the Veterans of Foreign Wars, and various other municipalities and organizations recommend that Gulf War veterans refrain from donating blood or body organs until more is known about the possible communicability of Gulf War Syndrome.

Symptoms & Treatments

Common Symptoms

There is a large body of symptoms and syndromes associated with the previously described exposures. A survey of 10,051 ill veterans by Operation Desert Shield / Desert Storm Association found eleven symptoms that at least 80% of surveyed veterans experience. They include:

This is only a partial listing. For a more exhaustive list of symptoms, please see the Checklist of Symptoms attached to this Guide.

Multiple Chemical Sensitivities (MCS)

MCS is a disease which is debated and controversial throughout the medical field. However, many veterans are being diagnosed with MCS, and others have newly-acquired sensitivities to chemicals. MCS has not been recognized by the Department of Veterans Affairs and is not a compensable disability.

MCS is characterized by multiple organ system disruptions triggered by exposure to certain chemicals or environmental pollutants. Common symptoms of people with MCS are disturbances in the central nervous system but may also include immune, autoimmune, respiratory, endocrine/metabolic, neuromuscular, gastrointestinal, and genitourinary disorders. Persons with MCS must avoid exposures to pesticides, household cleaners, fumes, and many other toxins. For more information on MCS, see the Health & Research Organizations area of the Resources section of this Guide.

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS)

CFIDS is also known as CFS (chronic fatigue syndrome), CEBV (chronic Epstein-Barr virus), ME (myalgic encephalomyelitis) and various other names. It is a complex illness characterized by incapacitating fatigue (experienced as exhaustion and extremely poor stamina), neurological problems, and a constellation of symptoms that can resemble other disorders. These symptoms tend to wax and wane but are often severely debilitating. There is no marker or test to definitively diagnose CFIDS, and it is therefore a diagnosis by exclusion. For more information on CFIDS, see the Health & Research Organizations area of the Resources section of this Guide.

Private Medical Research

Since many of the toxins individuals were exposed to have immunodamaging and neurodamaging effects, and since many of the observed infections are commonly associated with autoimmune and other chronic diseases, there is abundant evidence to warrant further research into the possibility that Gulf War Syndrome may be an immune system imbalance syndrome, triggered by the neurological and toxicological effects of war-related exposures. This is the research Dr. Howard Urnovitz of Berkeley, CA is pursuing among Gulf veterans. He has found HERVs (human endogenous retroviruses) are strongly (re)activated among Gulf veterans and family members, indicating that their immune systems are dysfunctional. As well, a study he conducted with two VAMCs found that veterans do not have expected antibody reactions to the polio vaccince, again indicating an immune system imbalance.

Several private researchers have reported in independent studies finding various opportunistic infections present in ill veterans and their families. This may support the supposition that those who are ill have immune system imbalances. While each of these studies has been limited in scope, there was no pattern to subject selection other than the symptoms that have come to be associated with the syndrome. In each isolated study, the findings indicated that a large number of the veterans examined were infected with the specific pathogen under scrutiny. These studies include:

A limited endocrine study ( Dr. W. Boone, PhD, Greenville, SC) found that the seminal fluid of veterans studied contained fungal- or protozoa-like structures, a decreased protein content, and an increased pH, possibly resulting in enhanced polyamine synthesis, which could result in ammonia. This might possibly explain the burning sensation during intercourse being reported by veterans and their spouses.

In general, studies proposed by independent, non-governmental researchers have not been well funded - if they have received any outside funding at all. There appears to be a strong bias towards funding governmental researchers studing approved theories of causation, including psycological stress, PTSD, fatigue, and other sanctioned diagnoses.

Laboratory Tests

These are laboratory test and/or signs to test for that have been found helpful or necessary.

Treatments

Each person is different, so we cant offer a medical opinion of your illness nor recommend treatments specific to you. However, medical researchers and practioners have had some success in treatment of those ill with Gulf War Syndrome. Specifically, several paractitioners are reporting success with ongoing therapy with the antibiotic doxycycline and/or therapy with other types of antibiotics.

Alternative Medicine

It is extremely frustrating to be chronically ill. It is especially hard when traditional western medicine cant find the cause or cant treat the symptoms. Alternative medicine offers therapies that have been reported by many seriously ill sufferers to relieve some physical symptoms and moderate chronic pain. Remember, though, that some treatments may not help, cause further problems, or be a dupe by those wanting to make money off the chronically ill. It is up to you, and your medical advisors, to determine what works best for you.

Sufferers of Gulf War Syndrome have reported that some of the following therapies have helped reduce symptoms and chronic pain:

Traditional Chinese Medicine - herbs & accupuncture Magnetic Therapy (specifically mattress pads) Kumbucha Tea Meditation and Visualization Chiropractic Therapeutic Massage Bio Feedback Homeopathy Vitamins & Nutritional Supplements

Congressional & Federal Actions

House Committees

The House Veterans Affairs Committee has held numerous hearings on the health effects of the Persian Gulf war and the responsiveness of governmental agencies. Most recently the Subcommittee on Human Resources and Intergovernmental Relations, chaired by Rep. Christopher Shays (R-CT), investigated the responsiveness of the VA to Gulf War veterans.

Senate Committees

Senator Reigle, at the time the Chair of the Committee on Banking, Housing, and Urban Affairs, sponsored the most comprehensive research on Gulf War Syndrome and the relation to chemical and biological weapons exposures.

Senator Rockefeller, at the time Chair of the Committee on Veterans Affairs, held hearings on the experimental drugs and vaccines administered to troops.

Persian Gulf Coordinating Board

This Board was established in January 1994 to address the health concerns of Gulf War veterans. It is composed of the heads of the Departments of Defense, Veterans Affairs, and Health and Human Services. Its purpose is to oversee and coordinate working groups focused on research, clinical issues, and disability compensation.

In August 1995 it published A Working Plan for Research on Persian Gulf Veterans Illnesses. This report is intended to be a government blueprint to guide the search for answers about the health of Gulf veterans and an inventory of federal research currently in progress. Of the 26 DoD and VA studies clearly outlined, nine (35%) are on psychiatric topics.

NIH & NAS

In April 1994 the National Institutes of Health (NIH) sponsored a Technology Assessment Workshop on the Health Effects of the Persian Gulf War. The panel found the complex biological, chemical, physical, and psychological environment in the Gulf appears to have produced complex adverse health effects. They recommended reexamining the necessity of a blood ban.

The National Academy of Science (NAS) has been contracted by the VA and DoD to review existing scientific and other information on the health consequences of the Gulf war.

CDC Research

The CDC has two main epidemiological studies it is conducting. The first is an investigation of the illnesses experienced by air national guard members in Pennsylvania. They have found a substantial increase in symptoms among Gulf vets as compared to Gulf-era service members. A study has been published and research is ongoing.

The CDC is also working with the Iowa Department of Public Health to conduct an epidemiological study by telephone to compare 1,500 Iowan Gulf veterans with 1,500 Iowan Gulf-era veterans to determine the prevalence of symptoms, diseases, and risk factors. The survey will include the status of spouses and children. This is an ongoing study.

Presidential Advisory Committee

In May 1995, President Clinton appointed a committee to review activities related to illnesses present in Gulf War veterans. They will examine research, coordinating efforts, medical treatment, outreach, reviews, risk factors, and chemical and biological weapons. An Interim Report was released in February 1996, and their final report is due in December 1996.

Veterans Administration Programs & Actions

Registry

In 1992 the VA established the Persian Gulf Registry Health Examination Program. Every Gulf War veteran who has health concerns related to their service in the Gulf is entitled to a free exam. If you have already taken the medical exam, you can set up an appointment to update the registry entry. The exam consists of a fairly extensive medical history questionnaire, a physical exam by a medical provider, a chest X-ray and certain laboratory tests. In June 1994 the VA made its examination guidelines the same as the DoD guidelines to ensure consistency. The Registry exam is free and does not require a means test (an examination of your income level to determine eligibility). The names and certain data about those who take the exam are added to the Persian Gulf Registry.

Most family members and civilians are not eligible to be on the Registry or have exams. However, the VA has recently implemented a program of limited registry exams for spouses and children of ill veterans. Call the VA hotline to Register.

The Registry is not an epidemiological study and will not provide answers as to the prevalence of illness in Gulf veterans. However, it does provide the VA an opportunity to see which problems are common among Gulf vets. As well, it gives the VA and the veterans community an idea of the total number of veterans who are ill.

Many veterans have been dissatisfied with the Registry exams. Some have reported being required to fill out means test paperwork or waiting for many months for an available appointment. Others have noted that VA physicians are not well educated about the possible exposures and their health consequences. Despite the problems, the Registry exam can be important. It is possible that the exam will find health problems which are always best detected early. It is important to follow-up on any reported symptoms. The VA has a specific protocol designed for follow-up on symptoms reported during the exam, but many physicians are not aware that the protocol exists. The VA may well be able to provide treatment or compensation.

Finally, a couple of points to keep in mind: Try to arrange for the questionnaire, the physical exam and the lab work to be done on the same day. Often the VA arranges for each to be done on a separate day, which means multiple trips to the hospital. Request a copy of all medical records, including lab results, completed questionnaires, and examination reports. Do this every single time you go to the VA for health care. It is vital that you keep your own copies of medical records because records can disappear, become altered or take a long time to get. When it comes time to file a claim you will be happy to have the necessary records at your finger tips. The Registry exam DOES NOT initiate a claim for disability benefits. Nor does filing a claim for benefits initiate your name being placed on the Registry. Both actions must be done separately.

Medical Treatment

In 1992 Congress authorized treatment of Persian Gulf veterans on a priority basis under Public Law 102-585. The legislation requires the VA physician to determine whether the symptoms or illness may be related to service in the Gulf and, if so, to provide treatment. The law has not made it entirely clear what priority care means. According to the VA, priority care in this context does not mean that a veteran gets to go to the head of the line. Rather, it means they are entitled to care without undergoing a means test. Other interpretations include the idea that Persian Gulf vets have the same priority for care as former POWs who are receiving care for non-service connected conditions or Agent Orange veterans. This priority places qualifying veterans ahead of other non-service connected veterans when scheduling appointments, referrals, and follow-ups.

For Gulf vets with unexplained symptoms, local VA physicians may refer vets to one of four Persian Gulf Referral Centers for additional specialty consultations. They are located in Washington, DC, Birmingham, AL, Houston, TX, and Los Angeles, CA. Many VA physicians are not aware that veterans can be referred to one of the four referral centers. Make sure your physician is aware of this option if they are not making progress towards diagnosis and treatment.

VA Hotline: 800-PGW-VETS This is the VAs main number for providing assistance with questions about care and benefits. They will refer you to your local VAMC.

Research

The VA has two major epidemiological studies in progress. The first is a national random health survey of 15,000 Gulf vets compared to 15,000 Gulf-era vets. The hope is that this survey will determine the prevalence of symptoms and certain health outcomes in veterans and their spouses and children, as well as risk factors possibly associated with these signs and symptoms. This study will be conducted by mail, with some sampling of respondents by examining medical records and performing physical exams. The second study is a mortality follow-up study. Data has been gathered and analyzed. It seems to show a higher death rate for Gulf vets, but only from accidents and other traumatic causes. The time period examined was extremely limited.

The VA has three major research centers working on issues related to illnesses among Gulf veterans and several independent studies. They are as follows:

We also understand that the VAMC Birmingham, AL is studying how to detect the neurological effects that would be expected after exposure to certain chemical weapons.

Filing VA Diability Claims

Overview

Disability compensation and pension are VA entitlements that make up for your loss of income when you become disabled.

Service connected compensation is available for disabilities that were incurred during, or aggravated by, military service. Compensation is payable based on the degree to which you are disabled by the service connected condition. Effective 12/1/95, the benefit rate for a 10% disability is $91; for a 100%, or total, disability, it is $1870. Veterans who are rated at 30% or greater for service connected disabilities may receive additional compensation for dependants.

Non service connected pension is available to veterans with very low income who served during war time and are totally disabled. The disabilities do not have to be service connected, and combat service is not required. Additional pension for dependants is also available.

Benefit payments are also available to eligible survivors of deceased veterans.

Service Connected Claims

Service connected compensation is available to veterans with physical or mental disabilities that were incurred during or aggravated by service. It is not income dependant; that is, your income and assets are not considered when determining compensation. It does not have to be related to combat, it just has to be connected in some way to your time in service. In general, you have to prove three things: You currently have a physical or mental disability; Something happened in service: for example, you contracted a disease that began in service; you suffered an injury in service; something happened to you that affected your health while in service; you were treated for a chronic condition shortly after service; or a condition you had before service worsened due to service. There is a link between your current disability and what occurred in service. Primarily, this must be proved with an experts opinion, such as a doctor.

Steps Step 1: Get Help. The absolute best thing you can do for yourself is to get help from a well trained Veterans Service Officer (VSO) in your area as early as possible in the claims process. The claims process is confusing, technical, and frustrating - so be prepared for the long haul. VSOs are trained by the various veterans service organizations (VFW, DAV, etc.) and provide free representation. They are often located at the VAs regional offices, although they do not work for the VA.

Changing your VSO midstream is sometimes not possible when your claim is being adjudicated, so make sure you pick a good VSO. Ask around in the veterans community (especially Vietnam vets with Agent Orange exposure) for a referral. Ask questions to ascertain their knowledge of the special regulations for Persian Gulf vets. Find someone who will educate you as well as actively advocate for you. Veterans service organizations are located under the Resources section of this guide.

Step 2: File a Claim. At the first appointment with your VSO make sure you get the appropriate forms and be careful in completing them. Do not wait until you are very ill to file your claim. It is important to get your claim in as soon as you can in order to establish the earliest possible effective date if you are granted benefits.

Step 3: Get Records. A free set of all military service and medical records is available to you. File a Request Pertaining to Military Records, Standard Form 180, with the appropriate military agency. Compile your own records of civilian medical treatment. Civilian doctors and hospitals have procedures for allowing you to get your records. Records of treatment in VA medical facilities are available for free by filing a VA Form 70-3288 with the VA medical facility. If you have in your possession copies of any military medical records, protect them. No one knows exactly how many records have been lost or destroyed, but some veterans groups estimate as many of 50% of Gulf veterans medical records are missing. Be aware that some psychiatric medical records may be released only to a doctor or counselor.

Step 4: Put Facts Together. VA employees have a duty to help you work up, or develop evidence for, your case. They are obligated to do this only after you have presented a well-grounded claim to the VA. It is important for you to work with your VSO to put together a well-grounded claim. Even after you do so, however, the VA employees who will review your claim work with many hundreds of veterans cases. Consequently, your ongoing participation with your VSO may be critical in the proper development of your claim. Help your VSO and yourself by writing out a list (with dates) of your health problems in the order they have occurred. Submit that list with copies of the medical records that document the problem.

Step 5: Cooperate with the VA. Once you file your claim, the VA may make an appointment for you to see one of its doctors for a disability evaluation. If you do not go to this exam the VA may reject your claim. If the VA asks for additional information, be very careful to respond within the deadlines in its letter. If you do not have the information requested, or you have already provided it, do not simply ignore the letter doing so may let the VA deny your claim. Write back and state the evidence was previously provided or that you do not have the required information. Emphasize to the VA that you think the evidence already provided is enough to allow your claim if you and your VSO believe that to be the case. When writing to the VA, be sure to use your claim # and the VAs reply # on all correspondence.

Step 6: Be Prepared to Wait: Currently the back log of claims waiting for adjudication is enormous. Gulf war claims are being sent to one of four regional centers for adjudication and are often warehoused there for many months. Your claim may take up to a year or more to adjudicate especially if you have not done good work up- front providing the necessary documentation. . Step 6: Be Prepared to Appeal: As of March 1996, only 12% of environmental exposure claims and 5% of undiagnosed illnesses claims of Persian Gulf veterans had been granted compensation. The odds are that your claim will be denied. When the VA denies your claim, they must notify you and tell you what additional rights you have for appeal. Dont be discouraged - request a reconsideration, or appeal, within the deadline. Often the appeals are denied as well, but dont despair. At this point you get to go to a Medical Review Board - in person if you desire. This is where you may well have success, and you can bring in expert medical and technical testimony to bolster your case.

Non-Service Connected Pensions

Disabled veterans who lose their claims for compensation should consider applying for pension. Pension benefits are available to veterans with war-time service, who have limited incomes and assets and who are totally and permanently disabled for reasons primarily not related to their military service. VA Form 21-526 can be used to apply for a pension.

A pension usually provides much less money than compensation, but for many veterans it is a necessary means of support.

Denials

If your claim is denied, you and your advocate should promptly do two things: file a notice of disagreement (NOD) and request a copy of the rating decision.

An NOD can be as simple as a letter to the VA Regional office saying that you disagree with its decision. The notice should include the date of the adverse decision and the claim number (C-number). The NOD must be postmarked within one year of the date on the denial letter or you will lose your right to appeal. There are no extensions. Once you file a NOD, two important things happen. First, the VA will respond to your NOD with a statement of the case (SOC). The SOC should describe in some detail the laws that apply to your claim and why your claim was denied. Second, once you file an NOD you can request a hearing in front of a VA hearing officer at the regional office. If the hearing officer determines that you have presented new and relevant evidence, he or she can make a new decision. If the decision of the hearing officer is unfavorable, you can still appeal to the Board of Veterans Appeals.

Appeals

Along with your SOC, the regional office will send you the VAs Form 9, the substantive appeal form. You and your advocate must complete and return this form to the VA if the Board of Veterans Appeals in Washington, DC is to consider your case. You have 60 days from the date on the SOC or you have the remainder of one year from the date the VA first denied you claim, whichever deadline is later, to file the VA Form 9.

The Form 9 asks if you wish to appear at a hearing before the BVA in Washington, DC or before a traveling BVA member at the regional office. At a hearing, a BVA member will listen to arguments and permit you to submit evidence about your appeal. In most cases, if you are at all able to appear in person at a hearing before the BVA, you should do so. Even if you do not request a hearing, however, the members of the BVA will review the evidence in you case and make another decision about your claim.

If you disagree with a BVA decision, you might appeal to the US Court of Veterans Appeals in Washington, DC. You could also file a motion for reconsideration with the BVA or, if you have new and material evidence about your claim, you can reopen your claim at a regional office.

Rules for Undiagnosed Illnesses

The VA has issued a regulation to compensate veterans of the Gulf War for illnesses that have not yet been diagnosed. (See Appendix C for a copy of the VA Regulations.) Congress has never before directed the VA to pay compensation benefits for illnesses that can not be diagnosed and for which a specific cause has not yet been identified. This regulation is called Compensation for Certain Disabilities Due to Undiagnosed Illnesses. This regulation applies only to illnesses that cannot be diagnosed. If your condition has been completely and adequately diagnosed, the rules explained below do not apply to you.

The new regulation permits the VA to pay compensation benefits for a disability caused by chronic illnesses or symptoms (that exist for at least six months) and that cannot be diagnosed (identified). Before the VA will grant you compensation benefits as a Gulf veteran with undiagnosed illnesses, you must:

You need not have suffered from symptoms every day for six months; you may have suffered from symptoms that have come, gone, and then reappeared over a six-month period. And your symptoms do not have to be objective - that is, you do not have to be able to see or touch the symptoms or signs for your illness to qualify. However, you must be able to document the symptoms.

DoD Programs and Actions

Registry

The DoD Registry is very similar to the VA Registry. It includes questionnaires and a CCEP exam (see below).

DoD Hotline: 800-796-9699 The DoD Hotline answers general questions, allows you to register your name and refers individuals to a medical center.

Medical Treatment

The DoD instituted a program in 1994 called the Comprehensive Clinical Evaluation Program (CCEP). It is supposed to provide an in-depth medical evaluation at one of 13 DoD medical centers to all eligible beneficiaries who have experienced health problems since the Gulf war.

The DoD has established a specialized care center at Walter Reed Army Medical Center in Washington, DC to provide therapeutic care after the CCEP exams The center attempts to provide intensive programs directed at improving the functional status of patients experiencing disabling symptoms involving pain and fatigue. However, reports from many veterans who have participated in this program do not give it a high rating.

Discharge

Options

If you become ill while on active duty and are unable to return to active duty, there are several options: You can be discharged as not fit for duty with disability severance pay if the degree of disability is rated at 30% or less and you have less than 20 years service. Severance pay is a lump-sum payment based on your basic military pay. The VA must offset your severance pay before it can pay you compensation benefits for the disability that caused your discharge.; You can be placed on the Temporary Disability Retirement List (TDRL) with a temporary disability rating that will be evaluated later for permanancy; You can be medically retired (disability retirement), which gives you many of the benefits that are available to other military retirees. If you are medically retired, you will be paid between 30% and 75% of your basic pay for the rest of your life. You are also eligible for VA benefits, and are entitled to the same health care benefits as other retired military personnel.

If you become ill while on active duty you may be compelled to make very important long-term decisions at a time of great anxiety. It is very important that you understand that waiving some of your rights for any reason may not serve your long term interests. Never waive a right without the advice of informed counsel.

You need to understand your rights and how your service will arrive at its decision. If your illness disables you, your records will be reviewed by a medical board. If the medical board finds you not fit for duty, it will make a recommendation that will then be reviewed by a physical evaluation board (PEB). Among other things, they will determine whether you are fit for duty, whether your disability is permanant, and the percentage evaluation at which your disability will be rated.

If you are a Gulf War vet with an undiagnosed condition, a May 22, 1995 memorandum from Under Secretary of Defense Dorn directed the DoD PEBs to evaluate your illness by analogy to a condition listed in the VAs schedule for rating disabilities, just as the VA is adjudicating claims. This means that a member of the active military can now be discharged, even if his or her illness cannot be diagnosed, and the percentage of disability will be determined by the new, and uncertain, VA rules.

The May 1995 Memorandum also directed the services to note in a service members records that he or she became ill as a result of Persian Gulf Conflict service, if this is the case, based on the presumptions detailed in the 1995 National Defense Authorization Act (Public Law 103-337) for future use by the VA. This annotation is very important; however, it is unclear who, or what board, is to make this crucial determination and entry in a service members record.

If you disagree with any of the PEBs determinations, you can request a formal hearing. You can - and should - be represented for free by a military attorney. You can also choose to obtain a civilian lawyer at your own expense, or to be represented by an advocate from a veterans service organization. The PEB will make another decision after the hearing. If you disagree with that decision, you can appeal to the Physical Review Counsel, then to your services board for correction of military records (BCMR), and then to a federal court, if necessary.

Do not waive your right to a hearing and accept a rating of less than 30%, even if you are anxious to return to civilian life or tired of dealing with the military on this issue, unless you have made a comprehensive analysis of your medical problems and options. Get competent advice from someone who is knowledgeable in this area of law. You have valuable in-service rights. Once waived, they are lost forever. See the Private Attorneys area of the Resources section of this guide for legal assistance or referrals.

Research

Counseling and P.T.S.D.

Vet Centers

There are 194 VA-funded vet centers located throughout the United States. Originally created for the use of Vietnam veterans with PTSD, the Vet Centers have been opened to combat veterans of all eras, including the Persian Gulf War.

One of the primary purposes of the Vet Centers is to help veterans work through post traumatic stress. Such stress is typical in people who experience a disaster or traumatic event in either civilian or military life. A typical traumatic event in the life of a soldier is being in combat and having his or her life threatened or seeing others die. Sometime after the traumatic event, often years later, a veteran may begin to experience some combination of the symptoms listed below.

The VA recognizes PTSD as a condition for which it will pay monthly compensation. The Vet Centers and certain specialized units in VA Medical Centers provide treatment. PTSD is treatable and symptoms can be dramatically lessened.

Symptoms of Post Traumatic Stress Disorder (PTSD)

Sleep Disorders Dreams / Nightmares Depression or Deep Sadness Anger/Rage Alienation/Emotional Numbing (Avoiding Feelings) Isolating Yourself from Others Guilt / Survival Guilt Anxiety Intrusive Thoughts Flashbacks Hypervigilance/Hyperalertness Exaggerated Startle Reaction (Jumpiness) Difficulty Concentrating Memory Impairment Low Self-Esteem Problems with Authority Employment Difficulties Relationship Difficulties Self - Medication with Drugs and Alcohol

VA Readjustment Counseling

Until October 1994, Persian Gulf veterans were eligible for readjustment couseling through the Persian Gulf Family Support Program. The programs funding was cut by Congress in 1994, but some hospitals (notably the Atlanta VAMC) have continued the program, though with reduced funding. Check with your local VAMC to see if they offer counseling programs.

How to Live With Chronic Illnesses

Chronic illnesses are long-term, uncertain, and tend to be multiple diseases. They require proportionally large efforts at palliation, are disproportionally intrusive upon the lives of the ill and their families and require a wide variety of ancillary services. There is often conflict between providers, patients, funding agents, and family members on issues surrounding the illness. They can be expensive to treat and manage.

Often it is hard to combat a disease that is so intangible. You may feel like giving up. Or becoming even sicker so that people will see that you are suffering. Often we want them (the doctors) to get off their duffs, figure out whats wrong with us and fix it. Sometimes this may not happen, either because they honestly cant fix it or because they havent yet found the appropriate fix for us. Fear of what the future holds is common. It becomes difficult to make plans and hope becomes a dream. Depression can set in and make you feel even worse.

There are some things you can do to help yourself though. It may seem like some of these suggestions are fluffy New-Age type pallatives. But the key idea to keep in mind is that when you are chronically ill any stressor, whether physical or emotional, can have negative health effects. To take action and help yourself as much as possible, instead of being the victim of the government and the Gulf War, can be very healing and energizing. These are some options to help yourself and your family cope and live with chronic illnesses:

Excercise - Excercise may sound impossible, but dont think of what you considered excercise before you became ill. Think of a new goal that is realistic now, such as walking to the corner and back or climbing the stairs. Just the fact that you are moving, making goals and trying to meet them is helpful.

Reduce Expectations: Give yourself permission to say no and set new limits. Get the shoulds out of your life.

Stress Reduction Excercises: This can include deep breathing, physical excercise, meditation, yoga, tai chi, visualization, laughter, or just taking a hot bath.

Create a Bigger Box: Examine and change your beliefs about pain and your life. Considering pain as energy makes it less fearsome.

Treat Yourself: Once a day do something you look forward to. Its ok to have fun even when youre in pain.

Notice Problem Areas: Notice places in the day where you loose energy or have more pain. What is going on during these times? What can you do to minimize discomfort?

Change Your Diet: Hidden food allergies are a common source of headaches and discomfort. The better your eating habits, the stronger your body will be to conteract damaging influences. Create Healthy Boundaries: Spend your energy on healing, not on those who dont believe you are ill or who are constantly demanding things from you. Learn to create healthy boundries.

Naps and Sleep: Often a powerful avenue to healing.

Doing Good: There is tremendous healing power in doing good. Make a point of performing ordinary acts of kindness that will move you out of self involvement.

Reach Out: Call a phone buddy who knows what youre going through. Or, even better, join a support group of vets and families who are ill. If there is none in your area, start one. Call the NGWRC for guidance or ask an administrator at the nearest vets center to help. Also, your local hospital or community may have support groups established already for people with chronic illnesses like CFIDS, lupus, MS, etc. Often they welcome others who have a similar, but different, chronic illness.

Counseling: See someone who specializes in chronic illnesses. They can help you learn coping strategies that work.

Social Security Admin. Programs

Given the failure of the VA to grant disability compensation to most veterans with Gulf War Syndrome, it is important to know that other federal programs are available. The Social Security Administration offers both disability compensation and supplemental security income benefits. The amount is well below VA compensation levels and you must be unemployable (unable to work 40 hours per week) to qualify for benefits. In some cases, veterans can receive both SSA and VA disability compensation. Some veterans who were denied VA benefits have been able to secure SSA benefits. SSA claims can take several years to process so, as with VA claims, begin the process as soon as possible.

Family members and civilians who have Gulf War Syndrome, or birth defects related to the Gulf War, are not eligible for VA programs and thus need to explore other options. Unfortunately, there are not many other options beyond Social Security programs. There are two books cited in the Books, Articles, & Testimonies area of the References section of this Guide specifically about SSI and SDI that may be helpful. Also, contact the NGWRC for further assistance.

Litigation Against Chemical Companies

In 1994, a Texas law firm filed a class action lawsuit against U.S., French, Swedish, Swiss, German, and other foreign corporations. The lawsuit claimed they had manufactured, sold, or shipped chemical and biological dual-use compounds that were allegedly used by Iraq in the Gulf War. They also claimed that some shipments violated U.S. export regulations. The lawsuit was filed on the behalf of Gulf War veterans and family members who claimed that they were injured by those chemical and biological compounds. Several more law firms have since joined the lawsuit. The law firms filing suit hope to prove that Gulf War Syndrome is the direct result of exposure to low levels of biological and nerve agents from Iraqi missile attacks and from fallout from coalition force bombing of Iraqi weapons facilities during the war.

The law firms are representing veterans and families on a contingent-fee basis, meaning all fees and expenses will come out of any awarded monetary damages. Therefore, the law firms are assuming all financial risks for the lawsuit. Veterans do not have to pay to be part of this lawsuit. However, they also will get only a small fraction of any settlement. The firms involved in the lawsuit are:

Resources or "Where to Get Help"

Health and Research Organizations

Association of Birth Defect Children 827 Irma Street Orlando, FL 32803 (800) 313-ABDC

The Association of Birth Defect Children is conducting a survey of children, with parents who served in the Persian Gulf, who were born with or acquired birth defects or illnesses.

CFIDS Association of America P.O. Box 220398 Charlotte, NC 28222 (800) 442-3437 Email: 71222.2463@compuserve.com

The CFIDS Association provides information and physician referral for individuals who are concerned about CFIDS.

MCS Referral and Resources 2326 Pickwick Road Baltimore, MD 21207 (410) 448-3319 Fax: (410) 448-3317

MCS Referral and Resources provides information and physician referral for individuals who are concerned about Multiple Chemical Sensitivities.

Miliary Toxics Project P.O. Box 246 Norway, ME 04268 (207) 743-2541 Fax: (207) 743-2648 Email: mtp@igc.apc.org

The Military Toxics Project has a Depleted Uranium Citizens Network that provides information on DU contamination and exposures.

Gulf War Syndrome Organizations

Recognizing that no one was going to help veterans or families unless they helped themselves, groups of Persian Gulf veterans, families and civilians have formed accross the country. These groups, unlike the larger veterans organizations, either have issues pertaining to Gulf War Syndrome as their primary focus or are willing to go the extra mile for Gulf veterans and their families.

These organizations are a good source of information and many are continually pressuring state and federal officials to further investigate these issues. In some states where there is not yet a support group, NGWRC has recruited referral coordinators and national organizers to help individuals seeking assistance. The volunteers can be contacted through our national office at (202) 628-2700 ext 162.

Veterans Service Organizations

Free representation at hearings before a VA regional office, the Board of Veterans Appeals, or the Court of Veterans Appeals may be available through a veterans service organization. Their veterans service officers (VSOs) may be able to offer substantial assistance in preparing and submitting claims to the VA.

These organizations generally have local service representatives in VA regional offices and hospitals. Contact a VSO at the nearest VA office or hospital, locate a service organization in your local phone book, or contact the organizations national office for a referral at the addresses listed below.

Other Veteran & Military Organizations

WWW Sites, Bulletin Boards and Email List

Email List

Gulf War Veterans Mailing List: To subscribe to the list send mail to GWVM@structured.net with the message body reading subscribe GWVM or use our automated subscription form..

Gulf War Syndrome Specific Sites

Desert Storm Justice Foundation - www.dsjf.org The WWW site of one of our member groups.

Gulf War Veterans of Arkansas - www.gulfwar.org/GWVA/ The WWW site of one of our member groups. This site contains various news articles, backround information on GWS, the Tuite reports, the DoDs CCEP reports, and lots more. Gulf War Veterans Resource Pages - www.gulfwar.org The original, award winning home page presence on the WWW relating solely to Gulf War Syndrome and veterans issues.

National Gulf War Resource Center, Inc. - www.gulfwar.org/Resource_Center Information on NGWRC programs and information sources available. The self-help guide is available for downloading here.

Persian Gulf Information Network, Inc. - 24 Hour Bulletin Board of member organization. Call 615-431-9021 or 615-431-9023.

Presidential Advisory Committee on Gulf War Veterans Illnesses Home Page - www.gwvi.gov

General Sites of Interest

American Legion - www.legion.org

Chronic Illnet - www.calypte.com Chronic Illnet is sponsored by Calypte Biomedical, a private medical research firm located in Berkeley, CA. This site provides a place for medical professionals, researchers, and others to exchange of information and access articles on various chronic illnesses. It has specific information for those with Gulf War Syndrome, and resources, research, and disussion about many other chronic illnesses.

DoD GulfLink - www.dtic.dla.mil/gulflink This is the DoDs presence on the internet, with extensive declassified documents relating to chemical exposures in the Gulf.

Military Veteran Resource WWW Page: Baudos Vet Links www.teleport.com/~baudo/ Home of the Veterans News and Information Service.

National Veterans Legal Services Program - www.nvlsp.org

Vietnam Veterans of America - www.vva.org

State and County Agencies

Almost every state has a state department of veterans affairs. Many cities and counties also have veterans services offices that provide representation and assistance to veterans and their families at no charge. Look in the government section (usually in front) of your local telephone directory for state, county and city veterans services. Often your state will have special programs not available elsewhere, such as Californias CalVet low interest home loans.

Legal Aid and and Legal Services Offices

Free representation by lawyers or paralegals at legal aid or legal services offices in your county may be available if your family is considered low income. Even when they can not represent you directly, many have access to resources and guides that you may find helpful and they may let you use.

Private Attorneys

A strange, but true, government regulation disallows veterans from hiring a lawyer (at market rate) to represent them during the VA claims process. You may pay a private lawyer to represent you regarding a VA claim, but only under certain specific restrictions. You must have filed a notice of disagreement with a VA regional office on or after Nov. 18, 1988 and the Board of Veterans Appeals must have subsequently issued a decision denying your appeal. You can then pay a lawyer to reopen your claim at the VA regional office or appeal the BVA decision to the Court of Veterans Appeals. You must hire the lawyer within one year of the BVA decision. These regulations do not apply if a lawyer is willing to represent you for free or if someone who does not have an interest in the claim pays the lawyer.

The organizations listed below may represent you or provide a referral to lawyers specializing in GI or veterans issues.

GI Rights Hotline 1-800-FYI95GI 1-800-394-9544

A free, confidential, non-governmental, nationwide hotline for information about discharges, discrimination, and legal referrals.

National Veterans Legal Services Project (NVLSP) 2001 S Street NW, Suite 610 Washington, DC 20009 (202) 265-8305 Email: NVLSP@aol.com

NVLSP assists some veterans with appeals at the Court of Veterans Appeals and publishes a wide variety of documents and guides that can be of assistance to veterans. NVLSP is a nonprofit law firm which serves as a national support center in the area of veterans law.

National Organization of Veterans Advocates P.O. Box 42334 Washington, DC 20015

The National Organization of Veterans Advocates provides referrals to lawyers specializing in veterans issues.

Veterans Due Process, Inc. P.O. Box 68237 Portland, OR 97268 (503) 659-9912

Veterans Due Process is a private organization that advocates on veterans legal issues.

Selected References

Books, Articles and Testimonies

Medical Reports and Papers

U.S. Government Books and Reports

Self-Help Guide Author/Editor

Erika Lundholm, California Association of Persian Gulf Veterans

Major Contributors

Dan Fahey & Elinor Roberts, Swords to Plowshares; Charles Sheehan-Miles, NGWRC; and the Board of Directors and Membership of the National Gulf War Resource Center, Inc.

Generous Donors

Donations made by the following individuals and organizations have made it possible to write, publish, and distribute this Guide. Without their generous assistance, this Guide would not be. We extend our heartfelt gratitude.

Dr. Howard Urnovitz

Swords to Plowshares

James Tuite, III

Gulf War Research Foundation

National Veterans Foundation

Dean Lundholm, Sr.

Gulf War Veterans of Georgia

Dedication

This guide could not have been completed if not for the hard work and devotion of Charles Sheehan-Miles, former Executive Director of the NGWRC. Therefore, I would like to dedicate the Guide to him. May we all help others as you have helped us.

Also of assistance were previous veterans self-help guides prepared by the National Veterans Legal Services Program, Swords to Plowshares, and the Vietnam Veterans of America. We extend our heartfelt thanks to these organizations for all the energy, enthusiasm, and knowledge they have contributed towards the field of veterans self-help guides.

The contents of this guide are for informational purposes only and neither the National Gulf War Resource Center, Inc. nor its principals assume responsibility for the accuracy or veracity of the information contained herein. This guide is distributed freely to Gulf War veterans, families, civilians, service providers and others interested in helping those who are ill due to the Persian Gulf War. Please feel free to copy and distribute this Guide for educational, counseling, self-help, and scholarly purposes. We request only that proper credit be given. Any other use requires the written authorization of the National Gulf War Resource Center, Inc.


© 1996 National Gulf War Resource Center, All Rights Reserved. Web Page design by Charles Sheehan-Miles.
Material located on these pages may be duplicated or distributed for the purpose of helping veterans. Commercial use is prohibited.

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