The Fallout of War

[thedrifter]

The Fallout of War
Iraqi Ammo Debris Fell on Jim Stutts in '91. In Many Ways, He's Being Pelted Still.
By Richard Leiby
Washington Post Staff Writer
Monday, December 30, 2002; Page C01



"I'm not the same person as I was when I left," says James Stutts, a physician who volunteered for ambulance duty during the Gulf War and is now disabled by dementia.
(J. Breck Smither For The Washington Post)


BEREA, Ky. -- The doctor sits at home, filling the hours with television, writing himself reminders that look like prescriptions. "From the desk of Dr. James Stutts," says his notepad, itself a reminder that he practiced medicine until, one day, he knew it was no longer safe. He could not remember faces and names.

Before he retired, Lt. Col. Stutts commanded medical staffs on military bases. He used to helicopter into combat zones to treat the wounded. He still keeps his Army uniform pressed and ready, as if someday he might return to duty.

He is 54 and disabled by dementia. He is a casualty of the Persian Gulf War -- one of the tens of thousands of men and women who left feeling healthy but fell sick after coming home. They filed disability claims at a rate far higher than veterans of other wars.

As the United States deploys troops in anticipation of another battle with Iraq, the Pentagon says it still has no answer for an enigma that has confounded experts for more than a decade: What caused all those Gulf veterans' symptoms? The memory lapses, fatigue, joint pains, rashes, headaches, dizzy spells . . . not to mention the cancer, Lou Gehrig's disease and birth defects.

Many vets speculated that they were poisoned by a combination of vaccines, pesticides, oil fire pollution and other battlefield toxins, including chemical and biological weapons stockpiled by Saddam Hussein. For years their maladies weren't taken seriously: It's stress, it happens after every war and it's all in your head, the military doctors said.

Stutts and his wife, Carol, believed as much. They doubted reports of this so-called Gulf War Syndrome. But by 1996, the doctor himself could no longer work. He suffered limb spasms and seizures that made him fall down stairs.

Bracing himself on a cane, Stutts deposits a pile of medical records on the kitchen counter. One file contains images of his brain. "It's like Swiss cheese," he says.

Here are notices from the Pentagon, saying he may have been exposed to the nerve gas sarin in the Persian Gulf. Here, too, is a recent determination from the Department of Veterans Affairs, ruling Stutts fully disabled and citing "neurotoxin exposure" during his deployment. Now he is a patient at a VA clinic in nearby Lexington, where 100 Gulf War vets -- most in their thirties and forties -- are being treated for symptoms of early Alzheimer's.

It's all evidence of . . . something. After 11 years, the VA and Pentagon no longer dispute that troops got sick. They've spent hundreds of millions of dollars studying why.

With his medical training, Stutts understands that good science takes time and hypotheses must be rigorously tested. But as a patient, he has reached certain conclusions.

"I'm not the same person as I was when I left." And: "I would have preferred to have stepped on a land mine than to be exposed to what I was exposed to over there."

Out of the Blue?

THUD-THUD-THUD. Brown columns of smoke thrust from the desert floor into a milky blue horizon.

"Yeah, baby. Woo!" a soldier shouts. More explosions. "Let's get it on!"

The Army engineers ooh and aah like they're watching fireworks on the Fourth of July. It's March 4, 1991, and they're in southern Iraq, a few miles from a massive ammunition depot called Khamisiyah. They've rigged charges to blow up 39 of 100 ammo bunkers at the site. The engineers are finishing a job begun during the air war in January, when pilots targeted Hussein's conventional and chemical weapons facilities.

"Air Force, eat your heart out," somebody taunts on a videotape shot that afternoon. Thunderheads of dust and sand roil the sky, resembling nuclear mushrooms.

Suddenly -- incoming! Artillery shells and debris start raining down on troops observing the demolition. The "cook-offs" reach units up to 12 miles away.

"We felt all hell had broken loose," Sgt. Brian Martin of the 37th Engineer Battalion would later tell a congressional panel. His videotape became part of the evidence for a House Government Reform and Oversight Committee report that excoriated the military in 1997 for resisting "strong evidence" linking Gulf War illnesses to battlefield toxins.

Neither Martin nor anybody else on the ground realized that at least one of the bunkers -- No. 73 -- contained hundreds of Iraqi rockets filled with sarin and cyclosarin. Six days later, at a nearby open rubble pit, the troops detonated more rockets.

The CIA knew about this deadly stockpile, but its warnings didn't reach commanders in the field in time, documents show. For five years after the war, the Pentagon denied that U.S. troops were exposed to any chemical fallout.

Then after persistent pressure from Congress and veterans advocates, the military announced in June 1996 that 400 soldiers at Khamisiyah were "presumed exposed." A year later, the number swelled to 100,000, after experts studied the winds and movement of the Khamisiyah "plume." They determined that troops in Iraq, Kuwait and Saudi Arabia were within range. Personnel received notices saying they "may have been exposed to a very low level" of sarin, but "long-term health problems are unlikely."

How much nerve agent was released? About 818 pounds, according to a Pentagon study two years ago. But that's just the latest guesstimate; earlier intelligence reports said more than a ton was detonated in Bunker 73 alone. (One drop of sarin would kill a person within minutes.)

The Pentagon argues this point: Nobody died at Khamisiyah. Nobody showed obvious signs of being gassed. It wasn't until months later that young soldiers complained of feeling old and feeble.

"I am an ex-paratrooper who needs a cane and wheelchair to get around," Martin, 33, testified. "I get lost when I drive sometimes and forget where I am at sometimes."

In Range

In January 1991, then-Capt. Stutts deployed to Saudi Arabia with the 138th Medical Support Company. He recalls being bored. He had served as a medical corpsman during two tours in Vietnam, swooping into jungles amid bloodbaths. Operation Desert Storm, with its 100-hour ground war, produced relatively few casualties.

"I didn't come over here to twiddle my thumbs," he told fellow doctors. Stutts volunteered for air ambulance duty with the 316th Medical Detachment that choppered into southeastern Iraq.

Was he ever close enough to see or hear the explosions at Khamisiyah? Sitting on his living room couch nearly 12 years later, he squeezes his eyes shut and strains to fill his mental screen.

He must have been because he received Pentagon letters confirming it, in 1997 and 2000.

Otherwise, it's all a blank.

"That's the thing that I really hate from day to day," he says. "I can't remember things that are important."

The Volunteer

To prod her husband's recollections, Carol Stutts leafs through old military records and photo albums. Who's this handsome guy? She laughs, knowing the answer: It's Jim as a teenage sailor on a hospital ship.

One of six kids in a working-class Milwaukee household, Stutts joined the Navy in 1965, straight out of high school. He viewed the service as his only route to medical school. It took him 17 years to get there.

In between came active duty and the reserves and jobs in Philadelphia emergency rooms. Recalling the onslaught of gunshot victims, he says, "I went from one combat zone to another." He enrolled at Philadelphia College of Osteopathic Medicine in 1982 on a full scholarship from the Army.

By 1988, Stutts was raising a daughter and working as director of health services at an Army base in Bayonne, N.J. He'd lost his first wife to cancer.

One day he noticed a personal ad in a local paper. It was placed by Carol -- a buoyant 29-year-old looking to get married and start a family. She quickly decided on Jim. He was stable, determined.

"I had energy I could bottle and sell," Stutts recalls. "I could work circles around the most avid worker."

When America launched Operation Desert Shield, he volunteered. He was 42.

In November 1990, before deploying, the doctor had his ruptured appendix removed. Surgeons also discovered Crohn's disease, a colon disorder, which he controlled with medication and diet. But he felt strong, an officer with taut muscles and no gray in his hair.

Falling Down

After four months at war, Stutts returned to take a medical command in Yuma, Ariz. He never before had had trouble completing the two-mile run and calisthenics for his semiannual fitness qualifications. But that summer his muscles and joints ached. He felt fatigued. "I guess I'm just getting old," he told himself.

In 1992 Stutts left active duty, moving the family (now including a young son) to take an emergency room job in Kentucky, near Berea, a charming college town in the Appalachian foothills. He also joined the National Guard.

Later he went into private practice, and did well financially. But his mind -- and overall health -- kept failing. Walking in the back yard or standing in the bathroom, he'd suddenly collapse. He had headaches, dizziness, strange temperature fluctuations.

Just watching TV, sharp pains shot through his legs. He recalls retreating into his den, hoping not to alarm Carol and the children as he rolled on the floor, trying to deaden the pain.

In November 1996, he shut down his practice. But repeated visits to experts showed nothing medically wrong, except some progression of his Crohn's disease. The VA enrolled him in a stress management group.

Carol started to have doubts. Was Jim really sick?

"Knock it off," she screamed at him one day. "Get back to work."

He wanted to, he said. But with worsening memory lapses, he didn't trust himself to drive, let alone care for patients. By late 1997 he was found "unfit for retention" by the National Guard.

One of his doctors, J. Wesson Ashford, wrote in late 1998: "The concern is that these symptoms are caused by sarin neurotoxicity and that sarin is still present in his system."

By now Stutts sometimes needed a wheelchair. By now Carol was starting to feel less like a wife and more like a widow.

False Alarms?

Talk to Gulf War veterans around the country and you'll hear this refrain:

"I tell my wife, 'I feel like a 60-year-old man, like I'm falling apart,' " says Todd Kelly, 36, a former Army paratrooper now working as an engineer in Portland, Ore.

After the war, Kelly experienced joint pains and concentration problems; he still has irritable bowel syndrome. The VA gave him a 60 percent VA disability rating. He was near the Khamisiyah demolition, but like other vets, Kelly doesn't blame his symptoms on one possible toxic exposure.

"We cleaned our vehicles with scrub brushes and diesel fuel for a month," he says. "I'm sure it's not very good for you. It's not Palmolive."

The troops endured sandstorms. They inhaled ash and a mist of oil from destroyed wells. They breathed the dust of spent shells that contained depleted uranium. Bedeviled by bugs, they doused themselves with pesticides and wore flea collars.

During the air war, Kelly watched through night-vision goggles as coalition pilots pounded hundreds of targets in Iraq. Everybody knew Hussein was stockpiling nasty germs and chemicals. What became of that fallout?

The troops's chemical attack alarms sounded constantly. Stressed-out soldiers fumbled for their gas masks and heavy protective suits. They gobbled nerve agent pre-treatment pills.

The Pentagon says that the thousands of alarms were all false; that the equipment was overly sensitive. Eventually some commanders just shut them off.

Throughout the 1990s, Senate and House panels gathered documents and testimony suggesting that Gulf troops were harmed by chemical warfare agents. Today, after their own exhaustive studies, defense officials say it's all anecdotal, or wrong, and there's no proof.

But, citing "lessons learned," deployment health experts express confidence that, this time, alarms and protective equipment and training will all be better. The General Accounting Office isn't so sure; it recently cited "many problems in the Defense Department's capabilities to defend against chemical and biological weapons."

The lesson learned by vets like former Pfc. Kelly is not to trust the official story. "I'm a walking experiment for my government" is how he sees it. Like Agent Orange and the atomic tests, it may take decades for the entire truth to come out, he says.

"They knew all along there were chemicals released in the theater of operations, but they didn't want to tarnish the victory. They should be honest about it."

The Evidence

A standard-issue gas mask and chemical protection suit decorate one corner of Steve Robinson's small office in Silver Spring. A former Army Ranger sergeant, he's head of the National Gulf War Resource Center, a veterans' advocacy group. Crunching recent VA statistics, he has come up with what he calls the "post-war casualty rate" of America's last war with Iraq.

In his view, the numbers demolish the notion of a clean or easy victory. Estimated veterans: 573,000. Number who have proved, to the satisfaction of government doctors, that they had a service-related medical problem: 160,000.

Which comes to nearly 28 percent -- a rate of approved disability claims exceeding World War II (6.6 percent), Korea (5 percent) and Vietnam (9.6 percent).

Some VA and Pentagon officials say the rate is inflated by the government's recent, more liberal policies of evaluating service-related illnesses. Others say the rigors of military life -- all that running and parachuting -- result in higher claims in categories like musculoskeletal woes. Others postulate that previous generations of vets were just tougher.

But, at both the VA and the Pentagon, the top doctors concur on one point: The Gulf vets are not fakers or malingerers.

"This is not a psychosomatic issue," says Michael Kilpatrick, deputy director for deployment health support in the Department of Defense.

Still, after years of study, military doctors say no research has established an etiology, an underlying physical cause.

As for exposure to sarin or other toxins, "I have not seen any scientific evidence to tie those exposures to the illnesses we've seen among Gulf War veterans," says VA toxicologist Mark Brown. "We know people came back with difficult-to-diagnose illnesses. We don't know the cause, but we can provide treatment."

Activists and congressional investigators say the Pentagon wasted years by focusing on a stress explanation. In the case of sarin -- developed as a pesticide in the 1930s -- the Army has long been aware of its effects.

In his book "Gassed in the Gulf," former CIA analyst Patrick Eddington cites an information sheet the Army distributed to troops a dozen years ago. It listed "symptoms of chronic, low dose exposure" to nerve agents, including sarin: "Memory loss, decreased alertness, decreased problem-solving ability, and language problems are suspected but have not been proved by scientific study."

The Pentagon's official position, as stated twice on its Web site: "Current medical evidence indicates that long term health problems from these levels of nerve agent are unlikely."

But in military-funded animal studies, evidence is slowly accumulating that exposure to non-lethal levels of sarin can later suppress the immune system, and cause brain changes and behavior problems. Other researchers have examined survivors of the Tokyo subway sarin attack in 1995, finding neurological problems and memory loss as seen in Gulf War patients.

Francis L. O'Donnell, a Defense Department consultant who has reviewed Japanese studies of the incident, calls the data "fuzzy." Some of those hospitalized were later shown to have subtle nervous system changes, he says, but he also notes that among them were alcohol users. "Is that important or not? I don't know."

O'Donnell's bottom line: "It is unclear what were the effects of the sarin, versus what were the effects of the panic."

In other words, maybe stress caused their symptoms.

'These Guys Are Sick'

SQUEAK. SQUEAK. SQUEAK. A sharp sound, like a bad wheel on a shopping cart, echoes through the holiday-decorated hallways of the Lexington VA hospital.

"The tin man needs oil," Jim Stutts says, then offers a stoic smile.

It's the noisy metal brace attached to his left leg. As the gaunt doctor-patient limps by, staffers greet him warmly by name.

He's checking in with his physicians, Wes Ashford and Joel Stephenson. As usual they can't offer much optimism. His brain scans keep showing degeneration.

The doctors do have a new memory drug that may help the symptoms, even if there's no cure. And they believe him, just as they believe the other 153 area patients enrolled in the Gulf War clinic.

"These guys are sick," says Stephenson, who oversees the clinic. "Like Dr. Stutts, they are successful people on the outside. They don't want to be here."

Worst off are the combat troops, the doctors say. The men and women from medical units who treated them also report rashes, headaches, other pains.

"About everybody across the board has joint pains -- everybody, including me," says Linda Godfrey, the clinic's case manager. A nurse, she served in the Khamisiyah fallout zone.

A couple of months after returning, her body burned like fire, forcing her to wear ice packs at work. "It came and went without rhyme or reason for four years," says Godfrey.

Extensive neuropsychological tests have demonstrated that the brain damage in Gulf War patients is similar to that of elderly patients with Alzheimer's. "You can't dispute it," Stephenson says flatly.

Ashford, a psychiatrist, is an Alzheimer's specialist who runs the hospital's memory disorders clinic. On a hallway wall, he displays computer images of 10 vets' brains, pinpointing areas of reduced blood flow. Compared to the smooth gray hemispheres of a normal brain, these resemble landscapes pocked by gaping craters. Bombs come to mind.

"The striking thing is," Ashford says, "you don't see these problems in the Vietnam vets, the Korean War vets, the World War II vets."

Yes, one explanation could be sarin: "If you get a few molecules in a particular area . . ."

But that's "idle speculation," Ashford quickly amends. Such a hypothesis must be tested. "We don't have an explanation and I don't want to pretend that we do."

Spreading the Blame

The service was Stutts's life: 32 years, counting the reserves and the National Guard.

He doesn't want it to be over. He blames, bitterly, Saddam Hussein; the Western weapons suppliers who sold Iraq its poisons; his own government, for its "deplorable" treatment of vets.

"All I want is my health back," he says, wearing an Army sweat shirt, which he will take off and put on repeatedly as he feels chills, then fevers. "I want my military command back. I want to wear the green uniform. I want my medical practice. I want to be able to get my social and family life back."

It's a long list, but one thing isn't on it. He doesn't ask for an answer. He believes he already has one.

? 2002 The Washington Post Company


Sempers,

Roger