# ***GULF WAR RISK FACTOR REPORT REPRINTS***

# 

### Deplete Uranium

# *The following article originally appeared in the September 1999 issue of the* Gulf War Review *newsletter. The second article, entitled Depleted Uranium Health Effects Updated, was printed in the June 2000 issue. The third article, entitled DU Article Published, was in the May 2001 issue. For information about the newsletter, contact Mr. Donald J. Rosenblum, Deputy Director, Environmental Agents Service (131), VA Central Office, 810 Vermont Avenue, NW, Washington, DC 20420, telephone: 202-273-8580.*

# 

# **VA Depleted Uranium Programs Seek to Address Veterans' Concerns**

# 

The Department of Veterans Affairs (VA) has established a Depleted
Uranium (DU) screening program for Gulf War veterans who are concerned
about the possible long-term health effects of DU exposure. The purpose
of this communication is to describe: (1) DU and how veterans may have
been exposed to it; (2) the known health effects of DU; (3) the DU
screening program; and (4) the Baltimore DU Follow-up Program.

**Depleted Uranium Exposure**

DU is derived from the heavy metal uranium, which occurs naturally as
mineral deposits that are mined and processed for use in nuclear power
plants or nuclear weapons. DU is the natural uranium left over after
more of the highly radioactive uranium isotopes used in these power
plants and weapons are extracted. DU contains about half of the
radioactivity of natural uranium. It is considered a very low-level
radioactive material. However, as with other heavy metals, such as lead,
uranium can be toxic to the kidneys and other organs including the
lungs.

Depleted uranium was first used in the development of major weapon
systems because of its high density and superior mechanical properties,
and because it is relatively abundant and cost effective.

American troops in the Persian Gulf were exposed to DU in several ways.
A few were injured by "friendly fire," more were crewmembers in
relatively close contact with munitions in tanks or other vehicles. U.S.
soldiers also may have been exposed to smoke or particulate containing
DU while fighting a fire at Doha Depot or by entering or salvaging
vehicles or bunkers that were hit by DU projectiles.

# **Limited Health Information**

## 

##  Information on the possible health effects of DU exposure in military settings is very limited. Most information about possible effects on humans comes from studies of uranium miners and millers and associated occupations, which are somewhat different from Gulf War veterans. For example, miners were possibly exposed to radon and other toxic substances present in the mines, making their experience not directly comparable to Gulf War veterans. Other significant differences relate to the length and intensity of exposures. Miners are typically exposed over a long period of time while veterans typically had a short exposure period.

## 

##  The miners studies did find that uranium could affect the kidneys and the respiratory system. Long-term chemical exposure is thought to affect the kidneys and long-term inhalation may cause lung problems. Uranium miners who inhaled uranium dust for extended periods showed increased risks of lung cancer. However, exposure to radon accounts for virtually all of this increase lung cancer risk. Animal studies have not conclusively demonstrated that natural uranium causes lung cancer in animals. At present, it is not known to what extent, if any, DU exposures will affect the health of Gulf War veterans.

Screening Program

Gulf War veterans who are concerned about potential DU exposure are
invited to contact the Gulf War Health Registry Coordinator at their
nearest VA Medical Center. Interested veterans may request a DU protocol
examination that includes a complete Gulf War Registry examination (if
not already done), a DU exposure questionnaire, and if needed, a 24-hour
urine collection for total uranium. The 24-hour urine test measures
total uranium, not DU specifically. However, this urine test would
include any DU that is present. It is important to note that any
possible health effects are due to total uranium concentration, not DU
alone.

As noted previously, uranium is a naturally occurring metal. Because of
this, uranium is present in the food and water we consume. Therefore, a
certain amount of uranium is expected to be present in the urine. The
amount expected would depend on how much uranium is consumed in one's
daily diet. At present, there is no valid technology that is sensitive
enough to accurately measure DU in a urine sample where the total
uranium is low enough to be considered "normal." (Normal means that the
amount of uranium would be expected based on food and water
consumption.) If an individual's sample falls above the normal limits,
isotopic analysis to specifically determine the amount of DU will be
performed.

# **Baltimore DU Follow-Up Program**

In 1993, the VA established the Depleted Uranium (DU) Follow-up Program
at the Baltimore VA Medical Center. This clinical surveillance program
was designed for identifying, characterizing and following individuals
exposed to DU during the Gulf War. The goals of the follow up project
are to provide an on-going clinical surveillance of Gulf War veterans
who have known or suspected imbedded DU fragments, DU contaminated
wounds, or significant amounts of inhaled DU. The clinical surveillance
is designed to detect the health effects, if any, of DU containing
shrapnel or inhalation exposure, and to provide recommendations for
treatment to participating veterans and the physicians caring for them.

The medical follow-up program is also involved in the coordination and
distribution of urine analysis materials for the DU screening program.
The staff assists with processing specimens, coordinating specialized
tests and analysis, and reporting results to patients, physicians, and
the Gulf War database.

Most of the people participating in the DU follow-up program were
exposed to DU when their U.S. Army vehicle was struck by DU containing
munitions. Veterans of friendly fire incidents during the Gulf War are
being invited to participate in the scheduled clinical evaluations as
their exposure histories and current locations are confirmed.

In addition to helping individual veterans, the information gained
through the DU screening and medical follow-up programs will improve our
understanding of the potential health effects of DU and expand our
knowledge about fragment removal, uranium absorption and distribution,
and how uranium is eliminated from the body. Program officials hope that
the program will also improve methods of the evaluation of uranium dose
and the detection of health effects.

The evaluation of the toxicological and radiological effects of DU are
intended to improve the scientific basis for providing advice about
fragment removal, and to better understand uranium absorption in the
body, uranium distribution in human tissue, and how uranium is excreted.
Improved methods to assess uranium dose in humans may also result from
these efforts. In addition, the DU program hopes to improve ways to
detect toxic effects from low dose uranium exposure.

# **Other Problems**

Other Gulf War veterans who think that their health problems are related
to service in the Gulf War, including but not limited to DU exposure,
are encouraged to contact their nearest VA Medical Center for a Gulf War
Registry health examination. The telephone number of the medical center
can be found in local telephone directories under Department of Veterans
Affairs in the "U.S. Government" listings. Gulf War veterans may wish to
contact the nearest VA veteran center for readjustment counseling. Many
of the counselors there are themselves military veterans. The telephone
number can be found in the local directories as described above.

Veterans with service-related disabilities may wish to file a claim for
disability compensation. A Veterans Benefits Counselor (VBC) at the
nearest VA regional office or medical center can provide the application
form and any needed assistance. The national toll-free number to reach a
VBC is 1-800-827-1000.

**Depleted Uranium Health Effects Updated**

The September 1999 issue of the Gulf War Review included a front page
article regarding the Department of Veterans Affairs (VA) program to
respond to the needs of Gulf War veterans regarding the possible
long-term health consequences of exposure to depleted uranium (DU).

Early this year, the scientific journal Environmental Research published
a research article by scientists and physicians who are working on the
VA depleted uranium program. The authors wrote, in part, that a small
group of Gulf War veterans have retained fragments of depleted uranium
shrapnel. The long-term health consequences of which are unclear, but
subtle effects have been detected in these patients. The investigators
evaluated the clinical health effects of DU exposure in Gulf War
veterans comparing them to Gulf War veterans who were not exposed to DU
fragments.

Medical history was taken and follow-up medical examinations were
performed on 29 exposed and 38 nonexposed Gulf War veterans. The authors
found persistent elevated urinary uranium seven years after first
exposure. Adverse health effects in the kidney, a presumed target organ
of uranium were not present. However, other effects were observed. There
was a statistical relationship between urine uranium levels and lower
performance on computerized tests assessing performance efficiency.
Furthermore, there were small effects seen in prolactin levels, which is
a hormone important to reproduction. Again, the actual health impacts of
these effects are not clear.

**DU Article Published**

Depleted uranium (DU), a by-product of the uranium fuel enrichment
process, was used in both projectiles and armor by the U.S. military
because of its density and low relative cost. However, because of its
radioactivity -- albeit low level -- and health concerns about uranium
(including its toxicity to the kidneys), some veterans and the
Department of Veterans Affairs (VA) officials are worried about the
long-term health consequences of exposure to DU on Gulf War veterans.

A substantive front-page article regarding DU is included in the
September 1999 issue of the Gulf War Review. That newsletter is
available from the Environmental Agents Service (131), VA Central
Office, 810 Vermont Avenue, N.W., Washington, DC 20420, many VA medical
centers, regional offices, and many vets centers. It is also on- line at
[*www.va.gov/health/environ.persgulf.htm*](http://www.va.gov/health/environ.persgulf.htm).

In response to the concerns about health effects in Gulf War veterans,
in August 1998 through the end of 1999, an already existing surveillance
program following DU "friendly fire" victims was enlarged to look at the
wider veterans community's exposure to DU. A total of 169 Gulf War
veterans submitted 24-hour urine samples for determination of urinary
uranium concentration. Possible DU exposure was determined from 30
separate questionnaire items condensed into 19 distinct exposure
scenarios. Twelve individuals (7.1 percent) had urine uranium levels in
the high range, and 157 (92.9 percent) had low level. A second test for
six of the twelve (the other six dropped out of the study) found three
of these individuals in the low range.

The exposures scenarios of the high and low urinary uranium groups were
similar, with the presence of retained shrapnel being the only predictor
of high uranium levels. The researchers concluded that the study results
emphasized the unlikely occurrence of an elevated urine uranium result
and consequently any uranium-related health effects in the absence of
retained DU metal fragments in the veterans.

The project results were described early this year in the medical
journal *Health Physics* (Health Phys. 80(3):270-273; 2001) in an
article entitled *Urinary Uranium Concentrations in an Enlarged Gulf War
Veteran Cohort*. Melissa A. McDiarmid, Susan M. Engelhardt, and Marc
Oliver authored the paper. For correspondence or reprints of the article
write to M.A. McDiarmid, University of Maryland, Occupational Health
Project, 405 W. Redwood Street, Baltimore, MD 21201. Dr. McDiarmid heads
the VA's DU Follow-Up Program at the VA Maryland Health Care System in
Baltimore.