GULF VETS operations iraqi freedom/ 

enduring freedom review 

Vol. 2, No. 1 Information for Veterans Who Served in Iraq and Afghanistan February 2005 

and Their Families 

Perlin on Challenges Facing VA in 2005
	 

Foremost among the 

challenges we face in 

2005 is our continuing 

effort to improve the 

service we provide to our 

Nation’s newest veterans, 

especially those who return 

ill or injured from Iraq 

and Afghanistan. 

Excerpt from a letter, dated January 4, 2005, to all Veterans 

Health Administration employees from Jonathan B. Perlin, 

Acting Under Secretary for Health (the top ranking medical 

official in VA). 

Jonathan B. Perlin 

Acting Under Secretary for Health 

New Report on Health Effects from Fuels, 

Combustion Products, and Propellants 

On Monday, December 20, 2004, the independent 

National Academy of Sciences’ Institute of Medicine 

(IOM) issued the third volume in a series of reports 

called Gulf War and Health. The 500+ page report 

looked at scientific evidence to reach conclusions about 

possible connections between certain exposures and 

health problems. 

Background 

In 1998, Congress passed legislation (actually 

two separate laws: Public Laws 105-277, and 105-

368), which directed VA to contract with the National 

Academy of Sciences for an evaluation of the scientific 

and medical literature regarding associations between 

illness and exposure to toxic agents to environmental 

or wartime hazards, and medicines or vaccinations 

associated with service in the 1990-91 Gulf War. While 

Congress had veterans of the 1990-91 conflict in mind 

when the legislation was enacted, we have included 

this information on the OIF/EF Review because it is 

likely that many of the more recent veterans had similar 

exposures. 

The IOM completed two earlier comprehensive 

reviews: Gulf War and Health, Volume 1: Depleted 

Uranium, Pyridostigmine Bromide, Sarin, and Vaccines 

and Gulf War and Health (2000); and Volume 2: 

Insecticides and Solvents (2003). More recently, 

IOM also conducted and released an update of the 

sarin review, entitled Gulf War and Health: Updated 

Literature Review of Sarin. 

The latest release examines the possible health effects 

of hydrazines and red fuming nitric acid (used in rocket 

fuel), hydrogen sulfide, oil-fire byproducts, diesel-heater 

fumes, and fuels (for example, jet fuels, and gasoline). 

(Continued on page 2.) 

Also in This Issue 

Two New VA Brochures Highlight Health Care and Assistance for Iraqi Freedom/Enduring Freedom Veterans ....... 2 

Registry Statistics ............................................................ 2 

Research Advisory Committee Issues Report, VA 

Announces Additional Funding for Research of Gulf 

War Illnesses .................................................................... 2 

VA Vet Centers Break Down Barriers to Care for 

Veterans with Readjustment Problems.............................. 3 

VA Gulf War Programs Recognized for Outstanding 

Service to Veterans .......................................................... 4 

Readers’ Survey ................................................................ 5 

Conclusions from the First Gulf War: After More 

Than 10 Years of Gulf War Veterans Medical 

Evaluations, What Have We Learned? ............................. 6 

Q’s and A’s ...................................................................... 6 

Ionizing Radiation Brief Fact Sheets Available, 

One on Depleted Uranium ............................................... 7 

What’s New in Depleted Uranium and Health ................. 8 

About the “Review” ......................................................... 8 

Clarification ...................................................................... 8 

Information on VA Disability Compensation.................9 

Address Changes and Duplicates.......................................9 

WRIISCs Ready to Help OIF and OEF Veterans ........... 10 

Delays Enable Increased Printing and Distribution 

of Newsletter................................................................... 10 

Where to Get Additional Information and 

Assistance........................................................................ 11 

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Department of Veterans Affairs 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Continued from page 1.) 
	

Committee Conclusions 

The committee established by IOM to consider 

these exposures concluded that there is some evidence 

linking combustion products (such as “smog”) and 

lung cancer. The committee found limited evidence 

linking combustion product exposure and cancers at 

several other sites (oral, nasal, laryngeal, and bladder), 

asthma, and two reproductive outcomes after exposure 

during pregnancy: preterm birth and low birthweight or 

intrauterine growth retardation. 

For the propellant components of Scuds, only 

hydrazines were found to have a suggestive association 

with lung cancer, although these were apparently 

not used as fuels during the 1991 war in Iraq. For 

additional information regarding these conclusions, see 

their website: www.nap.edu. 

VA Response 

VA is currently examining the report in the form of 

“prepublication copy-uncorrected proofs” to determine 

what action is warranted by the report, that is whether 

the regulations governing disability compensation or 

other aspects of VA policy need to be modified in light 

of their conclusions. 

Further Reports 

In accordance with the laws mentioned above, IOM 

is planning further reports on potential health hazards 

encountered by U.S. troops in Southwest Asia. 

Two New VA Brochures Highlight

Health Care and Assistance for Iraqi

Freedom/Enduring Freedom Veterans 

In December 2004, VA released two brochures for 

veterans of the military conflicts in Iraqi and Afghanistan. 

The 6-page Iraqi Freedom publication describes some of 

the health risks to U.S. service members serving in Iraqi 

in 2003-2004 and beyond. These include environmental 

health hazards, infectious diseases, such as, leishmaniasis, 

preventive measures, pesticides and health, deployment 

stress, and deployment-related health effects. 

This fact sheet also includes information about VA 

health care services, research, and disability compensation. 

It also provides information about other sources of information on this subject. The publication is formally known as 

Information Bulletin (or IB) 10-166 Revised, December 

2004, Iraqi Freedom Veterans: Information for Veterans 

Who Served in Iraq in 2003-2004 and Beyond and Their 

Families. It replaces a similar brochure on veterans of the 

first Gulf War. It has been available online at www.VA.gov/ 

GulfWar. Copies can also be obtained at the local VA 

medical centers, VA regional Office, and the Vet Centers. 

The Afghanistan brochure contains similar 

information about veterans who served in Operation 

Enduring Freedom. It is entitled, Enduring Freedom 

Veterans: Information for Veterans Who Served in 

Afghanistan and For Their Families. It is identified as 

IB 10-71 Revised, December 2004. Copies are on the 

internet at www.VA.gov/EnvironAgents, and at most 

VA facilities. 

Both publications are available from the 

Environmental Agents Service (131), 810 Vermont 

Avenue, N.W, Washington, DC 20420. Please indicate 

which publication you want, and the quantity sought. 

There is no charge for these publications. 

Registry Statistics 

Operation Iraqi Freedom Veterans 

Initial Examinations through 2003 – 80 

Initial Examinations through 2004 – 1,125 

Total Examinations, including followup 

examinations through 2004 – 1,128 

Total Examinations in January 2005 – 33 

Total Agent Orange Registry Examinations – 415,461 

January 2005 Agent Orange Registry 

Examinations – 2,115 

Operation Enduring Freedom Veterans are not eligible 

for a Registry examination, but may qualify for a similar 

examination. Contact the nearest VA medical center for 

details. 

Research Advisory Committee Issues 

Report, VA Announces Additional 

Funding for Research on Gulf War 

Veterans Illnesses 

On the day following Veterans Day 1994, Secretary of 

Veterans Affairs Anthony J. Principi announced approval 

for up to $15 million in additional research funding for 

Gulf War illnesses. “We still don’t have a definite cause 

for Gulf War illnesses.” Principi said. “There has to be 

a reason why some of our veterans came home healthy, 

while others serving along side them did not.” 

Principi’s announcement coincided with the release of 

a 143-page report, entitled Scientific Progress in Understanding Gulf War Veterans’ Illnesses: Report and Recommendations of the Department of Veterans Affairs Research 

Advisory Committee on Gulf War Veterans’ Illnesses. 

The Committee, authorized by Section 4, Public Law 

105-368, and appointed by Secretary Principi in 2002, 

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offered 10 findings and more than 4 dozen recommendations, including a recommendation that 15 million dollars 

be specifically added to VA’s current research and development budget in support of a Gulf War illnesses research 

program. 

The funding commitment represents the VA’s single 

largest set-aside of research funding for a specific area of 

investigation and could make up about 20 percent of VA’s 

new research grants awards for FY 2005. During the past 

decade, VA has spent more than $50 million for research 

into Gulf War veterans’ illnesses. Much of that research is 

still ongoing. While VA is still examining the report, Principi added, he is convinced that there is sufficient justification for further scientific research. 

“I appreciate the hard work done during the last two and 

a half years, led by Jim Binns,” Principi said. “I know they 

share my commitment to solve this mystery. The full report 

and additional information about the Committee is available 

at the following web site: www.VA.gov/rac-gwvi. 

VA Vet Centers Break Down Barriers to 

Care for Veterans with Readjustment

Problems 

The below article was drafted by Connie Torres, who 

spent 10 weeks in the Environmental Agents Service as 

a Hispanic Association of Colleges and Universities 

intern in the Summer of 2004. Ms. Torres conducted the 

necessary interviews and wrote the story. 

For many combatants, war is hell!! No man or 

woman returns from war the same as when they left. 

And yet they are expected to pick up where they left 

off, to go on as if little has changed. As studies have 

described, many veterans need a little --some need a lot 

--of help readjusting to civilian life. For many, asking 

for help may be seen as a sign of weakness, instead of 

recognition that a problem exists, and it requires the 

commitment to do something about it. Getting help 

requires strength. 

Since 1979, VA’s Vet Centers have been providing 

counseling to combat veterans and their families. The 

program now has 206 locations across the Nation and in 

Guam, Puerto Rico, and the U.S. Virgin Islands. 

Originally set up to assist Vietnam-era veterans 

with their transition from combat to civilian life, the 

program’s scope has expanded and currently serves 

veterans of the Korean War, World War II, Lebanon, 

Grenada, Panama, Persian Gulf, Somalia, Kosovo/ 

Bosnia, veterans of Operations Enduring Freedom 

(OEF), Iraqi Freedom (OIF) and operations within the 

Global War on Terrorism (GWOT). 

As the scope expanded, so did the number of sites 

where veterans could get help. In 1980, only a year after 

the centers first opened, there were 91 vet centers. Ten 

years later, in 1990, there were a total of 201 vet centers. 

Five additional locations subsequently were added. VA 

Vet Center officials indicate that the program has helped 

more than 1.1 million veterans since October 1992. 

PTSD and Military Service 

The Vet Centers’ priority is readjustment counseling, 

not only to veterans but also families of veterans. 

Readjustment counseling is aimed at helping veterans 

adjust to feelings of anger, unfamiliarity, or isolation that 

they might experience returning from military service. 

Readjustment problems also can include post-traumatic 

stress disorder (PTSD). 

PTSD is a normal reaction that usually comes after 

a person experiences or witnesses a trauma such as war 

or sexual assault. Loneliness, isolation, and change in 

environment while in combat can also cause PTSD. 

When not dealt with, an individual with PTSD can 

experience a range of sometimes disabling emotions 

and experiences such as grief, anxiety, paranoia, and 

difficulty trusting others. About 25 percent of soldiers 

involved in combat and 15 percent of soldiers who were 

not directly involved in combat experience PTSD or 

PTSD-like problems. 

Although it is not known when or if an individual 

will overcome problems associated with PTSD, the Vet 

Centers make sure that some healing is achieved. “We 

may not cure people, but we make a lot of people’s lives 

better,” said Dr. Jerry Clark, Team Leader of the Vet 

Center in Alexandria, VA. 

Veterans Helping Veterans 

About 80 percent of the Vet Center counselors 

working with veterans are former veterans themselves, 

and 60 percent of them have been in combat. According 

to Dr. Clark, a Vietnam veteran himself, veterans feel 

more comfortable knowing that they are talking with 

someone who knows of the ordeals and distress that 

sometimes comes with being involved in combat. “That 

counts to them,” said Dr. Clark. 

As the Center’s Team Leader, Dr. Clark has the 

responsibility of meeting with veterans and seeing that 

they are placed with counselors who are suited to help 

them adjust. The matching may be based on who the 

veteran feels more comfortable with, which in turn 

may be based on gender, race, or similar experience 

in combat. Centers stress the importance of veterans 

feeling comfortable with the atmosphere and people they 

are with. If that’s accomplished then veterans are more 

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likely to continue with their counseling. Dr. Clark has 

been counseling in Vet Centers for 10 years; he spent 8 

years in Des Moines, IA, and has been working 2 years 

in Alexandria, VA. Dr. Clark said that the centers are 

good areas for social work and that his “respect for the 

VA population” influenced him to work at the centers. 

Christopher Reed, Veterans Service Representative of 

VA’s Central Office in Washington DC, is another example of a veteran extending his services to help other 

veterans. Reed makes regular trips to Walter Reed Army 

Medical Center in Washington, DC, where he spends 

time with veterans. As a “mentor,” he informs veterans 

about the various counseling services of the Vet Centers. 

A veteran from the 1993 War in Somalia, Reed is aware 

of the difficulties that sometimes come with adjusting to 

everyday life. Upon his discharge, Reed was unaware of 

the services of Vet Centers. Today he believes that if he 

had known to take advantage of the program it “would 

have changed my life in several aspects.” That’s why he 

makes sure to recommend Vet Centers to those he feels 

may need the assistance. 

The Centers also provide bereavement counseling to 

spouses, parents, and children of Armed Forces personnel who died while serving in combat. The counseling services for families consist of extensive transition 

services, such as outreach and referral services. Like 

readjusting counseling, bereavement counseling is provided free of charge. 

The Vet Center’s programs for veterans include 

trauma counseling, special populations, networking, 

wellness, leadership, management, and transitional assistance. These are managed through individual, group, or 

marital and family counseling, medical referrals, assistance in applying for VA benefits, employment counseling, guidance and referral, alcohol/drug evaluations, 

information and referral to community resources, sexual 

trauma counseling and referral, and community education. Participants in Vet Centers often receive additional 

assistance from VA medical centers or regional offices. 

For additional information regarding this program and 

the nearest Vet Center, call toll- free 1-800-827-1000 or 

go to www.VA.gov/rcs. 

VA Gulf War Programs Recognized for 

Outstanding Service to Veterans 

In March 2004, the Office of Public Health and 

Environmental Hazards in VA Central Office sent 

the first Environmental Hazard Center of Excellence 

Awards to 13 field facilities. The award, based on a nonscientific survey mailed in August 2003, gave veterans 

the opportunity to evaluate the Environmental Health 

Registry staff. 

A

Dr. Kurt Schlegemilch, Director, 

VAMC poses with award winning 

team at Grand Junction. 

The veterans 

receiving the survey 

were those who had 

been involved in the 

gent Orange, Gulf 

War, and Ionizing 

Radiation Registry 

Program. 

According to 

Environmental Agents Service (EAS) Director, Dr. 

Mark Brown, the award was intended to “recognize 

outstanding service to veterans.” He also emphasized 

that the facilities that did not receive an award were not 

criticized. In fact, overall the responses were positive 

and those not chosen in this round of awards received 

many excellent reports from the veterans they serve. 

The survey asked veterans to name a VA Registry 

clinician or coordinator that has provided them with 

“outstanding customer service.” However, respondents 

generally choose to acknowledge the facility rather than 

a particular individual. 

The facilities received the new award certificate, 

entitled “Environmental Health Center of Excellence 

Award,” in recognition of the expertise, patience and 

dedication displayed by the VA staff. The exceptional 

centers were: 

• VA Medical Center (VAMC) Boise, ID; 

• VAMC Cheyenne, WY; 

• VAMC, Durham, NC; 

• VAMC Fargo, ND; 

• VAMC, Fresno, CA; 

• VAMC, Grand Junction, CO; 

• VAMC Manchester, NH; 

• VAOPC, Oakland Park, FL; 

• W.G. (Bill) Hefner VAMC, Salisbury, NC; 

• VAMC, San Francisco, CA; 

• VAMC White River Junction, VT; 

• VA Community Based Outpatient Clinic 

(OPC) Williamsport, PA; and 

• VAOPC, Winston-Salem, NC. 

The significance of the award and the uniqueness 

in which the recipients were chosen makes the award 

much more valuable. This was the first time veterans 

were given a survey that allowed them to evaluate 

the Registry services and staff of their medical center. 

Honorees were unaware of the survey and were 

overwhelmed to know that the award was based on the 

evaluation by veterans. “It makes the award much more 

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meaningful,” said Daniel Duffy, VAMC’s clinical coordinator for Special Programs in White River 

Junction, VT. For Cindy Force, Network Program 

Support Unit Manager/ Environmental Health 

Coordinator of the VAMC in Durham, NC, the veteran’s 

input was a positive boost. “It makes you feel as though 

you’ve done your job well,” said Force. 

Despite the surprise of the award, facilities are aware 

of their capabilities, which they attribute to the staff’s 

friendliness and knowledge. Jim Nelson, administrative 

officer of the VAOPC in Winston-Salem, NC, described 

the staff as “very personal and friendly with patients,” 

two essential qualities other facilities also associated 

with their success. The VAMC in Manchester, NH, 

takes great pride in positive feedback it has received. 

“We seldom have complaints,” said Timothy Dorgan, 

Eligibility Coordinator. 

Recipients of the award also mentioned that because 

of their great staff, they feel confident that they will 

receive the award again. Program Assistant Marj 

Doescher, of the VAMC in Boise, ID, acknowledged 

the employees’ impressive work, and offered advice 

for other facilities. Doescher stressed the importance of 

being aware of programs: “Knowing the program and 

being able to clarify is vital,” said Doescher. 

Susan H. Mather, M.D., M.P.H., Chief Public Health 

and Environmental Hazards Officer, signed each certificate. Each one, marked with a gold seal, was mailed to 

the Director with the request that it be displayed in an 

area where it could be easily recognized, preferably with 

the Agent Orange, Gulf War, and Ionizing Radiation posters and newsletters. 

Due to the positive responses, the Office of Public 

Health and Environmental Hazards looks forward to 

conducting this survey and offering this special recognition again in the near future. “I felt it was a success, it 

was well received by coordinators,” said EAS Program 

Analyst Michelle Foster. 

Foster was responsible for arranging the survey and 

for announcing the results at the national EAS quarterly 

conference call. A survey is planned for this year and 

should continue in the upcoming years. 

 The above article was drafted by Connie Torres, Hispanic Association of Colleges and Universities summer 

intern in EAS. 

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Readers’ Survey 

The editor of this newsletter is seeking feedback on 

the three issues published to date. Please take a few 

minutes to provide your comments, suggestions, 

recommendations, and advice for future issues of the 

newsletter. 

In completing the brief questionnaire we ask that you not 

critique the VAhealth care system, explain the difficulties 

you may have encountered in getting financial benefits 

from VA, or discuss your health problems. 

Rather, we want your ideas with regard to the newsletter. 

You are welcome and even encouraged to bring those 

other problems to our attention in another letter. Please 

send your survey response to Mr. Donald J. Rosenblum, 

Environmental Agents Service (131), ATTN: 

OIF/OEF Survey, Department of Veterans Affairs, 

810 Vermont Avenue, N.W., Washington, DC 20420. 

You can use this paper or write on your own. 

Thank you in advance for your cooperation. 

Are you a veteran? Yes No 

Are you the spouse of a veteran? Yes No 

Are you a first time reader of this newsletter? Yes No 

What do you think of the Review? _______________ 

Does it meet your needs? Why or why not?________ 

What changes would you like to see in this 

publication? Additions? Deletions?______________ 

Additional comments or suggestions?______________ 

For the greatest impact, please respond as soon as 

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Conclusions from the First Gulf War: The authors are Gregory C. Gray, formerly director, 

After More than 10 Years of Gulf War Center for Deployment Health Research, Naval Health 

Veterans Medical Evaluations, What Research Center, San Diego, now with the Department 

Have We Learned? of Epidemiology, University of Iowa; Gary D. 

Veterans have suffered a wide range of health 

problems since returning from the first Gulf War. 

However, health care registry data and epidemiologic 

(population) studies of health care use have revealed 

no unique Gulf War syndrome nor identified specific 

exposures that might explain these health problems. 

That was a major conclusion of a team of scientists 

from the U.S., Great Britain, and Canada in a recent issue 

of the American Journal of Preventive Medicine (Am 

J Prev Med 2004;26(5):443-452). They observed that 

Gulf War veterans have had an increase in injury, mental 

health, and multi-symptom condition diagnoses similar 

to those that have affected other military populations. 

Despite the expenditure in excess of $1 billion in 

understanding and treating Gulf War veterans during 

the past decade, scientists have been unable to fully 

understand and explain these diagnoses. 

This paper focused on the health care experience 

of veterans included in VA’s Gulf War Veterans Health 

Registry, Department of Defense’s Comprehensive 

Clinical Evaluation Program; United Kingdom Ministry 

of Defence’s Gulf War Medical Assessment Programme; 

and Canada Department of National Defence’s Canadian 

Gulf War Registry. Using multiple search techniques, the 

authors reviewed health care usage data from these four 

national Gulf War Registries. 

The authors suggested that in addition to evaluating 

possible therapies for multi-symptom conditions, 

researchers should work to identify risk factors for the 

development of such conditions. They commented that 

if military personnel likely to develop multi-symptom 

conditions can be identified early in their service, special 

training and interventions might be used to reduce the 

impact of these conditions. 

They added that DoD seems to be moving in that 

direction in studying military personnel who served 

in the recent deployment in Afghanistan and Iraq. 

Predeployment, in theater, and postdeployment data are 

being evaluated to identify predictors of postdeployment 

symptom-based illnesses. Personnel at high risk of 

developing multi-symptom conditions may benefit from 

cognitive behavior therapy, coping skill training, or other 

interventions to help them prepare for intensive stresses 

of war. 

The authors also praised DoD for improved disease 

and injury surveillance and freely reporting occurrences 

that may be associated with military service. “Such close 

surveillance with rapid public reporting is commendable.” 

Gaskstetter of the Uniformed Services University of the 

Health Sciences; Han K. Kang, Director, Environmental 

Epidemiology Service, Department of Veterans Affairs; 

John T. Graham, British Liaison Officer, Defence Staff, 

British Embassy; and Ken C. Scott, Deputy Chief of 

Staff, Medical Policy, Canadian Forces. 

Individuals with questions or comments for the 

authors or who wish to respond to something in the 

article should address their correspondence to: Gregory 

C. Gray, M.D., University of Iowa College of Public 

Health, 200 Hawkins Dr. C21K GH, Iowa City, IA 

52242. Dr. Gray email address is gregory-gray@uiowa. 

edu. 

Q’s and A’s 

The “Review” occasionally includes a questions-andanswers feature in which VA officials respond to inquiries from readers and others regarding possible health 

problems and concerns of Operations Iraqi Freedom, and 

Enduring Freedom veterans and their families and about 

programs initiated by VA and other Federal departments 

and agencies to help these veterans. Dr. Mark A. Brown, 

Director, Environmental Agents Service, answered the 

first question. 

Q. I’ve heard that a parasite Schistosoma haematobium, found in Iraq has caused health problems for some 

Iraqi Freedom Veterans and may eventually lead to bladder 

cancer. Is that correct? 

A. Schistososmiasis is found in Iraq, but not Afghanistan, and infection is thought to be not very common. 

Schistosoma haematobium, which causes urinary schistosomiasis, is the only species of Schistosoma reported in 

Iraq. Western personnel would not be at risk of schistosomiasis unless they waded or swam in infested water. We 

will probably not have many cases of long-term chronic 

infection with this parasite among OIF veterans because 

the disease is treatable. If schistosomiasis is suspected in a 

veteran, the first step would be to send urine specimens to 

the laboratory to look for characteristic eggs of this parasite. If a veteran had medical evidence of long-term infection with this parasite and they developed bladder cancer, 

then they might have a basis for a compensation claim. 

Another question that has been received from several 

sources is: 

Q. Are Iraqi Freedom and Enduring Freedom veterans 

eligible for Gulf War Registry health examinations offered 

at VA health care nationwide? And what is involved in the 

Registry exam program? 

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A. For the answer, we turned to Helen Malaskiewicz, 

Senior Program/Management Analyst in the 

Environmental Agents Service, and National Registry 

Coordinator. She has been in that position for more than a 

decade. 

According to Ms. Malaskiewicz: For Operation Iraqi 

Freedom veterans, the answer is definitely “yes.” We 

encourage all Gulf War veterans, which includes everyone 

who has served in the war in Iraq, to contact the nearest 

VA medical center for an appointment. 

Under the Registry program, VA Environmental Health 

Clinicians conduct a comprehensive physical examination. 

Participating veterans are given the following baseline 

studies: a complete blood count, blood chemistries, 

enzyme studies, and urinalysis. A chest x ray is taken if 

medically necessary. Additional appropriate diagnostic 

studies are performed and consultants are obtained as 

indicated by the patient’s symptoms and physical and 

laboratory test result. Laboratory and other finding are 

filed in the veteran’s permanent record, maintained by the 

VA medical system. 

In gathering each veteran’s medical history, the 

examiner records the time of onset of symptoms or 

conditions, the intensity of symptoms or conditions, the 

degree of physical incapacitation, and details of any 

treatment received. The examiner pays special attention 

to conditions and diagnoses that may be associated with 

service in the Operation Iraqi Freedom. Following the 

examination, the VA Environmental Health Clinician 

is responsible for personally discussing with each 

individual veteran the findings of the examination 

and completed diagnostic studies. In addition, each 

veteran will receive a followup letter explaining these 

finding and advising him or her of future actions or 

recommendations. 

Operation Enduring Freedom veterans are not eligible 

for the Gulf War Registry health exam and may not 

be included in the Registry. However, VA health care 

providers are equally concerned about the medical 

difficulties that those who served in Afghanistan have 

experienced, and have welcomed concerned Afghanistan 

veterans to come to VA for a medical examination 

similar to that offered to Iraqi Freedom veterans. 

Since 1998, VA has been authorized to provide a 

broad range of health care services to U.S. veterans 

who served on active duty in a designated theater of 

operations, which would include Afghanistan. Such 

veterans are eligible for 2 years after leaving the military 

for VA hospital care, medical services, and nursing 

home care for any illness, even if there is insufficient 

medical evidence to conclude that their illness was a 

result of their combat service. Dental services are not 

included in the 2-year program. What this means is that 

combat veterans have access to high quality health care 

at VA medical facilities for 2 years after their separation 

from military service, based on their service in combat, 

without having to prove that their health problems may 

be related to their combat service or to toxic exposures 

during their active service. 

After the 2 years have ended, the veteran’s copayment status will depend on whether the medical condition was officially found by VA to be service-connected 

or whether the veteran is otherwise qualified for care. He 

or she will be enrolled in the appropriate priority group 

level. For information regarding enrollment, see www. 

VA.gov/elig/ or contact the nearest VA medical center. 

For locations of VA facilities, consult the local 

telephone directory under “U.S. Government” listings, 

see www.VA.gov or call 877-222-VETS (or 8387). 

Additional questions should be sent as follows: 

Mr. Donald J. Rosenblum 

Deputy Director, Environmental Agents Service (131) 

Attn: OIF/EF REVIEW –Q’s & A’s 

Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20420 

We will answer as many questions as possible 

and will not identify the questioner. Questions about 

personal, medical problems are not generally considered 

appropriate for inclusion in the newsletter. 

Ionizing Radiation Fact Sheets Available, 

One on Depleted Uranium 

A series of fact sheets known as “Ionizing Radiation 

Briefs” has recently been prepared and released by the 

Environmental Agents Service. Each stand alone fact 

sheet covers an aspect or concern of veterans who were 

exposed to ionizing radiation. 

Included among the Briefs is a 4-page fact sheet on 

depleted uranium (DU), suspected by some individuals as 

the cause of some health problems experienced by some 

who served in the Gulf War or in Afghanistan. Other 

available briefs provide general information on ionizing 

radiation, describe the ionizing radiation registry, discuss 

the VA’s disability compensation program, identify information resources on radiation health effects, list illnesses 

linked to ionizing radiation, and offer further information 

on related topics.

 Readers can get the DU brief or any other or all available ionizing radiation fact sheets from the Environmental 

Health Coordinator at the nearest VA medical center or 

from the Environmental Agents Service (131), ATTN: IR 

BRIEFS, VA Central Office , 810 Vermont Avenue, N.W., 

Washington, DC 20420. Also the Briefs are available 

online at www.VA.gov/Irad. 

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What’s New in Depleted Uranium and

Health 

• Possible health problems from being exposed to 

depleted uranium (DU) have been a controversy and a 

concern ever since DU was used in the 1991 Gulf War. 

• “Friendly fire” casualties who have DU shrapnel 

still in their bodies are being carefully followed at the 

Baltimore VA Medical Center DU Screening Program. 

Other than the wounds caused by the shrapnel itself, and 

continued high levels of DU in their urine, so far, no other 

health problems related to DU have been found in these 

veterans. 

• In 2000, the independent National Academy of 

Sciences Institute of Medicine concluded that there was 

not enough scientific evidence to show that DU exposure 

caused any health problems for veterans of the 1991 Gulf 

War. Their report can be seen at www.nap.edu. 

• Published scientific research on veterans from 

the 1991 Gulf War has not shown any health effects to 

be clearly related to DU exposure, even among veterans 

with retain DU fragments in war wounds (other than the 

sometimes very serious shrapnel wound itself). 

• For veterans who are concerned about DU 

exposure, VA offers a DU urine screening test through the 

Baltimore VA Medical Center. Every veteran of the 1991 

Gulf War and the more recent conflicts in Southwest Asia 

is eligible for the DU screening program. 

• As of December 31, 2004, VA has tested 327 

veterans of the Gulf War for DU. Only a few of these 

had slightly elevated urine uranium levels which appear to 

have no health significance. 

• Trace amounts of natural uranium are part of 

our environment, and all of us are exposed through food 

and water. This background exposure can be detected as 

uranium coming out in urine. But this is not considered 

to be a significant health concern, except perhaps in a 

few areas that have unusually high levels of background 

uranium in drinking water. 

• The United Nations Environment Programme is 

reported to be studying a number of sites in Iraq. This 

group has published three studies examining DU use in the 

former Yugoslavia and concluded that “The levels of DU 

contamination were not a cause for alarm.” 

• The World Health Organization 2003 DU fact 

sheet stated that there is “inadequate/insufficient” evidence 

of DU health effects in humans in previous conflict zones. 

• Not all DU health questions have been 

conclusively resolved, although the bulk of past clinical 

evaluations and research has not shown it to be a major 

health risk. Therefore, the DU testing program in 

Baltimore will continue indefinitely. 

• The latest report to Congress on Federal 

Sponsored Research on Gulf War Veterans’ Illnesses for 

2002 listed ten studies on DU. 

About the “Review” 

The “OIF and OEF Review” is produced by 

VA’s Environmental Agents Service (EAS) to 

provide information on long-term health and other 

concerns of Operation Iraqi Freedom and Operation 

Enduring Freedom veterans, their families, and 

others. The “Review” describes actions by VA and 

other Federal departments and agencies to respond 

to these concerns and gives updates on a wide range 

of VA programs for veterans. For other issues of 

this newsletter, and related information regarding 

the current conflict in Iraq, please see our Web site 

at www.VA.gov/GulfWar. 

EAS anticipates publication once or twice a 

year, depending on the amount of news on this 

subject and on budgetary considerations. This 

issue was completed in early February 2005. It 

does not include developments that occurred after 

that time. 

Comments, questions, and suggestions for 

future issues are encouraged and can be sent to the 

Gulf War Review, Donald J. Rosenblum, Deputy 

Director, Environmental Agents Service (131), 

VA Central Office, 810 Vermont Avenue, N.W., 

Washington, DC. 20420. 

Requests for additional copies of this and/or 

future issues should also be sent to Mr. Rosenblum. 

Supplies are limited. Please specify the quantity 

and issue date requested. 

Clarification 

The earlier issues of this publication included stories 

on the 2-year rule for recent combat veterans. Under 

this rule, military veterans who served in a combat zone 

or area of hostilities comparable to that seen during 

combat are eligible for 2 years of free medical care from 

VA for many conditions. That is to say, veterans do not 

have to prove that a medical problem is connected to 

their military service to receive free VA care for that 

condition, nor must they have relatively low incomes. 

We want to clarify that the benefit does not cover 

treatment for medical problems clearly unrelated to 

military service and disorders that existed before the 

person joined the military unless the condition worsened 

during military service. 

Furthermore, while the article correctly reported the 

above information, it neglected to explain that dental 

care eligibility is totally different from medical care, and 

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that dental services are not covered by the 2-year rule. 

We regret any problems that our omission may have 

caused. 

Information on VA Disability

Compensation 

Like all veterans, Operation Iraqi Freedom and Operation Enduring Freedom veterans may be eligible for 

monthly payments, called disability compensation, from 

VA if they are suffering from service-connected illnesses 

or injuries. The disability must have happened or made 

worse during active military service. Furthermore, the 

veteran must have left military service through separation 

or discharge under conditions that were other than dishonorable. 

Disability compensation varies according to the degree 

of disability and the number of dependents. Benefits are 

not subject to Federal or state income tax. The receipt 

of military retirement pay, disability severance pay, and 

separation incentive payments know as SSB and VSI 

(Special Separation Benefits and Voluntary Separation 

Incentives) also affects the amount of VA compensation 

paid. 

The disability ratings range from 0 to 100 percent (in 

increments of 10 percent). For example, in 2005, an 

OIF or OEF veteran with a disability rating of 10 percent 

receives $108; a veteran with disability rating of 50 percent gets $646; and a veteran who is totally disabled and 

evaluated at 100 percent receives $2,299 monthly. 

Veterans with disability ratings between 30 and 100 

percent are also eligible for monthly allowances for a 

spouse ranging from $39 to $130, and for each child, $19 

to $66. (The amount depends on the disability rating.) 

A veteran who is in need of regular aid and attendance 

of another person, or who is permanently housebound 

may be entitled to additional benefits. VA must make that 

determination before the veteran can get these benefits. 

Additional information including online applications can 

be seen at www.VA.gov. 

Must Apply to be Considered 

Compensation is not automatically provided to the 

OIF, OEF, or other veterans. VA veterans service representatives (VSR) can provide the necessary application and assist veterans who need help in completing it. 

VSR’s are located at all VA Regional Offices, in VA medical centers, and at most VA clinics. For help in locating 

a VSR near you, call the following toll-free telephone 

number: 1-800-827-1000 or go online at www.VA.gov. 

Other Benefits 

In addition to the compensation program described 

above, individual OIF and OEF veterans may be 

eligible for the full range of other benefits offered 

by VA, including education and training, vocational 

rehabilitation, home loan guarantees, life insurance, 

pension, burial benefits, and more. 

To learn more about VA’s programs, OIF veterans and 

other interested parties can visit the VA home page www. 

VA.gov or call 1-800-827-1000. 

This information was provided by benefit experts in the 

Veterans Benefits Administration in VA Central Office. 

Address Changes and Duplicates 

If this newsletter has your old address, please use 

this form to update our mailing list. Send the completed 

form to the Gulf War Review, AustinAutomation Center 

(200/397A), 1615 Woodward Street,Austin, TX 78772-

0001. If you have access to the Gulf War Review via 

the VA Web site www.VA.gov/GulfWar and wish to 

discontinue receiving a copy by mail, please complete 

the above form and return it to the Austin Automation 

Center. If you are receiving more than one copy of the 

newsletter, please let us know. Write to the address 

above. Please provide your name, address, and social 

security number. Thank you. 

Check or circle the language that describes your 

situation. 

____My address has changed, and I would like to 

continue to receive the newsletter. 

_____I am receiving more than one copy, but I only 

want to get a single copy. 

_____I don’t need to get the newsletter by mail as I 

can read it at www.VA.gov/GulfWar. 

_____Other (explain)_________________________ 

Please print your:
	

First Name ________________________
	

Middle ___________________________
	

Last ______________________________
	

SSN: _____________
	

New Street/RFD/Military Unit: __________________
	

APO/FPO: ____ (Indicate which if applicable)
	

City: ____________________
	

Alpha State/or APO/FPO Code: ___
	

ZIP Code: ________
	

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WRIISCs Are Ready to Help OIF and 

OEF Combat Veterans 

VA’s War Related Illness and Injury Study Centers 

(WRIISCs) provide service to combat veterans who 

have difficult-to-diagnose disabling illnesses though 

clinical care, risk communication, education, and 

research that focuses on the potential environmental 

exposures and adverse health outcomes. 

The Centers replaced the Gulf War Referral Centers 

several years ago, expanding their mission to offer 

comprehensive clinical care to combat veterans of all 

eras. The two current centers are located at VA medical 

centers in Washington, DC, and East Orange, New 

Jersey. Center officials work closely with Department 

of Defense personnel who are performing similar 

post-deployment health issues for active duty service 

members and veterans. Once a diagnosis is determined, 

treatment, based on the WRIISC’ s conclusions, is 

provided by the VA medical center that referred the 

veteran. 

The WRIISCs were set up to respond to the health 

problems of veterans from both past and future conflicts. 

Improving the care of patients with war-related 

conditions require the same scientific rigor American 

health scientists have applied to other important 

problems. 

Some veterans have persistent unexplained 

symptoms following deployment to a combat zone. 

Individual veterans who have completed a thorough 

medical evaluation at their local VA medical center may 

be eligible for an in-depth examination and evaluation 

at one of the WRIISCs. VA primary care providers of 

veterans with undiagnosed illnesses can request an 

evaluation at one of the WRIISCs. The referral process 

is coordinated by VA Central Office. Referral acceptance 

is a joint decision of VA Central Office, the WRIISCs, 

the referring providers, and the patient. More than 

750 individuals have been treated at the two WRIISCs 

during the past 3 years. 

Veterans may not refer themselves. Patients 

interested in a referral should work through their VA 

health care provider. For additional information, see 

www.VA.gov/EnvironAgents or call 1-800-PGWVETS (1-800-749-8387). 

Delays Enable Increased Printing and 

Distribution of Newsletter 

The headline of the lead article of the June 2004 issue 

of Operations Iraqi Freedom/Enduring Freedom (OIF/ 

OEF) Review declared that it was being mailed directly 

to approximately 136,000 recently returned veterans of 

the wars in Iraq and Afghanistan. The article was true 

when written, but an interesting and unusual thing happened since its preparation. The roster of Gulf War and 

Afghanistan returned veterans continued to grow and 

reached about 180,000 before the newsletter was distributed. In response, VA printed and mailed tens of thousands of additional copies. Future issues are likely to go 

to even more veterans. 

In addition, copies of all issues of this newsletter 

are continuing to be sent to all VA medical centers, VA 

regional offices, vet centers, veterans service organizations, and other interested groups and individuals. 

Anyone who wants back issues and future editions of 

the newsletter can get them at www.VA.gov/GulfWar. 

Copies of these newsletters are continuing to be listed 

under Gulf War Review, a separate newsletter also 

prepared by VA’s Environmental Agents Service in 

Washington, DC. 

The address for the Environmental Agents Service is: 

Environmental Agents Service (131), VA Central Office, 

810 Vermont Avenue, N.W., Washington, DC 20420. 

The office can also provide you with additional copies if 

available. 

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Where to Go for Information and Assistance
	

Active duty military personnel with questions 

or concerns about service in Southwest Asia 

(including Operations Desert Storm, Desert Shield, 

Iraqi Freedom, and Enduring Freedom) - contact 

your commanding officer or call the Department 

of Defense (DoD) Gulf War Veterans’ Hotline 

(1-800-796-9699) for information. DoD also offers 

the “Direct Veterans Hotline,” with the toll-free 

number 1-800-497-6261. 

Any Gulf War veterans (Included Operations 

Desert Shield, Desert Storm, and Iraqi Freedom 

veterans) with concerns about their health should 

contact their nearest VA medical center. The 

telephone number can be found in your local 

telephone directory under Department of Veterans 

Affairs in the “U.S. Government” listings. 

Medical care is available, and a Gulf War Registry 

examination for veterans who served in Iraq is also 

available on request. 

The VA Gulf War Information Helpline can also 

provide information and assistance. The toll-free 

telephone number is 1-800-PGW-VETS (1-800-749-

8387). 

Check our Web sites for more Gulf War 

information on health care and other benefits 

(including those for Operations Iraqi Freedom, 

Desert Shield, and Desert Storm veterans) at www. 

VA.gov/GulfWar. 

Gulf War veterans in need of marital/family 

counseling should contact the nearest VA medical 

center or VA Vet Center, also listed in your 

phonebook under Department of Veterans Affairs 

in the “U.S. Government” listings. For additional 

information about these programs call the Gulf War 

Information Helpline at 1-800-PGW-VETS (1-800-

749-8387). 

Gulf War veterans seeking disability compensation 

for illnesses incurred in or aggravated by military 

service can contact a Veterans Benefits Counselor at 

the nearest VA regional office or health care 

facility at 1-800-827-1000, or call the VA Gulf War 

Information Helpline at 1-800-PGW-VETS (1-800-

749-8387). You can also start a claim online at www. 

VA.gov. 

Gulf War veterans interested in learning about the 

wide range of benefit programs administered by VA 

should contact a Veterans Benefits Counselor at the 

nearest VA regional office or health care facility at 

1-800-827-1000, or call the VA Gulf War Information 

Helpline at 1-800-PGW-VETS (1-800-749-8387). 

Representatives of veterans service organizations, including the American Legion (1-800-433-

3318), Veterans of Foreign Wars of the United States 

(1-800-VFW-1899), Disabled American Veterans 

(1-877-426-2838), etc., have been very helpful to 

Gulf War veterans, especially veterans who are seeking disability compensation. (These organizations are 

cited as examples. There are many other excellent 

organizations. VA does not endorse or recommend 

any one group over another.) 

County Veterans Service Officers also have been 

of great help to many military veterans, including 

those who served in the Gulf War, who are seeking benefits they earned through their service to the 

Nation. 

For additional Federal benefit information, see 

VA’s Federal Benefits for Veterans and Dependents 

booklet. It is updated annually to reflect changes in 

law and policies. It is available for purchase from 

the U.S, Government Printing Office, Superintendent 

of Documents, Washington, DC 20402, Web site: 

bookstore.gpo.gov. VA’s World Wide Web pages are 

updated throughout the year to present the most current information. The VA home page (www.VA.gov) 

contains links to selections on compensation and pension benefits, health care benefits and services, burial 

and memorial benefits, etc. 

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Department of

Veterans Affairs 

Central Office (131) 

810 Vermont Avenue, N.W. 

ashington, DC 20420 W


	 OFFICIAL BUSINESS
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/ ope rations iraqi freedom 

enduring freedom review 

Information for Veterans Who 

Served in Iraq and Afghanistan 

and Their Families 

February 2005