Chronic Casualties
By Richard Leiby
The Washington Post | The Lexington Herald-Leader

Sunday 5 January 2003

Years after serving in the Persian Gulf War, Dr. James Stutts of Berea still fights crippling symptoms, the cause of which he can't fully explain. There are tens of thousands like him.

The doctor sits at home, filling the hours with television, writing himself reminders that look like prescriptions.

"From the desk of Dr. James Stutts," his notepad says, 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 he might return to duty someday.

He is 54 and disabled by a list of disorders, including dementia. He is a casualty of the Persian Gulf War -- one of 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: What caused all those Gulf War veterans' symptoms? The memory lapses, fatigue, joint pain, 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, 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 might have been exposed to the nerve gas sarin in the Persian Gulf. Here, too, is a recent determination from the Department of Veterans Affairs that rules Stutts fully disabled and cites "neurotoxin exposure" during his deployment. Now he is a patient at the Veterans Affairs hospital on Cooper Drive in Lexington, where 100 Gulf War vets -- most in their 30s and 40s -- are being treated for symptoms of early Alzheimer's.

'I'm not the same person'

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."

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.

Stutts volunteered for air ambulance duty with the 316th Medical Detachment, which 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."

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 teen-age 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, who was looking to get married and start a family. She quickly decided on Jim. He was stable and determined. "I had energy I could bottle and sell," Stutts recalls. "I could work circles around the most avid worker."

Feelings of fatigue

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. He was an officer with taut muscles and no gray in his hair.

After four months at war, Stutts returned to take a medical command in Yuma, Ariz. He never before had had trouble completing the 2-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 to take an emergency room job in Berea, a charming college town in the Appalachian foothills. He also joined the National Guard.

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

Just watching TV, sharp pain shot through his legs. He recalls retreating to 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. Repeated visits to experts showed nothing medically wrong, except some progression of Crohn's disease. The VA enrolled him in a stress-management group. By late 1997, he was found "unfit for retention" by the National Guard.

One of his doctors, 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."

Diesel, ash and pesticides

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

Vets learned skepticism

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."

A standard-issue gas mask and chemical protection suit decorate one corner of Steve Robinson's small office in Silver Spring, Md. 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.

No underlying cause

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.

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.

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 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.

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."

Pockmarked brains

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."

The service was Stutts' 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

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