Sicke Veterans Sue KBR over Burn Pit Toxin Exposure

Full Article at: Sick Veterans Sue KBR Over Iraq and Afghanistan Burn Pits
Salem-News.com

KBR burned biohazard materials
 including human corpses, medical supplies, paints, solvents, asbestos,
 pesticides, animal carcasses, tires, lithium batteries, Styrofoam, wood, rubber, medical waste, large amounts of plastics, and even entire trucks.


Open burn pit at al Asad Marine Air base in Iraq
This photo taken at the al Asad Marine Air base in Iraq's Anbar Province during the summer of 2008, shows the type of burn pit smoke that the service members are suing over. Salem-News.com photo by Tim King

(WAYNE, N.J.) - A lawsuit was filed alleging that KBR, Inc.
(NYSE KBR) endangered the health and safety of American soldiers in
 Iraq and Afghanistan by exposing them to huge quantities of toxic dust, fumes and other air pollutants by burning unsorted waste in vast open-air pits without any safety controls.



The lawsuit filed Tuesday in federal court in New Jersey by the law firm of Jon L. Gelman LLC on behalf of two military veterans whose
illnesses – which include respiratory disease, chronic cough,
debilitating headaches, and neurological skin disorders – were
 allegedly caused by 24/7 hazardous emissions from burn pits.



KBR is accused of operating burn pits in such an unsafe manner that
 they permitted thick, noxious smoke emerging from the flames,
 sometimes colored blue or green by burning chemicals, to hang over US
bases and camps across Iraq and Afghanistan since 2004.



According to the complaint, the burn pits are so large that tractors 
are used to push waste onto them and the flames shoot hundreds of feet
into the air. KBR allegedly burned waste such as biohazard materials
including human corpses, medical supplies, paints, solvents, asbestos,
 items containing pesticides, animal carcasses, tires, lithium 
batteries, Styrofoam, wood, rubber, medical waste, large amounts of plastics, and even entire trucks.



Attorney Jon L. Gelman said, “It is alleged that KRB failed to follow
prescribed safety protocols for the proper disposal of waste
materials, and protect the health and safety of those soldiers serving
in and about those areas. It was common knowledge that open-air incineration of toxic substances, including known carcinogens,
endangered those individuals living in and about those areas. A
 company should not willfully disregard appropriate safety precautions and endanger US Solders heroically serving their country."

The plaintiffs are: Gene L. Matson of Superior, Wisconsin and Timothy J. Watson of Clarkesville, Tennessee.



The defendants are KBR, Inc., of Houston; Kellogg, Brown & Root LLC. 
of Austin, Texas; Kellogg, Brown & Root Services, Inc., of Houston; 
and Halliburton Company, of Houston.

The case is: Gene L. Matson, et al. v KBR, Inc., et al. (In the U.S.
 District Court of New Jersey (Case No. 2:10-cv-01492-KSH-MAS).



Attorney Contact: Jon L. Gelman, of Jon L. Gelman LLC, Wayne, NJ, 973.696.7900 or visit: gelmans.com.

Law Professor Talks about PTSD and Veterans that Wind Up before the Court

Audio at: Veterans with PTSD Stand Up in Court
By Virginia Prescott on Wednesday, March 24, 2010.
listen: Windows Media | MP3
Audio Help

Veterans affairs stats suggest that 27 percent of active duty vets were at risk for mental health problems including post-traumatic stress disorder. Those are the kinds of problems that can eventually land former soldiers in court. In 2008, more than 700,000 US veterans were either in prison, on probation or on parole. Many of them were found guilty of crimes related to PTSD.

Typically, judges focus on a defendant’s crimes rather than on their background or good deeds - like military service - when sentencing defendants in court. Increasingly, however, judges are ignoring the guidelines and writing more lenient sentences for soldiers who commit crimes after returning home from Iraq or Afghanistan.

The U.S. Department of Veteran Affairs reports approximately 27 percent of active-duty veterans are at risk for mental health problems, such as post-traumatic stress disorder. And this mental and emotional baggage is weighing heavily on judges as they evaluate veteran crimes.

Douglas Berman is a law professor at Ohio State University and an expert on judicial sentencing. He joined us today to talk about veterans getting off the hook more easily in the courtroom.

National Journal: The Emerging PTSD Defense"

Terminally Ill Camp Lejeune Marine Receives 100% Disability

Full Article at: VA ruling on former Marine's illness may affect thousands
By Sandra Jontz, Stars and Stripes
European edition, Saturday, March 27, 2010

"Paul Buckley, a former Marine, has been granted full disability benefits by the Veterans Affairs Department after it was determined that his years living and working at Camp Lejeune, N.C., led to him contracting multiple myeloma, an incurable bone cancer.

A government decision to give disability benefits to a former Marine sickened by toxins at Camp Lejeune, N.C., could have far-reaching effects for thousands of other families who lived and worked at the military base over the years.

Paul Buckley, who was diagnosed with multiple myeloma four years ago, received a letter from the Department of Veterans Affairs earlier this month stating that “all reasonable doubt has been resolved in your favor.” Buckley’s incurable bone marrow cancer “was directly related to military service,” the letter continued.

“This is not the type of cancer you get from smoking or eating French fries,” said Buckley, 46, who now lives in Hanover, Mass. “I was too young to get this illness and I didn’t have any of the risk factors.”

But in the 1980s, Buckley was assigned to Camp Lejeune, where scientists found the presence of the degreaser trichloroethylene, or TCE, the dry-cleaning solvent tetrachloroethylene, or PCE, and the carcinogen benzene in the drinking water.

His doctors believe exposure to those chemicals was the likely cause of his cancer − a claim the U.S. government repeatedly denied until he received his letter from the VA on March 8.

For Buckley, the sudden reversal means that he can start collecting VA benefits, which will extend to his wife when he dies.

The VA’s ruling could have much broader ramifications: By some estimates, up to 1 million people lived or worked at the base between 1957 and 1987."

Philly-VA Fined $227,500 for Egregious Failures in Prostate Cancer Care

Full Article at: NRC fines Phila. VA $227,500 over prostate care

By Josh Goldstein

Inquirer Staff Writer

The Philadelphia VA Medical Center was hit with a $227,500 fine by the Nuclear Regulatory Commission yesterday for poor care in a prostate cancer program that resulted in 97 veterans getting incorrect doses of radiation.

The fine levied against the Department of Veterans Affairs was the second largest ever by the NRC against a medical facility. The VA has 30 days to contest the fine.

"The VA Philadelphia had a total breakdown in management oversight, a total breakdown in the program, and a total breakdown in safety culture that resulted in these egregious failures," said Steve Reynolds, director of the division of nuclear material safety for NRC Region III, which oversees the Veterans Health Administration.

The largest NRC fine was $280,000 in 1996 against the owners of hospitals in Indiana, Pa., and Marlton. That case involved the death of a patient.

"Fortunately nobody died here," Reynolds said.

At least not yet."

VA's Top Technology Officer Say Disability Claim System Can't be Fixed

Full Article at: VA official: Disability claims system ‘cannot be fixed'
"The Veterans Affairs Department's chief technology officer said Thursday that

"In my judgment, it cannot be fixed," said Peter Levin. "We need to build a new system, and that is exactly what we are going to do."

Levin's comments came at a meeting organized by the House Veterans' Affairs Committee to toss around ideas for repairing a system that has a backlog of about 1.1 million claims awaiting decisions and an error rate on claims of 17 to 25 percent, depending on who is counting.

Rep. Bob Filner, D-Va., the veterans' committee chairman, described the system as an "insult to veterans" who, on average, wait six months for an initial decision on benefits and who can wait for years if the decision is appealed.

"It looks like we are going backwards rather than forward," Filner said. "No matter how much we raise the budget, no matter how many people we hire, the backlog seems to get bigger."

"People die before their claim is adjudicated. They lose their home. Those lost their car," Filner said."

Federal Investigation Substantiates Mismanagement at Indiana VA Hospital

Full Article at: Federal Report Sheds Light On VA Hospital Concerns

By Brien McElhatten

Story Published: Mar 9, 2010 at 10:24 PM EST

FORT WAYNE, Ind. (Indiana's NewsCenter) - A federal investigation substantiates reports of resource mismanagement at the VA hospital.

The 17-page document released on March 2nd, highlights problem areas with the VA Northern Indiana Health Care System. The report traced complaints of "persistent instrumentation problems with operating room sets and peel packages; ongoing reusable medical equipment issues; supply processing and distribution stocking and dating of supplies; pharmacy stocking of operating rooms, post anesthesia care unit, endoscopy unit medications and management issues."

The investigation, conducted by the VA Office of Inspector general, substantiated some, but not all of the complaints made by staff members. It found that surgical instrument sets were returning improperly from a VA sterilizing facility in Marion. Some tools were marked with water spots, while tool packages occasionally contained the wrong tools or missing instruments. Investigators discovered that several technicians were unable to identify basic pieces that make up those kits.

Hospital Assistant Director Helen Rhodes says the employees were new at the time of the investigation, and that pictures of the tools and properly assembled tool kits have been issued to them to prevent recurrences.

In addition to improperly packaged tool sets, instruments like endoscopes occasionally returned from sterilization covered in water spots, prompting dozens of surgeries to be postponed in the summer of 2009."

WOODING v. U.S., No. 07-4695, Federal Tort

Full Article at: Leagle, Inc.
WOODING v. U.S.

HENRY L. WOODING; PHOEBE G. WOODING, his wife,
v.
UNITED STATES OF AMERICA
Henry L. Wooding, Appellant.

No. 07-4695.

United States Court of Appeals, Third Circuit.

Submitted Pursuant to Third Circuit LAR 34.1(a) February 26, 2010.

Opinion Filed: March 9, 2010.

Before: CHAGARES, STAPLETON and LOURIE,[ 1 ] Circuit Judges.
NOT PRECEDENTIAL
OPINION OF THE COURT

STAPLETON, Circuit Judge.

Appellant Henry Wooding filed this civil action against the United States under the the Federal Tort Claims Act ("FTCA"), 28 U.S.C. § 2671, et seq., alleging that he was injured during a surgical procedure at the Department of Veterans Affairs Medical Center in Pittsburgh, Pennsylvania. Wooding appeals the order of the District Court granting summary judgment to the United States.

Because we write only for the benefit of the parties, we assume familiarity with the facts of this civil action and the proceedings in the District Court. We will affirm essentially for the reasons stated by the District Court.
I.

In 2001, Wooding was referred to the orthopedic clinic at the Veterans Affairs Medical Center in Pittsburgh, Pennsylvania. There, he was treated by Dr. Peter Dirksmeier, an orthopedic surgeon. At all times relevant to this lawsuit, Dr. Dirksmeier was an orthopedic spinal surgery fellow at the University of Pittsburgh Medical Center.[ 2 ] As part of his medical treatment, Wooding and Dr. Dirksmeier discussed the possibility of surgery, including the risks and benefits of undergoing spinal surgery. Wooding claims that he inquired about Dr. Dirksmeier's level of experience when he and Dr. Dirksmeier were discussing the possibility of surgery. According to Wooding, Dr. Dirksmeier's answers gave him the impression that he had significant experience perform ing surgery. Wooding also alleges that Dr. Dirksm eier did not inform him that he had only recently completed his residency. Wooding claims he would not have allowed Dr. Dirksmeier to operate on him, if he had been aware of his actual level of experience.

In July 2001, Wooding underwent surgery. He alleges that, during the surgery, "a surgical bite was taken, which punctured the dura . . . resulting in the flow of cerebrospinal fluid." [A 11] As a result of the surgery, Wooding claims that he experienced a loss of feeling from the chest to the feet and extreme pain in his neck and shoulders, among other injuries. In 2003, Wooding filed an administrative claim, claiming that he had been injured as a result of medical negligence and seeking $1,500,000 in damages. Two years later, he wrote a letter requesting that his claim be amended to add an informed consent claim and increase the damages sought to $2,500,000. The United States denied his claim, and Wooding filed this civil action.

Wooding's complaint included two counts, but only Count One is at issue in this appeal.[ 3 ] In Count One, Wooding alleged a cause of action under the doctrine of informed consent, claiming that he would not have consented to the surgery if he had been accurately informed of Dr. Dirksmeier's experience and the risks of the surgery. However, Wooding subsequently renounced any claim based on a failure to inform him of the risks of the surgery in his response to a government motion for partial summary judgment. The District Court then allowed Wooding to proceed with Count One solely on a theory of misrepresentation.

Before the bench trial, the United States moved for summary judgment on the misrepresentation claim, arguing that summary judgment was appropriate because Wooding had not produced a medical expert who would testify that Wooding's injuries were proximately caused by Dr. Dirksmeier's alleged lack of experience performing surgeries. The District Court granted the Government's motion, concluding that expert testimony was required to establish that Wooding's injuries were caused by Dr. Dirksmeier's alleged inexperience, not by the surgery itself. Wooding filed a timely appeal of that order.
II.

Under Pennsylvania law, a plaintiff alleging intentional misrepresentation must show "1) a representation, 2) which is material to the transaction at hand, 3) made falsely, with knowledge of its falsity or recklessness as to whether it is true or false, 4) with the intent of misleading another into relying on it, 5) justifiable reliance on the misrepresentation, and 6) resulting injury proximately caused by the reliance." Porreco v. Porreco, 811 A.2d 566, 570 (Pa. 2002); Bortz v. Noon, 729 A.2d 555, 560 (Pa. 1999).[ 4 ] The Supreme Court of Pennsylvania has recognized the potential viability of a claim of intentional misrepresentation in a case where a doctor misrepresents his qualifications to a patient. See Duttry v. Patterson, 771 A.2d 1255, 1259 (Pa. 2001).[ 5 ]

Here, Wooding alleged that Dr. Dirksmeier and the Veterans Affairs Medical Center misrepresented Dr. Dirksmeier's level of experience and gave Wooding the impression that he had more experience perform ing surgeries than he actually had. Accordingly, to make out a claim for intentional misrepresentation, Wooding was required to show that his injuries were proximately caused by his reliance on Dr. Dirksmeier's alleged misrepresentations. See Bortz v. Noon, 729 A.2d at 560. Thus, in this case, Wooding must show that his injuries were caused by Dr. Dirksmeier's alleged lack of experience, and not simply a result of the surgery. This requires expert testimony, because the causal link is not obvious to a lay person. Cf. Quinby v. Plumsteadville Family Practice, Inc., 907 A.2d 1061, 1070-71 (Pa. 2006) (recognizing that a plaintiff must produce a medical expert to testify as to causation in "all but the most self-evident medical malpractice actions"). Wooding concedes that the expert he has retained will only testify that the injuries were caused by the surgery, not by Dr. Dirksmeier's alleged lack of experience. Accordingly, the District Court correctly granted summary judgment on his misrepresentation claim.

On appeal, Wooding argues that expert testimony on the issue of whether Dr. Dirksmeier's alleged inexperience caused his injuries is unnecessary. Instead, he contends that he is only required to show that he would not have consented to an operation performed by Dr. Dirksmeier, if he were aware of his actual level of experience. Essentially, he is making an argument under the doctrine of informed consent. The Supreme Court of Pennsylvania foreclosed this possibility in Duttry, when it held that a doctor's misrepresentations about his experience was irrelevant to an informed consent claim. See 771 A.2d at 1259. Therefore, Wooding's argument fails, and the grant of summary judgment was appropriate.

Because we affirm the District Court's decision, we need not address the Government's alternative argument that Wooding's amendment to his claim was untimely or Wooding's request that we provide guidance on the type of damages that are available in this civil action.
III.

For these reasons, we will affirm the order of the District Court.WOODING v. U.S.

HENRY L. WOODING; PHOEBE G. WOODING, his wife,
v.
UNITED STATES OF AMERICA
Henry L. Wooding, Appellant.

No. 07-4695.

United States Court of Appeals, Third Circuit.

Submitted Pursuant to Third Circuit LAR 34.1(a) February 26, 2010.

Opinion Filed: March 9, 2010.

Before: CHAGARES, STAPLETON and LOURIE,[ 1 ] Circuit Judges.
NOT PRECEDENTIAL
OPINION OF THE COURT

STAPLETON, Circuit Judge.

Appellant Henry Wooding filed this civil action against the United States under the the Federal Tort Claims Act ("FTCA"), 28 U.S.C. § 2671, et seq., alleging that he was injured during a surgical procedure at the Department of Veterans Affairs Medical Center in Pittsburgh, Pennsylvania. Wooding appeals the order of the District Court granting summary judgment to the United States.

Because we write only for the benefit of the parties, we assume familiarity with the facts of this civil action and the proceedings in the District Court. We will affirm essentially for the reasons stated by the District Court.
I.

In 2001, Wooding was referred to the orthopedic clinic at the Veterans Affairs Medical Center in Pittsburgh, Pennsylvania. There, he was treated by Dr. Peter Dirksmeier, an orthopedic surgeon. At all times relevant to this lawsuit, Dr. Dirksmeier was an orthopedic spinal surgery fellow at the University of Pittsburgh Medical Center.[ 2 ] As part of his medical treatment, Wooding and Dr. Dirksmeier discussed the possibility of surgery, including the risks and benefits of undergoing spinal surgery. Wooding claims that he inquired about Dr. Dirksmeier's level of experience when he and Dr. Dirksmeier were discussing the possibility of surgery. According to Wooding, Dr. Dirksmeier's answers gave him the impression that he had significant experience perform ing surgery. Wooding also alleges that Dr. Dirksm eier did not inform him that he had only recently completed his residency. Wooding claims he would not have allowed Dr. Dirksmeier to operate on him, if he had been aware of his actual level of experience.

In July 2001, Wooding underwent surgery. He alleges that, during the surgery, "a surgical bite was taken, which punctured the dura . . . resulting in the flow of cerebrospinal fluid." [A 11] As a result of the surgery, Wooding claims that he experienced a loss of feeling from the chest to the feet and extreme pain in his neck and shoulders, among other injuries. In 2003, Wooding filed an administrative claim, claiming that he had been injured as a result of medical negligence and seeking $1,500,000 in damages. Two years later, he wrote a letter requesting that his claim be amended to add an informed consent claim and increase the damages sought to $2,500,000. The United States denied his claim, and Wooding filed this civil action.

Wooding's complaint included two counts, but only Count One is at issue in this appeal.[ 3 ] In Count One, Wooding alleged a cause of action under the doctrine of informed consent, claiming that he would not have consented to the surgery if he had been accurately informed of Dr. Dirksmeier's experience and the risks of the surgery. However, Wooding subsequently renounced any claim based on a failure to inform him of the risks of the surgery in his response to a government motion for partial summary judgment. The District Court then allowed Wooding to proceed with Count One solely on a theory of misrepresentation.

Before the bench trial, the United States moved for summary judgment on the misrepresentation claim, arguing that summary judgment was appropriate because Wooding had not produced a medical expert who would testify that Wooding's injuries were proximately caused by Dr. Dirksmeier's alleged lack of experience performing surgeries. The District Court granted the Government's motion, concluding that expert testimony was required to establish that Wooding's injuries were caused by Dr. Dirksmeier's alleged inexperience, not by the surgery itself. Wooding filed a timely appeal of that order.
II.

Under Pennsylvania law, a plaintiff alleging intentional misrepresentation must show "1) a representation, 2) which is material to the transaction at hand, 3) made falsely, with knowledge of its falsity or recklessness as to whether it is true or false, 4) with the intent of misleading another into relying on it, 5) justifiable reliance on the misrepresentation, and 6) resulting injury proximately caused by the reliance." Porreco v. Porreco, 811 A.2d 566, 570 (Pa. 2002); Bortz v. Noon, 729 A.2d 555, 560 (Pa. 1999).[ 4 ] The Supreme Court of Pennsylvania has recognized the potential viability of a claim of intentional misrepresentation in a case where a doctor misrepresents his qualifications to a patient. See Duttry v. Patterson, 771 A.2d 1255, 1259 (Pa. 2001).[ 5 ]

Here, Wooding alleged that Dr. Dirksmeier and the Veterans Affairs Medical Center misrepresented Dr. Dirksmeier's level of experience and gave Wooding the impression that he had more experience perform ing surgeries than he actually had. Accordingly, to make out a claim for intentional misrepresentation, Wooding was required to show that his injuries were proximately caused by his reliance on Dr. Dirksmeier's alleged misrepresentations. See Bortz v. Noon, 729 A.2d at 560. Thus, in this case, Wooding must show that his injuries were caused by Dr. Dirksmeier's alleged lack of experience, and not simply a result of the surgery. This requires expert testimony, because the causal link is not obvious to a lay person. Cf. Quinby v. Plumsteadville Family Practice, Inc., 907 A.2d 1061, 1070-71 (Pa. 2006) (recognizing that a plaintiff must produce a medical expert to testify as to causation in "all but the most self-evident medical malpractice actions"). Wooding concedes that the expert he has retained will only testify that the injuries were caused by the surgery, not by Dr. Dirksmeier's alleged lack of experience. Accordingly, the District Court correctly granted summary judgment on his misrepresentation claim.

On appeal, Wooding argues that expert testimony on the issue of whether Dr. Dirksmeier's alleged inexperience caused his injuries is unnecessary. Instead, he contends that he is only required to show that he would not have consented to an operation performed by Dr. Dirksmeier, if he were aware of his actual level of experience. Essentially, he is making an argument under the doctrine of informed consent. The Supreme Court of Pennsylvania foreclosed this possibility in Duttry, when it held that a doctor's misrepresentations about his experience was irrelevant to an informed consent claim. See 771 A.2d at 1259. Therefore, Wooding's argument fails, and the grant of summary judgment was appropriate.

Because we affirm the District Court's decision, we need not address the Government's alternative argument that Wooding's amendment to his claim was untimely or Wooding's request that we provide guidance on the type of damages that are available in this civil action.
III.

For these reasons, we will affirm the order of the District Court.

VAOIG Investigation Patient Information Breach Atlanta-VA

Full Article at: VA investigating security breach of veterans' medical data

By Bob Brewin 03/09/2010

The Veterans Affairs Department's inspector general has launched a criminal investigation into a physician assistant's alleged downloading of veterans' clinical data at its Atlanta medical center, sources have told Nextgov.

The assistant allegedly recorded two sets of patient data on to a personal laptop for research purposes. One set included three years' worth of patient data and another held 18 years of medical information, according to a source familiar with the incident and who asked not to identified.

Roger Baker, VA's chief information officer, commented on an item about the incident that was posted Monday evening on a Nextgov blog that the physician assistant's laptop was never connected to the VA network and any data she recorded on her laptop was "hand entered."

But the source told Nextgov the VA inspector general is investigating whether the assistant used two thumb drives to transfer the data to the laptop.

The department has not disclosed the number of patients involved in the incident, what kind of personal data was copied, or whether it plans to notify the veterans whose records were downloaded."

Brain Scans Show Clear Differences in Veterans Suffering from Gulf War Syndrome

What is clear, he says, is that “our data now clearly show, beyond a shadow of a doubt, that there are brain abnormalities – physiological differences – between ill veterans and normal ones.” And from the new scans, “we can tell the ill veterans from the well veterans. And we can distinguish syndromes one, two and three from each other.”

Full Article at: Brain Scans Depict Gulf War Syndrome Damage

By Janet Raloff, Science News Email Author
March 10, 2010

"Nearly two decades after vets began returning from the Middle East complaining of Gulf War Syndrome, the federal government has yet to formally accept that their vague jumble of symptoms constitutes a legitimate illness. Here, at the Society of Toxicology annual meeting, yesterday, researchers rolled out a host of brain images – various types of magnetic-resonance scans and brain-wave measurements – that they say graphically and unambiguously depict Gulf War Syndrome.

Or syndromes. Because Robert Haley of the University of Texas Southwestern Medical Center in Dallas and the research team he heads have identified three discrete subtypes. Each is characterized by a different suite of symptoms. And the new imaging linked each illness with a distinct – and different – series of abnormalities in the brain.

Men with the same symptoms exhibited similar brain changes, features starkly different from healthy vets their age who had served in the same battalions. (That said, a few vets’ symptoms seemed to encompass more than one syndrome. And in such instances, imaging confirmed their brains showed impairments that extended beyond those associated with a single syndrome.)"

"What’s emerged is evidence to suggest “that there are three major syndromes responsible for Gulf War Illness,” he says. They appear loosely linked to at least three different types of agents to which many troops were exposed: sarin nerve gas, a nerve gas antidote (pyridostigmine bromide) that presented its own risks and military-grade pesticides to prevent illness from sand flies and other noxious pests. But Briggs acknowledges that no one knows for sure which combination of agents or environmental conditions might have conspired to trigger Gulf War illness.

What is clear, he says, is that “our data now clearly show, beyond a shadow of a doubt, that there are brain abnormalities – physiological differences – between ill veterans and normal ones.” And from the new scans, “we can tell the ill veterans from the well veterans. And we can distinguish syndromes one, two and three from each other.”

The new neuroimaging on a subset of 57 Gulf War vets was completed eight months ago. Yesterday’s presentations represent an unveiling of the complex statistical analyses of data gleaned from those functional MRI scans (or fMRIs), brain-wave recordings, and other magnetic resonance tools.

Some testing employed old-style technologies. For instance, about a dozen years ago, Haley’s team performed magnetic resonance spectroscopy, also known as MRS, to study the chemical composition of various regions in the brains of Gulf War vets. And these tests uncovered the first solid indicators that there were physiological abnormalities in men complaining of Gulf War Illness. Such as a perturbation in the ratio of two chemicals active in the brain’s basal ganglia: n-acetyl aspartate (or NAA) and creatine.

Don’t know what that means? I didn’t either. So Briggs explained.

“The basal ganglia is sort of the switching system of the brain. It’s where a lot of communication between the left and right hemispheres occurs.” Because it crosses the midbrain region, he says, “it’s heavily involved in a lot of these decisionmaking and attention/inhibition networks” – processing centers that, if messed up, could explain many symptoms reported by sick vets.

NAA is a biomarker of healthy nerve cells. So any decrease is a bad sign. The concentration of creatine, which comprises the fuel for brain activities, tends to remain constant, Briggs says, so “it’s often used as an internal standard” against which to compare things like NAA.

The Gulf War syndromes are each associated with a roughly 10 percent lower than normal NAA-to-creatine ratio in the left and right basal ganglia, Briggs says – “an indicator of either sick or dead neurons.”

After Haley’s team initially published evidence in the late ‘90s of the diminished NAA-to-creatine ratio in sick vets, two other labs confirmed this characteristic MRS feature in sick Gulf War veterans, Briggs notes. More recently, when one of those labs failed to reconfirm those changes during a followup study, the UT Southwestern team began to wonder whether it had erred the first time it had conducted the pioneering tests. Or whether the sick vets had simply gotten well over the past 10 years.

“Our new follow-up [MRS] tests now show our initial findings were right,” Haley says – “and that the soldiers haven’t gotten better with time.”

Many of scans that his team unveiled here at SOT rely on a technology – fMRI – that was not available in the late ‘90s. So it provides new evidence of what sets sick vets apart.

This technology allows researchers to identify which areas are active as the brain works. Haley’s multi-center team designed a series of fMRI tests that required subjects to look at threatening pictures of a battlefield, or imagine the theme behind two words to come up with a third (“desert” and “humps” might be the clues given to suggest “camel”), or to learn words and recall faces.

In healthy veterans, appropriate parts of the brain lit up as they thought, reasoned, viewed – even experienced extremes of temperature. But in men suffering from Gulf War Illness, Haley says, “a different part would often light up as their brain attempted to work around its damage.”

Affected areas of the brain in each test varied. The thalamus, for example, is involved in attention and inhibition, Briggs explains. “It is activated differently in syndrome two versus controls,” he notes. Not surprisingly, people with that particular syndrome have problems with those traits. The researchers also correlated what combinations of areas in the brain respond in concert during particular tasks. And sometimes, the collection of brain locales that lit up in sick vets differed markedly from those in healthy vets (see images above)."

Congress Request's Detailed Data on Camp Lejeune Water Contamination

Full Article at:
Congressional probers seek data on Lejeune water contamination
McClatchy Newspapers

By Barbara Barrett,

WASHINGTON — Congressional investigators late Tuesday requested detailed documents from Navy Secretary Ray Mabus and a private contractor that was involved in the testing and cleanup of contaminated water at Camp Lejeune, N.C. , over the past two decades.

More letters to the Environmental Protection Agency and a second private contractor are expected this week.

Among investigators' questions: why a federal agency charged with understanding the health impacts of the contamination didn't realize until recently that benzene — a fuel solvent known to cause cancer in humans — was among the substances found in drinking water at Camp Lejeune .

For years, the Marines apparently didn't provide documents about the benzene to the Agency for Toxic Substances and Disease Registry , which has worked for nearly two decades to understand the contamination and its health impacts, said Rep. Brad Miller , D- N.C. , the chairman of the oversight panel on the House Science and Technology Committee .

"We want to know what did (the Navy and the Marine Corps ) know about the water, when did they know and what did they do about it," Miller said in an interview.

"Did they know about it during the 30 years when Marines and families were exposed to the water?" Miller asked. "Did they know about it and not do anything to stop it?"

In his letter, Miller told Mabus that he wants access by next Monday to a password-protected online database that contains thousands of records related to the contamination, thought to have occurred from 1957 to 1987.

The database hasn't been made public. It was finally made accessible to the Agency for Toxic Substances and Disease Registry last year.

The agency tossed out a 1997 study on health effects after it learned that benzene was among the chemicals in the water. Until then, Miller wrote Mabus, the agency didn't have the documents it needed to complete its work."

Pro Bono Program for Veterans at the Federal Circuit

Chief Judge Paul R. Michel’s
Full Speech at: 2009 STATE OF THE COURT SPEECH
As prepared for delivery at the
Federal Circuit Bar Association Annual Bench-Bar Conference
White Sulphur Springs, WV
June 19, 2009

PRO BONO PROGRAMS
We have a program for appointing counsel in selected MSPB cases. Attorneys
are chosen at random from a list of several dozen volunteers. Thus far, seven cases
have been selected, six of which have been resolved in the employee’s favor. The
seventh remains pending.

We recently instituted a similar screening procedure for pro se veterans appeals.
If you or your firm would accept pro bono appointment in such cases, please provide
your business card to Pam Twiford. If you have a preference for either the MSPB or
Veterans cases, please let Pam know. This is a great opportunity for all, but especially for younger litigators who can get valuable experience briefing and arguing appeals.

We thank the individual attorneys and their law firms for their generous
assistance in both personnel and veterans cases.
Of course, our new veterans program merely supplements the major efforts on
behalf of veterans by the Federal Circuit Bar Association and the Finnegan Henderson
law firm. We appreciate their generous work as well. It is difficult to imagine litigants more deserving of counsel than disabled veterans.

DoD Clinical Trials, PTSD and TBI Research

Among eight planned clinical trials, one, to begin this spring, will test the benefit of administering a synthetic form of a neurosteroid drug to PTSD patients. The drug appears naturally in the brain, but at lower levels among some PTSD patients, explained Dr. Holly Campbell-Rosen, grants manager for the program.

“The idea is that by giving it to people, it will help relieve them of some anxiety, rage, aggression and other PTSD symptoms,” she said.

One clinical trial will study the link between endocrine dysfunction in participants with mild TBI, and the benefit of treating them with hormone supplements, explained Dr. Charmaine Richman, grants manager for the program.

Another trial will attempt to identify biomarkers – biological changes in the cells or blood – associated with TBI. The idea, Richman explained, is to come up with a quick, relatively noninvasive way to diagnose TBI, ideally, within 24 hours of the injury when the signs are the most obvious. This, she said, will lead to faster intervention and a better likelihood of reversing the damage.


Full Article at: Research Shows Promise for Wounded Warriors, Public

By Donna Miles
American Forces Press Service
FORT DETRICK, Md., March 4, 2010 –

A sign on the highway identifying the exit ramp for Fort Detrick gives little indication of the revolutionary science being advanced behind its gates – aimed at unlocking everything from cures for breast and prostate cancer to new ways to treat post-traumatic stress and traumatic brain injuries.

The U.S. Army Medical Research and Materiel Command is overseeing these and dozens more innovative projects through its Congressionally Directed Medical Research Programs.

Congress funded the initial effort in 1992 to promote cutting-edge breast cancer research. Eighteen years later, CDMRP is the world’s second-largest funder for breast, prostate and ovarian cancer research.

But with a $400 million budget now funding 17 different programs, it has expanded its focus to confront some of the world’s most devastating health problems.

The CDMRP differs from many other medical research programs because it’s willing to take on promising but high-risk research, recognizing the potential payoffs, explained Navy Capt. (Dr.) Melissa Kaime, the program director.

“Innovation has been our watchword from the beginning,” she said, with a goal of moving beyond incremental science to spawn big advances and even breakthroughs.

The projects tap into some of the world’s most respected minds at universities and medical centers around the country, working together through consortia on some programs to conduct research and clinical trials. Many involve wounded warriors receiving care at military medical facilities or Department of Veterans Affairs’ clinics.

One program will test new ways to identify and treat combat veterans suffering from post-traumatic stress disorder or traumatic brain injuries.

Among eight planned clinical trials, one, to begin this spring, will test the benefit of administering a synthetic form of a neurosteroid drug to PTSD patients. The drug appears naturally in the brain, but at lower levels among some PTSD patients, explained Dr. Holly Campbell-Rosen, grants manager for the program.

“The idea is that by giving it to people, it will help relieve them of some anxiety, rage, aggression and other PTSD symptoms,” she said.

Another program aims to assess behavioral therapies to treat combat-related PTSD – something Dr. Kim del Carmen, grants manager for the 15 associated research projects that are part of the STRONG STAR consortium, says has not been done for active duty service members.

Another research project under her purview is studying the benefit of providing treatment in primary-care facilities, rather than dedicated mental health clinics. Anecdotal evidence shows there’s less stigma associated with getting care in primary-care settings, but the study will provide scientific evidence of its impact, del Carmen said.

One project already under way in central Texas is studying the benefit of providing troops diagnosed with PTSD four 30-minute sessions with a behavioral health consultant over the course of six weeks.

Just over a dozen participants have completed their full treatments to date at Brooke Army Medical Center, Wilford Hall Medical Center and the South Texas Veterans Health Care Services facility. The results are showing promise, del Carmen said, with almost half of the participants no longer being diagnosed with PTSD and most others exhibiting less-severe symptoms.

Yet another consortium, being conducted by four academic institutions and their associated hospitals and training centers in the Houston area, is seeking to develop better ways to diagnose mild traumatic brain injury and improve patients’ prospects of overcoming it through almost immediate treatment.

One clinical trial will study the link between endocrine dysfunction in participants with mild TBI, and the benefit of treating them with hormone supplements, explained Dr. Charmaine Richman, grants manager for the program.

Another trial will attempt to identify biomarkers – biological changes in the cells or blood – associated with TBI. The idea, Richman explained, is to come up with a quick, relatively noninvasive way to diagnose TBI, ideally, within 24 hours of the injury when the signs are the most obvious. This, she said, will lead to faster intervention and a better likelihood of reversing the damage.

Research being funded through the Congressionally Directed Medical Research Programs will benefit not only warfighters, but society as a whole, Kaime said.

“Good research has a way of extending itself beyond its borders,” she said. “So if we find good research techniques or novel pathways and it can be translated into the broader scientific context, we all win – in ways we can’t even imagine now.”

Reports of a First Mesothelioma Vaccine

Full Article at: First mesothelioma vaccine
March 5, 5:14 AMBirmingham Science News Examiner Paul Hamaker


Dutch physicians and researchers have developed the first vaccine for mesothelioma as reported in American Journal of Respiratory and Critical Care Medicine and released to the public on March 4, 2010.

Mesothelioma is a cancerous disease of the lungs that results from exposure to asbestos. The disease can remain dormant for as long as fifty years before becoming active. Survival times are a year to fifteen months with radiation treatment.

The Dutch vaccine uses tumor lysate-pulsed dendritic cells. "Dendrite cells are extremely potent antigen-presenting cells specialized for inducing activation and proliferation of CD8+ cytotoxic T lymphocytes (CTL) and helper CD4+ lymphocytes." Basically the technique uses the body’s immune system to manufacture mesothelioma specific antibodies.

"Each vaccine was composed of 50 million mature dendritic cells pulsed with autologous tumor lysate and keyhole limpet hemocyanin (KLH) as surrogate marker." The presence of T cells that were antagonistic to the tumors are the sign of succes in this therapy.

Treatment is a series of three vaccinations administered intradermally and intravenously over a two week period after chemotherapy.

The results were eighty percent effective in the test group. The earlier a person received the treatment the greater their chances were to be free of mesothelioma. The only side effects were a skin rash and flu like symptoms that lasted a day or two.

Alabama has one of the highest rates of mesothelioma and one of the greatest potentials for new cases of mesothelioma because of the number of plants that used asbestos or buildings that contained asbestos.

According to http://www.mesothelioma.com the sites in Birmingham that employed potential mesothelioma victims are Birmingham Steel Corporation, Sloss Industries Corporation, James H. Miller Electric Generating Plant, and all older school buildings.

The web site also gives access to treatment options and assistance for Veterans.

Consolidative dendritic cell-based immunotherapy elicits cytotoxicity against malignant
mesothelioma
Joost P. Hegmans1, Joris D. Veltman1, Margaretha E. Lambers1, I. Jolanda M. de Vries2, Carl
G. Figdor2, Rudi W.Hendriks1, Henk C. Hoogsteden1, Bart N. Lambrecht1,3, and Joachim .G.
Aerts1,4
1. Department of Pulmonary Medicine, Erasmus MC, Rotterdam
2. Department of Tumor Immunology, Nijmegen Centre for Molecular Life Sciences
(NCMLS), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
3. Department of Respiratory Medicine, Ghent University, Ghent, Belgium
4. Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands

http://www.thoracic.org/newsroom/press-releases/resources/Aerts_Mesothelioma.pdf

Pyridostigmine bromide and the long-term subjective health status

Psychol Rep. 2002 Jun;90(3 Pt 1):707-21.
Pyridostigmine bromide and the long-term subjective health status of a sample of over 700 male Reserve Component Gulf War era veterans.

Schumm WR, Reppert EJ, Jurich AP, Bollman SR, Webb FJ, Castelo CS, Stever JC, Kaufman M, Deng LY, Krehbiel M, Owens BL, Hall CA, Brown BF, Lash JF, Fink CJ, Crow JR, Bonjour GN.

School of Family Studies and Human Services, Kansas State University, Manhattan 66506-1403, USA. schumm@humec.ksu.edu

Data from a 1996-1997 survey of approximately 700 Reserve Component male veterans indicate that the consumption of pyridostigmine bromide pills, used as a pretreatment for potential exposure to the nerve agent Soman, was a significant predictor of declines in reported subjective health status after the war, even after controlling for a number of other possible factors. Reported reactions to vaccines and other medications also predicted declines in subjective health. While higher military rank generally predicted better health during and after the war, educational attainment, minority status, number of days in theater, and age generally did not predict changes in subjective health. Although servicemembers were directed to take three pills a day, veterans reported a range of compliance--less than a fourth (24%) followed the medical instructions compared to 61% who took fewer than three pills daily and 6% who took six or more pills a day. Implications for use of pyridostigmine bromide are discussed.

PMID: 12090498 [PubMed - indexed for MEDLINE]

VA Training Letter: Adjudicating Claims Based on Service in the Gulf War and Southwest Asia

Qualifying Chronic Disabilities Associated with Service in Southwest Asia

Qualifying chronic disabilities include two distinct categories: (1) “undiagnosed illness” and (2) “medically unexplained chronic multisymptom illness.” The first category, by definition, cannot be associated with a diagnosis. However, the second category refers to diagnosed illnesses that are without conclusive pathophysiology or etiology and are characterized by a cluster of signs and symptoms featuring fatigue, pain, disability out of proportion to physical findings, and inconsistent laboratory findings. Examples of unexplained chronic multisymptom illnesses are provided in § 1117. They include, but are not limited to: (1) chronic fatigue syndrome; (2) fibromyalgia; and (3) irritable bowel syndrome. Service connection is appropriate for any of these when diagnosed.
================================================================================

DEPARTMENT OF VETERANS AFFAIRS Veterans Benefits Administration Washington, D.C. 20420

February 4, 2010

Director (00/21) In Reply Refer To: 211A
All VA Regional Offices Training Letter 10-01


SUBJ: Adjudicating Claims Based on Service in the Gulf War and Southwest Asia

Purpose

Compensation and Pension (C&P) Service is providing the following information and guidelines in order to promote regional office awareness, consistency, and fairness in the handling of disability claims from Veterans with service in Southwest Asia.

Background

The United States military presence in Southwest Asia began in 1990 with Operations Desert Shield and Desert Storm. Troops remain in the theater of operations and currently support Operations Enduring Freedom and Iraqi Freedom.

After the initial Operations Desert Shield and Desert Storm, Congress set forth statutory directives, codified at 38 U.S.C. § 1117, upon which the regulations at 38 C.F.R. § 3.317 are based. These laws address a range of chronic disabilities reported by Veterans who served in Southwest Asia that do not correspond to recognized categories of diseases. The directives and regulations defined such disabilities as “undiagnosed illnesses”; however, subsequent amendments to 38 U.S.C. § 1117 expanded the definition of a chronic disability to include certain diagnosed illnesses with inconclusive etiologies.

These statutory and regulatory provisions apply to any Veteran who served in Southwest Asia, even though their establishment arose from Operations Desert Shield and Desert Storm. As such, adjudication of disability claims for certain diagnosed chronic illnesses from Veterans who served in Southwest Asia differs from procedures for other disability claims.

Questions

Questions can be e-mailed to VAVBAWAS/CO/211/ENVIRO.

/s/
Bradley G. Mayes,
Director
Compensation and Pension Service
Adjudicating Claims Based on Service in the Gulf War and in Southwest Asia

I. Introduction

History of Disability Patterns Associated with Gulf War and Southwest Asia Service

The first Gulf War of 1990-1991, sometimes referred to as the Persian Gulf War, resulted in the liberation of Kuwait from the hostile military forces of Iraq. Operations Desert Shield and Desert Storm involved nearly 700,000 United States service personnel. The initial military operation was successful and relatively short-lived, but led to a continuing presence of United States military personnel in Southwest Asia, and ultimately to the current Gulf War’s Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq.

Following cessation of initial Gulf War military operations in 1991, Veterans of this conflict began to report patterns of chronic debilitating medical symptoms. They typically included some combination of chronic headaches, cognitive difficulties, widespread bodily pain, unexplained fatigue, chronic diarrhea, skin rashes, respiratory problems, and other abnormalities. These symptoms did not correspond easily to recognized categories of diseases and presented a problem for health care diagnoses and treatment procedures, as well as for regional office decision makers attempting to adjudicate claims for disability compensation. Because the problem involved a significant percentage of Gulf War Veterans, estimated at 25 percent, the Department of Veterans Affairs (VA) initiated studies seeking to explain these chronic illness patterns.

Numerous scientific studies have been conducted, including a series by the National Academy of Sciences’ Institute of Medicine (IOM) and a recent study by the Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC). The goal of these studies has been to explain disability patterns associated with Gulf War service in terms of the potential health hazards experienced in the Southwest Asian environment. Among the environmental hazards linked to service during the initial Gulf War are: smoke and particles from over 750 Kuwaiti oil well fires; widespread pesticide and insecticide use, including personal flea collars; infectious diseases indigenous to the area, such as leishmaniasis; fumes from solvents and fuels; ingestion of pyridostigmine bromide tablets on a daily basis, as a nerve gas antidote; the combined effect of multiple vaccines administered upon deployment; and inhalation of ultra fine-grain sand particles. Although IOM studies have produced inconclusive results regarding the specific effects of the environmental hazards on Gulf War Veterans’ health, the RAC study indicates that service in Southwest Asia may be associated with disturbances of the brain and central nervous system, including dysfunctions of the autonomic nervous system, neuromuscular system, neuroendocrine system, and sensory systems, as well as the immune system.

Although most studies have focused on the initial Gulf War, information is accumulating that indicates environmental hazards may also be widespread in the current theater of Gulf War operations and may contribute to the disability patterns typically associated with Southwest Asia service.

Gulf War Legislation and Regulations

In 1994, Congress enacted the “Persian Gulf War Veterans’ Benefits Act,” which is codified at 38 U.S.C. § 1117. This legislation sought to promote research on the medical disability patterns associated with Gulf War service and to provide compensation for “disabilities resulting from illnesses that cannot now be diagnosed or defined, and for which other causes cannot be identified.” Through this legislation, the term “undiagnosed illnesses” was introduced and incorporated into VA regulations at 38 C.F.R. § 3.317.

As more research was conducted and more knowledge of the disability patterns associated with Gulf War and Southwest Asia service accumulated, Congress amended § 1117 in 2001 by expanding the associated disabilities to include “medically unexplained chronic multisymptom illnesses.” The Congressional Joint Explanatory Statement accompanying this statutory amendment described the new terminology as “a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.” This language was subsequently incorporated into the revised VA regulations at § 3.317. The result of this change was to include both “undiagnosed illnesses” and certain “diagnosed illnesses” under the overarching heading of “a qualifying chronic disability.” Examples of qualifying chronic disabilities were identified by Congress and incorporated into VA regulations. These included chronic fatigue syndrome, irritable bowl syndrome, and fibromyalgia.

Although these three chronic disabilities were intended by Congress to serve as examples, the amended regulation indicated that they were the only disability patterns available for consideration as medically unexplained chronic multisymptom illnesses. Because military personnel continue to operate in Southwest Asia and continue to be exposed to potential environmental hazards, including some not experienced during the initial 1990-1991 Gulf war, C&P Service has determined that an adjustment to the regulation is in order. Therefore, § 3.317 will be amended to clarify that the three currently listed medically unexplained chronic multisymptom illnesses are only examples and are not exclusive. This will allow medical examiners more latitude in evaluating disability patterns based on service in Southwest Asia.

II. Adjudication Guidelines for Regional Offices

Qualifying Veterans

Although the initial directives for adjudicating disability patterns associated with Gulf War service were intended to assist Veterans of the 1990-1991 Persian Gulf War, they remain in effect today and must be applied to all veterans with Southwest Asia service. The regulatory definition of a “Persian Gulf Veteran” provided in § 3.317 includes service in a large area of Southwest Asia, but does not include Afghanistan. Considering the importance of current U.S. military operations in Afghanistan and its environmental similarity to all other regions of Southwest Asia, C&P Service has determined that Veterans with service in Afghanistan fall under all laws related to Gulf War and Southwest Asia service. A regulatory amendment to make this official is forthcoming.

Types of Claims Involved

Disability claims based on Gulf War and Southwest Asia service are generally filed directly by the Veteran. Many were filed in the years following the initial 1990-1991 Gulf War and the rate of filing from these Veterans has diminished. However, such filings continue to occur because of the chronic nature of the disability patterns. Additionally, current evidence indicates that environmental hazards similar to those faced during the initial Gulf War, as well as new potential hazards, are faced by troops currently serving in Iraq and Afghanistan. Therefore, regional office personnel must be aware that a variety of disabilities may affect any Veteran with Southwest Asia service. This means that a thorough review of medical evidence associated with claims from these Veterans is necessary to identify any signs and symptoms potentially associated with Southwest Asia service that are not directly claimed.

Threshold Requirements for Service Connection

Veterans with objective indications of a qualifying chronic disability associated with service in Southwest Asia may be service connected only if the disability became manifest during military service in Southwest Asia or to a degree of 10 percent or more, not later than December 31, 2011. This date will likely be extended by Congressional action. In addition, to establish the chronic nature of the disability, it must exist for at least 6 months or exhibit intermittent episodes of improvement and worsening over at least a 6-month period.

Service connection will not be granted if there is affirmative evidence that the qualifying chronic disability: (1) was not incurred during active military service, (2) was caused by intervening conditions or events occurring between the Veteran’s last service in Southwest Asia and the onset of the illness, or (3) is the result of the Veteran’s own willful misconduct or the abuse of alcohol or drugs.

Qualifying Chronic Disabilities Associated with Service in Southwest Asia

Qualifying chronic disabilities include two distinct categories: (1) “undiagnosed illness” and (2) “medically unexplained chronic multisymptom illness.” The first category, by definition, cannot be associated with a diagnosis. However, the second category refers to diagnosed illnesses that are without conclusive pathophysiology or etiology and are characterized by a cluster of signs and symptoms featuring fatigue, pain, disability out of proportion to physical findings, and inconsistent laboratory findings. Examples of unexplained chronic multisymptom illnesses are provided in § 1117. They include, but are not limited to: (1) chronic fatigue syndrome; (2) fibromyalgia; and (3) irritable bowel syndrome. Service connection is appropriate for any of these when diagnosed.

Although medically unexplained chronic multisymptom illnesses may be diagnosed, and are therefore different from undiagnosed illnesses, if the diagnosis is partially understood in terms of etiology or pathophysiology, then it will not be considered medically unexplained. This caveat represents the intention of Congress to exclude from § 1117 certain readily diagnosable illnesses such as diabetes and multiple sclerosis, which are considered to be of partially understood etiology. The issue of whether a Veteran’s particular chronic multisymptom disability pattern is without a conclusive etiology, or represents a disability pattern with a partially understood etiology, must be determined on a case-by case basis and will require a medical opinion.

Signs and Symptoms of Qualifying Chronic Disabilities

Signs and symptoms that may be manifestations of both undiagnosed illnesses or medically unexplained chronic multi-symptom illnesses include, but are not limited to: (1) fatigue, (2) signs or symptoms involving skin, (3) headache, (4) muscle pain, (5) joint pain, (6) neurological signs or symptoms, (7) neuropsychological signs or symptoms, (8) signs or symptoms involving the upper or lower respiratory system, (9) sleep disturbances, (10) gastrointestinal signs or symptoms, (11) cardiovascular signs or symptoms, (12) abnormal weight loss, and (13) menstrual disorders.

Development in Claims based on Service in Southwest Asia

Development procedures are covered in M21-1MR at Part IV, Subpart ii, Chapter 1, Section E. The procedures are generally the same as those for any disability claimed by the Veteran or reasonably raised by the regional office. However, as stated previously, C&P Service is amending § 3.317 to clarify that chronic fatigue syndrome, irritable bowl syndrome, and fibromyalgia are not the only disability patterns that can be considered as medically unexplained chronic multisymptom illnesses. Therefore, until the amended regulation becomes final, regional office personnel will be required to hold any claim where the medical evidence shows a disability pattern that is not one of the three currently identified. These claims can be held under end product (EP) code 698 until the amended regulation is finalized. Initial development can proceed normally because the determination that a Southwest Asia Veteran’s particular disability pattern is a previously unidentified medically unexplained chronic multisymptom illness cannot be made until after a VA medical examination has been conducted and a medical opinion rendered.

This Training Letter highlights and clarifies the development procedures most closely associated with service in Southwest Asia. They include: (1) procuring service treatment records, all relevant private medical records, and Gulf War Registry examination results, if applicable; (2) acquiring relevant non-medical and lay evidence; (3) verifying service in Southwest Asia; (4) identifying the specific nature of the disability; and (5) requesting a VA medical examination.

Special efforts and inquiries may be necessary when procuring medical evidence in these claims because of the difficulties involved with determining whether or not a diagnosis has been established. Also, non-medical and lay statements take on greater importance. Therefore, extended development may be necessary and consideration must be given to evidence such as any time lost from work and any attempts by the Veteran to seek medical treatment for the disability pattern. Consideration must also be given to lay statements describing the Veteran’s disability pattern from persons in a position to know the Veteran. Such statements may constitute probative evidence by describing changes in the Veteran’s appearance, physical abilities, and mental or emotional status.

Rating Procedures

Rating procedures are covered in M21-1MR at Part IV, Subpart ii, Chapter 2, Section D. When service connection is in order, consideration must be given to assigning a diagnostic code that represents the greatest degree of disability. There may be instances where a chronic undiagnosed illness or diagnosed multi-system illness affect distinct body systems. In such a case, a determination should be made that is most consistent with the evidence and most beneficial to the Veteran.

A special hyphenated analogous diagnostic code system has been developed by VA to track disability claims based on Gulf War and Southwest Asia service. The system involves use of two four-digit number sets separated by a hyphen to identify a qualifying chronic disability. The first four-digit number set starts with the numbers “88,” and is followed by the first two numbers of the body system diagnostic code most closely associated with the disability pattern. If, for example, a disability pattern involves the bronchial pulmonary system, which begins its diagnostic code numbers with 66, the first four-digit number set would be 8866. The second four-digit number set would be the actual diagnostic code that most closely describes the Veteran’s disability pattern. In this example, the Veteran may have signs and symptoms resembling bronchial asthma and so diagnostic code 6602 for bronchial asthma would be used. When the two four-digit number sets are combined, the hyphenated analogous diagnostic code would be 8866-6602. A more detailed explanation of this system is provided in M21-1MR. Once the disability pattern has been associated with a diagnostic code, the criteria in that code should be used to assign a rating percentage based on the level of disability experienced by the Veteran.

This analogous diagnostic code number system has its historical roots in the disabilities that emerged following the 1990-1991 Gulf War. At the time, the associated disabilities were referred to as “undiagnosed illnesses.” The term has remained in common usage despite legislative changes that added diagnosed medically unexplained chronic multisymptom illnesses as a distinct category of qualifying disease. Therefore, regional office personnel must be aware that this number system applies to all qualifying chronic disability claims associated with service in Southwest Asia during the Gulf War, not just those where an undiagnosed illness is involved. Any claim made directly by a Veteran, or developed by the regional office based on the Veteran’s records, which involves a diagnosed medically unexplained chronic multi-symptom illness must also be rated using this number coding system.

VA Medical Examination Requests

Because of the non-specific etiology of disability patterns, special considerations must be given to the initial evidence associated with these claims and the issue of when to request a VA medical examination. Regarding the issue of establishing a Veteran’s current disability, which generally serves as the basis for requesting the VA examination, one of two scenarios may occur. Either there is evidence that the Veteran has previously sought medical treatment for the disability pattern and has been “diagnosed” with a condition or there is no evidence that the Veteran has previously been medically treated for the disability pattern.

If a Veteran has previously sought treatment for a multi-symptom illness from a private physician, it is not likely that a resulting medical report will describe the Veteran’s disability pattern as an “undiagnosed illness.” Medical personnel in general and physicians in particular are trained to produce a diagnosis as the basis for treatment. Therefore, a “diagnosis” may appear in the Veteran’s private medical report. However, such a diagnosis is not grounds for denying the claim because medically unexplained chronic multi-symptom illnesses are diagnosable. Regional office personnel must consider the nature of the diagnosis and the disability description provided in the medical report. If the diagnosis involves one of the chronic multi-symptom illnesses described in § 3.317, service connection is appropriate and a VA examination may be necessary to determine severity in order to assign a disability rating. Even if the disability pattern differs from one of the identified chronic multi-symptom illnesses, as would be the case with signs and symptoms of certain respiratory conditions, consideration must still be given to requesting a VA examination. In such a case, it is appropriate to proceed with a VA examination to determine if the condition can be characterized as a disability pattern with an inconclusive etiology. It should also be kept in mind that when medical evidence shows a definite diagnosed condition for a Veteran with Southwest Asia service, that diagnosed condition could have been incurred or aggravated during service and would therefore be subject to service connection on a direct basis outside the provisions of § 3.317.

If there is no medical evidence that the Veteran has previously been treated for the disability pattern and the only significant evidence is the Veteran’s lay statement describing the disability pattern, a VA examination is still warranted. Case law from the Court of Appeals for Veterans Claims (CAVC), interpreting 38 CFR § 3.159(c)(4), establishes a relatively low threshold for requesting VA medical examinations. In McLendon v. Nicholson, 20 Vet.App. 79 (2006), the Court identified four criteria that, when met, require VA to provide a medical examination. In summary, they are: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence that a qualifying in-service event occurred, (3) an indication that the disability may be associated with the Veteran’s service, and (4) insufficient competent medical evidence on file for a decision on the claim.

Regarding Gulf War Illness claims and the first criterion, CAVC has repeatedly held that statements describing visible injuries and pain provided by the Veteran serve as competent evidence for the existence of such injuries and pain. In McLendon, the Court specifically stated that the Veteran “is fully competent to testify to any pain he may have suffered.” Therefore, in claims based on service in Southwest Asia, the Veteran’s lay description of the pain or other signs and symptoms of the disability pattern is competent evidence sufficient to establish a current disability or persistent or recurrent symptoms of a disability. Regarding the second criterion, once service in Southwest Asia is verified, occurrence of the qualifying in-service event is established. The third criterion is a low threshold that involves establishing an indication that the disability pattern may be associated with the Veteran’s period of service. This criterion is met by virtue of the Veteran’s service in Southwest Asia and a statement of a current disability pattern, particularly when such a pattern is consistent with those set forth in § 3.317. The final criterion is met when the regional office does not have sufficient evidence on file to generate a rating decision. This would almost always be the case in these claims because the VA medical examination report is the most likely means for determining whether service connection can be granted under § 3.317.

When requesting VA medical examinations, send the claims file to the examiner, specify that the examiner is to conduct a general medical examination and any required specialty examinations, and include the following italicized language with the request.

Upon exam completion, rating personnel should be aware that VA examiners have been provided with the following language along with the examination request. The language identifies four possible disability patterns that may appear in the examination reports. If the examiner has determined the Veteran’s disability pattern to be either (1) an undiagnosed illness or (2) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, including but not limited to, chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome, then service connection must be granted based on § 3.317. If the examiner has determined the Veteran’s disability pattern to be either (3) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis, then service connection cannot be granted under § 3.317 and may only be granted if the medical evidence is sufficient to establish service connection on a direct basis.
Notice to Examiners Regarding Gulf-War Related Disability Claims

Examiner,

VA statutes and regulations provide for service connecting certain chronic disability patterns based on exposure to environmental hazards experienced during military service in Southwest Asia. The environmental hazards may have included: exposure to smoke and particles from oil well fires; exposure to pesticides and insecticides; exposure to indigenous infectious diseases; exposure to solvent and fuel fumes; ingestion of pyridostigmine bromide tablets, as a nerve gas antidote; the combined effect of multiple vaccines administered upon deployment; and inhalation of ultra fine-grain sand particles. In addition, there may have been exposure to smoke and particles from military installation “burn pit” fires that incinerated a wide range of toxic waste materials.

The chronic disability patterns associated with these Southwest Asia environmental hazards have two distinct outcomes. One is referred to as “undiagnosed illnesses” and the other as “diagnosed medically unexplained chronic multisymptom illnesses” that are without conclusive pathophysiology or etiology. Examples of these medically unexplained chronic multi-symptom illnesses include, but are not limited to: (1) chronic fatigue syndrome, (2) fibromyalgia, and (3) irritable bowel syndrome. Diseases of “partially explained etiology”, such a diabetes or multiple sclerosis, are not considered by VA to be in the category of medically unexplained chronic multisymptom illnesses.

Additionally, signs and symptoms that may be manifestations of both undiagnosed illnesses or diagnosed medically unexplained chronic multi-symptom illnesses include, but are not limited to: (1) fatigue; (2) signs or symptoms involving the skin; (3) headache; (4) muscle pain;
(5) joint pain; (6) neurological signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the upper or lower respiratory system; (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders.

Please examine and evaluate this Veteran with Southwest Asia service for any chronic disability pattern. Please review the claims file as part of your evaluation and state that it was reviewed. The Veteran has claimed a disability pattern related to (insert symptoms described by Veteran).

Please provide a medical statement explaining whether the Veteran’s disability pattern is: (1) an undiagnosed illness, (2) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (3) a diagnosable chronic multisymptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis.

If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either (3) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis, then please provide a medical opinion, with supporting rational, as to whether it is “at least as likely as not” that the disability pattern or diagnosed disease is related to a specific exposure event experienced by the Veteran during service in Southwest Asia.

Education and Training Services Available for Female Veterans,

Full Article at: Services for female veterans available
Thursday, March 4, 2010

Applications are still being accepted for female veterans, service women and military spouses to receive free job training, career and education counseling, job search assistance and other specialized services from Women's Rights Information Center through Project STARS, a new program funded in part by Women United in Philanthropy.

Computer training classes that enhance job skills and qualifications, and lead to Microsoft Office Specialist Certification, are being offered at Fairleigh Dickinson University's Hackensack campus in state-of-the-art technology facilities. FDU is a collaborating partner in the project, along with the Bergen County One-Stop Career System and Women Lawyers in Bergen (WLIB).

Military women aiming to earn a college degree to enhance their career and earnings potential can meet with FDU's Director of Veterans Services, who will explain how the Yellow Ribbon program can pay for a college education and how the faculty can help ease the transition to college life.

Individual career counseling sessions are conducted at the Women's Center's Englewood location to provide Project STARS participants with assistance in resume preparation, interviewing, online job search and finding a new or better position. The Center works with a wide range of businesses and organizations, including the Bergen County One Stop, to locate job openings and connect with employers that are hiring.

Additional services are available through Project STARS for help dealing with personal and family issues. For anyone needing legal advice on marital law, child custody rights or child support, a private consultation with an attorney from Women Lawyers in Bergen can be scheduled. For help dealing with other private concerns, support counseling is available through confidential referral to female, non-military specialists.

Enrollment is limited on a first-come first-served basis. To secure space or for more information, call 201-568-1166 or e-mail info@womensrights.org. To learn more about the Center, its programs, services and activities, visit www.womensrights.org. Women's Rights Information Center, located at 108 West Palisade Avenue in Englewood, is a non-profit, community based organization that has been helping women and their families to become self-sufficient since 1973. Services are provided at low cost or no cost.

Applications are still being accepted for female veterans, service women and military spouses to receive free job training, career and education counseling, job search assistance and other specialized services from Women's Rights Information Center through Project STARS, a new program funded in part by Women United in Philanthropy.

Computer training classes that enhance job skills and qualifications, and lead to Microsoft Office Specialist Certification, are being offered at Fairleigh Dickinson University's Hackensack campus in state-of-the-art technology facilities. FDU is a collaborating partner in the project, along with the Bergen County One-Stop Career System and Women Lawyers in Bergen (WLIB).

Military women aiming to earn a college degree to enhance their career and earnings potential can meet with FDU's Director of Veterans Services, who will explain how the Yellow Ribbon program can pay for a college education and how the faculty can help ease the transition to college life.

Individual career counseling sessions are conducted at the Women's Center's Englewood location to provide Project STARS participants with assistance in resume preparation, interviewing, online job search and finding a new or better position. The Center works with a wide range of businesses and organizations, including the Bergen County One Stop, to locate job openings and connect with employers that are hiring.

Additional services are available through Project STARS for help dealing with personal and family issues. For anyone needing legal advice on marital law, child custody rights or child support, a private consultation with an attorney from Women Lawyers in Bergen can be scheduled. For help dealing with other private concerns, support counseling is available through confidential referral to female, non-military specialists.

Enrollment is limited on a first-come first-served basis. To secure space or for more information, call 201-568-1166 or e-mail info@womensrights.org. To learn more about the Center, its programs, services and activities, visit www.womensrights.org. Women's Rights Information Center, located at 108 West Palisade Avenue in Englewood, is a non-profit, community based organization that has been helping women and their families to become self-sufficient since 1973. Services are provided at low cost or no cost."

PTSD Veterans Swap Guilty Plea for Rehabiliatation

Full Article at: Veterans Suspected of Crimes Swap Guilty Pleas for Rehabilitation

SUMMARY
Tom Bearden reports on special courts that give veterans probation and treatment, especially for post-traumatic stress disorder, instead of prison sentences if they plead guilty to a crime.
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Transcript

TOM BEARDEN: Nic Gray was a sergeant with the 1st Infantry Division, based at Fort Riley, Kansas. He was part of the Iraq troop surge in February 2007.

NIC GRAY, former U.S. soldier: We were just building COPs, which are the combat outposts, which is really what the surge was all about, was taking small neighborhoods and building little bases in them that are troubled, and then clearing and maintaining as well.


TOM BEARDEN: He returned to the States that fall, left the Army when his time was up, and moved to Colorado Springs to start a business. One night last October, he was on the phone talking with a buddy who served with him in Baghdad.

NIC GRAY: We were just kind of talking about our experiences, about, you know, our time over there. And that's pretty much the last thing that I remember. The next thing that I recall is coming to in an orange jumpsuit in county jail, charged with two felonies.

TOM BEARDEN: Gray, who suffers from PTSD, apparently had a flashback, and went on a rampage in his neighborhood, attacking a parked car, kicking in a neighbor's door, threatening the couple inside.

NIC GRAY: I was on a mission in my neighborhood, and I was clearing houses.

TOM BEARDEN: What do you mean?

NIC GRAY: Well, essentially, clearing a house is when you go ahead and you bust in the front door or side door, and you go inside to ensure that there's no, in this case, insurgents in there to go ahead and be able to harm you or your -- your -- your fellow soldiers as well."

VA Investigators Want Charges Against Central Office Violators

Full Article at: VA staffers face discipline over travel, porn
By Jim McElhatton

"Department of Veterans Affairs investigators are calling for disciplinary action against several officials following an internal probe into the VA's special-events office in Washington.

The officials include a director who took taxpayer-funded trips to Las Vegas and San Diego that included a sailing trip and a golf outing, records show.

The same official - Diane Hartmann, director of national programs and special events - also authorized herself to receive hundreds of hours of leave to which she wasn't entitled, according to a new report by the VA Office of Inspector General.

Another employee, whose name and job title VA officials so far have withheld, was caught with thousands of pornographic images on his work computer.

The findings were made public following Freedom of Information Act (FOIA) requests by The Washington Times and others seeking copies of the 45-page inspector general's report.

Questions about the report sent to Ms. Hartmann's VA work e-mail account were not returned, nor were numerous telephone and e-mail messages left with an attorney Monday and Tuesday."

Veteran's Fiduciary Sentenced to 5 Years for Stealing from at Risk Veterans

Full Article at: An Apple Valley woman has been sentenced to federal prison time for stealing money from veterans

Connie Hanson was trusted to protect the financial interests of vulnerable military veterans who could not look out for themselves.

One veteran couldn't pay for repairs to his home. Another didn't have enough money for a haircut. Those stories are just a snapshot of more than 30 Minnesota veterans who were victims of the person who was supposed to be taking care of them.

Hanson was a fiduciary, an independent contractor with the Department of Veterans Affairs, and was responsible for taking care of the finances of veterans who are disabled, aging or ill.

Instead, Hanson gambled with their financial futures to feed her own gambling habit. She pleaded guilty to stealing hundreds of thousands of dollars from the people who needed it most.

On Tuesday, Hanson was sentenced in federal court to nearly five years in prison and ordered to pay more than a million dollars in restitution.

Stephen Grisham is a fiduciary himself. His organization took over the accounts of the veterans who lost their money.

"When you're appointed as a fiduciary for someone, there is a lot of trust and a great responsibility that needs to be taken seriously and unfortunately in that case she broke that trust," Grisham said.

Authorities say Hanson took money from her clients over the last few years. The scam was caught when the bank that handles the accounts discovered unusual activity. The I.R.S. unraveled the complicated financial scheme.

"A lot of money involved, a lot of emotion involved. Things needed to be made right and hopefully we've uncovered what we needed to," said Janet Oakes, a special agent with the Internal Revenue Service"

Vet, Represented by Ezra and Associates , Files Legal Malpractice Suit

Full Article at: Legal malpractice suit claims lawyer gave incorrect info regarding VA suit
3/3/2010 4:35 PM By Kelly Holleran

A man claims he became the victim of legal malpractice when an Illinois law firm he hired to represent him voluntarily dismissed his medical malpractice complaint, which prevented him from filing a similar complaint.

Michael K. Biggs filed a lawsuit Feb. 4 in St. Clair County Circuit Court against John P. Womick and Womick Law Firm.

Biggs claims on May 21, 2006, he hired Womick and Womick Law Firm to investigate and prosecute claims against the United States. Biggs intended to sue the United States after he says he received substandard care at the Veterans Administration Hospital in Marion.

Biggs visited Dr. Mohammad Jabbar at the Veterans Administration Hospital because of anal pain he began experiencing prior to Aug. 5, 2004, according to the complaint.

On Aug. 5, 2004, Jabbar performed surgery on Biggs, but failed to diagnose an anal fistula, which is a tiny channel that develops in the presence of inflammation, the suit states. In addition, during the surgery Jabbar failed to protect the anal sphincter, which is a muscle surrounding the anus. Because he failed to protect the anal sphincter, Jabbar dissected it during surgery but failed to recognize the damage he caused, the complaint says.

Because of the incident, Biggs claims he became sick, sore, lame and disordered; experienced fecal incontinence, pain, suffering, disfigurement, disability and a loss of his enjoyment of life; and incurred medical costs.

After Biggs contacted Womick following the surgery, the attorney filed a lawsuit Sept. 5, 2007, in U.S. District Court for the Southern District of Illinois against the United States, according to the complaint. On Feb. 4, 2008, Womick dismissed the complaint and told Biggs he could re-file his claim within one year, the suit states.

However, Womick was incorrect in his statement that Biggs could re-file the complaint because the Federal Tort Claims Act does not contain a state savings clause, the complaint says.

As a result, Biggs' complaint against Jabbar and the United States has been barred, and he claims to have suffered personal and pecuniary damages.

"That but for the negligence of Womick, Biggs would have recovered fair and reasonable compensation from the Defendant United States of America in the underlying action," the suit states.

In the six-count suit, Biggs seeks a judgment of more than $300,000, plus costs and other relief the court deems just.

D. Jeffrey Ezra, Sarah D. Smith and Shaun M. Lieser of Ezra and Associates in Collinsville will be representing him.

St. Clair County Circuit Court case number: 10-L-51."

Massachusetts Bar Association Offering Free Program to Assists Veterans

I try to list all free legal services for veterans but this one seems a bit weak, only offering 2 hrs of free legal help for veterans. Come on guys and gals you can do better than that, how about a weekend full of free help?

Massachusetts Bar Association Pro Bono Program Assists Veterans

Published: March 02, 2010

On Thursday, April 29, the Massachusetts Bar Association is sponsoring a pro bono legal service called Veterans Dial-A-Lawyer. The voluntary program runs from 5:30 to 7:30 p.m.

Volunteer attorneys will offer free legal advice and information to veterans and their families who are experiencing legal problems such as access to benefits, family issues, employment concerns and landlord/tenant matters.

This successful program is undertaken each fall and spring as a supplement to the "Dial-A-Lawyer" program held each month by the bar and volunteer attorney members.

If you are an attorney who would like to volunteer for Veterans Dial-A-Lawyer, contact the MBA's Boston office at (617) 338-0556 or the Springfield office at (413) 731-5134.

For information visit CLE Events on The Metropolitan Corporate Counsel website at www.metrocorpcounsel.com.

To register, call (617) 338-0556, or to fill out a registration form, visit www.massbar.org. For email inquiries contact LRS@massbar.org.

Veterans Groups Threaten Lawsuit if VA Fails to publish Agent Orange Related Diseases by March 12th

Full Article at: VA delay may stall benefits for Vietnam vets

By Kelly Kennedy - Staff writer
Posted : Tuesday Mar 2, 2010 9:40:58 EST

Three veterans groups have threatened the Veterans Affairs Department with a lawsuit if VA does not publish regulations by March 12 about three Agent Orange-related diseases that the Institute of Medicine has deemed should be presumed connected to military service.

Every two years, the IoM reviews scientific evidence to determine if diseases could have been caused by dioxin, the harmful ingredient in Agent Orange. Agent Orange is an exfoliate widely used during the Vietnam War to clear forests.

In its latest review, IoM found that ischemic heart disease, Parkinson’s disease and B-cell leukemias all could be linked to Agent Orange exposure. VA is required by the Agent Orange Act of 1991 to publish a regulation, making veterans eligible for benefits, within 210 days of such findings. In this case, that would have been Feb. 19. VA doesn’t have to pay out benefits until after the regulation is actually published.

The American Legion, Military Order of the Purple Heart, and the National Veterans Legal Services Program sent a letter to VA on Monday demanding that the organization publish the regulation by March 12"

Hippocampal Changes Detected in PTSD Veterans

This is a very small study, but the results are definitely worth exploring with a larger group to see what that yields.

Full Article at: Stress-affected brain region is smaller in veterans with PTSD
March 2, 2010

(PhysOrg.com) -- A specific region of the hippocampus, a brain structure that is essential to memory, is significantly smaller in veterans with post-traumatic stress disorder than in those without the condition, according to a study by researchers at the San Francisco VA Medical Center and University of California, San Francisco.

The researchers used magnetic resonance imaging to scan the brains of 40 veterans - 20 with combat-related PTSD and 20 without - and found that the region known as the CA3/dentate gyrus was more than 11 percent smaller on average in the veterans with PTSD.

Just as significantly, the CA1 region of the hippocampus, which shrinks as a part of normal aging, was not significantly affected in the veterans with PTSD, according to principal investigator Norbert Schuff, PhD, a senior research scientist at the SFVAMC Center for Imaging of Neurodegenerative Diseases and professor of radiology at UCSF.


“This is the first time in human subjects that PTSD has been shown to be associated with changes in certain specific hippocampal regions and not in others,” says Schuff.

The hippocampus, a finger-joint size structure found in both hemispheres of the brain, is essential for laying down memories, as well as for retrieving them, explains study author Thomas C. Neylan, MD, director of the PTSD program at SFVAMC and a professor of psychiatry at UCSF. He notes that recurring or intrusive memory of traumatic events is a common symptom of PTSD, “and thus the hippocampus is of great interest in PTSD research.”

The dentate gyrus contains adult neural stem cells, and is a site for the creation of new neurons, while the CA3 region contains receptors for glucocorticoids, which are steroids that are elevated in the brain during stress. Previous studies in animals had shown that these regions are the parts of the hippocampus most directly affected by stress, says Neylan, “so we thought these changes might show up in people with PTSD, and they did.” He notes that the two regions are too closely intertwined physically to be imaged separately by current MRI technology, and so are measured together.

Neylan says the results raise the intriguing possibility that since the dentate gyrus has the ability to create new neurons, “these changes might actually be reversible through treatment.”

Schuff cautions that while the results are highly suggestive, they cannot yet be used by clinicians to identify individuals with PTSD. “This is a research finding, which deals in group comparisons,” he says. “We can only observe that these changes have occurred on average across the entire group with PTSD. We can’t yet nail it down to an individual. That will require much further study.” He emphasizes that the findings also need to be replicated independently in a new and larger population of PTSD subjects in order to eliminate the possibility of spurious results.

“This is an incremental step toward establishing a physical biomarker for PTSD,” adds Neylan. “A biomarker is our ultimate goal, since, currently, PTSD is diagnosed based on a subjective neuropsychiatric examination rather than on physical symptoms.”

Neylan predicts that a biomarker would provide clinicians and researchers with an objective way to measure the progress of PTSD treatment, “which would also allow us to no longer think of PTSD as a mental health diagnosis, with all of its associated stigma for our veteran and military patients, but to view it as a physical wound instead.”

Provided by University of California, San Francisco