Although DoD had conducted extensive research into environmental and medical concerns associated with the various DU munitions, several data gaps were identified during the Gulf War that necessitated further investigation. This section addresses environmental assessments of DU contamination on the battlefield, recent environmental studies of various DU munitions, results of current medical studies, future monitoring efforts, and on-going and planned research.
A. Environmental Assessments
Since Desert Shield/Desert Storm, the US Army Center for Health Promotion and Preventive Medicine (CHPPM) has conducted limited environmental sampling in the Gulf Region. Using radiation levels as a marker for the presence of DU or its compounds, i.e. DU oxides, a 16-member medical team deployed to Saudi Arabia, Kuwait, and Bahrain from October 19, 1994 to December 3, 1994, in part to evaluate potential occupational and environmental hazards to personnel deployed to the region. Potential exposures to DU were only one of the environmental concerns evaluated.
Figure 9. Dr. Rostker (Special Assistant for Gulf War Illnesses) At Kuwait's "Valley of Death" Boneyard.
The team performed a screening survey for DU exposures at the "Valley of Death Boneyard" at the Udairi Range. This is the area used to store many of the vehicles destroyed by DU munitions during the Gulf War. The team collected a series of samples to evaluate the radiological hazard associated with the boneyard. The team selected vehicles, which had been hit by DU rounds, as confirmed by radioactivity levels at the penetration holes. Wipe samples were taken near the penetration holes to determine if the contamination was "fixed," as in molten spatters that had reformed and hardened around entrance or exit holes, or removable, i.e. oxides or residues that could be swept away. The report concluded that the remaining contamination was fixed. The team collected soil samples in drainage pathways on the site, and used lapel-mounted "personal breathing zone" samplers to assess personnel exposures at the site. The report concluded that:
[N]o measurements significantly exceeded any applicable regulatory or consensus radiation protection exposure limit values used for assessing radiological health risk. In addition, these results indicate no DU exposure hazard to military personnel working outside the boneyard but still within its immediate vicinity as long as there are no ongoing operations within the boneyard.
CHPPM also conducted radiological analysis of 215 air samples collected during the 1991 Kuwaiti Oil Well Fires study at various military facilities throughout Kuwait and Saudi Arabia. The report stated that "[A]ny dose assessments calculated using the measured radionuclide concentrations from air filter samples are well below US regulatory limits for the general public."
In an effort to further evaluate environmental conditions encountered by US troops in Kuwait and Saudi Arabia, the US Army Central Command deployed the 520th Theater Army Medical Laboratory to Camp Doha in early March 1998, to supplement the already deployed Theater Medical Surveillance Team. These personnel conducted environmental surveillance during the Spring and early Summer. If available, the results of any DU investigations that they undertake will be incorporated in the next update of this DU Environmental Exposure Report.
In addition, there has been independent research concerning environmental testing for ambient exposures to uranium in the Gulf War Region. A study by Firyal Bou-Rabee, a professor in the Department of Geology at Kuwait University, reported on sampling performed on air, tap water, and soil samples at various locations in Kuwait. The report stated that the uranium in tap water was very low, which he attributes to the fact that their tap water is produced from desalinated seawater. Although the report did not specify where the ambient air sampling was conducted, the report concluded, "these uranium concentrations in the surface air do not represent any substantial radiological hazard for the Kuwait population." The total annual intake of uranium by inhalation in Kuwait was reported to be less than 0.2% of the recommended annual limit on intake for members of the general population.
B. Developmental Testing and Evaluation of DU Munitions - Post Gulf War
The M919 25mm APFSDS-T cartridge that entered service in 1995 for use in Bradley fighting vehicles is the only new DU munition to be fielded by the US since the Gulf War. The results of the environmental sampling conducted during the hazard classification testing on the M919 were consistent with hazard classification testing performed on other DU munitions with certain caveats (see Tab E). The report concluded, "no measurable DU became airborne as a result of the External Fire Stack Test." During hard impact testing, less than 10% of the DU was aerosolized and less than 0.1% of the initial mass of the penetrator was in the respirable range. Eighty-three percent (83%) of the oxide formed was insoluble.
In order to evaluate real-life hazards of a fire involving a fully loaded Bradley Fighting Vehicle (BFV), the Army also conducted a burn test of a BFV equipped with TOW anti-tank missiles and 1,125 M919 25mm cartridges in 1994. The BFV was completely engulfed by the fire and burned vigorously for about an hour. The fire subsided after an hour, but continued to emit a plume over the next five hours with smoldering hot spots into the next day. Of the 1,125 DU penetrators, 625 were accounted for, including nine live rounds found within a few meters of the test pad. Although 500 rounds were unaccounted for, the report indicated that a large percentage was trapped within the melted remains and a significant amount of the DU oxide was mixed within the ash and settled inside and around the hull of the vehicle. Although a small amount of DU oxide was released during the fire and subsequent explosions, only trace amounts were detected on the air monitoring filters placed at various distances from the Bradley during the 29 hours of air sampling. The major difference between the Bradley Burn test and previous stack test burns was that six readily accessible piles of DU oxide were discovered in the burned out remains of the BFV. The BFV burn test was the first burn test that actually involved a vehicle fire. Previous burn tests were conducted in conjunction with hazard classification tests and involved metal and wooden storage crates. The results of the BFV fire may be more "life-like" and representative of actual battlefield results than previous hazard classification tests under less realistic conditions. The final report is scheduled to be released in the Fall of 1998.
Depleted uranium hard impact aerosolization testing was conducted in various foreign armored vehicles in June 1995 at the US Army Research Lab Test Facility located at the Department of Energy's Nevada Test Site as a piggyback to a Joint Live Fire Lethality Test of 120/25 mm DU munitions versus Soviet-produced armored vehicles. Both source term and resuspension testing of DU aerosols were conducted. Several technical and procedural difficulties seriously affected the data and limited the conclusions that could be drawn from this testing. In spite of these drawbacks, there were several key findings:
C. DoD and VA Medical Surveillance Programs for Gulf War Veterans
In 1993, the Office of the Army Surgeon General reviewed medical records of soldiers who had been hospitalized for wounds sustained in friendly fire incidents in the Gulf War. This review identified 22 soldiers whose records indicated retained metal fragments that might contain DU. Thirteen additional soldiers were identified as having been injured and potentially exposed to DU by friendly fire, but were not specifically identified as having metal fragments. Since 1993, the Baltimore Veterans Affairs (VA) Medical Center DU Follow-up Program has followed thirty-three of these individuals who were manning US Army vehicles at the time they were struck by DU munitions.
The 33 individuals evaluated at the Baltimore VAMC in 1993 and 1994 underwent a comprehensive medical and psychological evaluation. They also underwent a full-body x-ray survey, looking for retained metallic fragments. While these veterans have very definite medical afflictions resulting from their wartime injuries, they are not sick from the heavy metal or radiological toxicity of DU. Some veterans have multiple tiny fragments of DU scattered in their muscles and soft tissues. These fragments cannot be surgically removed without causing extensive damage to the surrounding tissues. Individuals who demonstrated increased excretion of uranium in the urine had evidence of retained DU fragments on X-rays. No detectable adverse effects on the kidneys were observed. No cases of cancer have been diagnosed in these participants; nor would one expect any at this point since the latency period for the onset of cancers possibly related to environmental exposure is at least twenty years. Since the Gulf War, all babies fathered by the veterans in the DU Program were born without observable observable birth defects.
In 1997, this group of DU-exposed servicemen returned to the Baltimore VA Medical Center for a three-day follow-up evaluation. Again, no detectable adverse effects on the kidneys were observed. Urine uranium excretion was still elevated above normal levels for the individuals retaining embedded DU fragments.
Another VA follow-up program was initiated in 1993 to evaluate the exposures of the 144th Service and Supply Company, the Army National Guard unit from New Jersey, which operated the damaged equipment yard at King Khalid Military City. Twenty-seven members of this unit were exposed to DU for a period of several weeks before being informed that some of the equipment in the yard had DU contamination. A cohort of 12 volunteers was medically evaluated at the Boston VA Medical Center in 1992. Eight of these servicemen volunteered to undergo urine testing and whole-body radiation counting, and four others underwent only the whole-body radiation counting. Although these individuals were potentially exposed to DU dust on and off over several weeks, the test results showed no residual body-burdens of DU.
In July, 1998, the Department of Defense (DoD) and the Department of Veterans Affairs (DVA) instituted a medical follow-up program to evaluate veterans who received the largest DU exposures during the Gulf War. The follow-up program is aimed at ensuring that Gulf War veterans with higher-than-normal levels of uranium in their bodies are identified and given appropriate monitoring and treatment. The follow-up will be executed in phases. It is likely that most soldiers will have normal levels of uranium in their bodies. This program will provide reassurance to them. The program requires a 24-hour urine collection for urine uranium level and a detailed DU exposure questionnaire in addition to the examination Gulf War veterans receive through the Comprehensive Clinical Evaluation Program (CCEP) or the Department of Veterans Affairs (VA) Gulf War Registry. The notification and medical evaluation components of the program are described below.
1. Identification and Notification of Gulf War Veterans with Potential DU Exposures
As discussed in Section III and depicted in Table 1, the investigation by the Office of the Special Assistant has classified possible Gulf War DU exposures into 13 separate activities, which are in turn categorized into three levels. This investigation was intended to determine how many US service personnel may have been exposed to DU, to what degree, and the possible health impact of these exposures. Underlying all of the Gulf War illnesses investigations is the responsibility to provide useful information to Gulf War veterans and their health care providers.
Initially, the Office of the Special Assistants investigators will concentrate on locating the soldiers in Level I. Level I includes approximately 113 soldiers who were in or on top of a vehicle at the time it was penetrated by DU munitions, plus an estimated 30 to 60 more who entered burning DU-contaminated US vehicles to perform rescue operations. This group (especially the ones with retained DU fragments) is considered to have had the highest exposure to DU.
Trained interviewers will contact these 140 to 180 individuals by telephone, for two major purposes. First, the veterans will be informed about the availability of the DoD and VA DU medical screening programs, and they will be encouraged to enroll in the VA or DoDs Comprehensive Clinical Evaluation Program (CCEP) program for which they are eligible. They will be informed that a follow-up letter will be sent within a week of the initial phone contact. This letter will contain additional information on how to enroll in the medical programs and who to call for further assistance at the Office of the Special Assistant. Copies of the follow-up letter and a fact sheet on DU, as well as more detailed information about the phases of the follow-up program, are presented in Tab K. Thirty-three of the Level I individuals are already being followed by the Baltimore VA.
Second, the Office of the Special Assistant has analyzed friendly fire incidents in order to identify surviving troops who may have been exposed to DU. These veterans will be contacted by the Office of the Special Assistant and asked to provide information about their relevant experiences in order to reconstruct possible DU exposure levels and to establish a fuller accounting of personnel who were in or on the vehicles, or who performed immediate rescue operations.
After the initial emphasis on locating the individuals in Level I, the Office of the Special Assistant will expand its efforts to contact individuals from Level II whose duties required them to make numerous trips into equipment contaminated with DU (an estimated 115 to 183 individuals). This group includes 12 members of the Battle Damage Assessment Team, 6-12 Logistics Assistance Representatives, 27 members of the 144th Service and Supply Company, 30-60 unit maintenance personnel who performed maintenance on or in DU-contaminated systems, 30-60 EOD and unit personnel who downloaded equipment and munitions from DU-contaminated equipment, and 10-12 Radiation Control team members.
If after evaluating the groups described above, there is medical justification for looking at lesser exposed groups, the notification and medical follow-up will be extended to groups, such as the estimated 600 soldiers involved with the cleanup of the North Compound of Doha. In any case, veterans who are not among those to be notified and are concerned about their possible DU exposures will be able to obtain a DU medical evaluation from a DoD or VA physician, at the appropriate facility that is closest to them.
Should any health problems be detected, there will be an opportunity for a medical follow-up with a local primary care physician and/or specialists. The staff at the Baltimore VA is available to consult with primary care physicians about how to assess DU exposures clinically, how to interpret the results of tests for urinary uranium, how to educate veterans who have concerns about DU, and other relevant clinical questions.
2. DoD and VA Medical Evaluation Program for Gulf War Veterans with Potential DU Exposures
The DU medical evaluation program consists of three elements:
The Phase I registry exam includes: several questionnaires on demographics, Gulf War-related exposures, and medical history; a thorough physical examination; routine laboratory tests; and consultations with specialists, if needed. An additional exposure questionnaire will be added, which includes questions on the dates and locations of deployment, specifics about the potential type and duration of DU exposure (i.e., friendly fire vs. inspection of DU-contaminated vehicles), and whether the individual was wounded.
Each individual in the DU surveillance program will be asked to provide a 24-hour urine collection in a special container. Each of these urine specimens will be shipped to the Baltimore VA and analyzed by a single laboratory used for the uranium monitoring. The Baltimore VA will mail the results and their interpretation to the individual veteran, with a copy to the examining physician. Recommendations for follow-up will depend on whether the urinary uranium level is normal or increased.
Based on the ongoing monitoring of the 33 participants in the Baltimore program, the vast majority of individuals who enroll in the DU medical surveillance program are expected to demonstrate normal urinary uranium levels. These individuals should receive education and reassurance through appropriate communication from their primary care physicians.
If an individual demonstrates an elevated urinary uranium level, he or she will be referred to the Baltimore VA for further evaluation. Based on the results of the thirty-three participants in the Baltimore program, a high urinary level is a likely indication of previously unrecognized, retained DU fragments. Any individual showing elevated levels of uranium in their urine will be encouraged to receive follow-up in the Baltimore VA program. This follow-up will include periodic medical exams and urinary uranium determinations.
Based on more than 103,000 exams that have been performed in the CCEP and VA Gulf War Registry, many previously unrecognized or asymptomatic health problems have been detected (e.g. hypertension or diabetes mellitus). Therefore, it is likely that some of the veterans who enroll in the DU medical evaluation program will have health problems unrelated to DU exposure. Using appropriate clinical terms, physicians should carefully explain and interpret these health problems to veterans. Veterans who have chronic health problems should receive follow-up primary care at the appropriate military Medical Treatment Facility or VA Medical Center.
Some Gulf War veterans have expressed concerns about potential DU exposures, which were at much lower levels than those experienced by the veterans involved in the Level I or Level II categories. For example, some veterans are concerned about potential exposures from climbing on board damaged Iraqi vehicles, or from being present in the South Compound during the fire at Doha, in July 1991. While they are considered to have a much lower risk than the veterans in the friendly fire incidents, veterans with these lower exposures may still have questions for their physicians. Veterans in these lower exposure categories will not be specifically identified or contacted by the Office of the Special Assistant, but they may refer themselves to the DoD or VA for medical advice. If these individuals and/or their physicians believe it is warranted, they will receive a DU medical evaluation. The physicians who perform the CCEP exams and the VA Gulf War Registry exams at each of the Medical Treatment Facilities and VA Medical Centers nationwide have been trained to perform DU medical evaluations. These medical evaluations are modeled on the evaluations developed by the Baltimore VA.
D. Postwar Research
There are two major, ongoing laboratory investigations of the health effects of DU, at the Armed Forces Radiobiology Research Institute, and at the Lovelace Respiratory Research Institute.
The Armed Forces Radiobiology Research Institute (AFRRI) in Bethesda, Maryland, is currently assessing the toxicity of embedded depleted uranium (DU) in the Sprague-Dawley rat. This research has relevance to Gulf War veterans who have retained DU fragments, which cannot be removed because the surgery would cause significant tissue damage. In previous studies in experimental animals, the major effect of short-term, high doses of uranium was cellular damage in the kidneys.
The goal of the AFRRI study is to evaluate kidney, behavioral, neurological, and reproductive toxicity associated with DU pellets implanted in the muscles of male and female Sprague-Dawley rats. Tissues are also assessed for uranium concentrations and cellular changes. There are two groups of comparison rats, animals implanted with tantalum pellets, a control metal, and animals that do not receive implants. The final evaluations of the animals, at 18 months after implantation, will be completed in 1998.
The uranium pellets appear to be dissolving very slowly over time, leading to high levels of uranium in the kidney, urine, and bone. Despite the high DU levels in the kidney, there is no evidence of kidney toxicity, based on several assays. These results indicate that kidney toxicity may be less of a hazard than anticipated.
These experiments demonstrate that uranium can cross the blood-brain barrier, similar to other heavy metals. Despite this, there is no evidence for behavioral neurotoxicity in male rats. They have been tested with a functional observational battery, and evaluated for passive avoidance and spontaneous locomotor activity.
The potential effects of DU on reproduction have been evaluated with pregnant rats. The female rats with the DU implants did not show any effects on ability to become pregnant or to carry the litter to term. There were no adverse maternal effects of DU, such as effects on maternal pregnancy weight gain or food and water intake. There were no effects of DU on the litters, such as the number of pups per litter, or weight of the pups. There was a correlation between DU levels in the maternal kidney, placental tissue, and fetal tissue. The possible effects of DU on the development of the offspring are now being investigated.
In another study, the Lovelace Respiratory Research Institute (formerly Inhalation Toxicology Research Institute), Albuquerque, NM, is conducting similar studies on rats implanted with three dose levels of DU munitions alloys. The studies will attempt to assess potential carcinogenicity of the implanted materials as well as to assess various cellular and biophysical/biochemical effects.
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