March 16, 2016

The Honorable Thad Cochran

Chairman
Subcommittee on Defense
Committee on Appropriations
Washington, DC 20510

The Honorable Richard J. Durbin

Ranking Member
Subcommittee on Defense
Committee on Appropriations
Washington, DC 20510

Dear Chairman Cochran and Ranking Member Durbin:

Thank you for your continued support for the Gulf War Illness Research Program (GWIRP) within the
Department of Defense (DOD) Congressionally Directed Medical Research Programs (CDMRP),
including the $20 million provided to the program by Congress for Fiscal Year (FY) 2016. As your
Committee begins work on the FY 2017 DOD Appropriations Bill, we are writing to provide a
program update and to request that you include the funding necessary to continue the GWIRPs
successful work on behalf of Gulf War veterans.
We have made strides in the fight against Gulf War Illness, but many challenges remain. Since the
2008 report of the congressionally-mandated Research Advisory Committee on Gulf War Veterans
Illnesses (RAC) and the 2010 report of the Institute of Medicine (IOM), science has shown that Gulf
War Illness is a physical conditionlikely caused by toxic exposuresaffecting between one-quarter
and one-third of the nearly 700,000 veterans who served. The most recent RAC update in 2014
affirmed these conclusions, and a 2016 IOM update found little evidence to warrant changes to the
conclusions made by the [2010 IOM] committee . . .1 Common symptoms include some combination
of widespread pain, headache, persistent problems with memory and thinking, fatigue, breathing
problems, stomach and intestinal symptoms, and skin abnormalities.2 Studies also have found an
elevated incidence of Lou Gehrigs disease (ALS) among Gulf War veterans as well as significantly
elevated rates of death due to brain cancer among those who were most exposed to the release of nerve
gas by the destruction of the Khamisiyah Iraqi arms depot.
The positive news is that treatment research has increased significantly since 2008, particularly
reflecting the work of the GWIRP at CDMRP, and that early results represent encouraging steps toward
achieving the 2010 IOM treatment goals to speed the development of effective treatments, cures, and,
it is hoped, preventions.3 Indeed, the GWIRP has served as a model of how to conduct treatmentoriented research to address a challenging illness and is succeeding where earlier programs failed. By
1Institute of Medicine, Update of Health Effects of Serving in the Gulf War, 2016, Gulf War and Health, no. 10 (2016): 6
2Research Advisory Committee on Gulf War Veterans Illnesses, Research Update and
Recommendations, 2009-2013, Gulf War Illnesses and the Health of Gulf War Veterans, (2014): 5.

Congressional design, the program is narrowly focused on identifying treatments and diagnostic
markers. Its highly competitive, peer-reviewed process is open to all researchers, whereas U.S.
Department of Veterans Affairs (VA) research is restricted to VA staff, few of whom have expertise in
this rapidly-evolving, cutting-edge area.
GWIRP-funded studies have found treatmentslike CoQ10, acupuncture, carnosine, and xylitol/saline
nasal irrigationthat help alleviate some GWI symptoms, and ongoing evaluations of treatments
include off-the-shelf medications and alternative therapies for which there is a rationale for GWI
symptom relief. Other studies by multisite, multidisciplinary teams are focused on identifying
treatments to attack the underlying disease and are showing great promise, finding that even low-dose
chemical warfare agent and/or pesticide exposure leads to the following findings, among others:
persistent brain changes associated with GWI; evidence of a GWI chronic central nervous system
inflammatory state; a potential explanation of GWI immunological dysfunction; inflammation and
immune dysfunction in GWI after exercise challenge; evidence suggesting small fiber peripheral
neuropathy in a subset of GWI veterans; lipid dysfunction following GWI exposures; and persistent
changes in axonal transport in the brain. Some of the new pilot studies of treatments approved in 2015
include: vagus nerve stimulation; D-Cycloserine; anatabine; liposomal glutathione and curcumin; and a
mitochondrial cocktail extending the benefits of CoQ10. New research to identify underlying disease
mechanisms and biomarkers includes: studies of novel autoantibody serum and cerebrospinal fluid
biomarkers; microtubule abnormalities; neurovascular and autonomic dysfunction; brain autoimmune
dysfunction; muscle mitochondrial assessment; and an objective blood test from stimulated gene
expression. In addition to improving the health of Gulf War veterans, these important discoveries also
will help protect current and future American servicemembers who could be at risk of toxic exposures.
Recognizing the programs progress, the most recent RAC report recommends that Congress should
maintain its funding to support the effective treatment-oriented [GWIRP].4 We agree and respectfully
request that you provide the necessary resources to continue this vital and effective program in the
FY17 DOD Appropriations Bill. Furthermore, it is critical to the programs success and accountability
that it remains a stand-alone program within CDMRP, rather than combined with other diseases.
Thank you for your consideration of our request, which is supported by the American Legion, Veterans
of Foreign Wars, Disabled American Veterans, Paralyzed Veterans of American, AMVETS, Vietnam
Veterans of America, National Vietnam and Gulf War Veterans Coalition, the National Gulf War
Resource Center, and Veterans for Common Sense.
Sincerely,

3 Institute of Medicine, Update of Health Effects of Serving in the Gulf War, Gulf War and Health, no. 8 (2010): ix.
4 Research Advisory Committee on Gulf War Veterans Illnesses, Research Update and
Recommendations, 2009-2013, Gulf War Illnesses and the Health of Gulf War Veterans, (2014): 14.

________________________
Tammy Baldwin
United States Senator