June 26, 2013

Institute of Medicine

Committee on Developing a Consensus Case Definition CMI related to 1991 Persian Gulf War Veterans

Testimony of David K. Winnett, Jr.

Captain, United States Marine Corps (Retired) Personal background; I am a 59 year old male. I served twenty continuous years as a United States Marine; enlisting as a Private (E-1) in 1975. By 1979 I had attained the rank of Staff Sergeant (E-6). In 1982 I was selected from a Marine Corps-wide pool of 2,500 applicants to be appointed along with 249 other Marines to the rank of Warrant Officer. I rose to the rank of Chief Warrant Officer-3. In 1990 I was selected for a commission as an unrestricted officer and was appointed a First Lieutenant. I served in the 1991 Persian Gulf War as a First Lieutenant. At the time of the war I had already served in the military for sixteen years. I mention this because I am not in the majority in terms of the average age group for ailing Gulf War Veterans; most of whom are in their forties. I was assigned to the 1st Marine Division Headquarters during the Persian Gulf War, where I was responsible for all of the vehicle assets assigned to the Division Headquarters. During the ground war I coordinated large vehicle convoys in support of Division combat operations throughout the theater of operations. In 1992 while serving at Marine Barracks Guantanamo Cuba I was promoted to the rank of Captain. After a year at GITMO I was assigned to my final duty station at MCAS, El Toro, California. I served there as the Station Transportation Officer until my retirement from the Marine Corps in 1995. I am a five year Veteran in the fight for justice for the more than two hundred thousand Persian Gulf War Veterans who suffer from Gulf War Illness. I am an active member of the National Gulf War Resource Center and a four-time “Consumer Reviewer” on the Congressionally Directed Medical Research Programs (CDMRP) for Gulf War Illness Research. I have also

recently been appointed as a member of CDMRPs “Integration Panel” for that same research program. I am the sole administrator of the closed Facebook page: “Gulf War Illnesses” which currently has an active membership of seven hundred Gulf war Veterans, family members, and others interested in advancing the cause of our ill Veterans. History of my Symptoms; Note – I have been rated with mild COPD. But the VA’s rating does not tie my respiratory problems to the Persian Gulf War. I had a very serious case of LLL Pneumonia the first year of my enlistment in 1975 which caused permanent scarring of the LLL. This led to at least twice yearly bouts with pneumonia in the years that followed and in 1987 the LLL began to bleed. I was hospitalized for three weeks at Balboa Naval Hospital during this timeframe and subsequently put on a six-month observational “Medical Board”. I bled twice more in that time and was close to being medically discharged. Thankfully the hemoptysis stopped just as the pulmonologists were contemplating removal of my LLL. You can imagine my concern when three years later I found myself surrounded by 700 burning oil wells in Kuwait. Late 1990; while deployed forward (in the desert) awaiting the start of the war, while showering one day I noticed a very painful lump inside my left testicle. I was seen at the field hospital where the physician initially thought that the lump might be "torsion". It turned out to be internal inflammation caused by an infection. I was treated with antibiotics and it resolved within a week to ten days. Late 1991: While stationed at GITMO I began to experience frequent bouts of intermittent blurry vision. One day the vision in my left eye will be extremely blurry, the next day it would be normal. The same would happen with my right eye. Physicians at GITMO were unable to diagnose the problem. Note: The problem continues to this day but in 1995 after I had left active duty the VA diagnosed this problem as “Ophthalmic Migraine”. Late 1991: Also at GITMO – I began to experience intense inching on my upper forearms. Physicians at GITMO took skin scraping samples but were unable to identify any kind of fungus or other skin related problem that would cause the itch. As long as I don’t scratch the area when it itches, the skin shows no visible signed of irritation. The problem continues intermittently to this day.

Late 1991/Early 1992: While still at GITMO I began experiencing extreme difficulty controlling the bladder muscles that start and stop urination. I was checked for prostate problems but the prostate was normal. Two years later in 1993 while assigned to MCAS El Toro I underwent a bladder operation intended to correct what the Urologist believed to be “tight bladder neck”. The bladder neck was surgically widened. The operation had no effect whatsoever on the problem which continues to this day. I strongly believe that this problem is related to the nerves that are used to consciously control urination. I am forced to sit when I urinate because of the time and difficulty it takes to begin urinating – even with a very full bladder. And when I am able to start, the flow is very slow. There is a tendency for me to lose my concentration whereupon the urine flow stops. Mid-1993; I began to experience additional vision problems. When viewing something up close and then looking up to focus on something distant, I noticed a very bothersome delay in the time it took my eyes to refocus on the distant object. The problem persists. 1995; I began to experience sensory deficits. Specifically, my sense of alertness and mental acuity seemed dulled, as if I were on some kind of drug (which I was not). The feeling manifested further by causing me to shuffle when I walked. I often tripped on things because my foot coordination was disrupted. I reported these problems to the VA, but no evaluation was performed. In 1999 I finally saw a civilian neurologist who prescribed a drug called Lamictal. Lamictal helped significantly but unfortunately my neurological problems were still evolving. 2000; By the year 2000 I had begun to develop chronic weakness and fatigue. Although retired and now working in the public sector I was continuing to exercise at least three times a week. Running three miles, doing upper and lower body work in the gym at Los Angeles Air Force base. But over the course of two to three years it became progressively more difficult to run. I forced myself to complete the intended distance, but I was considerably slowed by the profound fatigue that running caused. Eventually I just could no longer muster the will to endure the pain and fatigue that running exacerbated. In hindsight I do strongly believe that my diligent post-military exercise regimen served to slow the onset of the much more severe fatigue and muscle pain I now live with.

2002/2003; My skin problems began to worsen. I developed very red and itchy bumps on my face and upper torso. I visited a civilian Dermatologist in Torrance, CA where I was living and working for the City. The doctor took a biopsy of a lesion above my right eyebrow. The pathology results prompted him to tell me that in his 30-year career, he had “never seen cells put together like that”. The only treatment available was anti-itch skin creams. Later that year I had another punch biopsy taken from my back at the Los Angeles Air Force Base Clinic. The sample was sent to the Armed Forces Institute of Pathology. The AFIP was unable to definitively diagnose the skin problem but noted that Cutaneous Lupus could not be ruled out. 2005: I was seeing a Rheumatologist in Los Angeles by the name of Ginder Marshall for my muscle pain and fatigue. Dr. Marshall conducted extensive tests over a period of months and eventually arrived at a diagnosis of “Undifferentiated Connective Tissue Disorder”. During this time I was prescribed drugs such as gabapentin, flexiril, and others in this class of muscle relaxers. I was unable to tolerate this class of drug because they significantly impaired my ability to concentrate at work. They created what many people call brain fog. Very unpleasant. 2006; My VA claims related to the Gulf War began to be approved. I was surprised to read that one of my disability ratings was for “Dysthymia”. I had not applied for any mental health related problems but during my exams they had sent me to be interviewed by a VA Psychiatrist. The Psychiatrist opined that I was “as likely as not” depressed due to having to deal with the myriad of physiological medical issues. I could not argue that observation. Indeed it is mentally taxing to be in pain and profoundly fatigued all of the time. 2008; I had been experiencing severe muscle fasciculation (twitching) in my abdomen, my anal sphincter, my legs, my face and my arms. At times this twitching would grow increasingly severe as to cause very painful muscle contractions, producing unbelievably intense cramps. Thankfully during a GWI study at Georgetown that year I was prescribed Clonazepam. The VA continued me on this drug which I’ve taken ever since. For the most part the fasciculations have subsided. I am very impressed with this drug. I use it at bedtime and there are virtually no side effects during the day.

2008-2011; I continued working for the City of Torrance as their Fleet Manager. During this time, in addition to my PCM I was seeing an Infectious Diseases Specialist, Dr. John Chia in Torrance, as well as a Rheumatologist, Dr. William Liu. Dr. Chia diagnosed me with CFS and Fibromyalgia. Dr. Chia believes that CFS is caused by an Enterovirus, having done extensive research in that area. He tried me on Lyrica, but I experienced the same brain fog that the muscle relaxers had on me. Even in the tiniest doses. He finally prescribed a time-released form of Ritalin called “Concerta”, which greatly helps my daytime fatigue with few side effects. Dr. Liu on the other hand was dealing with my muscle pain issues. I ended up taking Vicodin, and continue on it to this day. I often tell people that the three drugs that keep me as functional as possible are Clonazepam, Concerta, and Vicodin. September 2011; Muscle biopsy taken from my left thigh during surgery at Long Beach VA Medical Center. Operation performed under general anesthesia. Biopsy samples were sent to UC Irvine. Results; “Indicative of Denervation”. November 2011; I found that my medical problems were adversely impacting my ability to perform the significant responsibilities of running a 700 vehicle municipal fleet, so I put in for retirement. I subsequently moved to Texas where I currently reside. Present Day: I continue to advocate for and assist in any way that I can the cause of ailing Persian Gulf War Veterans, the majority of whom continue to have their Persian Gulf War related disability claims denied by the VA. David K. Winnett, Jr. Captain, USMC (Ret.) 204 Falling Hills New Braunfels, Texas 78132 Cell: (830) 708-9832 Email: USMC1ONE@GMail.com