Wnited States Senate WASHINGTON, DC 20510 March 27, 2015 The Honorable Thad Cochran ‘The Honorable Rictard J. Durbin Chairman Ranking Member Subcommittee on Defense Subcommittee on Defense Committee on Appropriations Commitee on Appropriations Washington, DC 20510 Washington, DC 20510 Dear Chairman Cochran and Vice Chairman Durbin: ‘Thank you for your interest in and 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) 2015. As your Committee begins work on the FY 2016 DOD Appropriations bill, we are writing to share with you the progress being made by the GWIRP and to request that you include the funding. necessary to continue this successfil program’s work on behalf of Gulf War veterans. While we have made progress in the fight against Gulf War Illness, many challenges remain. The 2014 report of the Congressionally-mandated Research Advisory Committee on Gulf War Veterans" Illnesses (RAC) reaffirmed the conclusions of the major scientific reviews by the RAC in 2008 and the Institute of Medicine in 2010. The report states, “Scientific research [since 2008] ... supports and further substantiates ... that Gulf War illness is a serious physical disease, affecting at least 175,000 veterans of the 1990-1991 Gulf War, that resulted from hazardous exposures in the Gulf War theater.” ‘According to the report, 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.” Studies reviewed by the report have found an elevated incidence of Lou Gehrig’s disease (ALS) among Gulf War veterans as well as significant’y 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 in the report is that “[t}reatment research has inereased significantly since 2008, particularly reflecting the work of the Gulf War Illness Research Program (at] CDMRP” and that “[elarly results provide encouraging signs that the treatment goals identified in the 2010 Institute of Medicine report are achievable: ‘to speed the development of effective treatments, cures, and, itis, hoped, preventions.”” Indeed, the GWIRP has served as a model of how to conduct treatment-oriented research to address a challenging illness and is succeeding where earlier programs failed. By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 treatments—like CoQ1O, acupuncture, and camosine—that 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; potential explanation of GWI immunological dysfunction; inflammation and immune dysfunetion in GW1after exercise challenge; evidence suggesting small fiber peripheral neuropathy in a subset of GWI veterans; and lipid dysfunction following GWI exposures. 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. In view of this progress, the 2014 RAC report recommends that “Congress should maintain its funding to support the effective treatment-oriented [GWIRP].” We agree and respectfully request that you provide the necessary resources to continue this vital and effective program. Furthermore, itis critical to the program’s success and accountability that it remains a stand-alone program within CDMRP, rather than being 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, Sergeant Sullivan Center, National Vietnam and Gulf War Veterans Coalition, and Veterans for Common Sense. Sincerely, Tamed ymmy Baldwin Sherrod Brown United States Senator United States SenatorKirsten Gillibrand United States Senator Brian Schatz, United States Senator Pita Bernie Sanders United States Senator — Ren Woy Ron Wyden United States Senator Edward Markey United States Senator eee Charles E. Schumer United States Senator Mazie K. Hirono United States Senator Gary C. Peters United States SenatorYo I Mall eee doe Jeff Merkley Jeanne Shaheen United States Senator United States Senator