When retired U.S. Army Master Sgt. Stephen Dailey describes his service in the Middle East during the Gulf War, he says it was like the world around him was burning.

The military burned everything — enemy bunkers, oil wells, even extraneous supplies and garbage that it didn’t want to fall into enemy hands — you name it, it burned, incinerated in giant burn pits carved into the ground. And soldiers, like Dailey, inhaled the smoke.

Those war-time exposures have manifested in a myriad of medical ailments reported to the Department of Veteran Affairs hospitals by Veterans and their families. These problems have been lumped together under the label “chronic multisymptom illness,” also referred to as Gulf War Illness, which affects at least 250,000 Veterans.

U.S. Army Master Sgt. Stephen Dailey

Retired U.S. Army Master Sgt. Stephen Dailey in Washington, DC during his military service.

Dailey can attest to the life-altering effects of war-time exposure and chronic multisymptom illness. Almost as soon as he returned home to Huntington, he began suffering. His wife, Teresa Dailey, said she first noticed something was wrong when her husband’s legs would shoot straight up to the ceiling while he was fast asleep. He had chronic breathing problems and unexplainable skin rashes, and most recently, a medullary thyroid cancer diagnosis.

Doctors told the family that there are typically two causes for the development of this type of cancer — genetics or environmental exposure. Dailey had genetic testing with no mutations found, so the family is convinced it must be connected to the world burning around him during his time in the Middle East.

Congress passed the PACT Act in 2022, which focuses on this problem — the toxicity of military burn pits and chemical agents, and the Veterans suffering from exposures during deployment. The legislation expands healthcare benefits, adds conditions for exposures, identifies locations of presumptive exposures, implements exposure screening at VA healthcare centers and expands research, education and treatment efforts.

To really help, researchers must figure out what the exposures were, the impact of those toxicants on the body and how those mixed toxicants change the effects. It’s exceedingly complicated, and that’s exactly where West Virginia University experts come in. 

Timothy Nurkiewicz, chair of physiology, pharmacology and toxicology at the WVU School of Medicine and director of the Center for Inhalation Technology, together with a team of researchers, is beginning to unravel these complicated questions. The project is a collaboration between WVU, the National Guard, Minneapolis Veterans Affairs and Northwestern University.

“They combusted everything from batteries to oil, all kinds of hydraulic fluids, paper, metal, plastic, any kind of waste that you could imagine,” Nurkiewicz said of routine operations related to military burn pits. “The research we’re doing is investigating the impact on inhalation exposure by the emissions generated and the health effects that they have on Veterans. Our research has shown that complex mixtures do cause more robust cardiopulmonary disease.”

A pellet stove

A pellet stove is used to recreate burn pit conditions at the WVU Health Sciences Center's Inhalation Facility.

The team’s research is happening in the multimillion-dollar, state-of-the-art Inhalation Facility within the WVU Health Sciences Center. They’ve fashioned a pellet stove to recreate burn pit conditions to first figure out what’s in the smoke, and then to discover its impact on humans breathing it in. 

The stove receives spurts of jet fuel as an accelerant — the same accelerant often used for burn pit operations — that ignites specifically designed pellets created courtesy of Jingxin Wang, professor and director of the WVU Center for Sustainable Biomaterials and Bioenergy. Nurkiewicz said the pellet composition is based on samples of sand and ash collected from bases in Iraq. There are also additives like paper, rubber, plastic and nylon, substances most commonly found in burn pits.

The pellets are fed into the stove, and as they burn, the team captures the emissions to analyze the toxicants. Lab animals will be exposed to some of those emissions, and researchers will observe how those exposures change their physiology and behavior and then collect blood samples to search for biomarkers. 

Salik Hussain, assistant professor of physiology and pharmacology, and an expert in mixed exposures and translational research on pulmonary outcomes, will study the identified toxicants both separately and combined, and also their potential impact on pulmonary inflammation and function. 

“These were young, healthy individuals when they went off to war,” Hussain said of Veterans suffering from exposure-related illnesses. “These deployments were to regions with poor air quality, and there was significant job-related stress while they were there. Add the obnoxious mixture of stuff that these burn pits create, and you have an ideal scenario for very adverse outcomes. There is an urgent need to look at the biochemical processes going on and figure out what needs to be done to help these Veterans cope.”

The research also aims to establish biomarkers that identify specific exposures that can aid in treatment protocols. The team will work with the Minneapolis Veterans Affairs Health Care System to run blood tests on a large cohort of Veterans diagnosed with chronic multisymptom illness. Where the biomarkers converge could point toward a future blood test for CMI. 

Retired U.S. Army Master Sgt. Dailey

Retired U.S. Army Master Sgt. Dailey served during the Gulf War.

The project — which received support from the West Virginia Clinical and Translational Science Institute and the WVU Health Sciences’ Office of Research and Graduate Education — may increase the likelihood that Veterans suffering from chronic multisymptom illness will get the treatments and services they need.

“The greater goal of our research is to provide a more exact diagnosis that is irrefutable from a clinical perspective,” Nurkiewicz said. 

No one hopes for a more exact diagnosis more than Jessica Haas, a nurse, chronic multisymptom illness advocate and Stephen Dailey’s daughter. She’s watched her father suffer, heard her mother’s stories and shares her frustration about the treatment Veterans receive, along with the continued uncertainty that surrounds chronic multisymptom illness, to anyone who will listen.

Inspired by her father’s struggles and from stories she’s heard from other Veterans, she’s currently working to obtain a nursing certification in military exposure. She thinks all medical personnel, especially ones who deal with Veterans, should have to do the same.

“We desperately need something that applies across the board so that doctors and nurses know without a doubt what they’re dealing with,” Haas said. “For years I’ve watched my dad suffer, and there wasn’t even a mention of chronic multisymptom illness or Gulf War Illness in his chart. Imagine the Veterans we can help when there is. I hope this research gets us closer to that.”