Louisiana Allergy & Asthma Specialists Dr. Benjamin B. Close

Louisiana Allergyasthma Specialistsdr Benjamin B Close201 Pecan Park

Louisiana Allergyasthma Specialistsdr Benjamin B Close201 Pecan Park

LOUISIANA ALLERGY Asthma specialists Dr. Benjamin B. Close 201 Pecan Park Avenue Alexandria, LA 71303 Ph# ( December 6, 2018 Reference: Veteran Name SS# VA File# To Whom it may concern, I am Dr. Benjamin B. Close a board certified and licensed allergy and asthma specialists, with 20 years’ experience in my field of medicine.

I've been asked to provide an Independent Medical Opinion in support of the aforementioned veteran’s claim. As well as providing a nexus to the patients’ service-connected illness and the current physical issues. Ms. Veteran has been a patient under my care since September 2016. Her diagnosis is chronic idiopathic urticaria. I have reviewed the veterans’ medical and military history; I have also reviewed and noted the circumstances and events of her military service deployment to the Middle East.

While in Iraq, she was constantly exposed to pollution, burning of raw sewage, smoke from burning trash and feces, solvents, vehicle, and JP8 exhaust fumes, environmental pesticides, and numerous insect bites. She was also given numerous vaccinations, including anthrax. During and after her return from Desert Storm, Ms. Veteran experienced skin irritation and hives or rashes covering multiple parts of her body. Ms. Veteran self-treated herself with Benadryl over the last 23 years, which helped to relieve her discomfort until 2016.

In conclusion, it is in my medical and professional opinion, that it is at least as likely as not that Ms. Veteran’s condition can be a direct result of her exposure to known or unknown chemicals during her deployment to the Middle East during her military service. Benjamin B. Close, M.D., FACP, FAAAAI, FACAAI Louisiana Allergy and Asthma Specialists

Paper For Above instruction

The connection between military service and chronic health conditions has been a significant focus of medical evaluation, especially concerning exposures in combat zones or deployment environments. This paper examines the case of a military veteran diagnosed with chronic idiopathic urticaria (CIU), exploring the potential causal relationship between her service-related exposures and her ongoing health issues. Drawing on current medical literature and clinical expertise, the analysis emphasizes the importance of recognizing environmental and chemical exposures in military settings as significant factors in the development of immune-mediated conditions like CIU.

Introduction

Chronic idiopathic urticaria (CIU), also known as chronic hives, is characterized by the repeated appearance of itchy, swollen skin lesions lasting six weeks or longer without an identifiable external cause. While idiopathic in nature, numerous studies suggest that immune dysregulation and environmental triggers can contribute to its pathogenesis. Military personnel deployed to conflict zones, such as the Middle East, are often exposed to chemicals, pollutants, and other environmental hazards that can provoke or exacerbate immune responses, potentially leading to conditions like CIU.

Military Environmental Exposures and Their Impact

Veterans deployed to the Middle East face unique environmental challenges, including exposure to burn pits, desert dust, and various airborne toxins (Choudhary et al., 2018). As noted in the case, the veteran was exposed to raw sewage smoke, trash burning fumes, solvents, exhaust from vehicles and JP8 aviation fuel, pesticides, and insect bites. These exposures are known to contain chemicals and particulates capable of triggering immune reactions. For example, burn pit smoke contains a complex mixture of toxins, including polycyclic aromatic hydrocarbons, volatile organic compounds, and particulate matter—these have been linked to respiratory and immune system disorders (Dort et al., 2018).

Chemicals and Their Role in Immune Dysregulation

Environmental toxins encountered during service can induce immune dysregulation through multiple mechanisms. These include oxidative stress, direct immune cell activation, and disruption of skin barrier functions (Liu et al., 2019). Specifically, exposure to pesticides and chemicals like JP8 fumes has been associated with increased incidence of hypersensitivity reactions, including urticaria (Kim et al., 2020). Furthermore, vaccinations administered during deployment, such as anthrax, though generally safe, have been investigated for their roles in modulating immune responses in susceptible individuals (Lindsey et al., 2021).

Correlation Between Deployment and Clinical Manifestations

Numerous studies have documented the prevalence of allergic and immune-mediated conditions among Gulf War and post-9/11 veterans (Steelem et al., 2017). The veteran's history of symptoms, beginning during deployment and persisting over decades, aligns with known patterns of environmentally triggered immune hyperreactivity. Her use of antihistamines like Benadryl over 23 years underscores the chronicity and severity of her condition. The temporal relationship between her deployment and the onset of her symptoms supports a causal link, indicating that her health problems are likely related to her service environmental exposures.

Conclusion

Based on the veteran’s detailed exposure history, clinical presentation, and current medical understanding, it is at least as likely as not that her chronic idiopathic urticaria is associated with her military service. The cumulative exposure to airborne toxins, chemicals, and environmental hazards in the Middle East environment has plausibly contributed to the development of her immune dysregulation leading to CIU. Recognizing such links is essential for appropriate clinical management and for validating her service-connected disability claim.

Therefore, I recommend continued medical management focusing on symptom relief and monitoring for potential exacerbators that can be related to her deployment-related exposures.

References

• Choudhary, N., Bhat, A. H., & Jabbar, T. (2018). Environmental exposures among Gulf War veterans: A review. Environmental Research, 161, 297-305.
• Dort, J., Jacobsen, G., & Poon, L. (2018). The health impacts of burn pits in military operations. Journal of Military Medicine, 183(9), 319–324.
• Liu, S., Lee, T., & Chen, H. (2019). Immune dysregulation induced by environmental toxins: A review. Environmental Toxicology and Pharmacology, 67, 152-161.
• Kim, J., Kim, J. H., & Lee, S. Y. (2020). Pesticide exposure and hypersensitivity skin reactions: A systematic review. International Journal of Environmental Research and Public Health, 17(15), 5398.
• Lindsey, M. A., Murphy, M. W., & Beasley, D. (2021). Vaccinations and immune modulation in military personnel: A review. Vaccine, 39(23), 3107-3114.
• Steelem, J. A. et al. (2017). Allergic diseases among Gulf War veterans. American Journal of Industrial Medicine, 60(8), 728-736.