The Iraqi invasion of Kuwait on August 2, 1990, led to Operations Desert Shield and Desert Storm and the deployment of approximately 697,000 US military personnel to the Kuwait Theater of Operations (KTO). As part of the deployment, the United States shipped thousands of vehicles and other equipment to the Persian Gulf, primarily, to Saudi Arabia. While most of the equipment was fully operational, much of it retained the three-color "woodland camouflage" paint scheme designed for operations in the European Theater or other non-desert areas of operation. This "woodland cammo" pattern obviously stuck out in the barren desert environment, making it easier for enemy gunners or reconnaissance assets to locate and target the vehicles. Consequently, there was an urgent operational requirement to repaint some of the incoming equipment with tan-colored chemical agent resistant coating (CARC) to provide desert camouflage protection.

CARC is a polyurethane paint that provides superior durability, extends service life for military vehicles and equipment, provides surfaces with superior resistance to chemical warfare agent penetration, and greatly simplifies decontamination. Established DoD occupational safety and health guidance called for proper personal protective equipment, including respiratory equipment, to protect painters. Several compounds in CARC formulations, if taken into the body in sufficiently high concentrations, may cause short- and long-term health effects. The most notable of these compounds is hexamethylene diisocyanate (HDI), which hardens, or plasticizes, the paint. Exposure to high concentrations of aerosolized HDI during spray painting leads to immediate respiratory irritation and watery eyes. Long-term exposure can cause or aggravate respiratory problems, in particular, asthma. The use of personal protective equipment, such as respirators, coveralls, eye protection, gloves, and head coverings, can prevent or minimize exposures to HDI. The HDI in polyurethane paint does not present a hazard after the paint dries and cures, unless exposed to heat sufficient for thermal decomposition of the coating, such as welding.

Solvents used in CARC and paint thinners, as well as solvents used to clean equipment, can be hazardous via skin contact and breathing. Exposures to solvents can lead to dizziness, rashes, and nausea. However, the proper wear of personal protective equipment greatly decreases the risks associated with exposure to solvents.

The purpose of this report is to:

• Clarify the issue of who could have been exposed to the hazards of CARC in theater;
• Discuss the scenarios under which CARC exposures could have occurred in theater;
• Describe the health effects associated with exposure to CARC; and
• Present recommendations for improvements in the policy regarding CARC to improve future usage.

Beginning in September 1990, a small group of Department of the Army civilians from Anniston, Alabama established the first in-theater painting operation at the port of Ad Dammam, Saudi Arabia (referred to as the Anniston Ad Dammam site). This group, experienced in CARC painting operations, arrived with their own personal protective equipment, including paint suits, gloves, boot covers, and air-purifying respirators. The 900^th Maintenance Company, a National Guard unit from Alabama, assumed operation of this paint site in February 1991.

In addition, the Army Materiel Command established two major new CARC spray painting operations in-theater at the Saudi Arabian ports of Ad Dammam and Al Jubayl in December, 1990, to process the majority of the Army equipment arriving in theater. The 325^th Maintenance Company, of the Florida Army National Guard, operated these sites. The members of the 325^th Maintenance Company lacked training or experience in CARC spray paint operations and the necessary personal protective equipment. By the time the two main painting sites had ceased operations in February 1991, a total of over 8,500 vehicles and other equipment had been painted in theater.

In addition to the two major CARC painting sites manned by the 325^th, a number of smaller CARC painting facilities were established throughout the theater. These smaller sites operated for shorter periods and generally used brush and roller painting application techniques, rather than spray painting.

In April 1991, before redeployment from the Kuwait Theater of Operations, the Army’s VII Corps reestablished painting operations in Ad Dammam and Al Jubayl to return tan vehicles to their original woodland camouflage paint schemes. Initially, personnel from the 325^th Maintenance Company staffed these operations, but were later replaced by members of the incoming VII Corps. Altogether, these sites processed over 8,000 vehicles and other equipment, painting them with woodland CARC before shipping them to Europe, the United States, or other destinations.

During the painting operations, some servicemembers in the 325^th Maintenance Company began reporting health problems. Prompted by these complaints, health and safety inspectors visited the major CARC painting sites on several occasions throughout the period from December 1990 through June 1991. With few exceptions, the inspection reports cited weak overall command and control, serious deficiencies in the type and quantity of personal protective equipment available, and soldiers who had not received sufficient training and information regarding the potential hazards associated with CARC paint operations. The inspections also revealed that some soldiers exhibited symptoms consistent with exposure to CARC.

These inspections brought some positive changes. The quality and availability of the personal protective equipment improved, additional training was provided, and in some instances, paint operations were suspended until the safety deficiencies were corrected. Air-supplied respirators, replacement air hoses, air compressors, gloves, and eye protection, as well as explosion-resistant lighting and electrical outlets, became increasingly available. Nevertheless, some of this equipment did not arrive at the paint sites until months after the initiation of painting activities. Equipment failure and maintenance difficulties, as well as inconsistent adherence to proper health and safety procedures by painters and their chain-of-command, were some of the factors that led to the persistent problem of unsafe working conditions.

Following their deployment, some service members from the 325^th Maintenance Company communicated their CARC painting experiences and concerns to their US representative, Charles Canady of Florida’s 12^th District. A series of correspondence between the congressman and DoD officials discussed the issues of CARC exposures and follow-on medical care for Operation Desert Storm National Guard members. The matter was referred to the National Guard Bureau for investigation. The National Guard Bureau Inspector General (IG) issued an assessment addressing health care issues for veterans of Operations Desert Shield and Desert Storm in June 1994.

A number of veterans of the 325^th Maintenance Company have sought treatment or assistance from the military health system or the Department of Veterans Affairs health care for symptoms they believe to be linked to their Gulf War exposures. The Department of Veterans Affairs has linked the illnesses suffered by some of the members of the 325^th to exposures to CARC. The process of evaluating and treating veterans of the 325^th Maintenance Company continues to the present day.

Veterans have voiced concerns about health problems that they attribute to their exposure to CARC. The most frequently cited symptoms are: coughing, eye and throat irritation, skin rashes, headaches, nausea, and asthma—symptoms often indicative of adverse health effects resulting from exposures to the HDI in CARC and the solvents often used in the related mixing, spray application, and clean-up activities. In a number of cases, personnel who were directly involved in the major spray painting operations of CARC were diagnosed with respiratory ailments that could be attributed to exposure to CARC (although other, unknown causitive factors cannot be ruled out). However, this investigation cannot definitively link CARC paint to the undiagnosed illnesses reported by Gulf War veterans that were not engaged in painting operations.

The Office of the Special Assistant for Gulf War Illnesses developed three important findings from its investigation of CARC painting performed in the Gulf theater. These lessons and recommendations are summarized below.

• Some soldiers reported that a number of standard operating procedures, including painting vehicles with CARC, were modified in the rush to mobilize personnel and equipment for Operations Desert Shield and Desert Storm. In some cases, safety considerations were disregarded or otherwise compromised. In the future, military operational planning should incorporate measures to meet occupational safety and health standards even under "surge requirements". Prior planning should improve the military’s ability to quickly establish austere, field-expedient, but safe CARC painting sites. Advance hazard awareness training and education would help prevent or minimize risky practices and needless exposures. In the future, the CARC-painting mission should be assigned to appropriate units before deployment—units that could rapidly obtain the required occupational and safety training and guidance, procure personal protective equipment, and plan for the assignment of direct, qualified oversight by trained, certified safety and occupational health professionals.

• Upon their return to the United States, members of the 325^th Maintenance Company left active duty without completing post-deployment occupational health evaluations, missing the opportunity to identify and document many of the problems they encountered. To prevent the recurrence of this type of situation, the services (including the Reserve Component) need to insure compliance with medical surveillance policies and procedures aimed at establishing both a baseline (pre-deployment) health status of individuals, and capturing any deployment-related exposures and health symptoms after their return from deployments.

• The redeployment painting operations conducted in-theater were better organized and more established than were the field-expedient operations initially established for tan painting. Nevertheless, routine safety inspections continued to document numerous problems. Occupational Safety and Health Administration (OSHA) regulations do not apply to combat operations. However, redeployment operations should strictly adhere to OSHA regulations. In addition, existing DoD guidance governing safety and occupational health issues in deployment settings were not observed in numerous cases.

Subsequent sections of this report will examine issues relevant to CARC painting and include:

• A description of CARC, including technical information, health and safety standards, and doctrine available prior to the Gulf War;
• An examination into the use of CARC during the Gulf War, including the locations and major units involved; and
• A discussion of the medical care for the 325^th Maintenance Company following the Gulf War.

Tabs A and B contain an acronym and abbreviation listing, a glossary, and a bibliography. See Tabs C through E for a technical discussion of CARC specifications and formulations, examples of solvents used in painting operations, and a discussion of safety and health regulations, respectively. Tab F provides a brief summary of the changes in to the interim report.

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