The Institute of Medicine (IOM) has a long-standing role of providing assistance to the Department of Veterans Affairs (VA) with regard to veterans’ health. The current series of studies on Gulf War and Health, of which this study is one, began in 1998 when Congress passed two laws on Gulf War veterans’ health in response to the recognition that many Gulf War veterans returning from the 1991 Persian Gulf War were suffering from a multisymptom illness of poorly understood pathogenesis that proved difficult to diagnose and treat.
The United States is once again engaged in a military conflict in the Middle East. The conflicts in Afghanistan (Operation Enduring Freedom [OEF]) and in Iraq (Operation Iraqi Freedom [OIF]) have been characterized by a type of combat different from that seen in the 1991 war, in that there have been many more deaths, polytrauma, and traumatic brain injury (TBI). The VA, under authorization granted in the 1998 legislation, has asked IOM to determine long-term health outcomes associated with TBI. TBI has been called the signature injury of OEF and OIF primarily due to blast exposure that is characteristic of this conflict. Exposure to blast might cause instant death, injuries with immediate manifestation of symptoms, or injuries with delayed manifestation. Blast-induced neurotrauma, however, has not been studied sufficiently to confirm reports of long-term effects.
That many returning veterans have TBI will likely mean long-term challenges for them and their family members. Veterans will need support systems at home and in their communities to assist them in coping with the long-term sequelae of their injuries. Further, many veterans will have undiagnosed brain injury because not all TBIs have immediately recognized effects or are easily diagnosed with neuroimaging techniques.
In an effort to detail the long-term consequences of TBI, the committee read and evaluated some 1,900 studies that made up its literature base, and it developed criteria for inclusion of studies to inform its findings. It is clear that brain injury, whether penetrating or closed, has serious consequences. The committee sought to detail those consequences as clearly as possible and to provide a scientific framework to assist the brave men and women who have fought in OEF and OIF as they return home. We are honored to have been of service.
I am deeply appreciative of the expert work of our committee members and their extraordinary commitment to the task at hand. The committee extends its appreciation to the many people who presented information at its open meeting and to the IOM staff. In particular we would like to thank Renee Wlodarczyk, Jen Saunders, and Naoko Ishibe who helped with a myriad of tasks including literature searches, retrieving articles, entering data into the numerous tables in the document, and for their contributions in the development of several chapters of the report. We appreciate Joe Goodman’s attention to our meeting and travel needs; and to Carolyn Fulco for her guidance and oversight.
George W. Rutherford, MD, AM
Chair, Committee on Gulf War and Health: Brain Injury in Veterans and Long-Term Health Outcomes