toms warrant classification as a new syndrome; and (3) are exposures to specific biological and chemical agents during the Gulf War associated with veterans’ symptoms and illnesses?

This chapter’s exclusive focus is on health studies of Gulf War veterans. The questions posed above are designed to guide the reader through a complex body of research. The chapter summarizes studies of veterans’ mortality, hospitalizations, and diagnosable illnesses and provides a brief overview of the Gulf War veterans’ registry programs established by the Department of Veterans Affairs (VA) and the Department of Defense (DoD). The chapter also examines in greater depth the epidemiologic studies that have been conducted to date—on general health status and on specific health endpoints. The information presented here provides background for the reader and the context for committee members as they considered evidence related to health effects of the agents selected for study. Later chapters deal with the specific agents and their health effects in any population, including veterans.


Approximately 697,000 U.S. service men and women were deployed in Operations Desert Shield/Desert Storm in 1990 and 1991 (PAC, 1996). The demographic composition of this deployment was more diverse than in past deployments; there were greater racial and ethnic diversity, more women, and more reserves and National Guard troops (Table 2.1).

Soon after the war ended in 1991, veterans began to seek medical treatment for a variety of symptoms and illnesses (PAC, 1996). The Department of Defense and the Department of Veterans Affairs responded to veterans’ health concerns by establishing programs for veterans to voluntarily receive clinical examinations largely for diagnostic purposes. By 1994, these registry programs had been revised and renamed the Comprehensive Clinical Evaluation Program (hereinafter called the DoD registry) and the Persian Gulf Registry and Uniform Case Assessment Protocol (hereinafter called the VA registry), respectively. The programs are similarly structured: they begin with an initial physical examination, including patient and exposure history and screening laboratory tests, followed by the opportunity for referral to more specialized testing and consultation if needed (Joseph, 1997; Murphy et al., 1999).4 About 125,000 Gulf War veterans underwent registry health examinations through March 1999 (IOM, 1999a), the majority conducted under the auspices of the VA. These programs continue to register participants.

The most common symptoms reported between 1992 and 1997 from among 52,835 participants of the VA registry were fatigue, skin rash, headache, muscle and joint pain, and loss of memory (Table 2.2) (Murphy et al., 1999). An almost


Several independent advisory committees have reviewed these programs and made recommendations for their refinement (NIH, 1994; IOM, 1995–1998; PAC, 1996).

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