Summary

Many of the 700,000 Gulf War veterans have complained of mysterious illnesses since the war's end in 1991. Some believe that their chronic, disabling conditions are a result of wartime exposure to a host of potentially hazardous substances, including drugs used to protect against chemical warfare, fuel in shower water, depleted uranium, and smoke from oil-well fires. The Pentagon acknowledged last year that some veterans may have been exposed to the nerve agent sarin following the postwar demolition of Iraqi ammunition facilities. GAO found that nearly six years after the end of the Gulf War, little is known about the causes of illnesses among returning veterans. Neither the Defense Department nor the Department of Veterans' Affairs has systematically attempted to determine whether ill Gulf War veterans are any better or worse today than when they were first examined. Ongoing epidemiological research should provide descriptive data on veterans' illnesses, but formidable methodological problems are likely to prevent researchers from pinpointing the causes of veterans' illnesses. GAO questions the Pentagon's decision to attribute veterans' symptoms to stress or parasites while discounting chemical agents as a contributing factor. In a related testimony (GAO/T-HEHS-97-158, June 19, 1997), GAO discusses the views of Gulf War veterans on the care they have received from the Department of Veterans Affairs. GAO summarized the Gulf War illnesses report in testimony before Congress; see: Gulf War Illnesses: Enhanced Monitoring of Clinical Progress and of Research Priorities Needed, by Donna Heivilin, Director of Planning and Reporting in the National Security and International Affairs Division, before the Subcommittee on Human Resources, House Committee on Government Reform and Oversight, GAO/T-NSIAD-97-190, June 24 (19 pages); and Gulf War Illnesses: Reexamination of Research Emphasis and Improved Monitoring of Clinical Progress Needed, by Donna Heivilin, Director of Planning and Reporting in the National Security and International Affairs Division, before the Senate Committee on Veterans Affairs, GAO/T-NSIAD-97-191, June 25 (19 pages).

GAO noted that: (1) neither DOD nor VA has systematically attempted to determine whether ill Gulf War veterans are any better or worse today than when they were first examined; (2) while ongoing epidemiological research will provide descriptive data on veterans' illnesses, formidable methodological problems are likely to prevent researchers from providing answers regarding the causes of veterans' illnesses; (3) over 100,000 of the approximately 700,000 Gulf War veterans have participated in DOD and VA health examination programs established after the war; (4) based on the examinations and reports provided by DOD and VA, nearly 90 percent of the examined veterans are symptomatic, reporting a wide array of health complaints and disabling conditions; (5) while some measures of quality are in place for military or VA health care, neither agency can now determine the appropriateness or effectiveness of the treatment received by ill Gulf War veterans; (6) federal research on Gulf War veterans' illnesses has not been pursued proactively; (7) without accurate exposure information, the investment of millions of dollars in further epidemiological research on the risk factors for veterans' illnesses may result in little return; (8) the Presidential Advisory Committee on Gulf War Veterans' Illnesses concluded that stress is likely to be an important contributing factor to the broad range of illnesses being reported by Gulf War veterans; (9) however, the link between stress and these veterans' physical symptoms is not well established in the evidence the Committee cited, and the reported prevalence of post-traumatic stress disorder among Gulf War veterans may be overestimated; (10) based on a small number of diagnosed cases, VA and DOD concluded that the likelihood of leishmania tropica (a parasite) as an important risk factor has diminished and the Committee found it unlikely to be "responsible for long term health effects in Gulf War veterans," but the extent of asymptomatic leishmania infection is unknown; (11) the Committee concluded that it was unlikely that the health effects reported by Gulf War veterans are the results of exposure to organophosphate or mustard chemical warfare agents, even though there is substantial evidence that organophosphate compounds might be associated with delayed or long-term health effects; and (12) unresolved questions concern the extent to which veterans may have been exposed to: (a) chemical agents as a result of fallout from the destruction of suspected chemical weapons storage sites; and (b) the biological agent aflatoxin, the health effects of which may not be known for months, or even years, after exposure.