DoD, and testimony from veterans and other interested individuals. Gulf War veterans are more likely than nondeployed veterans to report symptoms, illness, and functional impairment, although no study has been able to identify a single accepted condition or group of diagnoses that explains the symptoms experienced (IOM 1999a).
Reported symptoms experienced by Gulf War veterans include fatigue, joint and muscle pain, headache, memory loss, depression, anxiety, respiratory problems, and diarrhea (Perconte et al. 1993; Southwick et al. 1993; Stretch et al. 1995; Sostek et al. 1996; Iowa Persian Gulf Study Group 1997; Pierce 1997; Fukuda et al. 1998; Proctor et al. 1998; Wolfe et al. 1998; Coker et al. 1999; Department of Veterans Affairs 1999; IOM 1999a; Kang et al. 2000). Almost 80% of Gulf War veterans examined by the VA and DoD have readily identifiable medical conditions. However, about 20% of symptomatic veterans report multiple symptoms for which no diagnosis has been identified (Department of Veterans Affairs 1999). The committee examined the most commonly reported symptoms and grouped them into (1) established and accepted symptom-based conditions experienced by people in the general population who have recognized diagnoses of unknown etiology and (2) individuals who fall into no clear diagnostic category.
In this report, conditons of unknown etiology for which treatments are examined include chronic fatigue syndrome (fatigue, headache, cognitive dysfunction, and other symptoms), depression (fatigue, loss of memory and other general symptoms, cognitive dysfunction, and sleep disturbances), fibromyalgia (muscle pain, sleep disturbances, fatigue), and irritable bowel syndrome (diarrhea, constipation, abdominal pain, nausea, vomiting, and other gastrointestinal symptoms). Other diagnoses such as headache and panic disorder are included in the report because they involve symptoms similar to those reported by Gulf War veterans. Posttraumatic stress disorder (PTSD) is included because of its increased prevalence in veteran populations. 1
The committee examined treatments for these recognized diagnoses to determine what might be learned and borrowed from the management of these conditions to apply to the treatment of Gulf War veterans. There is, however, a group of veterans with symptoms that do not fit any of the above diagnostic categories. For those veterans, the committee reviewed relevant literature and described practice approaches currently being researched. Chapter 5 provides detailed information evaluating individual treatments for each of these conditions.
1 The committee acknowledges that the VA has significant expertise in the area of PTSD. The diagnosis is included here, however, because of its prevalence in this as well as other veteran populations.