consultation if needed (Joseph, 1997; Murphy et al., 1999).6 About 125,000 Gulf War veterans underwent registry health examinations through March 1999 (IOM, 1999a), most conducted under VA auspices. The programs continue to register participants.

The symptoms most commonly reported in 1992–1997 by the 52,835 participants in the VA registry were fatigue, rash, headache, muscle and joint pain, and loss of memory (Table A.2) (Murphy et al., 1999). An almost identical set of symptoms was reported most frequently among the roughly 20,000 participants in the DOD registry (CDC, 1999). Veterans classified in the DOD registry as having “symptoms, signs, and ill-defined conditions” complained most frequently of fatigue, headache, and memory loss (Roy et al., 1998). Clinicians were able to arrive at a primary diagnosis for about 82% of symptomatic DOD registry participants (Joseph, 1997) and for a similar fraction of VA registry participants (Murphy et al., 1999) (Table A.2).

TABLE A.2 Most Frequent Symptoms and Diagnoses 53,835 Participants in VA Registry (1992–1997).

Symptoms or Diagnoses

Frequency, %

Self-Reported Symptoms

 

Fatigue

20.5

Skin rash

18.4

Headache

18.0

Muscle and joint pain

16.8

Loss of memory

14.0

Shortness of breath

7.9

Sleep disturbances

5.9

Diarrhea and other gastrointestinal symptoms

4.6

Other symptoms involving skin

3.6

Chest pain

3.5

No complaint

12.3

Diagnosis (ICD-9-CM)

 

No medical diagnosis

26.8

Musculoskeletal and connective tissue

25.4

Mental disorders

14.7

Respiratory system

14.0

Skin and subcutaneous tissue

13.4

Digestive system

11.1

Nervous system

8.0

Infectious diseases

7.1

Circulatory system

6.4

Injury and poisoning

5.3

Genitourinary system

3.0

Neoplasm

0.4

 

SOURCE: Murphy et al., 1999.

A registry program established by the United Kingdom Ministry of Defence for UK Gulf War veterans found similar types and frequencies of symptoms and diagnoses (Coker et al., 1999). The most recent publication from the British registry found 20% to be unwell, predominantly with psychiatric diagnoses, especially posttraumatic stress disorder (Lee et al., 2001). Across the registries, musculoskeletal disease; mental disorder; and symptoms, signs, and ill-defined conditions7 were the three most common diagnostic categories,

6  

Several independent advisory committees have reviewed these programs and made recommendations for their refinement (NIH, 1994; IOM, 1995, 1996, 1997, 1998; PAC, 1996).

7  

“Symptoms, signs, and ill-defined conditions” refers to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 780–799, which are reserved for 160 subclassifications of ill-defined common conditions not coded elsewhere in ICD-9-CM or lacking distinct physiologic or psychologic basis (US DHHS, 1998).



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