committee found that veterans of the Gulf War report higher rates of nearly all symptoms examined than their nondeployed counterparts. That finding was applied not only to Gulf War veterans from the United States but also to the Gulf War veterans deployed from the UK, Canada, Australia, and Denmark. Some studies examined performance on neurocognitive tests in association with symptoms that were considered possibly indicative of neurological or cognitive impairment (such as headache, confusion, and memory problems). Those few studies seemed to indicate that Gulf War veterans with such symptoms demonstrated neurobehavioral deficits, but, most of the studies did not include control groups (or, in some cases, valid control groups).

In many studies, investigators found a higher prevalence not only of individual symptoms but also of chronic multisymptom illnesses among Gulf War-deployed veterans than among the nondeployed. Multisymptom-based medical conditions reported to occur more frequently among deployed Gulf War veterans include fibromyalgia, chronic fatigue syndrome (CFS), and multiple chemical sensitivity (MCS). However, the case definitions for those conditions are based on symptom reports, and there are no objective diagnostic criteria that can be used to validate the findings, so, it is not clear whether the literature supports a true excess of the conditions or whether the associations are spurious and result from the increased reporting of symptoms across the board. The literature also demonstrates that deployment places veterans at increased risk for symptoms that meet diagnostic criteria for a number of psychiatric illnesses, particularly posttraumatic stress disorder (PTSD), anxiety, depression, and substance abuse. In addition, comorbidities have been reported, for example, symptoms of both PTSD and depression. The committee felt confident that several studies validated the increased risk of psychiatric disorders.

Some studies indicate that Gulf War veterans are at increased risk for amyotrophic lateral sclerosis (ALS). With regard to birth defects, there is weaker evidence that Gulf War veterans’ offspring might be at risk for some birth defects; the findings are inconsistent. There were increased rates of transportation-related injuries and mortality among deployed Gulf War veterans, however, that increase appears to have been restricted to the first several years after the war. Finally, long-term exacerbation of asthma appeared to be associated with oil-well fire smoke, but there were no objective measures of pulmonary function in the studies.

The health outcomes presented above are discussed in some detail in the following pages. They are grouped according to whether the findings were based on objective measures and diagnostic medical tests.

Outcomes Based Primarily on Symptoms or Self-Reports

The largest and most nationally representative survey of US veterans found that nearly 29% of deployed veterans met a case definition of "multisymptom illness", compared with 16% of nondeployed veterans. Those figures indicate that unexplained illnesses are the most prevalent health outcome of service in the Gulf War. Several researchers have tried to determine whether the symptoms that have been reported by Gulf War veterans cluster in such a way as to make up a unique syndrome, such as “Gulf War illness”. The results of that research indicate that although deployed veterans report more symptoms and more severe symptoms than their nondeployed counterparts, there is not a unique symptom complex (or syndrome) in deployed Gulf War veterans.

Among the many symptoms reported by Gulf War veterans are deficits in neurocognitive ability. Obviously such reports are of concern because of the potential for those deficits to have adverse effects on the lives of the veterans. Primary studies of deployed Gulf War veterans and non-Gulf War-deployed veterans, however, have not demonstrated differences in cognitive and



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