skin conditions occurred more frequently among Gulf War-deployed veterans; however, the findings are not consistent. From one study that did conduct a skin examination, there is some evidence of a higher prevalence of two distinct dermatologic conditions, atopic dermatitis and verruca vulgaris (warts), in Gulf War-deployed veterans.

Arthralgias (joint pains) were more frequently reported among Gulf War veterans. Likewise, self-reports of arthritis were more common among those deployed to the gulf. Again, in the context of global reporting increases, such data are difficult to interpret. Moreover, studies that included a physical examination did not find evidence of an increase in arthritis.

Finally, Gulf War veterans consistently have been found to suffer from a variety of psychiatric conditions. Two well-designed studies using validated interview-based assessments reported that several psychiatric disorders, most notably PTSD and depression, are 2-3 times more likely in Gulf War -deployed than in nondeployed veterans. Moreover, comorbidities were reported among a number of veterans, with co-occurrence of PTSD, depression, anxiety, or substance abuse. Most of the additional studies administered well-validated symptom questionnaires, and the findings were remarkably similar: an overall increase by a factor of 2-3 in the prevalence of psychiatric disorders.

Outcomes with Objective Measures or Diagnostic Medical Tests

A number of studies examined rates of injuries in Gulf War veterans. Those studies provide evidence of a modest increase in transportation-related injuries and deaths among deployed than among non-deployed Gulf War veterans in the decade immediately after deployment. However, studies with longer followup indicate that the increased injury rate was restricted to the first several years after the war.

With regard to all causes of hospitalization, studies provide some reassurance that excess hospitalizations did not occur among veterans of the Gulf War who remained on active duty through 1994, inasmuch as it has been noted that Gulf War veterans who left the military reported worse health outcomes than those who remained. Those studies, however, are limited by their inability to capture hospitalizations from illnesses that might have longer latency, such as some cancers. In addition, hospitalization data on people separated from the military and admitted to nonmilitary (Department of Veterans Affairs [VA] and civilian) hospitals or those who used outpatient facilities might be incomplete.

Veterans are understandably concerned about increases in cancer, and the studies reviewed did not demonstrate consistent evidence of increased overall cancer in the Gulf War veterans compared with nondeployed veterans. However, many veterans are young for cancer diagnoses, and, for most cancers, the time since the Gulf War is probably too short to expect the onset of cancer. Incidence of and mortality from cancer in general and brain and testicular cancer in particular have been assessed in cohort studies. An association of brain-cancer mortality with possible nerve-agent exposure was observed in one study, but however, there were many uncertainties in the exposure model used. Results for testicular cancer were mixed: one study concluded that there was no evidence of an excess risk, and another, small registry-based study suggested that there might be an increased risk.

Another concern for veterans has been whether ALS is increased in Gulf War veterans. Two primary studies and one secondary study found that deployed veterans appear to be at increased risk of for ALS. One primary study that had the possibility of underascertainment of cases in the nondeployed population was confirmed by a secondary analysis that documented a



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