In response to the growing concern about the physical and psychologic health of the returning Gulf War veterans from the 1990-1991 conflict, Congress passed two laws in 1998: PL 105-277, the Persian Gulf War Veterans Act, and PL 105-368, the Veterans Programs Enhancement Act. Those laws directed the secretary of veterans affairs to enter into a contract with the National Academy of Sciences (NAS) to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines in members of the armed forces. PL 105-277 also gave NAS permission to identify “other agents, hazards, or medicines or vaccines to which members of the Armed Forces may have been exposed.” In 1996, the Presidential Advisory Committee on Gulf War Veterans’ Illnesses (PAC 1996) found that stress was an important contributor to the Gulf War veterans’ illnesses and encouraged the government to continue its research on stress-related disorders. In response to the above laws, the Institute of Medicine (IOM) has had a program to examine health risks posed by specific agents and hazards to which Gulf War veterans might have been exposed during their deployment. Four reports have examined health effects related to depleted uranium, pyridostigmine bromide, sarin, and vaccines (IOM 2000); insecticides and solvents (IOM 2003); fuels, combustion products, and propellants (IOM 2005); and infectious diseases (IOM 2007).
In recent years, the charge to IOM has been expanded to include not only veterans of the 1991 Gulf War but veterans returning from OEF and OIF. Many of the biologic and chemical exposures and their possible health effects have been considered in previous IOM reports, but the health effects associated with deployment-related stress have yet to be considered. A recent IOM report, Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War (IOM 2006), reviewed the health status of Gulf War-deployed veterans compared with their nondeployed counterparts. That report found that veterans of the Gulf War report higher rates of nearly all symptoms than their nondeployed counterparts; in addition, a higher prevalence not only of individual symptoms but of chronic multisymptom illnesses was found among Gulf War-deployed veterans. Multisymptom-based medical conditions reported to occur more frequently among deployed Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity. The literature also demonstrates that deployment places veterans at increased risk for symptoms that meet diagnostic criteria for a number of psychiatric disorders, particularly posttraumatic stress disorder (PTSD), anxiety disorders, depressive disorders, and substance abuse. Furthermore, comorbidities have been reported, for example, symptoms of both PTSD and depression. Finally, the report noted that Gulf War veterans are at increased risk for amyotrophic lateral sclerosis and that there is weak evidence that Gulf War veterans’ offspring might be at risk for some birth defects (IOM 2006).
In light of the 1991 Gulf War and the nature of OEF and OIF, the Department of Veterans Affairs (VA) requested that IOM comprehensively review, evaluate, and summarize the peer-reviewed scientific and medical literature regarding the association between deployment-related stress and long-term adverse health effects in Gulf War veterans. In response to VA’s request, IOM appointed the Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress to conduct the review.
The 1991 Gulf War, OEF, and OIF reflect many changes from previous wars fought by the United States, particularly in the demographic composition of military personnel and the