Numerous studies, many of them discussed earlier in this chapter, indicate that war-zone-deployed veterans, both men and women and regardless of the conflict in which they served, consistently report more symptoms, more adverse health effects, and poorer health status than do veterans who served in the military at the same time but were not deployed or were deployed but not to a war zone (CDC 1988b; Cherry et al. 2001a; Eisen et al. 2005; Goss Gilroy Inc. 1998; Gray et al. 1999, 2002; Hotopf et al. 2003b; Iowa Persian Gulf Study Group 1997; Ishoy et al. 1999; Kang et al. 2000b; Kelsall et al. 2004a; Kulka et al. 1990; O’Toole et al. 1996b; Ozakinci et al. 2006; Pierce 1997; Proctor et al. 1998; Simmons et al. 2004; Steele 2000; Unwin et al. 1999; Wolfe et al. 1999). In particular, Gulf War veterans reported markedly more symptoms compared to their nondeployed counterparts, whether the veterans were from the United States, the UK, Canada, Australia, or Denmark. Increased symptoms have also been reported in Vietnam veterans from the United States and Australia (CDC 1988b; O’Toole et al. 1996b).

This section considers three aspects of this excess symptom reporting by deployed veterans from the Vietnam War, the Gulf War, and OEF and OIF that do not readily fit with the health outcomes already discussed: general symptoms that do not appear to be indicative of a specific illness or disorder, symptoms that appear to cluster into the ICD category of unexplained illness, and chronic pain of unknown origin. The committee has included the primary studies for general symptoms and unexplained illness in Table 6-14.

General Symptoms and Signs

Gulf War-deployed veterans reported many symptoms at rates 2-3 times higher than those seen in nondeployed veterans in several large studies from five countries: the United States (Kang et al. 2000b; Gray et al. 2002), the United Kingdom (Cherry et al. 2001a; Simmons et al. 2004; Unwin et al. 1999), Denmark (Ishoy et al. 1999), Canada (Goss Gilroy Inc. 1998), and Australia (Kelsall et al. 2004a). Similar results have been seen in veterans of the Vietnam War (CDC 1988b; Kulka et al. 1990) and World War II (Villa et al. 2002). Furthermore, the symptoms and reports of poor health persist, often for many years after the war (Ozakinci et al. 2006).

Among the symptoms most commonly reported by Gulf War and Vietnam veterans are fatigue, headaches, irritability or feeling anxious, poor memory, joint stiffness or pain, sleep difficulties (including problems in falling asleep or staying asleep and unrefreshing sleep, such as waking up feeling tired), and poor concentration. Several of the symptoms—such as sleep problems, abdominal pain, and chest pain—and neurologic problems have been discussed by the committee in previous sections on sleep disturbances, neurocognitive effects, cardiovascular diseases, and digestive system diseases.

CDC undertook the VES to assess the health status of Vietnam-theater and Vietnam-era veterans who served in the U.S. Army during 1965-1971; the study was completed in 1988, about 15-20 years after the war (CDC 1988b). A nationally representative random sample of 7924 theater veterans and 7364 era veterans completed a phase 1 telephone interview; in phase 2, a subsample of 2490 of the theater veterans and 1972 of the era veterans also completed physical- and psychologic-health screening examinations in 1985-1986. In phase 1, 19.6% of the 7924 theater veterans reported their health as fair or poor compared with 11.1% of 7364 era

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