The committee found limited but suggestive evidence of an association between deployment-related stress and chronic fatigue syndrome, fibromyalgia and chronic widespread pain, gastrointestinal symptoms, skin disorders, incarceration, drug abuse, and increased symptom reporting, unexplained illness, and chronic pain.

Finally, it should be repeated that the committee was charged with reviewing scientific data, not with making recommendations regarding VA policy.

TABLE S-1 Summary of Findings Regarding the Association Between Deployment to a War Zone and Specific Health and Psychosocial Effects

Sufficient Evidence of a Causal Association

Evidence from available studies is sufficient to conclude that there is a causal relationship between deployment to a war zone and a specific health effect in humans. The evidence is supported by experimental data and fulfills the guidelines for sufficient evidence of an association (below). The evidence must be biologically plausible and satisfy several of the guidelines used to assess causality, such as strength of association, dose-response relationship, consistency of association, and temporal relationship.

  • No effects.

Sufficient Evidence of an Association

Evidence from available studies is sufficient to conclude that there is a positive association. That is, a consistent positive association has been observed between deployment to a war zone and a specific health effect in human studies in which chance and bias, including confounding, could be ruled out with reasonable confidence. For example, several high-quality studies report consistent positive associations, and the studies are sufficiently free of bias and include adequate control for confounding.

  • Psychiatric disorders, including PTSD, other anxiety disorders, and depressive disorders.

  • Alcohol abuse.

  • Accidental death in the early years after deployment.

  • Suicide in the early years after deployment.

  • Marital and family conflict.

Limited but Suggestive Evidence of an Association

Evidence from available studies is suggestive of an association between deployment to a war zone and a specific health effect, but the body of evidence is limited by the inability to rule out chance and bias, including confounding, with confidence. For example, at least one high-quality study reports a positive association that is sufficiently free of bias, including adequate control for confounding, and other corroborating studies provide support for the association (corroborating studies might not be sufficiently free of bias, including confounding). Alternatively, several studies of lower quality show consistent positive associations, and the results are probably not due to bias, including confounding.

  • Drug abuse.

  • Chronic fatigue syndrome.

  • Gastrointestinal symptoms consistent with functional gastrointestinal disorders, such as irritable bowel syndrome or functional dyspepsia.

  • Skin disorders.

  • Fibromyalgia and chronic widespread pain.

  • Increased symptom reporting, unexplained illness, and chronic pain.

  • Incarceration.



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