Inadequate/Insufficient Evidence to Determine Whether an Association Exists

Evidence from available studies is of insufficient quantity, quality, or consistency to permit a conclusion regarding the existence of an association between deployment to a war zone and a specific health effect in humans.

  • Cancer.

  • Diabetes mellitus.

  • Thyroid disease.

  • Neurocognitive and neurobehavioral effects.

  • Sleep disorders or objective measures of sleep disturbance.

  • Hypertension.

  • Coronary heart disease.

  • Chronic respiratory effects.

  • Structural gastrointestinal diseases.

  • Reproductive effects.

  • Homelessness.

  • Adverse employment outcomes.

Limited/Suggestive Evidence of No Association

Evidence is consistent in not showing a positive association between deployment to a war zone and a specific health effect after exposure of any magnitude. A conclusion of no association is inevitably limited to the conditions, magnitudes of exposure, and length of observation in the available studies. The possibility of a very small increase in risk after deployment cannot be excluded.

  • No effects.

RECOMMENDATIONS

The committee recommends that DoD conduct predeployment and postdeployment screening for medical conditions, including psychiatric symptoms and diagnoses, and for psychosocial status to help collect direct evidence about the causal nature of the effects of deployment-related stress. Predeployment screening would also help to identify at-risk personnel who might benefit from targeted intervention programs during deployment and would establish a baseline against which later health and psychosocial effects could be measured after deployment. Postdeployment screening and assessment would provide data that could be analyzed to determine the long-term consequences of deployment-related stress and would allow VA and DoD to implement intervention programs to assist deployed veterans in adjusting to postdeployment life. Such assessments should be made shortly after deployment and should identify those exposures most stressful to the veteran. The assessments should be made at regular intervals thereafter (such as every 5 years) to identify the long-term health and psychosocial effects. The committee further recommends that any longitudinal assessments also be conducted in a representative group of nondeployed veterans to allow appropriate comparisons between deployed and nondeployed veterans regarding health and psychosocial effects.



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