(IOM) in evaluating the feasibility and design of an epidemiologic study that would assess health outcomes related to exposure to DU.

In response to DOD’s request, IOM entered into a contract to conduct the following study:

An IOM committee will examine and make recommendations regarding the critical elements needed for an epidemiologic study of veterans who were exposed to DU while on active duty. Those might include veterans who

• were exposed to smoke from fires resulting from the burning of vehicles containing DU munitions or fires at depots at which DU munitions were stored,

• worked in environments containing DU dust or residue from DU munitions,

• were within a structure or vehicle when it was struck by DU munitions,

• climbed on or entered equipment or structures struck by DU munitions, or

• were medical personnel who provided initial treatment to members of the armed forces who were exposed to DU.

The committee also will identify elements needed to study veterans’ children who were born after parental exposure to DU.

To approach its task, the committee first considered the necessary elements of a comprehensive epidemiologic study to assess exposure to DU and related health outcomes. The committee then evaluated DOD’s available data and research efforts and identified limitations and data gaps in the databases. Finally, it identified options for further study of potential health outcomes in DU-exposed military personnel and veterans.

The committee views a well-designed epidemiologic study as a two-stage process. The first stage is a comprehensive assessment of exposure to DU that permits identification of the exposed and unexposed components of the study population. The second stage should incorporate the exposure information into a prospective study to assess intermediate health outcomes and ultimately the relationship of exposure to the health outcomes of interest (see Figure 1-1).

Regarding the first stage, the committee offers recommendations for addressing the major gaps in available exposure information and provides guidance for assessing exposure of active-duty personnel and veterans to DU. The exposure-investigation stage of the process is instrumental in identifying study