health effects were based primarily on symptoms and self-reports, or on objective measures and diagnostic medical tests. Box 1-1 summarizes of the Volume 4 findings and recommendations.

BOX 1-1

Brief Summary of Findings and Recommendations

Outcomes Based Primarily on Symptoms or Self-Reports

  • No unique syndrome, unique illness, or unique symptom complex in deployed Gulf War veterans was found. Veterans of the Gulf War report higher rates of nearly all symptoms or sets of symptoms than their nondeployed counterparts; 29% of veterans meet a case definition of “multisymptom illness,” as compared with 16% of nondeployed veterans.

  • Multisymptom-based medical conditions reported to occur more frequently among deployed Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity.

  • Deployment places veterans at increased risk for symptoms that meet diagnostic criteria for a number of psychiatric illnesses, particularly posttraumatic stress disorder (PTSD), anxiety, depression, and substance abuse. In addition, co-morbidities were reported among a number of veterans, with PTSD, depression, anxiety, and/or substance abuse.

  • Studies of Gulf War deployed veterans vs nondeployed have not demonstrated differences in cognitive and motor measures as determined through neurobehavioral testing.

  • Studies of returning Gulf War veterans with at least one of the symptoms most commonly reported by Gulf War veterans (for example, fatigue, memory loss, confusion, inability to concentrate, mood swings, somnolence, gastrointestinal distress, muscle and joint pain, skin/mucous membrane complaints) found poorer performance on cognitive tests when compared to returning Gulf War veterans who did not report such symptoms.

  • Other symptoms that appear to be self-reported more often by deployed veterans are gastrointestinal symptoms, particularly dyspepsia; dermatologic conditions, particularly atopic dermatitis and warts; and joint pains (arthralgias).

Outcomes with Objective Measures or Diagnostic Medical Tests

  • Studies of mortality provide evidence for a modest increase in transportation-related injuries and mortalities among Gulf War deployed compared to nondeployed veterans in the decade immediately following deployment. However, studies with longer follow-up indicate that the increased injury rate was likely to have been restricted to the first several years after the war.

  • With regard to all-causes of hospitalization, excess hospitalizations did not occur among veterans of the Gulf War who remained on active duty through 1994. However, Gulf War veterans who left the military reported worse health outcomes than those who remained.

  • The studies do not demonstrate consistent evidence of increased overall cancer in the Gulf War veterans compared to nondeployed veterans. Studies of testicular cancer produced inconsistent results, but the latency period for many cancers may not have been reached among Gulf War veterans.

  • Studies indicate that Gulf War veterans might be at increased risk for amyotrophic lateral sclerosis (ALS).

  • There does not appear to be an increase in the prevalence of peripheral neuropathy in deployed versus non-deployed veterans, as defined by history, physical examination, and electrophysiologic studies.

  • It does not appear that there is a difference in the prevalence of cardiovascular disease or diabetes between deployed and nondeployed veterans.

  • Overall there is no consistent pattern of one or more birth defects with a higher prevalence for the offspring of male or female Gulf War veterans. Only one set of defects, urinary tract abnormalities, has been found to be increased in more than one well-designed study.

  • Respiratory symptoms are strongly associated with Gulf War deployment when using comparison groups of non-deployed veterans in most studies addressing this question. However, studies with objective pulmonary function measures find no association between respiratory illnesses with Gulf War deployment across the four cohorts in which this has been investigated.

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