In 2005, the Department of Veterans Affairs (VA) requested that IOM appoint a committee, the Committee on Gulf War and Health: A Review of the Medical Literature Relative to Gulf War Veterans’ Health (the Volume 4 committee), to review that body of literature and to summarize what was known about the current status of veterans’ health. In 2006, the committee produced a report, Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War, which summarized the overall health effects in veterans and noted which health outcomes were more evident in Gulf War veterans than in their nondeployed counterparts irrespective of the specific exposures experienced by the deployed veterans. The present report is an update of Volume 4 and covers the literature published since 2005 on the health effects seen in veterans deployed to the Persian Gulf in 1990-1991.

The specific charge to the Committee on Gulf War and Health: Health Effects of Serving in the Gulf War, Update 2009 (the Update committee), as requested by VA, was to review, evaluate, and summarize the literature on the following health outcomes that were noted in the 2006 report as seeming to have higher incidence or prevalence in Gulf War deployed veterans: cancer (particularly brain and testicular cancer), amyotrophic lateral sclerosis and other neurologic diseases (such as Parkinson’s disease and multiple sclerosis), birth defects and other adverse pregnancy outcomes, and postdeployment psychiatric conditions. The committee was also to review studies of cause-specific mortality in Gulf War veterans as recommended in the 2006 report. Finally, the committee was to examine the literature to identify any emerging health outcomes.

Thus, the Update committee limited its review to epidemiologic studies of health outcomes published since the last literature search conducted for Volume 4. The committee included in its review only studies that compared the health status of Gulf War veterans with that of nondeployed veterans or veterans deployed elsewhere, such as in Bosnia or Germany.


During its deliberations, the Update committee held two public sessions at which it heard from numerous interested parties, including representatives of veteran-service organizations and individual Gulf War veterans. VA Secretary Shinseki also asked the committee to invite representatives of the VA Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC) to make presentations on the findings and conclusions in its report Gulf War Illness and the Health of Gulf War Veterans: Scientific Findings and Recommendations, released in November 2008.

Extensive searches of the epidemiologic literature published since 2005 were conducted with the same search strategy as that used for Volume 4; over 1000 new citations were identified. After an assessment of the titles and abstracts found in the initial searches, the committee focused on some 400 potentially relevant epidemiologic studies for further review and evaluation.

The committee adopted a policy of using only peer-reviewed publications as the basis of its conclusions except for some government reports. The process of peer review by fellow professionals increases the likelihood of high quality but does not guarantee the validity of a study or the ability to generalize its findings. Accordingly, committee members read each study

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