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ment of Veterans Affairs (VA) for health problems that they believed were caused by their exposures to mustard agents or Lewisite. Two factors complicated resolution of these cases. First, there were often no records or documentation available of an individual's participation in the testing programs. Second, there was a great deal of uncertainty about which health problems were in fact the result of mustard agent or Lewisite exposure.

In June 1991 the VA announced guidelines for the handling of these cases. These guidelines included the loosening of normal requirements for documenting the individual's participation in the experiments and the identification of seven diseases that the VA would consider to be caused by mustard agents or Lewisite. These seven are asthma, chronic bronchitis, emphysema, chronic laryngitis, corneal opacities, chronic conjunctivitis, and keratitis (of the eye). In addition, the VA requested that the Institute of Medicine convene a committee to survey the scientific and medical literature in order to assess the strength of association between exposure to these agents and the development of specific diseases. The committee was also charged with identifying the gaps in the literature and making recommendations relevant to closing those gaps. This report details the committee's findings and recommendations.

Between October 1991 and August 1992, almost 2,000 scientific papers, technical reports, and other documents were reviewed by the committee. The experimental protocols used in the WWII testing programs were examined to assess the potential dose levels experienced by the experimental subjects. In addition, the committee consulted with a variety of outside experts and sought information from the affected veterans themselves, through a public hearing process that resulted in written or oral statements from over 260 veterans regarding their exposures to these agents and subsequent health problems.

The committee found large gaps in the literature pertaining to the long-term health effects of exposure to mustard agents and Lewisite. For many diseases, very little or no work had been done in the eight decades following the first use of sulfur mustard in World War I. Almost all of the work in the United States had been conducted or funded by chemical defense sections of the military and was concerned only with the acute effects of these agents and not with their long-term effects. As a result, the committee depended heavily on occupational studies of chemical weapons production workers in other countries, on what could be found on battlefield casualties, and on what was known about the effects of nitrogen mustard derivatives that have been used since WWII as cancer chemotherapy agents. In addition, the committee carefully considered the basic scientific data available regarding the biological mechanisms of tissue damage from mustard agents and Lewisite.



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