possible future effects of exposure to air pollutants and other environmental agents, and to serve as the basis for future medical surveillance. Exposures, particularly those associated with the oil well fires, were included as part of the history taking. As time passed it became apparent that a number of exposure issues and a host of symptoms needed further investigation.
As concern over the health problems of those deployed to the Persian Gulf escalated, DoD also decided to develop and implement a Persian Gulf clinical program for PGW veterans. DoD and DVA met and used experts to develop clinical protocols. By 1994 both had implemented similar and parallel clinical evaluation programs. The DVA clinical program is called the Persian Gulf Registry and Uniform Case Assessment Protocol (PGR/UCAP), while the DoD program is called the Comprehensive Clinical Evaluation Program (CCEP). By early 1997 almost 100,000 veterans had been examined through either the DVA (about 67,000) or the DoD (about 33,000) Persian Gulf Registry program.
Concern about the health of PGW veterans has led to a number of investigations and reports, many of which contain recommendations for research or for improving the diagnostic programs of DVA and DoD. Several population-based studies regarding the health of PGW veterans have been conducted. Most of these focus on specific components of health status or outcome, for example, mortality and hospitalizations. A major study of self-reported health complaints was jointly undertaken by the Centers for Disease Control and Prevention and the University of Iowa, but it was limited to Iowa residents. Another effort aimed at determining the health outcomes of troops deployed to the Persian Gulf compared to those of troops not deployed to the Gulf is the DVA National Health Survey of Persian Gulf Veterans and Their Family Members, the results of which are not yet available.
Despite these efforts to study the health of PGW veterans, many individuals in the U.S. Congress, in the federal government, and among the public believe that no study has yet been designed that adequately measures the health of those deployed to the Persian Gulf.
A recently released General Accounting Office (GAO) report concluded that “although efforts have been made to diagnose veterans' problems and care has been provided to many eligible veterans, neither DoD nor VA [DVA] has systematically attempted to determine whether ill PGW veterans are any better or worse today than when they were first examined” (GAO, 1997). The report also concluded that DoD and DVA have no systematic approach to monitoring the quality, appropriateness, or effectiveness of care provided to PGW veterans after their initial examination and that these agencies need to develop a plan to collect longitudinal information on the health outcomes and treatment effectiveness of PGW veterans.
After reviewing the GAO findings, the U.S. House of Representatives Appropriations Committee issued Report 105–175 which states that DoD and DVA should develop and implement a plan to provide (1) data on the effectiveness of the treatments received by these veterans and (2) longitudinal information on the health of veterans who reported diagnosed and undiagnosed illnesses after the war.
In response to these recommendations, the DVA and the DoD asked the IOM to conduct a study aimed at developing a research design to measure the health of Persian Gulf veterans. The first meeting of the Committee on Measuring the Health of Persian Gulf Veterans included a workshop designed to collect information regarding the health problems of those deployed to the Persian Gulf War and some of the efforts that have been made to study those problems. The following sections of this report provide a summary of that workshop.