and infectious diseases, in addition to psychological and physiological stress. Veterans have become increasingly concerned that their ill health may be related to exposure to these agents and circumstances.

In response to the veterans’ concerns, the Department of Veterans Affairs (VA) approached the National Academy of Sciences and requested that the Institute of Medicine (IOM) conduct a study to extensively review the literature and summarize the strength of the scientific evidence concerning the association between health effects and the chemical and biological compounds that were likely present during the Gulf War.

To carry out the charge as requested by the VA, the IOM formed the Committee on Health Effects Associated with Exposures During the Gulf War. As the committee began its deliberations in January 1999, one of its first tasks was to determine the initial group of compounds for study. The committee decided that the compounds of most concern to the veterans should be selected for initial review. Following meetings with leaders of different veterans’ organizations, the committee decided it would begin this first phase by studying the following compounds: depleted uranium, chemical warfare agents (sarin and cyclosarin), pyridostigmine bromide, and vaccines (anthrax and botulinum toxoid). Subsequent studies will examine the remaining agents.

Subsequent to the VA–IOM contract, two public laws were passed: the Veterans Programs Enhancement Act of 1998 (Public Law 105-368) and the Persian Gulf War Veterans Act of 1998 (Public Law 105-277). Each law mandated studies similar to the study already agreed upon by the VA and IOM. These laws detail several comprehensive studies on veterans’ health and specify numerous biological and chemical hazards that may potentially be associated with the health of Gulf War veterans.

It should be noted that the charge to the IOM committee was not to determine whether a unique Gulf War syndrome exists, nor was it to make judgments regarding levels of exposure of veterans to the putative agents. Additionally, the committee’s charge was not to focus on broader issues, such as the potential costs of compensation for veterans or policy regarding such compensation. These decisions remain the responsibility of the Secretary of Veterans Affairs (VA). This report does, however, provide an assessment of the scientific evidence regarding health effects that may be associated with exposures to specific agents that were present in the Gulf War. The Secretary may consider these health effects as the VA develops a compensation program for Gulf War veterans.

ADDRESSING GULF WAR HEALTH ISSUES

Past and Current Efforts

In the years since the Gulf War, a number of federal and private sector efforts have explored the causes of and treatments for the illnesses of Gulf War veterans. Initial efforts focused on concerns about potential health effects of the Kuwait oil-well fires. Subsequently, concern has broadened to encompass possi-



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