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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and Health: Volume 11: Generational Health Effects of Serving in the Gulf War. Washington, DC: The National Academies Press. doi: 10.17226/25162.
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G ULF W AR and H EALTH V O L U M E 11 Generational Health Effects of Serving in the Gulf War Committee on Gulf War and Health, Volume 11: Generational Health Effects of Serving in the Gulf War Board on Population Health and Public Health Practice Health and Medicine Division A Consensus Study Report of PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by Contract Number VA701-16-C-0029 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommenda- tions expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: International Standard Book Number-10: Digital Object Identifier: https://doi.org/10.17226/25162 Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Gulf War and health, Volume 11: Generational health effects of serving in the Gulf War. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25162. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www. nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

COMMITTEE ON GULF WAR AND HEALTH, VOLUME 11: GENERATIONAL HEALTH EFFECTS OF SERVING IN THE GULF WAR KENNETH S. RAMOS (Chair), Associate Vice President for Precision Health Sciences, Professor of Medicine and Director, Center for Applied Genetics and Genomic Medicine, University of Arizona Health Sciences TRACY L. BALE, Professor and Director, Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine JOHN R. BALMES, Professor of Medicine, University of California, San Francisco BRENDA ESKENAZI, Jennifer and Brian Maxwell Professor of Maternal and Child Health and Epidemiology, Director, Center for Environmental Research and Children’s Health, University of California, Berkeley ELAINE M. FAUSTMAN, Professor and Director, Institute for Risk Analysis and Risk Communication, Department of Environmental and Occupational Health Sciences, University of Washington MARI S. GOLUB, California National Primate Research Center, University of California, Davis RAFAEL A. IRIZARRY, Professor of Biostatistics, Dana-Farber Cancer Institute, Harvard University TAMARRA JAMES-TODD, Mark and Catherine Winkler Assistant Professor of Environmental Reproductive and Perinatal Epidemiology, Harvard T.H. Chan School of Public Health STEPHEN A. KRAWETZ, Associate Director, C.S. Mott Center for Human Growth and Development, Charlotte B. Failing Professor of Fetal Therapy and Diagnosis, Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University LINDA A. Mc CAULEY, Dean, Nell Hodgson Woodruff School of Nursing, Emory University JACOB D. Mc DONALD, Senior Scientist, Vice President, Chief Science Officer, Lovelace Respiratory Research Institute DYLAN S. SMALL, Professor, Department of Statistics, The Wharton School, University of Pennsylvania JACQUETTA TRASLER, Senior Scientist, Research Institute of the McGill University Health Centre, James McGill Professor in Pediatrics, Human Genetics, and Pharmacology and Therapeutics, McGill University CHERYL LYN WALKER, Director, Center for Precision Environmental Health, Professor, Department of Molecular and Cell Biology and Medicine, Baylor College of Medicine CAROL S. WOOD, Staff Scientist, Toxicology and Hazard Assessment Group, Environmental Sciences Division, Oak Ridge National Laboratory ROBERT O. WRIGHT, Ethel H. Wise Professor of Pediatrics, Chair, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai Study Staff ROBERTA WEDGE, Study Director CARY HAVER, Program Officer T. CHERI BANKS, Associate Program Officer PAMELA RAMEY-Mc CRAY, Senior Program Assistant ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice v PREPUBLICATION COPY—Uncorrected Proofs

Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Bruce A. Barron, University of Rochester Medical Center Joseph Braun, Brown University Dana C. Dolinoy, University of Michigan School of Public Health Seth Eisen, Washington University School of Medicine David Korn, Harvard Medical School Nancy E. Lane, University of California, Davis, School of Medicine Germaine Buck Louis, George Mason University Donald R. Mattison, Risk Sciences International, Ottawa Reza J. Rasoulpour, Dow AgroSciences Laura N. Vandenberg, University of Massachusetts Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Nancy F. Woods, University of Washington, and Maryellen L. Giger, The University of Chicago. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. vii PREPUBLICATION COPY—Uncorrected Proofs

Preface Veterans of the 1990–1991 Gulf War and the Post-9/11 conflicts in Iraq and Afghanistan were ex- posed to a variety of biological, chemical, radiological, psychosocial, and physical stressors during their deployments. Over the past 20 years the National Academies of Sciences, Engineering, and Medicine (the National Academies) has convened more than 10 committees of experts to assess the health effects that might be linked to those exposures. Some of the health effects identified by past committees include post-traumatic stress disorders, other mental health disorders, Gulf War illness, respiratory effects, and self-reported sexual dysfunction. Veterans’ concerns regarding the impacts of deployment-related ex- posures on their health have grown to include potential adverse effects on the health of their children and grandchildren. These concerns now increasingly involve female veterans, as more women join the military and are deployed to war zones and areas that pose potential hazards. The committee notes that veterans’ harmful exposures are not restricted to deployment; such exposures may occur during military service in general or even outside of active duty (for example, exposure to trichloroethylene in contaminated drinking water at Camp Lejeune). As such, the need for data and knowledge to protect the health of the children and grandchildren of veterans who may have experienced harmful exposures during deployment has become urgent. The exposure of male and female veterans to toxicants during their deployments may pose unknown risks to their future children, whether conceived during or after deployment. Harmful exposures may affect germ cells in both men and women and compromise the reproductive health of veterans and the future health of their children. For female veterans who may be deployed before they are aware they are pregnant, there may also be a risk to the developing fetus. The impact of exposures experienced during these periods on the developing embryo is largely unknown. Given these inherent risks, and in light of several public reports linking a parent’s or even a grandparent’s exposure to a toxicant to negative health outcomes in their descendants, veterans’ concerns about generational effects continue to escalate. While the public reporting of generational effects has garnered considerable attention, the scientific evidence to support those links is not compelling at this time. ix PREPUBLICATION COPY—Uncorrected Proofs

x PREFACE To address these gaps in data and knowledge, the Department of Veterans Affairs (VA) requested this eleventh update of the Gulf War and Health series of reports. This volume addresses two major tasks: evaluating the scientific and medical literature on reproductive and developmental effects and health outcomes associated with Gulf War and Post-9/11 exposures, and determining those research areas requiring further scientific study on potential health effects in the descendants of veterans of any era. To accomplish these tasks, the National Academies established a committee of 16 members repre- senting a broad range of areas of scientific and medical expertise. Its work was informed by two public meetings at which the committee heard from key stakeholders, including veterans, veterans’ service organizations, research scientists, and representatives from VA, the Department of Defense, and other governmental organizations that are also attempting to determine what, if any, generational health ef- fects may result from a veteran’s exposures prior to or during pregnancy. The committee completed a comprehensive evaluation of relevant literature and integrated its findings with the large amounts of data on reproductive and developmental health outcomes reviewed in previous updates. The synthesis of the evidence was then used to craft a path forward for VA to address veteran concerns related to multigenerational health effects, particularly as they relate to veterans’ children conceived during and after deployment, their grandchildren, and even future generations. The Volume 11 committee thanks those who presented valuable information to the committee, including Fred Tyson, National Institute of Environmental Health Sciences; Vicki Walker, National Toxicology Program; Antonia Calafat, Centers for Disease Control and Prevention; John Greally, Albert Einstein School of Medicine; Colleen Baird, U.S. Army Public Health Command; R. Loren Erickson, Peter Rumm, and Aaron Schneiderman, Department of Veterans Affairs; and the many veterans who shared their deployment experiences with the committee. The committee is most grateful to Roberta Wedge, our outstanding study director, who helped us navigate through the report process and ensured that progress was made at all times. The committee is also indebted to Cary Haver and Cheri Banks for their hard work in support of committee functions and to Pam Ramey-McCray for her graceful adminis- trative support of our activities. The committee acknowledges the expert assistance provided by Daniel Bearss of the National Academies Research Center helping to create and execute a detailed literature search strategy and for fact-checking the lengthy and sometimes complicated chapters included in the volume. A heartfelt thank-you to my fellow committee members for their collegiality, insights, hard work, thoughtfulness, and outstanding service over the past 2 years. The committee is optimistic that the recommendations contained in this report will help answer many of the critical questions facing VA and the nation as a whole regarding the complex interactions between genes, environment, and lifestyle that may influence health outcomes across multiple genera- tions. The report also provides specific guidance on the development of a health monitoring research program that can help gather the data required to evaluate generational effects and to establish a path forward in continuing to meet our responsibility to veterans of all conflicts. Kenneth S. Ramos, Chair Committee on Gulf War and Health, Volume 11: Generational Health Effects of Serving in the Gulf War PREPUBLICATION COPY—Uncorrected Proofs

Contents ACRONYMS AND ABBREVIATIONS ............................................................................................. xiii SUMMARY..............................................................................................................................................1  1 INTRODUCTION...........................................................................................................................15   2 COMMITTEE’S APPROACH.......................................................................................................25   3 INTRODUCTION TO THE STUDY OF GENERATIONAL EFFECTS......................................41   4 DEPLOYMENT-RELATED EXPOSURES...................................................................................63   5 PESTICIDES................................................................................................................................101   6 COMBUSTION PRODUCTS AND FUELS................................................................................191  7 SOLVENTS...................................................................................................................................315   8 OUTCOMES TOWARD HERITABLE EFFECTS......................................................................395   9 HEALTH MONITORING AND RESEARCH PROGRAMS......................................................407 10 PATHOPHYSIOLOGIC RESEARCH..........................................................................................459 11 MOVING FORWARD..................................................................................................................469 xi PREPUBLICATION COPY—Uncorrected Proofs

xii CONTENTS APPENDIXES A Committee Biographical Sketches................................................................................................481 B Glossary........................................................................................................................................487 PREPUBLICATION COPY—Uncorrected Proofs

Acronyms and Abbreviations αGSU glycoprotein hormone α-subunit γ-HCH gamma-hexachlorocyclohexane (lindane) ΣDAP sum of DAP 1-N 1-naphthol 1-OHNa 1-hydroxynaphthalene 1-OHP 1-hydroxypyrene 2-MMA 2-methoxyacetic acid 2-OHF 2-hydroxyfluorene 2-OHNa 2-hydroxynapthalene 4-OHPh 4-hydroxyphenanthrene 9-OHFlu 9-hydroxyfluorene 9-OHPh 9-hydroxyphenanthrene AChE acetylcholinesterase ADHD attention deficit–hyperactivity disorder AHLTA Armed Forces Health Longitudinal Technology Application system (of DoD) AhR aryl hydrocarbon receptor ALL acute lymphoblastic leukemia AMH anti-Müllerian hormone AML acute myeloid leukemia APC adenomatous polyposis coli aPR adjusted prevalence ratio ASD autism spectrum disorder ATSDR Agency for Toxic Substances and Disease Registry AVA anthrax vaccine absorbed xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv ACRONYMS AND ABBREVIATIONS BaP benzo[a]pyrene BASC Behavior Assessment System for Children BDNF brain-derived neurotrophic factor BMI body mass index BN-1MN binucleated cells with one micronucleus BNBAS Brazelton Neonatal Behavioral Assessment Scale BPA 3-phenoxybenzoic acid BRIEF Behavior Rating Inventory of Executive Functioning BSID-II Bayley Scales of Infant Development II BTEX benzene-toluene-ethylbenzene-xylene BuChE butyrylcholinesterase CARC chemical agent-resistant coating CBCL Child Behavior Checklist CCCEH Columbia Center for Children’s Environmental Health (study) CD3+ cluster of differentiation 3 CD4+ cluster of differentiation 4 CD19+ cluster of differentiation 19 CDCCA cis-3-(2,2- dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid CHAMACOS Center for the Health Assessment of Mothers and Children of Salinas (study) CHARGE Childhood Autism Risks from Genetics and Environment (study) ChE cholinesterase CHEAR Children’s Health Exposure Analysis Resource (of NIEHS) CI confidence interval CIA Central Intelligence Agency CO carbon monoxide CO2 carbon dioxide CPF chlorpyrifos CpG cytosine-adjacent-to-guanine (sites in the human genome) CPT-II Conners’ Continuous Performance Test-II Cr6 hexavalent chromium CYP1A1 cytochrome P450 1A1 CYP2E1 cytochrome P450 2E1 DAG directed acyclic graph DAP dialkylphosphate DBCA cis-2,2-dibromovinyl-2,2-dimethylcyclopropane-carboxylic acid DCA dichloroacetate DEDTP diethyldithiophosphate DEP diethylphosphate DETP diethylthiophosphate DFI DNA fragmentation index DLA Defense Logistics Agency DLC dioxin-like chemical DMDC Defense Manpower Data Center DMDTP dimethyldithiophosphate DMP dimethylphosphate PREPUBLICATION COPY—Uncorrected Proofs

ACRONYMS AND ABBREVIATIONS xv DMSS Defense Medical Surveillance System DMTP dimethylthiophosphate DNA deoxyribonucleic acid DNAm DNA methylation DNMT DNA methyltransferase DNMT3B DNA methyltransferase 3 beta DoD Department of Defense DOEHRS Defense Occupational and Environmental Health Readiness System DOHaD developmental origins of health and disease DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DU depleted uranium E2 estradiol EAA ethoxyacetic acid ECHA European Chemicals Agency EGBE ethylene glycol monobutyl ether (2-butoxyethanol) EGEE ethylene glycol monoethyl ether (2-ethoxythanol) EGMBE ethylene glycol monobutyl ether (2-butoxyethanol) EGME ethylene glycol monomethyl ether (2-methoxyethanol) EHR electronic health record ELEMENT Early Life Exposures in Mexico to Environmental Toxicants (study) EPA Environmental Protection Agency EU enriched uranium FAI free androgen index FDA Food and Drug Administration FeNO fractional exhaled nitric oxide FSH follicle-stimulating hormone FT4/FT3 free thyroxin/triiodothyronine ratio FT4 free thyroxine FVC forced vital capacity GD gestational day GnRH gonadotropin-releasing hormone GSTM1 glutathione S-transferase mu 1 (M1) GSTT1 glutathione S-transferase theta 1 (T1) GWAS genome-wide association study H2S hydrogen sulfide Hmlh1 human mutL homolog 1 HMRP health monitoring and research program HOME Health Outcomes and Measures of the Environment (study) HR hazard ratio HRMS high-resolution mass spectrometry HSD11B2 11β-hydroxysteroid dehydrogenase type 2 PREPUBLICATION COPY—Uncorrected Proofs

xvi ACRONYMS AND ABBREVIATIONS IARC International Agency for Research on Cancer ICM inner cellular mass IDR incidence density ratio IFNγ interferon gamma IGC immature germ cell IgE immunoglobulin E ILER individual longitudinal exposure record IOM Institute of Medicine iPSC induced pluripotent stem cell IQR interquartile range IRIS Integrated Risk Information System IRR incidence rate ratio JBB Joint Base Balad JP-4 jet fuel 4 JP-5 jet fuel 5 JP-8 jet fuel 8 KIDS Kinder Infant Development Scale LBW low birth weight LEP leptin LH luteinizing hormone md mean difference MDA malathion dicarboxylic acid MDI mental development index MGMT methyl guanine methyl transferase MHS Military Health System MilCo Millennium Cohort (DoD study) miRNA microribonucleic acid MLH1 mutL homolog 1 mRNA messenger ribonucleic acid Mt. Sinai Mount Sinai Children’s Environmental Health Cohort Study mtDNA mitochondrial DNA MVP Million Veteran Program (VA study) NAS National Academy of Sciences NBDPS National Birth Defects Prevention Study NBNA Neonatal Behavioral Neurological Assessment ncRNA noncoding RNA NHL non-Hodgkin’s lymphoma NIEHS National Institute of Environmental Health Sciences NIH National Institutes of Health NK natural killer (cell) NMDA N-methyl-D-aspartate NO nitrogen oxide PREPUBLICATION COPY—Uncorrected Proofs

ACRONYMS AND ABBREVIATIONS xvii NO2 nitrogen dioxide NRC National Research Council NTD neural tube defect O3 ozone OEF Operation Enduring Freedom OIF Operation Iraqi Freedom OND Operation New Dawn OP organophosphate OR odds ratio OSAGWI Office of the Special Assistant for Gulf War Illnesses PAH polycyclic aromatic hydrocarbon PB pyridostigmine bromide PBA 3-phenoxybenzoic acid PCDD polychlorinated dibenzo-p-dioxin PCDF polychlorinated dibenzofuran PCE tetrachloroethylene (perchloroethylene) PCOS polycystic ovary syndrome PDI psychomotor development index PGC primordial germ cell piRNA Piwi-interacting RNA PM particulate matter PND postnatal day PNET pancreatic neuroendocrine tumor PON1 paraoxonase 1 PR progesterone receptor PROGRESS Programming Research in Obesity, Growth, Environment and Social Stressors PTB preterm birth RNA ribonucleic acid ROS reactive oxygen species RR relative risk SDQ Strengths and Difficulties Questionnaire SES socioeconomic status SGA small for gestational age SHBG sex hormone binding globulin SIR standardized incidence ratio SM sulfur mustard SO2 sulfur dioxide sRR summary relative risk SRS Social Responsiveness Scale SSVS stochastic search variable selection TBDD 2,3,7,8-tetrabromodibenzo-p-dioxin TBG thyroxin-binding globulin PREPUBLICATION COPY—Uncorrected Proofs

xviii ACRONYMS AND ABBREVIATIONS TCA trichloroacetate TCDD 2,3,7,8-tetrachlorodibenzodioxin TCE trichloroethylene TCPy trichloro-2-pyridinol TDCCA trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid TDG thymine DNA glycosylase TDM tail distributed moment TET2 Tet methylcytosine dioxygenase 2 TGCT testicular germ cell tumor THREE Tracking Health Related to Environmental Exposures tRNA transfer RNA fragment TSH thyroid-stimulating hormone TTP time to pregnancy VA Department of Veterans Affairs VAERS Vaccine Adverse Event Reporting System VAO Veterans and Agent Orange VHEMBE Venda Health Examination of Mothers, Babies and Their Environment VISTA Veterans Information Systems and Technology Architecture (of VA) VOC volatile organic compound VSO veterans service organization WBC white blood cell WHO World Health Organization WISC-IV Weschler Intelligence Scale for Children, 4th edition WPPSI-III Weschler Preschool and Primary Scales of Intelligence-III XIST X-inactive specific transcript PREPUBLICATION COPY—Uncorrected Proofs

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For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the National Academies of Sciences, Engineering, and Medicine has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes.

Some of the health effects identified by past reports include post-traumatic stress disorders, other mental health disorders, Gulf War illness, respiratory effects, and self-reported sexual dysfunction. Veterans’ concerns regarding the impacts of deployment-related exposures on their health have grown to include potential adverse effects on the health of their children and grandchildren. These concerns now increasingly involve female veterans, as more women join the military and are deployed to war zones and areas that pose potential hazards.

Gulf War and Health: Volume 11 evaluates the scientific and medical literature on reproductive and developmental effects and health outcomes associated with Gulf War and Post-9/11 exposures, and designates research areas requiring further scientific study on potential health effects in the descendants of veterans of any era.

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