A. General

In previous wars, the expected hazards of war were directly responsible for the overwhelming majority of casualties. The attention of military leaders, their medical forces, and the nation as a whole was focused on the expected and known hazards of war. In WW II, Korea and Vietnam, US forces sustained large numbers of killed, wounded, combat stress casualties and high DNBI (disease/non-battle injuries) rates, especially due to infectious diseases. Post-war military and VA medical care was also focused on veterans who had been victims of the known hazards of war, some of which may have provided convenient explanations for undiagnosable complaints.

The very fact that combat casualties in Desert Shield/Storm period were lower by far than any previous large engagement (See Table 2) has allowed attention to be focused on other aspects of military health.

Table 2

Historical Casualty Data

B. Unexplained Medical Complaints in Gulf War Participants

What is the Problem

A certain number of Gulf War participants have come forward with symptomatic complaints, usually of a multi-system nature, and/or non-specific, which they attribute to their experience in the Gulf. Generally, their physical examinations and laboratory results are negative or non-diagnostic. The exact number of such veterans is currently unknown. This group has attracted the attention of the media and some members of Congress.

A variety of studies have attempted to shed light on specific aspects of the problem. These include epidemiological studies by the Army and Navy (123d ARCOM, Seabees), clinical studies (leishmaniasis, depleted uranium), environmental studies (9th ACR) and pathological studies (AFIP). The VA has responded to the diagnostic, clinical and political challenges with a registry of personnel and medical data and tertiary care referral program. Efforts are being made to determine the extent of and consequences of environmental exposure to oil fire products. Lacking however, are a thorough and comprehensive, epidemiologic study and analysis of the entire illness phenomenon.

Although the cases of unexplained medical complaints in Gulf War participants seem to be concentrated in reserve unitS and seem to affect older individuals, such "risk factors" have not been systematically examined by appropriate epidemiologic methods. The Army and the Navy medical departments have strong preventive medicine assets linked to capable biomedical research organizations. These assets have not been effectively utilized to address the entirety of the problem. Constraints such as the vagueness of the clinical syndrome, lack of a case definition, absence of a biological marker for the disease, and the differences between the medical and patient care systems of the reserves, the VA, and the active forces have been some of the barriers to a comprehensive epidemiological study. These obstacles must be overcome to gain a complete picture of the problem and develop a deeper understanding of the nature of the total health consequences of Persian Gulf War service.