The Department of Veterans Affairs (VA) research efforts examining the health of Persian Gulf veterans include epidemiological studies, and intramural and cooperative research. Specific efforts are listed below:
Mortality Follow-up Study of Persian Gulf Veterans
Action: VA Environmental Epidemiology Service (EES).
Purpose: Because of recurring and persistent questions about the mortality experience of Persian Gulf veterans, a mortality follow-up study is planned. The mortality experience of all 697,000 Persian Gulf veterans on the Defense Manpower Data Center (DMDC) file will be compared to a matched sample of Gulf-era veterans who did not serve in the Gulf. Cause-specific mortality for both veterans groups also will be compared to the number of deaths expected in the U.S. civilian population.
Status: Ongoing. Vital status determinations and death record gathering efforts have been initiated.
Results: Not available at this time.
Coordination: VA and DoD.
Random Survey of Persian Gulf Veterans
Action: VA Environmental Epidemiology Service (EES).
Purpose: A random survey of 15,000 Reserve/National Guard veterans and active duty personnel who served in the Persian Gulf is being planned by the VA in collaboration with DoD and HHS. This mail/telephone survey will be designed to determine the prevalence of symptomatology experienced by veterans after their service in the Gulf war, and the current health status of veterans and their family members. This Gulf war cohort will be compared to a matched group of 15,000 veterans and military members who served in the same era but who were not deployed to the Persian Gulf. A second representative sample of eligible respondents will be invited to undergo a physical examination to clinically evaluate reported symptomatology.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
Use of Roster of Veterans Who Served in Persian Gulf Area
Action: VA, Environmental Epidemiology Service (EES), and Defense Manpower Data Center (DMDC).
Purpose: To properly address the issue of possible exposure to environmental hazards, all individuals who served in the Gulf region need to be identified. To this end, the Defense Manpower Data Center (DMDC) has prepared a computer file of over 697,000 troops assigned to the Persian Gulf area during Operation Desert Shield/Desert Storm. This database has been made available to VA's Environmental Epidemiology Service, giving VA access to demographic data on all troops stationed in the Persian Gulf.
Status: Ongoing. The data file has been used by EES in its reviews of the Persian Gulf Veterans Health Registry and the VA Patient Treatment File, and for the planning of a mortality follow-up study of Persian Gulf veterans.
Results: Not available at this time.
Coordination: VA and DoD.
In support of research on the health consequences of exposure to environmental hazards during the Persian Gulf War, VA has established three hospital-based research centers to study military and civilian exposure to environmental and occupational hazards, including psychological stress. The three centers, which were chosen in August 1994 and funded beginning October, 1994, are located at: 1) VA Medical Center East Orange, NJ, 2) VA Medical Center Portland, OR, and 3) VA Medical Center Boston, MA.
Boston VAMC Environmental Hazards Research Center
Action: VAMC Boston, MA
Purpose: The Boston Environmental Hazards Research Center, in conjunction with Boston University, is conducting six Persian Gulf-related research projects aimed at determining health effects of environmental exposure to potential hazardous agents, with a particular emphasis on behavioral toxicology, immunotoxicology, cancer epidemiology, and behavioral psychopathology. This interdisciplinary work will extend current Persian Gulf-related research at the Boston VA Medical Center that includes assessment of health, psychological well-being, and neuropsychological function. Data shared among projects will allow investigators to examine such hypotheses as whether performance on psychological tests can be related to immune function, and the relation between pulmonary test results and health symptom complaints. One project will examine the possible relationship between the experience of multiple symptom-based health complaints and such clinical phenomena as chemical sensitivities, chronic fatigue syndrome, organic brain syndromes resulting from toxicant exposures, post-traumatic stress disorder (PTSD), and somatization disorders. Other studies will investigate the central and peripheral nervous system in a group of veterans with possible environmentally related disorders, while another will assess pulmonary and immune system function in the same study cohort. Additional approaches at the Boston Environmental Hazards Research Center will seek validation of neurobehavioral tests, a rodent study of immunologic changes thought to be related to petroleum products, a registry of cancer incidence among Persian Gulf veterans, and a study of cellular receptors as a susceptibility biomarker for polycyclic aromatic hydrocarbon (a component of incomplete petroleum combustion) exposure.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
East Orange, NJ, VAMC Environmental Hazards Research Center
Action: VAMC East Orange, NJ
Purpose: The New Jersey Environmental Hazards Research Center at the East Orange VA Medical Center, in conjunction with the UMDNJ - New Jersey Medical School, is undertaking four projects to gather information about illnesses among Gulf veterans for development of the most characteristic symptom profiles. An epidemiological study will compare two groups of Gulf veterans to collect and organize symptoms to define illness and identify risk factors through the case-control method. Study subjects will be divided into three groups based on symptom presentation-- chronic fatigue, chemical sensitivity, and asymptomatic -- to participate in a series of studies in such areas as viral, immunological, neuropsychological and autonomic neural function. One project will examine chemical sensitivity through physiologic and cognitive reactivity to chemical challenges. Those fulfilling chronic fatigue criteria will be tested to determine physiologic and cognitive reactivity to exercise. An animal study will evaluate psychosomatic interactions with chemical exposure and pyridostigmine bromide.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
Portland, OR, VAMC Environmental Hazards Research Center
Action: VAMC Portland, OR
Purpose: The Portland, OR, VA Medical Center, in conjunction with Oregon Health Sciences University's Center for Research on Occupational and Environmental Toxicology, is sponsoring an environmental hazards research center to examine, in four projects, health effects associated with exposure to selected environmental chemical hazards and biological hazards related to military service. The center will identify exposures through intensive interviews and study risk factors for unexplained illnesses through a case-control epidemiological study. The center also will screen veterans for medical, chemical, and biological markers of exposure and disease, and act as a repository for data collection and analysis. Scientists from the VA medical center and university research center will work together to explore, at the whole organ and at the molecular level, key scientific issues involving epidemiology, neurobehavior, neuroendocrinology, neurotoxicology, dermatology and parasitology. Researchers hope to define more accurately relationships between illnesses in Gulf veterans and post-traumatic stress disorder, or specific environmental, infectious and warfare chemical exposures. Researchers plan to estimate future risks of developing symptoms in the population of exposed veterans and to begin devising appropriate treatments and intervention.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
Action: VAMC Boston, MA
Purpose: To study a broad range of combat and non-combat experiences associated with deployment during Operation Desert Storm. The study will delineate and quantify those experiences and determine their impact on subsequent patterns of adjustment.
Status: Ongoing.
Results: Manuscript published. (See Appendix)
Reassessing War Stress: Exposure and the Persian Gulf War (1994). Journal of Social Issues, 49, (4), 15-31.
Report also included in: Returning Persian Gulf Troops: First Year Findings (1992). VA Northeast Program Evaluation Center. West Haven, CT
Coordination: VA, DoD and HHS.
Evaluation of Cognitive Functioning of Persian Gulf Veterans
Action: VAMC Boston, MA
Purpose: This study is designed to evaluate the cognitive functioning associated with health complaints in Persian Gulf War veterans. Using a carefully chosen battery of neuropsychological and cognitive tests a systematic evaluation will be conducted to determine if there are demonstrable cognitive changes in these veterans, and whether these patterns of cognitive performance differ from those found in a cohort of deployed veterans without self-reported health problems.
Status: Complete. Next phase is incorporated into the Boston Environmental Hazards Center.
Results: Not available at this time.
Coordination: VAMC New Orleans, DoD and HHS.
Psychological Adjustment in Operation Desert Shield/Storm Veterans
Action: VAMC Gainesville, FL
Purpose: In an effort to determine if differences exist between veterans deployed in Operation Desert Shield/Storm (ODS) and veterans without experience in the Persian Gulf in terms of overall mental health, psychological tests were given to two groups of National Guard and Reserve members from Northcentral Florida: one group actively involved in ODS and a control group. The total number of participants equaled 542.
Status: Complete.
Results: Report included in: Returning Persian Gulf Troops: First Year Findings (1992). VA Northeast Program Evaluation Center. West Haven, CT
Coordination: VA, DoD and HHS
Initial Contact Interviews with Marine Reservists in Operations Desert Storm
Action: VAMC Mountain Home, TN
Purpose: To provide a non-pathological model of early intervention, education, and support to Marine reservists by providing: (1) general information about normal reactions to combat/desert duty, (2) opportunities for group or individual discussion of experiences, (3) administration of standardized psychological questionnaires and instruments, and (4) information or referral regarding access to VA and other community services available for health/psychological/other related concerns.
Status: Ongoing.
Results: Manuscripts accepted for publication and currently in press. Report also included in: Returning Persian Gulf Troops: First Year Findings (1992). VA Northeast Program Evaluation Center. West Haven, CT
Coordination: VA, DoD and HHS.
Evaluation of Cognitive Functioning in Persian Gulf Veterans Reporting War-Related Health Problems
Action: VAMC New Orleans, LA
Purpose: To evaluate potential cognitive correlates of health complaints among veterans of the Persian Gulf War. Participants undergo a clinical diagnostic evaluation of psychological well-being, including standardized interview and self-report inventories. Neuropsychological functioning is assessed with a specialized battery, including tests evaluating relatively stable, premorbid cognitive/intellectual abilities and tests shown to have specificity and sensitivity for detecting changes in localized and diffuse cognitive brain functions.
Status: Ongoing.
Results: Not available at this time.
Coordination: VAMC Boston, DoD and HHS.
Memory and Attention in Post Traumatic Stress Disorder
Action: VAMC New Orleans, LA
Purpose: To provide in-depth evaluation of attention and memory dysfunction among two samples of veterans, veterans of the Vietnam War and veterans of the Persian Gulf War, suffering from Post Traumatic Stress Disorder. The protocol incorporates assessment of psychopathology and neuropsychological functioning among veterans with PTSD diagnoses, depression diagnoses, and those found to be free of psychopathology.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
Neuropsychological Functioning in Veterans
Action: VAMC New Orleans, LA
Purpose: To investigate neuropsychological functioning, especially attention, learning, and memory process, among Operation Desert Storm veterans, suffering PTSD and compare results with a sample of Operation Desert Storm veterans not suffering from PTSD. Participants undergo a clinical diagnostic evaluation, including self-report and interview questions that target PTSD symptomatology, substance abuse, and other psychopathology.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
Psychological Assessment of Operation Desert Storm Returnees
Action: VAMC New Orleans, LA
Purpose: To conduct comprehensive psychological assessments and debriefing among troops mobilized in support of Operation Desert Storm, identify psychological, somatic, and cognitive symptoms and mental disorders -- both early and persistent -- associated with Persian Gulf war-zone exposure; and explore personal and environmental factors that may differentiate Persian Gulf-deployed troops exhibiting war-related psychopathology from troops found to be free of psychological disturbances.
Status: Ongoing.
Results: Manuscripts published. (See Appendix)
Warzone trauma and stress-related symptoms in Operation Desert Storm/Shield (ODS) returnees (1993). Journal of Social Issues, 49 (4), 33-49.
Psychological symptoms and psychiatric diagnoses in Operation Desert Storm troops serving graves registration duty (1994). Journal of Traumatic Stress, 7, 159-171.
Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties (1994). Journal of Abnormal Psychology, 103 (2), 383-390.
Report also included in: Returning Persian Gulf Troops: First Year Findings (1992). VA Northeast Program Evaluation Center. West Haven, CT
Coordination: VA, DoD, and HHS.
A Comparison of Post-traumatic Stress Disorder (PTSD) Symptomatology among Three Army Medical Units Involved in Operation Desert Storm
Action: VAMC Phoenix, AZ
Purpose: The objective of this study were to compare three Arizona Army Reserve Medical Units involved in ODS for six factors related to PTSD: 1) intrusive memories and depressive symptomatology, 2) interpersonal adjustment problems, 3) ability of affect and memory, 4) ruminative features of PTSD, 5) other interpersonal difficulties, and 6) sleep problems. Incidence of substance abuse and effects on family were also investigated. One of the three units was deployed to Saudi Arabia, another to Great Britain, and the third was deployed locally.
Status: Complete.
Results: Not available at this time.
Coordination: VA, DoD and HHS.
Neurobehavioral Aspects of Persian Gulf Experience: A Pilot Study
Action: VAMC Pittsburgh (HD), PA
Purpose: The object of the study is to obtain neurobehavioral data from 50 veterans who participated in the Persian Gulf War. This project will study a group of veterans with known exposure or definitive evidence of toxicity to evaluate whether the exposed veterans demonstrate the same cognitive and physiological deficits found in victims of chronic organic solvent exposure. If results in this phase are positive, a second phase will be explored involving development of a screening assessment for individuals with reports of exposure.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD and HHS.
Monitoring Gulf War Veterans With Embedded Depleted Uranium (DU) Fragments
Action: VAMC Baltimore, MD, U.S. Army Center for Health Promotion, Aberdeen, MD, and the University of Maryland, with the assistance of the EPA Environmental Monitoring Laboratory in Nevada.
Purpose: To conduct clinical follow-up of Operation Desert Storm veterans with known or suspected embedded depleted uranium fragments and assess health risks from DU.
Status: Ongoing. The list of those to be followed is complete. This is an ongoing, multi-year effort. Exposed soldiers will be followed with X-rays and total body counting. Urine and blood samples will be collected for relevant kidney function tests and 24 hour urine collections will be analyzed for uranium.
Results: Not available at this time.
Coordination: DoD, VA and HHS.
Vaccine Mediated Immunity Against Leishmania
Action: VAMC Cleveland, OH
Purpose: To understand cytokine-based mechanisms responsible for curative and counter-productive responses during leishmania infection.
Status: Ongoing.
Results: Manuscript published. (See Appendix)
Recombinant interleukin 12 cures mice infected with Leishmania major (1993). Journal of Experimental Medicine, 177 (5), May 1, 1505-9.
Coordination: VA, DoD and HHS.
Protective Immunity in Experimental Visceral Leishmaniasis
Action: VAMC San Antonio, TX
Purpose: To characterize the mechanisms involved in protective immunity and identify vaccine candiate antigens in experimental visceral leishmaniasis.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD and HHS.
Immunological Evaluation of Persian Gulf War Veterans
Action: VAMC Birmingham, AL
Purpose: To evaluate potential changes in the immunological status of Persian Gulf War veterans using sensitive biological assays of immune cellular functions.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
Chronic Gastrointestinal Illness in Desert Storm Veterans: A Survey and Questionnaire
Action: VAMC Boston, MA
Purpose: To determine if there exists a statistically significant difference in chronic gastrointestinal symptoms in Persian Gulf veterans compared to age-matched controls. If such a difference is found, these data will serve as a starting point in designing future studies to investigate a possible etiology.
Status: Ongoing.
Results: Not available at this time.
Coordination: VA, DoD, HHS
Chronic Fatigue Syndrome (CFS)
Action: VAMC, East Orange, NJ, and VA Environmental Epidemiology Service (EES).
Purpose: A pilot study involving Persian Gulf War veterans who exhibited possible CFS when examined for the Persian Gulf Registry. The veterans will be mailed a questionnaire, and their responses will be evaluated by the VAMC research team. A case-reference group analysis will be conducted to determine risk factors associated with possible CFS.
Status: Ongoing.
Results: Not available at this time.
Coordination: VAMC, East Orange, NJ, and VA EES.
The following activities are evaluations and should not be considered research. The findings of these evaluation programs cannot be used to derive specific conclusions about a causal relationship between military service during Operation Desert Shield/Storm and any potential health problems. However, these clinical evaluation programs are important in the development of hypotheses that can be tested using rigorous epidemiological, clinical, and basic science approaches.
Health Surveillance of Persian Gulf Veterans - Persian Gulf War Veterans Health Registry
Action: VA Environmental Epidemiology Service (EES).
Purpose: In response to Public Law 102-585, VA has constructed a Registry computerized database derived from diagnostic examinations and interviews administered to Persian Gulf veterans at VA Medical Centers (VAMCs) and out-patient Clinics. The Registry provides concerned veterans medical evaluations and medical care. This registry (which includes over 39,000 veterans as of December 1994) provides VA the opportunity to identify the types of health problems reported by this self-selected group of veterans.
Status: Ongoing. A uniform, comprehensive case-assessment protocol has been developed by VA and coordinated with DoD to evaluate individuals with unexplained illnesses after Persian Gulf service. The initial step toward diagnosis of medical problems possibly related to Gulf service remains the Phase 1, Persian Gulf Registry examination. For those individuals whose health problems require further evaluation, this protocol provides a comprehensive consultative/diagnostic examination.
Results: Registry results updated every three months.
Coordination: VA, DoD, and HHS.
Pilot Clinical Program to Evaluate Medical and Psychological Effects of Exposure to Environmental Hazards
Action: VAMC Birmingham, AL
Purpose: To evaluate medical and psychological effects of exposure to environmental hazards. Results of examinations provided to veterans on VA's Persian Gulf Registry are reviewed to determine if these individuals should be called back for further testing. Veterans with possible exposure to environmental hazards are screened and evaluated with a comprehensive battery of neuropsychological tests.
Status: Ongoing. Over 400 veterans have been screened for symptoms related to possible environmental exposures, and 60 veterans have completed a comprehensive, standardized, neuropsychological evaluation protocol.
Results: Not available at this time.
Coordination: VA, DoD and HHS.
Health Surveillance of Persian Gulf Veterans - Patient Treatment File (PTF)
Action: VA Environmental Epidemiology Service (EES).
Purpose: As a part of the on-going health surveillance of Persian Gulf veterans, VA inpatient medical information on Gulf veterans is closely monitored and reviewed in comparison to Gulf-era veterans.
Status: Ongoing. Review of primary discharge diagnoses currently is ongoing.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.
Children of Persian Gulf Veterans in Mississippi
Action: VAMC Jackson, MS, Mississippi State Department of Health, and Centers for Disease Control and Prevention (CDC).
Purpose: Examination of children born to Persian Gulf veterans from four National Guard units and detachments for evidence of possible health effects related to their parents' service. In cooperation with the CDC and the Mississippi State Department of Public Health, the VAMC in Jackson, MS, requested the medical records of 55 children born to Persian Gulf Veterans for clinical review.
Status: Complete.
Results: Final report released December 1994.
Coordination: VA, HHS, and DoD.
VA Persian Gulf Expert Scientific Committee
Action: VA.
Purpose: The objectives of this chartered advisory committee are to advise the VA Assistant Chief Medical Director for Public Health and Environmental Hazards, and, subsequently, the VA Under Secretary for Health and Secretary of the VA, about medical findings affecting Persian Gulf era veterans. The Committee consists of 18 members selected on the basis of high professional achievement, expertise in injuries which might be related to Persian Gulf duty, active duty military background, and experience with veterans' organizations.
Status: Ongoing. The Persian Gulf Expert Scientific Committee has met six times.
Results: Not available at this time.
Coordination: VA, DoD, and HHS.