In late 1993, as information from initial descriptive studies became available and plans for future studies were being developed, it was evident that an assessment of the data and investigational activities was in order. Assessment activities were undertaken by the Defense Science Board (DSB), the National Institutes of Health (NIH), and the National Academy of Sciences/Institute of Medicine/Medical Follow-up Agency (IOM)
2.1 DEFENSE SCIENCE BOARD
DoD commissioned the Defense Science Board Task Force on Gulf War Health Effects. The Task Force was specifically charged with reviewing all available intelligence and reports of detection of chemical agents and toxins during Operations Desert Shield/Desert Storm (ODS/DS) and the post-conflict period. In addition, the Task Force was to review scientific and medical evidence relating the possibility of low-level exposure to chemical and biological warfare (CBW) agents to potential long term health effects. A similar review was conducted for possible industrial pollutants and other potential causes of unexplained illnesses. The DSB Task Force met six times between November 1993, and March 1994. In the course of its work, the Task Force heard presentations from a wide range of scientific and medical experts from within and outside DoD. The Task Force published its final report in June 1994 (DSB, 1994). The members of the DSB Task Force reached consensus on a number of key points, including:
1. There is "... no scientific or medical evidence that either chemical or biological warfare was deployed at any level against us, nor that there were any exposures of U.S. service members to chemical or biological warfare agents in Kuwait or Saudi Arabia."
2. There is "...no persuasive evidence that any of the proposed etiologies caused chronic illness on a significant scale in the absence of acute injury at initial exposure."
3. There is insufficient epidemiological evidence at this time "...to support the concept of any coherent `syndrome'."
Because many veterans report symptoms similar to Chronic Fatigue Syndrome (CFS), the DSB Task Force felt it would be advantageous to coordinate further research on veterans' illness in this category with ongoing studies of CFS in the civilian population.
2.2 NIH TECHNOLOGY ASSESSMENT WORKSHOP
The NIH Technology Assessment Workshop, "Persian Gulf Experience and Health", was convened April 27-29, 1994, and was co-sponsored by VA, DoD, HHS, and the Environmental Protection Agency (EPA). The expert panel addressed four issues: (1) the prevalence of unexplained illnesses; (2) whether a case definition could be developed; (3) potential etiologies of unexplained illnesses; and (4) recommendations for future research.
The panel found that insufficient epidemiological data existed to determine whether there was an increased prevalence of illnesses among veterans due to service in the Persian Gulf War (NIH, 1994). The panel also concluded that while there are several complexes or patterns of symptoms unexplained by established disease categories, it would be premature to establish a case definition. The panel could not identify a single or multiple etiology for unexplained illnesses, but noted the appearance in some Persian Gulf veterans of a newly identified form of leishmaniasis (viscerotropic leishmaniasis). The panel also suggested that the unique stresses of the Persian Gulf experience may have led to a previously unrecognized manifestation of post-traumatic stress disorder (PTSD).
2.3 NATIONAL ACADEMY OF SCIENCES/INSTITUTE OF MEDICINE/ MEDICAL FOLLOW-UP AGENCY
As directed by P.L. 102-585, VA and DoD entered into a contract with the National Academy of Sciences/Institute of Medicine/Medical Follow-up Agency (IOM) to "...review existing scientific, medical, and other information on the health consequences of military service in the Persian Gulf theater of operations during the Persian Gulf War." In contrast to the NIH Workshop, this effort was designed to conduct an assessment in greater depth, over a three year time period. As of March 1995, the IOM panel had met six times.
On January 4, 1995, the IOM issued a report "Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Action" (IOM, 1995). In general the IOM panel endorsed the DSB and NIH findings of no single disease entity with no single etiology. The panel also strongly emphasized the importance of population-based studies. The panel found no evidence that either chemical or biological warfare (CBW) agents were used against coalition troops during the Persian Gulf conflict and, as a consequence, recommended that this not be a factor in considerations of the causes of Persian Gulf veterans' illnesses. The panel also urged better coordination of research within the federal sector.