DOD and VA Have No Systematic Approach to Monitoring Gulf War Veterans’ Health After Initial Examination

Over 100,000 of the approximately 700,000 Gulf War veterans have participated in DOD and VA health examination programs. Of those veterans examined by DOD and VA, nearly 90 percent have reported a wide array of health complaints and disabling conditions. Without follow-up of their treatment, DOD and VA cannot say whether these ill veterans are any better or worse today than when they were first examined. Federal Research Strategy Lacks a Coherent Approach

Federal research on Gulf War veterans’ illnesses and factors that might have caused their problems has not been pursued proactively. We found that the bulk of ongoing federal research on Gulf War veterans’ illnesses focuses on the epidemiological study of the prevalence and cause of the illnesses. We found that the ongoing epidemiological federal research suffered from two methodological problems: a lack of a case definition, and absence of accurate exposures data. Without valid and reliable data on exposures and the multiplicity of agents to which the veterans were exposed, researchers will likely continue to find it difficult to detect relatively subtle effects and to eliminate alternative explanations for Gulf War veterans’ illnesses. In summary, the ongoing epidemiological research will not be able to provide precise, accurate, and conclusive answers regarding the causes of veterans’ illnesses because of these formidable methodological problems. Support for Key Government Conclusions Is Weak or Subject to Alternative Interpretations

Six years after the war, little is conclusively known about the causes of Gulf War veterans’ illnesses. Recommendations to DOD and VA

Because of the numbers of Gulf War veterans who continue to experience illnesses that may be related to their service during the Gulf War, we recommended in our report that the Secretary of Defense, with the Secretary of Veterans Affairs, (1) set up a plan for monitoring the clinical progress of Gulf War veterans to help promote effective treatment and better direct the research agenda and (2) give greater priority to research on effective treatment for ill veterans and on low-level exposures to chemicals and their interactive effects and less priority to further epidemiological studies.
Why GAO Did This Study

GAO discussed the results of its study on the government's clinical care and medical research programs relating to illnesses that members of the armed forces might have contracted as a result of their service in the Persian Gulf War, focusing on the: (1) efforts of the Departments of Defense (DOD) and Veterans Affairs' (VA) to assess the quality of treatment and diagnostic services provided to Gulf War veterans and their provisions for follow-up of initial examinations; (2) government's research strategy to study the veterans' illnesses and the methodological problems posed in its studies; and (3) consistency of key official conclusions with available data on the causes of the veterans' illnesses.

What GAO Found

GAO noted that: (1) over 100,000 Gulf War veterans have participated in DOD and VA health examination programs; (2) of those veterans examined by DOD and VA, nearly 90 percent reported a wide array of health complaints and disabling conditions; (3) although efforts have been made to diagnose veterans' problems and care has been provided to many eligible veterans, neither DOD or VA has systematically attempted to determine whether ill Gulf War veterans are any better or worse today than when they were first examined; (4) federal research on Gulf War veterans' illnesses and factors that might have caused their problems has not been pursued proactively; (5) the majority of the research has focused on the epidemiological study of the prevalence and cause of Gulf War illnesses rather than the diagnosis, treatment, and prevention of them; (6) while this epidemiological research will provide descriptive data on veterans' illnesses, methodological problems are likely to prevent researchers from providing precise, accurate, and conclusive answers regarding the causes of veterans' illnesses; (7) ongoing epidemiological federal research suffered from two methodological problems: a lack of case definition, and absence of accurate exposure data; (8) without valid and reliable data on exposures and the multiplicity of agents to which the veterans were exposed, researchers will likely continue to find it difficult to detect relatively subtle effects and to eliminate alternative explanations for Gulf War veterans' illnesses; and (9) support for some official conclusions regarding stress, leishmaniasis (a parasitic infection), and exposure to chemical agents was weak or subject to alternative interpretations.