VA, DOD, HHS, and other federal agencies  initiated research and investigations into these health concerns and the  consequences of possible hazardous exposures. 2.) Most Federally Funded Gulf War Illnesses Research Projects and Investigations Are Complete, but VA Has Not Collectively Analyzed Research Findings to Determine the Status of Key Research Questions

More than 80 percent of the 240 federally funded Gulf War illnesses  research projects have been completed. In recent years, funding for this  research has decreased, federal research priorities have expanded to  incorporate the long-term health effects of all hazardous deployments, and  interagency coordination of Gulf War illnesses research has waned. In a separate but related effort, as of April 2003, all of  DOD’s Gulf War investigations were complete. DOD has provided the most  funding for Gulf War illnesses research, funding about 74 percent of all  federal Gulf War illnesses research within this time frame. 1.) Additionally, VA has not reassessed the extent to which the collective  findings of completed Gulf War illnesses research projects have addressed  the 21 key research questions developed by the RWG. The  only assessment of progress in answering these research questions was  published in 2001, when findings from only about half of all funded Gulf  War illnesses research were available. Moreover, the summary did not  identify whether there were gaps in existing Gulf War illnesses research or  promising areas for future research. In 2000, we reported that  without such an assessment, many underlying questions about causes,  course of development, and treatments for Gulf War illnesses may remain  unanswered. Generally, these reports concluded that there were limited  exposures by troops to some hazards and limited or no short- or long-term  adverse effects expected from these exposures. Some Efforts Are Under Way to Monitor Cancer Incidence among Gulf War Veterans, but Research Limitations May Impede Reliability of Results

As of April 2004, federal agencies had funded seven research projects  related to cancer incidence among Gulf War veterans, four of which have  been completed. Few Research Projects Related to Cancer Incidence in Gulf War Veterans Have Been Funded

Of the 240 federally funded research projects on Gulf War illnesses, VA  officials stated that only 7 were related to cancer incidence in Gulf War  veterans—accounting for about 3 percent of the entire research portfolio. Research related to cancer incidence in Gulf War veterans may also be  hampered by incomplete federal data on the health characteristics of Gulf  War veterans. However, VA and RAC are  exploring ways to improve information sharing, including VA’s hiring of a  senior scientist who would both guide the agency’s Gulf War illnesses  research and serve as the agency’s liaison to provide routine updates to  RAC. RAC Officials Cite VA’s Poor Information Sharing and Limited Collaboration as Impediments in Meeting Its Mission

According to RAC officials, VA senior administrators’ poor information  sharing and limited collaboration with the committee about Gulf War  illnesses research initiatives and program planning may have hindered  RAC’s ability to achieve its mission of providing research advice to the  Secretary of VA. RAC is required by its charter to provide advice and make  recommendations to the Secretary of VA on proposed research studies,  research plans, and research strategies relating to the health consequences  of service during the Gulf War. However, most of these changes had not been formalized at the time of  our review. Appendix III: Charter for VA’s Research Advisory Committee on Gulf War Veterans’ Illnesses

Appendix IV: Comments from the Department of Veterans Affairs
Why GAO Did This Study

More than a decade after the 1991 Persian Gulf War, there is continued interest in the federal response to the health concerns of Gulf War veterans. Gulf War veterans' reports of unexplained illnesses and possible exposures to various health hazards have prompted numerous federal research projects on Gulf War illnesses. This research has been funded primarily by the Department of Veterans Affairs (VA), the Department of Defense (DOD), and the Department of Health and Human Services. GAO is reporting on (1) the status of research and investigations on Gulf War illnesses, (2) the efforts that have been made by VA and DOD to monitor cancer incidence among Gulf War veterans, and (3) VA's communication and collaboration with the Research Advisory Committee on Gulf War Veterans' Illnesses (RAC).

What GAO Found

Most federally funded Gulf War illnesses research projects and investigations are complete, but VA--the agency with lead responsibility for coordination of Gulf War illnesses issues--has not yet analyzed the latest research findings to identify whether there are gaps in current research or to identify promising areas for future research. As of September 2003, about 80 percent of the 240 federally funded medical research projects for Gulf War illnesses had been completed. In recent years, VA and DOD funding for this research has decreased, federal research priorities have changed, and interagency coordination of Gulf War illnesses research has waned. In addition, VA has not reassessed the extent to which the collective findings of completed Gulf War illnesses research projects have addressed key research questions. The only assessment of progress in answering these research questions was published in 2001, when findings from only about half of all federally funded Gulf War illnesses research were available. Moreover, it did not identify whether there were gaps in existing Gulf War illnesses research or promising areas for future research. This lack of comprehensive analysis leaves VA at greater risk of failing to answer unresolved questions about causes, course of development, and treatments for Gulf War illnesses. In a separate effort, DOD has conducted 50 investigations since 1996 on potential hazardous exposures during the Gulf War. Generally, these investigations concluded that there were limited exposures by troops to some hazards and, at most, limited short- or long-term adverse effects expected from these exposures. As of April 2003, all investigations were complete. Federal agencies have funded seven research projects related to cancer incidence among Gulf War veterans. However, several limitations exist that affect research related to cancer incidence. For example, some cancers may take many years to develop and be detected. In addition, some research projects studying cancer incidence have not studied enough Gulf War veterans to reliably assess cancer incidence. Research may also be impeded by incomplete federal data on the health characteristics of Gulf War veterans. RAC's efforts to provide advice and make recommendations on Gulf War illnesses research to the Secretary of VA may have been hampered by VA senior administrators' incomplete or unclear information sharing and limited collaboration on research initiatives and program planning. VA and RAC are exploring ways to improve collaboration, including VA's hiring of a senior scientist who would both guide VA's Gulf War illnesses research and serve as the agency's liaison for routine updates to the advisory committee. However, most of these changes had not been finalized at the time of our review.