They found that research efforts to determine the causes of the veterans’ illnesses were hampered by incomplete data on (1) the names and locations of deployed personnel, (2) the exposure of personnel to environmental health hazards, (3) changes in the health status of personnel while deployed, and (4) immunizations and other health services for personnel while deployed. Subsequently, in May 1997, we reviewed the actions DOD had taken since the Gulf War to improve its medical surveillance capabilities. DOD and VA Had No Systematic Approach to Monitoring Gulf War Veterans’ Health After Initial Examination

DOD and VA officials claimed that regardless of the cause of Gulf War veterans’ illnesses, the veterans had received appropriate and effective symptomatic treatment. Beyond the initial examination, neither DOD nor VA had mechanisms for monitoring the quality, appropriateness, or effectiveness of these veterans’ care or clinical progress, and they had no plans to establish such mechanisms. Aside from the hypotheses being emphasized in the research being done, we found that the bulk of ongoing federal research on Gulf War veterans’ illnesses was focused on the epidemiological study of the prevalence and cause of the illnesses. Support for Key Government Conclusions Was Weak or Subject to Alternative Interpretations

Six years after the war, little was conclusively known about the causes of Gulf War veterans’ illnesses. The magnitude of exposures to chemical agents has not been fully resolved. Third, many Army personnel did not receive required postdeployment medical assessments. In our report on the deployment and medical records for servicemembers deployed to Bosnia, we recommended that the Secretary of Defense direct the Assistant Secretary of Defense for Health Affairs, along with the military services, the Joint Chiefs of Staff, and the Unified Commands, as appropriate, to expeditiously complete and implement a DOD-wide policy on medical surveillance for all major deployments of U.S. forces, using lessons learned during Operation Joint Endeavor and the Gulf War; develop procedures to ensure that medical surveillance policies are implemented, to include emphasizing (a) the need for unit commanders to ensure that all servicemembers receive required medical assessments in a timely manner and (b) the need for medical personnel to maintain complete and accurate medical records; and develop procedures for providing accurate and complete medical assessment information to the centralized database. It is important to note that GAO has not evaluated DOD’s, VA’s, and the PGVCB’s proposed plans regarding the treatment and research for Gulf War veterans’ illnesses.
Why GAO Did This Study

GAO discussed two of its recent reports on health care issues of military personnel deployed for military operations overseas, focusing on the: (1) adequacy of the mechanisms used by the Department of Defense (DOD) and the Department of Veterans Affairs (VA) to monitor the quality, appropriateness, and effectiveness of Gulf War veterans' care and to follow up on their clinical progress over time; (2) government's research strategy for studying Gulf War veterans' illnesses and the methodological problems posed in its studies; (3) consistency of key officials conclusions with available data on the causes of the Gulf War veterans' illnesses; and (4) extent to which DOD's efforts for Operation Joint Endeavor in Bosnia were successful in overcoming the medical surveillance problems encountered during the Gulf War.

What GAO Found

GAO noted that: (1) in it's report on Gulf War veterans' illnesses, GAO noted that while DOD and VA had provided care to eligible Gulf War veterans, they had no system for following up on their health to determine the effectiveness of their care after initial treatment; (2) also, because of methodological problems and incomplete medical records on the veterans, research has not come close to providing conclusive answers on the causes of the illnesses; (3) given the data needed versus what is available, which is primarily anecdotal, it will be very difficult, if not impossible, to determine the causes of the illnesses; (4) the support for some official conclusions regarding stress, leishmaniasis, and exposure to chemical agents were weak or subject to other interpretations; and (5) regarding GAO's report on the medical surveillance of servicemembers deployed in Bosnia, while GAO found that DOD had improved its capability to monitor and assess the effects of deployments on servicemembers' health since the Gulf War, certain problems remained: (a) the database containing deployment information was inaccurate; (b) not all troops received postdeployment medical assessments; and (c) many of the medical records GAO reviewed were incomplete.