Following publication of the interim Depleted Uranium (DU) Environmental Exposure Report (EER) on August 4, 1998, comments were received from various veterans and from the Presidential Special Oversight Board. In addition, as part of the overall assessment of depleted uranium, the General Accounting Office (GAO) also published its report, which addressed several areas of our interim report. In this updated report, we include information based on additional research, interviews with veterans, consultation with subject matter experts, and new information received since the publication of the interim report. This report follows the same format as our interim 1998 report with important updates on the latest findings of:

• the Baltimore Veterans Affairs (VA) Medical Center DU Follow-up Program for victims of "friendly-fire";
• the expanded VA/DoD DU Medical Follow-up Program initiated in 1998;
• the Agency for Toxic Substances and Disease Registry's Toxicological Profile for Uranium;
• RAND's A Review of the Scientific Literature As It Pertains to Gulf War Illnesses, Volume 7, Depleted Uranium;
• the Armed Forces Radiobiology Research Institute's research efforts;
• the Lovelace Respiratory Research Institute's research efforts;
• the Institute of Medicine's report entitled "Gulf War and Health, Volume 1, Depleted Uranium, Sarin, Pyriodostigmine Bromide, Vaccines." and
• US Army's Center for Health Promotion and Preventive Medicine exposure estimates.

This report reaches conclusions about DU's possible role in causing Gulf War veterans' illnesses that are consistent with the new scientific and medical information available since our first DU report was written and on guidance from the PSOB. Our 1998 report, based on information available at the time, concluded:

Based on data developed to date, the Office of the Special Assistant believes that while DU can pose a chemical toxicity and radiological hazard under specific conditions, the available evidence does not support claims that DU caused or is causing the undiagnosed illnesses some veterans are experiencing.

The PSOB endorsed this statement based on its understanding of the information presented and on its own independent study that found, "…after review of the available evidence to date, exposure to DU is unlikely to be the cause of the unexplained illnesses affecting Gulf War veterans."^[666]

This report considers additional scientific and medical information that has become available since the first report. This information includes broad scope reviews of the potential health effects from uranium prepared by RAND, ATSDR, and the IOM. It also considers results of USACHPPM's revised and expanded health risk assessments for Levels I, II, and III, as well as published results of the Baltimore VA follow-up program. Taking all this information together, this report makes the following conclusion:

Based on data developed to date, we believe that while DU could pose a chemical hazard at high intakes, Gulf War veterans did not experience intakes high enough to affect their health. Furthermore, the available evidence indicates that due to DU's low-level radioactivity, adverse radiological health effects are not expected. The available scientific and medical evidence to date does not support claims that DU caused or is causing Gulf War veterans' illnesses. Nevertheless, medical research to date has suggested several areas of concern for soldiers with embedded DU fragments that warrant further medical follow-up which DoD and the VA are committed to perform.

This conclusion also provides appropriate cautions with respect to the recognized uncertainties in the basic scientific knowledge about uranium and its possible effects. Throughout our paper we cite ATSDR and RAND statements indicating that because of DU's low radioactivity, radiological effects are not expected. We recognize that the current state of radiation science predicts that some risk of cancer exists regardless of dose even if it cannot be distinguished from other causes. Our conclusion is consistent with IOM's finding that no cause-effect relationship has been established between exposure to uranium and suspected adverse health outcomes; i.e., renal dysfunction and lung cancer at cumulative exposures less than 20 rem. We further recognize that concerns based on the known latency period of certain radiation effects as well as those from the preliminary findings of DOD sponsored medical research require further medical evaluation before a complete assessment can be evaluated. Nevertheless, we phrased our conclusions to account for the additional knowledge about DU while providing caution in reaching a final conclusion that is still the subject of scientific research.

Based on new information from veterans and from the services, we expanded the following discussions:

• Outreach efforts to identify and contact each surviving member of friendly-fire incidents revealed additional background information on the circumstances surrounding the incidents and the nature of the veterans' injuries and activities immediately after the incidents.
• Veterans involved with the various tank fires provided further insight into the disposition of the munitions and tanks after the fires, as well as the fact that seven soldiers involved in the April 13, 1991 tank fire submitted urine uranium samples, which were all below minimum detectable levels.
• An interview of a munitions specialist involved with cleanup activities at the crash of the A-10 aircraft provided greater detail of the disposition and the extent of the aerosolization of DU ammunition.
• Discussions with technical experts and individuals responsible for welding operations augmenting the armor of M1 tanks provided further confirmation that DU armor plates were not involved.
• We identified the unit involved with an ammunition explosion allegedly involving DU munitions, and further interviews indicated that DU munitions were not involved.
• We added eight research summaries providing new information on the morphological characteristics of particles formed in hard impacts, the percentage of "hits and misses" for the A-10 under optimum combat conditions, the long-term ecological effects of exposure to uranium, contamination levels from the Bradley Burn Test, and soil sampling results from the Gulf theater.

In addition to this Tab, we added two other Tabs to summarize the findings of the various medical follow-up programs and comments from the General Accounting Office.

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