TO: Secretary William Perry, Department of Defense
Secretary Donna Shalala, Department of Health and Human Services
Secretary Jesse Brown, Department of Veterans Affairs

RE: Final Report

DA: December 31, 1996

On behalf of the Presidential Advisory Committee on Gulf War Veterans' Illnesses, I am pleased to transmit our Final Report. Over the past 16 months, the Committee has analyzed the full range of the government's outreach, medical care, research, chemical and biological weapons, and coordination activities pertinent to Gulf War veterans' illnesses. We also investigated short- and long-term health effects of Gulf War risk factors.

Together with our February 1996 Interim Report, we make several recommendations we believe can improve our government's approach to addressing the concerns of the men and women who served our country during Operations Desert Shield/Desert Storm. We emphasize, however, that in the main these are suggestions to fine-tune the government's programs on Gulf War health matters. The Committee has concluded that in all areas save one, the government has responded with a comprehensive series of measures to address Gulf War veterans' illnesses.

Many veterans clearly are experiencing medical difficulties connected to their service in the Gulf War. First and foremost, continuing to provide clinical care to evaluate and treat veterans' illnesses is vital. At the same time, however, a causal link between a single factor and the symptoms Gulf War veterans currently report remains elusive. And while the Committee finds that stress is likely to be an important contributing factor to Gulf War veterans' illnesses, the story is by no means complete: Veterans, their physicians, and policymakers clearly stand to benefit from the broad array of ongoing research.

This benefit can only be achieved with a thoughtful, inclusive dialogue between veterans and your Departments. In light of public skepticism arising from recent revelations related to chemical weapons, the Committee strongly believes that a sustained risk communication effort is the only way to repair what many believe has been a breach of the government's compact with Gulf War veterans. This effort cannot begin soon enough.

The Committee is pained by the current atmosphere of government mistrust that now surrounds every aspect of Gulf War veterans' illnesses. It is regrettable-but also understandable. Our investigation of the Department of Defense's efforts related to chemical weapons led us to conclude these early efforts have strained public trust in our government. Hence, evidence of possible chemical warfare agent exposures during the Gulf War must be thoroughly evaluated by a group independent of DOD. This process must be conducted in an open manner and include veterans. The Committee recognizes that in November 1996 DOD announced it was expanding its efforts related to low-level CW agent exposure. These initiatives-combined with independent, vigorous oversight-could begin to restore public confidence in the government's investigations of possible incidents of CW agent exposure.

In closing, the Committee notes that in preparing this report, we relied on the generosity of hundreds of citizens committed to addressing concerns about Gulf War veterans' health. We gratefully acknowledge the significant time and effort that individuals within and outside government devoted to our effort-their contributions were invaluable.

Lastly, the Committee has been fortunate to have a talented and dedicated staff: This Final Report would not have been possible without them. The Committee members, staff, and I thank you for the unique opportunity to contribute to this critically important issue.

Joyce C. Lashof, M.D.
Committee Chair

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