The Department of Defense and OSAGWI have worked diligently to fulfill the President's directive to "leave no stone unturned" in investigating the possible causes of Gulf War illnesses.
DoD has made no effort to deliberately withhold information from the general public or from veterans concerning its investigations or findings related to Gulf War illnesses. On the contrary, DoD has made an extraordinary effort to publicize its findings through the publication of reports and newsletters, public outreach meetings, briefings to veterans and active duty service members, the creation of a toll-free hotline, and the creation of an actively updated website.
The Board finds that the revised case narrative methodology fully reflects OSAGWI procedures and, more important, provides the most accurate method for assessing the likelihood that chemical warfare agent exposures may have occurred in the Persian Gulf.
The Board finds that in each of its case narratives, OSAGWI makes assessments regarding the presence of chemical and biological warfare agents that are consistent with available evidence.
The Board finds that in each of its environmental exposure reports, OSAGWI makes assessments regarding environmental exposures that are consistent with available evidence.
The Board finds that the Department of Defense appropriately implemented ten of the twelve recommendations contained in the PAC Special Report. (DoD was not required to act on two of the recommendations.)
Recommendations
The Board recommends that OSAGWIMRMD suspend its installation visits until it can devise a more efficient vehicle for conducting town hall meetings while maintaining its informative world-wide web site, 1-800 toll-free operators, and other existing outreach initiatives. The VA should assume the lead for Gulf War illness-focused town hall meetings because veteran questions have centered on that department�s services. OSAGWIMRMD should assume a supporting role in such meetings, and the MVHCB should facilitate the transfer of responsibility from DoD to VA for Gulf War illness-focused town hall meetings. OSAGWIMRMD should use those meetings to inform the public about its new responsibilities and use DoD news media, installation visits, and other initiatives to ensure that the active and reserve components of each military service also understand the organization�s enhanced mission. (Chapter 2)
The Board concurs with Dr. Harold Sox, chairman of the recent IOM study on Gulf War exposures, that combat stress should be investigated by the IOM with the same academic and scientific rigor that was used to evaluate other Gulf War exposures whose investigation Congress mandated. (Chapter 7)
The Board recommends that OSAGWIMRMD be an active participant in the development and implementation of the life-cycle military health record. (Chapter 8)
The Board recommends that OSAGWIMRMD and the MVHCB develop their mission requirements in support of meeting the needs of the reserve components. (Chapter 8)
The Board recommends continued support and extension of the MVHCB concept, charter, and strategic plan and further encourages the respective departments to provide senior level endorsement, participation, guidance, funding, and staffing for the MVHCB. (Chapter 8)
The Board recommends that the MVHCB and OSAGWIMRMD monitor developments by DIMHRS to resolve deficiencies and duplication in personnel management systems.
(Chapter 8)
The Board recommends that DoD and OSAGWIMRMD include the "cradle to grave" health record concept for all U.S. military members in its top-ten priorities list. This should include the computerized health record currently under development. (Chapter 8)
The Board recommends that DoD, VA, and DHHS continue to apply lessons learned to their efforts to create a comprehensive health record for each veteran. The Board recommends that the MVHCB be integrated into the planning activities directed at the government computerized multidepartmental patient record concept in an ex officio status. (Chapter 8)
The Board recommends that OSAGWIMRMD and the MVHCB closely monitor the development and resourcing of DoD�s research on the health effects of low-level CWA exposures and make recommendations as appropriate to ensure continued progress in this area. (Chapter 8)
The Board recommends that the MVHCB remain the focal point for the collective efforts of its chartering sponsors and that the recommendations of the MVHCB represent a synthesis of the individual departmental efforts. (Chapter 8)
Observations
The Department of Defense has acted responsibly, decisively, and in good faith in responding to the President�s charge to "leave no stone unturned" in the search for the cause(s) of the undiagnosed illnesses from which some Gulf War veterans still suffer.
Science alone should determine whether a Gulf War illness or syndrome exists. To date, research has not validated any specific cause of these illnesses, and the general population experiences the same symptoms associated with the undiagnosed illnesses of some Gulf War veterans.
Government agencies must continue to address the challenging Gulf War veterans issues of medical research, health care delivery, and disability claims processing.
The Board strongly believes that efforts to fund non-peer-reviewed research projects do not serve the best interests of the nation or its Gulf War veterans. Researchers and clinicians who advocate "alternative" diagnostic and treatment methods, as well as those proposing more conventional approaches, should be encouraged to respond to Requests for Proposal and Broad Area Announcements with well-constructed proposals capable of passing vigorous and independent peer review.
The Board notes that the executive and legislative branches of government do not have a mechanism to budget and to appropriate funding for health care, rehabilitation, and disability compensation costs that arise after every major conflict or military deployment involving hostile fire. The two branches should develop a budgetary process that automatically incorporates funding for these post-deployment services into the operational costs of a deployment. For example, when the Secretary of Defense estimates to the President the cost of a major operational mission (e.g., Desert Storm/Desert Shield), the estimate should include an allowance for follow-on medical care and treatment for the U.S. Government participants (military and U.S. Government civilian, not contractors). This cost, when funded, could serve as a mechanism for DoD and VA to provide medical care for veterans and military personnel suffering from illnesses of unknown etiology that were not present or identified prior to the operation or deployment.
The Board believes that DoD should fully support the Millennium Cohort Study and that the servicemembers selected to participate in the program should cooperate fully. This twenty-year research project will significantly enhance the Federal Government�s and the medical community�s understanding of the long-term health consequences of military service and facilitate improved clinical care and force health protection for members of the Armed Forces. The study will provide better insight into the possible health effects of service in Bosnia, Kosovo, Southwest Asia, and future deployments and also contribute to VA�s development of services that will meet the needs of veterans who participated in overseas operations.
The Board notes that DoD and VA do not share a core set of questions used in Gulf War illness studies, especially epidemiological studies. The two agencies should consult with the CDC National Center for Health Statistics to design a core set of questions that will result in responses that are comparable with those from other national surveys (i.e., NHIS or NHANES). DoD and VA lose the advantage of comparability of response to survey data from the general population when their questionnaires are not compatible with existing surveys.
The Board believes that DoD and/or VA should conduct a time series geographical information system analysis from a random sample of deployed Gulf War veterans to identify whether any health outcome clusters occurred in the Kuwaiti Theater of Operations.
The Board notes that the U.S. Government�s haste to respond to media and public expectations for definitive answers to the unintentional release of chemical warfare agents at Khamisiyah stimulated distrust of the government among many veterans and others as inaccurate initial estimates gave way to a flurry of increasingly more accurate, yet ever changing, revisions. The Board strongly believes that the public has the right to receive timely, accurate, and supposition-free information on matters of such grave import. Accordingly, the government must acknowledge when it possesses insufficient information to make an accurate assessment and resist the temptation to make definitive statements in the absence of reliable environmental and meteorological data, in-depth modeling, and careful analysis. Failure to do so will cause some veterans and others to falsely accuse the government of a cover-up and prompt many veterans to attribute their illnesses to exposures that did not occur, could not have occurred, or were too small to cause even transient observable effects.