President Clinton established the Special Oversight Board by Executive Order 13075 in response to a recommendation from the Presidential Advisory Committee on Gulf War Illnesses (PAC). The Board's charter (Appendix C) called for it to "provide advice and recommendations [and oversight] ... of Department of Defense investigations into possible detections of, and exposures to, chemical or biological weapons agents and environmental and other factors that may have contributed to gulf war illnesses ... [and to provide an] overall evaluation of DoD's plan for and progress toward the implementation of the 12 recommendations contained in the PAC's Special Report" (see Chapter 5).

Board operations began in June 1998 by focusing on the work of the Office of the Special Assistant for Gulf War Illnesses (OSAGWI), the primary DoD agency responsible for coordinating DoD's Gulf War investigations in this area of concern. The Board solicited the opinions of veterans groups, individual veterans, and scientists researching the etiologies of Gulf War illnesses. Since the release of its Interim Report in August 1999, the Board has conducted four public hearings and eight monthly meetings that have included presentations from DoD and Department of Veterans Affairs agencies (VA).

This final report addresses:

The Transition from OSAGWI to OSAGWIMRMD

The Deputy Secretary of Defense established OSAGWI on November 12, 1996, following DoD revelations that U.S. and coalition forces may have been exposed to low-level nerve agents from the destruction of Iraqi ammunition stores at Khamisiyah, Iraq. OSAGWI endeavored to determine the causes of Gulf War illnesses, to ensure that veterans were receiving proper care, and to recommend to the Secretary of Defense changes in doctrine, policy, and procedures to reduce the risks to troops during future deployments. OSAGWI has published seventeen case narratives and four environmental exposure reports as a result of its investigations into possible chemical and biological incidents and into environmental factors that may have contributed to adverse health outcomes. In addition, OSAGWI has devoted considerable effort to providing veterans, military personnel, and the public with timely and accurate information regarding Gulf War illnesses and related issues. Because of the success of OSAGWI's efforts and the need for continued research into the causes of Gulf War undiagnosed illnesses, the Board recommended that DoD create a follow-on organization to OSAGWI. This new organization, OSAGWIMRMD, will not only continue to focus on Gulf War illnesses but also will examine future force health protection issues.

OSAGWI Case Narratives

As of November 30, 2000, the Board has reviewed fourteen original and nine revised case narratives released by OSAGWI and OSAGWIMRMD (see Appendix F). The Board finds OSAGWI made assessments that were consistent with available evidence in all of its case narratives regarding the presence of chemical and biological warfare agents. The only known potential exposure of U.S. personnel to chemical warfare agents remains the accidental low-level release of nerve agents during demolition operations at Khamisiyah, Iraq, in March 1991.

OSAGWI Environmental Exposure Reports

As of November 30, 2000, the Board has reviewed three original and two revised environmental exposure reports (see Appendix F). The Board finds OSAGWI made assessments in each of its reports regarding environmental exposures that were consistent with available evidence. In particular, the Board concurs with the conclusions in the report on depleted uranium (DU) that available evidence does not support claims that DU caused or is causing the undiagnosed illnesses (or diagnosed illnesses) from which some Gulf War veterans still suffer. The Board agrees with the report on Chemical Agent Resistant Coating (CARC) that this special camouflage paint posed a health hazard only to the approximately 200 personnel who participated in spray-painting operations. The Board concurs with the reports on oil well fires that contaminant concentrations (less particulate matter) in the smoke were below those known to cause short- or long-term health effects and that, except for the possibility of exacerbating some pre-existing respiratory conditions, long-term health effects are unlikely. However, ongoing research must be completed and assessed before OSAGWIMRMD can make a final determination on oil well fires.

Presidential Advisory Committee Special Report Recommendations

The Board addressed the twelve PAC recommendations during several of its monthly meetings. Representatives from DoD, VA, and the Department of Health and Human Services (DHHS) described each agency's efforts to implement the recommendations. The Board has determined that DoD properly implemented ten of the recommendations. The Board advised DoD to take no further action on two recommendations:

1) "The White House should develop a plan to ensure Gulf War veterans and the public have access to and can be represented in the future deliberations about possible CBW agent exposures." The formation of the Presidential Special Oversight Board accomplished this recommendation.

2) "DoD should identify all individuals within a 300-mile radius from the Khamisiyah pit and conduct an additional, complementary notification." The Board has determined that OSAGWI's intensive analyses of the Khamisiyah event, with the subsequent revision of potential troop exposures, fulfilled the intent of this recommendation.

Overview of Gulf War Illnesses

The Board reviewed numerous published scientific studies on Gulf War illnesses. The Board also heard direct testimony from many of the primary authors of these studies. Based on this information, the Board evaluated ten potential exposures possibly associated with Gulf War illnesses. These exposures include: biological warfare agents; chemical warfare agents; depleted uranium; indigenous infectious diseases; oil well fires; pesticides; pyridostigmine bromide; sand; vaccines; and stress.

The Board makes the following conclusions:

The Role of Stress as a Contributing Factor in Gulf War Undiagnosed Illnesses

The Board concludes that stress is likely a primary cause of illness in at least some Gulf War veterans; it is a likely secondary factor in potentiating other causes of undiagnosed illnesses among some Gulf War veterans. The Board recognizes that veterans suffering from undiagnosed illnesses, even if caused by deployment stress, have real medical problems that pose a significant disruption in their lives.

An unfortunate reluctance exists on the part of the American public, some members of Congress, and especially among some members of the veteran community to recognize the impact that stress can have on an individual. These attitudes stem from a misunderstanding of the very real physiological and biochemical impact that stress can have on the human body. Stress can lead to genuine illnesses. No physician or researcher familiar with the effects of stress minimizes the suffering that patients often experience. The symptoms are indeed real; they are not imagined and they are not "all in the head." The fact that stress is a likely factor in some Gulf War veterans' illnesses does not imply that other potential exposures played no role. This issue requires continued research. The Board commends DoD for recognizing the role of stress in deployment and in combat and for developing and implementing programs to address this issue.

Lessons Learned in the Gulf War and Ongoing Initiatives

The Board commends the Departments of Defense, Veterans Affairs, and Health and Human Services for the many programs that they have initiated or will shortly implement to promote the health of service members and their families following future deployments.

These programs include:

Findings, Recommendations, and Observations




The Board included twelve recommendations in its Interim Report. DoD and OSAGWI have complied or are complying with the eight recommendations that remain valid.

The Board believes that the other four recommendations no longer apply due to policy changes and other factors:

This report, entitled Iraqi Chemical Warfare: Analysis of Information Available to DoD, is also known as the Mitre Report. The report was commissioned by the Office of the Assistant to the Secretary of Defense for Intelligence Oversight.