A Guide to Gulf
War Veterans Health
War Syndromes and Their
Evaluation: From the U.S. Civil War to the Persian Gulf War
De Meirleir D, et al.
A 37 kDa 2-5A Binding Protein as a Potential Biochemical Marker for Chronic
Fatigue Syndrome. American Journal of Medicine 2000; 108: 99-105.
The hypothesis of this study done in Belgium and France is that there
develops a problem with the regulation of the antiviral response, resulting
in chronic fatigue syndrome (CFS).
Smith TC, Gray GC, and
Knoke JD. Is Systemic Lupus Erythematosis, Amyotrophic Lateral Sclerosis,
or Fibromyalgia Associated with Persian Gulf War Service? An Examination
of Department of Defense Hospitalization Data. American Journal of Epidemiology
2000; 151: 1053-9. The authors studied military hospitalizations of
active duty personnel, comparing Gulf War veterans (GWV) (551,841) to
non-deployed veterans (NDV) (1,478,704) who remained on active duty as
of July 31, 1991.
Veterans Coordinating Board. Unexplained Illnesses Among Desert Storm
Veterans. Arch Int Med 1995; 155: 262-268. Summarizes the frequency
of unexplained illnesses among veterans evaluated by the DVA, the case
assessment protocol being used by DVA and DoD for GW veterans, and the
possible health risks unique to the GW.
Stretch, R.H. et
al. Physical Health Symptomatology of Gulf War-Era Service Personnel from
the States of Pennsylvania and Hawaii. Military Medicine 1995; 160: 131-136.
Congressionally-mandated questionnaire survey of veterans (active, reserve,
Guard) in Pennsylvania and Hawaii. Response rate was 31%. Deployed veterans
reported significantly more physical health symptoms and more physician
visits during the previous two weeks than non-deployers.
Southwick, S.M. et
al. Trauma-Related Symptoms in Veterans of Operation Desert Storm: A 2-Year
Follow-Up. Am J Psychiatry 1995; 152: 1150-1155. This paper reports
on the continuation of a study of 84 soldiers from two National Guard
units who had served in the GW. Sixty two completed evaluations at 2 years.
Depending upon the diagnostic criterion used, six or eight veterans met
the criteria for PTSD at 2 years.
The Iowa Persian Gulf Study
Group. Self-reported Illness and Health Status Among Gulf War Veterans.
A Population-Based Study. JAMA 1997; 277: 238-245. In this study of
Iowans from the National Guard, Reserve, or active component who were
on active duty during the Gulf War, a stratified random sample selected
4,886 subjects of whom 3,695 (76%) completed a structured telephone interview.
Personnel deployed to the Gulf reported significantly higher prevalence
rates of symptoms of depression, PTSD, chronic fatigue, cognitive dysfunction,
bronchitis, asthma, fibromyalgia, alcohol abuse, anxiety, and sexual discomfort.
Most of the self-reported GW exposures were significantly related to many
of the medical and psychiatric conditions.
Hyams, K.C. et al. The Impact
of Infectious Diseases on the Health of U.S. Troops Deployed to the Persian
Gulf During Operations Desert Shield and Desert Storm. Clinical Infectious
Diseases 1995; 20: 1497-1504. This paper assesses the impact of infectious
diseases (ID) on operations in the Persian Gulf based upon published reports
and data on the surveillance of 40,000 Marine Corps personnel in northeastern
Saudi Arabia. Leading ID were diarrheal disease and acute upper respiratory
infections. 19 cases of cutaneous leishmaniasis (expected) and 12 cases
of viscerotropic leishmaniasis (unexpected) occurred. The anticipated
serious threat from sandfly fever never materialized. There were one case
of West Nile fever, seven cases of malaria (Plasmodium vivax),
three cases of Coxiella burnetii infection (Q fever), and two cases of
meningococcal disease. The favorable experience with infectious diseases
Krivda, S.J. et al. Cutaneous
Findings in Gulf War Veterans. Arch Dermatol 1996; 132: 846-847. Studied
were 111 patients with dermatologic complaints between June 1994 and June
1995. Sixty-two different disorders were found. Authors comment that all
problems were diagnosable and not unusual.
et al. War Syndromes and Their Evaluation: From the U.S. Civil War to
the Persian Gulf War. Ann Intern Med 1996; 125: 398-405. Authors reviewed
and reported on articles and books about war-related illnesses published
since 1863. Poorly understood war syndromes have been associated with
armed conflicts since the Civil War. No single recurring illness is apparent.
Haley, R.W. et al. Is There
a Gulf War Syndrome ? Searching for Syndromes by Factor Analysis of Symptoms.
JAMA 1997; 277:215-222. Authors attempted to study 606 GW veterans
from the 24th Reserve Naval Mobile Construction Battalion (RNMCB-24).
Through factor analysis, the authors derived 6 different groups of symptoms
which they termed "Syndromes" in 63 (25%) of the participants.
The authors conclude that the reported symptom Syndromes may represent
generalized neurologic injuries possibly due to exposures to neurotoxins
occurring during the GW.
Haley, R.W. et al. Evaluation
of Neurologic Function in Gulf War Veterans. JAMA 1997; 277:223-230.
Building upon the above study, the authors compared 23 GW veterans with
the most severe symptoms of Syndromes 1, 2, and 3 (cases) with two groups
of veterans with no serious health problems. The 23 cases had more evidence
of brain dysfunction by several neuropsychological tests. Neurophysiological
and audiovestibular tests among cases generally did not exceed normal
limits for the testing laboratory, but the results were significantly
more in the abnormal direction in the cases than in the controls. The
authors conclude that the cases' scores "more in the abnormal direction
on objective tests of neurologic function" support their hypothesis
that "a subset of veterans with Gulf War-related illnesses appears
to have a subtle neurologic injury or illness contracted in the war."
Haley, R.W. and Kurt,
T.L. Self-reported Exposure to Neurotoxic Chemical Combinations in the
Gulf War. JAMA 1997; 277: 231-237. The authors administered surveys
to the 249 participants in the study above. The authors conclude that
they have demonstrated associations between specific risk factors (especially
cholinesterase-inhibiting compounds) and systematically defined syndromes
in GW veterans. They liken the syndromes to variants of organophosphate-induced
delayed polyneuropathy (OPIDP). The article's discussion elaborates on
the mechanism of OPIDP and the related scientific evidence which is compatible
with their hypothesis. They discuss at length the controversy about whether
or not chemical agents which do not cause acute symptoms can cause delayed
Unwin, C. et al. Health of UK
Servicemen Who Served in Persian Gulf War. Lancet (1999) 353: 169-178.
British servicemen who served in the Gulf War (GWV) were compared to those
who did not deploy to the Gulf and to others who deployed to the Bosnia
conflict. GWV reported all symptoms and conditions more frequently than
the comparison groups. Among servicemen in all three groups, perceptions
of poorer health were associated with virtually all potential risk factors
or exposures, regardless of deployment status. Patterns of symptoms were
the same in all three groups, suggesting that there is no specific "Gulf
War Syndrome." The authors plan further studies which will include
detailed examinations of symptomatic veterans and controls.
Ismail, K. et al. Is
There a Gulf War Syndrome ? Lancet (1999) 353: 179-182. The authors
used factor analysis to analyze the symptoms reported by British Gulf
War veterans and other veterans. Three factors (or groups of symptoms)
were identified and labeled mood-cognition, respiratory system, and peripheral
nervous system. Although Gulf War veterans reported a higher frequency
of symptoms than veterans who did not deploy to the Gulf and veterans
of the Bosnia deployment, the similarity in the patterns of symptoms among
all three study groups did not support the existence of a syndrome unique
to Gulf War veterans. The discussion compares this study with the two
previously published studies of Gulf War veterans which used factor analysis
(Haley, R. et al. and Fukuda, K. et al.).