Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation's veterans. Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties). For the purposes of this report, the committee defined CMI as the presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories-fatigue, mood, and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic-that may overlap with but are not fully captured by known syndromes (such as CFS, fibromyalgia, and IBS) or other diagnoses. Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified. Many thousands of Gulf War veterans1 who have CMI live with sometimes debilitating symptoms and seek an effective way to manage their symptoms. Estimates of the numbers of 1991 Gulf War veterans who have CMI range from 175,000 to 250,000 (about 25-35% of the 1991 Gulf War veteran population), and there is evidence that CMI in 1991 Gulf War veterans may not resolve over time. Preliminary data suggest that CMI is occurring in veterans of the Iraq and Afghanistan wars as well. In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness recommends how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans, recommends additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty and recommends such legislative or administrative action as the IOM deems appropriate in light of the results of its review.
Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation's veterans. Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties). For the purposes of this report, the committee defined CMI as the presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories-fatigue, mood, and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic-that may overlap with but are not fully captured by known syndromes (such as CFS, fibromyalgia, and IBS) or other diagnoses. Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified. Many thousands of Gulf War veterans1 who have CMI live with sometimes debilitating symptoms and seek an effective way to manage their symptoms. Estimates of the numbers of 1991 Gulf War veterans who have CMI range from 175,000 to 250,000 (about 25-35% of the 1991 Gulf War veteran population), and there is evidence that CMI in 1991 Gulf War veterans may not resolve over time. Preliminary data suggest that CMI is occurring in veterans of the Iraq and Afghanistan wars as well. In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness recommends how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans, recommends additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty and recommends such legislative or administrative action as the IOM deems appropriate in light of the results of its review.
For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the Institute of Medicine (IOM) has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes. The fourth volume in the series, released in 2006, summarizes the long-term health problems seen in Gulf War veterans. In 2010, the IOM released an update that focuses on existing health problems and identifies possible new ones, considering evidence collected since the initial summary. Gulf War and Health: Volume 10 is an update of the scientific and medical literature on the health effects associated with deployment to the Gulf War that were identified in Volumes 4 and 8. This report reviews and evaluates the associations between illness and exposure to toxic agents, environmental or wartime hazards, or preventive measures and vaccines associated with Gulf War service, and provides recommendations for future research efforts on Gulf War veterans.
More than 2 decades have passed since the 1990-1991 conflict in the Persian Gulf. During the intervening years, many Gulf War veterans have experienced various unexplained symptoms that many associate with service in the gulf region, but no specific exposure has been definitively associated with symptoms. Numerous researchers have described the pattern of signs and symptoms found in deployed Gulf War veterans and noted that they report unexplained symptoms at higher rates than nondeployed veterans or veterans deployed elsewhere during the same period. Gulf War veterans have consistently shown a higher level of morbidity than the nondeployed, in some cases with severe and debilitating consequences. However, efforts to define a unique illness or syndrome in Gulf War veterans have failed, as have attempts to develop a uniformly accepted case definition. Chronic Multisymptom Illness in Gulf War Veterans is a comprehensive review of the available scientific and medical literature regarding symptoms for chronic multisymptom illness (CMI) among the 1991 Gulf War Veterans. This report evaluates and summarizes the literature in an effort to identify appropriate terminology to use in referring to CMI in Gulf War Veterans. While the report does not recommend one specific case definition over another, Chronic Multisymptom Illness in Gulf War Veterans does recommend the consideration of two case definitions on the basis of their concordance with the evidence and their ability to identify specific symptoms commonly reported by Gulf War veterans. This report recommends that the Department of Veterans Affairs use the term Gulf War illness rather than CMI. The report recommends that that the Department of Veterans Affairs, to the extent possible, systematically assess existing data to identify additional features of Gulf War illness, such as onset, duration, severity, frequency of symptoms, and exclusionary criteria to produce a more robust case definition.
More than 2 decades have passed since the 1990-1991 conflict in the Persian Gulf. During the intervening years, many Gulf War veterans have experienced various unexplained symptoms that many associate with service in the gulf region, but no specific exposure has been definitively associated with symptoms. Numerous researchers have described the pattern of signs and symptoms found in deployed Gulf War veterans and noted that they report unexplained symptoms at higher rates than nondeployed veterans or veterans deployed elsewhere during the same period. Gulf War veterans have consistently shown a higher level of morbidity than the nondeployed, in some cases with severe and debilitating consequences. However, efforts to define a unique illness or syndrome in Gulf War veterans have failed, as have attempts to develop a uniformly accepted case definition. Chronic Multisymptom Illness in Gulf War Veterans is a comprehensive review of the available scientific and medical literature regarding symptoms for chronic multisymptom illness (CMI) among the 1991 Gulf War Veterans. This report evaluates and summarizes the literature in an effort to identify appropriate terminology to use in referring to CMI in Gulf War Veterans. While the report does not recommend one specific case definition over another, Chronic Multisymptom Illness in Gulf War Veterans does recommend the consideration of two case definitions on the basis of their concordance with the evidence and their ability to identify specific symptoms commonly reported by Gulf War veterans. This report recommends that the Department of Veterans Affairs use the term Gulf War illness rather than CMI. The report recommends that that the Department of Veterans Affairs, to the extent possible, systematically assess existing data to identify additional features of Gulf War illness, such as onset, duration, severity, frequency of symptoms, and exclusionary criteria to produce a more robust case definition.
For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the IOM is conducting an ongoing review of the evidence to determine veterans' long-term health problems and what might be causing those problems. The fourth volume in the series, released in 2006, summarizes the long-term health problems seen in Gulf War veterans. In 2008, the IOM began an update to look at existing health problems and identify possible new ones, considering evidence collected since the initial summary. In this report, the IOM determines that Gulf War service causes post-traumatic stress disorder (PTSD) and that service is associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; alcohol and other substance abuse; and anxiety disorders and other psychiatric disorders. To ensure that our veterans receive the best possible care, now and in the future, the government should continue to monitor their health and conduct research to identify the best treatments to assist Gulf War veterans still suffering from persistent, unexplained illnesses.
More than 3.7 million U.S. service members have participated in operations taking place in the Southwest Asia Theater of Military Operations since 1990. These operations include the 1990-1991 Persian Gulf War, a post-war stabilization period spanning 1992 through September 2001, and the campaigns undertaken in the wake of the September 11, 2001, attacks. Deployment to Iraq, Kuwait, Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, the United Arab Emirates, and Afghanistan exposed service members to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand suspended in the air, and exhaust from diesel vehicles. The effects of these were compounded by stressors like excessive heat and noise that are inevitable attributes of service in a combat environment. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations reviews the scientific evidence regarding respiratory health outcomes in veterans of the Southwest Asia conflicts and identifies research that could feasibly be conducted to address outstanding questions and generate answers, newly emerging technologies that could aid in these efforts, and organizations that the Veterans Administration might partner with to accomplish this work.
Military operations produce a great deal of trash in an environment where standard waste management practices may be subordinated to more pressing concerns. As a result, ground forces have long relied on incineration in open-air pits as a means of getting rid of refuse. Concerns over possible adverse effects of exposure to smoke from trash burning in the theater were first expressed in the wake of the 1990â€"1991 Gulf War and stimulated a series of studies that indicated that exposures to smoke from oil-well fires and from other combustion sources, including waste burning, were stressors for troops. In January 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain a registry for service members who may have been exposed to toxic airborne chemicals and fumes generated by open burn pits. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry analyzes the initial months of data collected by the registry and offers recommendations on ways to improve the instrument and best use the information it collects. This report assesses the effectiveness of the VA's information gathering efforts and provides recommendations for addressing the future medical needs of the affected groups, and provides recommendations on collecting, maintaining, and monitoring information collected by the VA's Airborne Hazards and Open Burn Pit Registry.
In 1998, in response to the growing concerns that many returning Gulf War veterans began reporting numerous health problems that they believed to be associated with their service in the Persian Gulf, Congress passed two laws which directed the Secretary of Veterans Affairs to enter into a contract with the National Academy of Sciences. They were tasked to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines associated with Gulf War service. In addition, the Institute of Medicine of the National Academy of Sciences provided conclusions to these studies that were considered when making decisions about compensation to veterans. Gulf War and Health Volume 4: Health Effects of Serving in the Gulf War summarizes in one place the current status of health effects in veterans deployed to the Persian Gulf irrespective of exposure information. This book reviews, evaluates, and summarizes both peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans.
Many individuals, groups, and federal agencies have a strong interest in finding answers to the numerous and complex questions regarding the health of Gulf War veterans. Various types of research and health measurement are needed to address these diverse issues. The Institute of Medicine (IOM) was asked by the Department of Veterans Affairs (VA) and the Department of Defense (DoD) to undertake a study to identify important questions concerning the health of Gulf War veterans and then to design a study to answer those questions. The committee determined that it is of fundamental importance to ask how healthy are Gulf War veterans? Are they as healthy as others? What characteristics are associated with differences between the health of Gulf War veterans and the health of others? To address these questions, it will be necessary to measure not only the health status of those who served in the Gulf War, but also to compare Gulf War veterans with other groups. Further, one must continue to follow these groups through time to determine whether the groups differ in the way their health status is changing. As the committee began to develop a design that would address the fundamental questions identified, it realized that such a study could have important implications for understanding not only the health of Gulf War veterans, but also the health of veterans of other conflicts.
In January 1995 the Institute of Medicine released a preliminary report containing initial findings and recommendations on the federal government's response to reports by some veterans and their families that they were suffering from illnesses related to military service in the Persian Gulf War. The committee was asked to review the government's means of collecting and maintaining information for assessing the health consequences of military service and to recommend improvements and epidemiological studies if warranted. This new volume reflects an additional year of study by the committee and the full results of its three-year effort.
For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the Institute of Medicine (IOM) has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes. The fourth volume in the series, released in 2006, summarizes the long-term health problems seen in Gulf War veterans. In 2010, the IOM released an update that focuses on existing health problems and identifies possible new ones, considering evidence collected since the initial summary. Gulf War and Health: Volume 10 is an update of the scientific and medical literature on the health effects associated with deployment to the Gulf War that were identified in Volumes 4 and 8. This report reviews and evaluates the associations between illness and exposure to toxic agents, environmental or wartime hazards, or preventive measures and vaccines associated with Gulf War service, and provides recommendations for future research efforts on Gulf War veterans.
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