As of December 31, 2000, 56,845 1990-1991 Gulf War veterans were enrolled by self-referral into the program. Of this number, 16,129 declined evaluation.

We have no evidence that biological weapons were used during the 1990-1991 Gulf War. In addition we have not found any reports of verified biological agent detections nor are we aware of anyone, soldier or civilian, who has reported experiencing symptoms consistent with exposure to a biological agent.

To date, there is also no evidence that any warfare agents were released as a result of coalition bombings during the air war campaign, January 17, 1991 through February 23, 1991.

During the 1990-1991 Gulf War we deployed 17 research and development systems to the Gulf region to monitor the air for suspected Iraqi biological warfare (BW) agents. Twelve of the 17 systems were mobile, and consisted of the Army's XM-2 high volume air samplers and Sensitive Membrane Antigen Rapid Test (SMART) identification tickets. The mobile systems moved across northeast Saudi Arabia to monitor for Iraqi BW agent attacks. The remaining five systems were employed in a static mode at critical logistics facilities and consisted of a modified commercial aerosol sampler with SMART tickets. The mobile units were mounted on HUMVEES and on Isuzu Troopers. These XM-2 air samplers had inherent limitations. They were too big and heavy, had low reliability and an unacceptable false alarm rate. Units that deployed with these systems included personnel from the Edgewood Research Development Engineering Center in mid-January 1991 and elements of the 9th CM Co, an active component unit from Fort Lewis, arrived a few weeks later. This unit was deactivated in February 1994.

Detections from these systems included the following:

Two thousand anthrax and botulinum SMART tickets were used during the 1990-1991 Gulf War. Less than 1% of these gave a positive reading at the respective sampling points. Confirmatory tests of the samples at the Navy's Forward Deployed Medical Diagnostic Lab indicated that all samples were free of suspected BW agent.

Since the 1990-1991 Gulf War we have pursued an aggressive program to field a robust detection system that will protect our forces against a wide spectrum of BW threats. We have fielded two new systems and are developing a third.

In December 1996, the Joint Program Office for Biological Defense (JPO-BD) awarded a contract for the engineering and manufacturing development of the Joint Biological Point Detection System (JBPDS); the next generation system with an enhanced, common biological detection suite that will be employed on all four services' platforms (i.e., Army and Marine Corps HUMVEESs, Navy ships and AF bases).

In June 1995 the Army had one platoon of the 11th Chemical Company at Fort McClellan, Alabama, equipped with the Biological Integrated Detection System (BIDS). On 16 September 1996, the Army activated its first biological detection company, the 310th Chemical Company (Reserve Component) at Fort McClellan. This company is equipped with 38 HMMWV-mounted BIDS and three Long Range Biological Standoff Detection Systems (LR-BSDS). These are enough systems to provide Corps-size coverage.

In September 1994 we fielded the Navy's Interim Biological Agent Detector (IBAD) aboard the USS LaSalle. Nine more IBADS have been deployed with the fleet since then. The Navy will have a total of 25 systems deployed by the end of September 1997.

A case narrative is a report of what we know today about specific events that took place during the Gulf War of 1990 and 1991. A case narrative focuses on a particular incident and can include personnel interviews, reviews of official documents from various commands and agencies, collection of scientific data, and original research. From a broader perspective, a case narrative is part of our overall effort to inform the public about the progress being made to solve the many mysteries of 1990-1991 Gulf War illnesses.

These announcements are another step in the investigative process. The case narratives are not final reports. These narratives are intended to generate additional dialogue with 1990-1991 Gulf War veterans who may have more information that will help us accurately understand what occurred with respect to each case under investigation. We encourage veterans with additional information to call the Gulf War Incident Hotline at 1-800-472-6719 or DSN 878-3261.

To investigate these incidents and to determine if chemical weapons were used, the DoD developed a methodology for investigation and validation based on work done by the United Nations and the international community where the criteria include:

1. A detailed written record of the conditions at the site;
2. Physical evidence from the site, such as weapons fragments, soil, water, vegetation or human/animal tissue samples;
3. A record of the chain of custody during the transportation of the evidence;
4. Testimony of eyewitnesses;
5. Multiple analyses; and
6. Review of the evidence by experts.

Our method is designed to provide a thorough, investigative process to define the circumstances of each incident and determine what happened. Alarms alone are not considered to be certain evidence of chemical agent presence, nor is a single individual's observation sufficient to validate a chemical agent presence, without corroboration. By following our methodology, gathering evidence, interviewing eyewitnesses and key personnel, and analyzing the results, the investigator assesses the validity of the presence of chemical warfare agents on the battlefield. Because information from various sources may be contradictory, we have developed the following assessment scale, ranging from "Definitely" to "Definitely Not." This assessment is tentative, based on facts available as of the date of the report publication; each case is reassessed over based on new information and feedback.

The standard for making the assessment is based on the following: do the available facts lead a reasonable person to conclude that chemical warfare agents were or were not present? When insufficient information is available, the assessment is "Indeterminate" until more evidence can be found.

• DOD Incident Reporting Line: 1-800-497-6261
• DOD Gulf War Medical Registry (CCEP): 1-800-796-9699
• Veterans’ Affairs Registry: 1-800-749-8387 (PGW-VETS)

Our best information on this question comes from the Comprehensive Clinical Evaluation Program (CCEP) which provides thorough medical evaluations of 1990-1991 Gulf War veterans in DOD health care facilities. Through June 1998, approximately 32,392 veterans have completed CCEP evaluations. Seventy five percent of all 32,392 CCEP participants have as their primary (main) diagnosis one of the following 42 most common diagnoses (ICD-9 Codes are shown in parentheses):

Musculoskeletal Disorders

Number of Participants 5224 / Percent of All Participants 16.2%

• Pain in Joint (719.4) 1776
• Osteoarthrosis (715) 1148
• Back Pain and Other Back Disorders (724) 901
• Disorders of Tendons, Muscle Attachments (726) 497
• Other Disorders of Soft Tissue (729) 464
• Vertebral Disc Disorders (722) 294
• Knee Derangements (717) 144

Symptoms which the CCEP Evaluation was unable to establish an explanatory diagnosis

Number of Participants 4397 / Percent of All Participants 13.6%

• Malaise and/or fatigue (780.7) 1381
• Sleep Disturbances (780.5) 1067
• General Symptoms and Hyperhidrosis (780.8-780.9) 625
• Symptoms of Respiratory System and Chest (786) 530
• Symptoms Involving the Skin (782) 334
• Alterations of Consciousness, Awareness (780-780.4) 197
• Abdominal Pain in Various Locations (789.0) 136
• Symptoms of Digestive System (787) 127

Psychological Disorders

Number of Participants 3989 / Percent of All Participants 12.3%

• Depressive Disorder (311) 942
• Neuroses (300) 897
• Prolonged PTSD (309.81) 850
• Affective Disorders (296) 563
• Adjustment Reactions (309) 387
• Sleep Disorders (307.4) 179
• Organic Brain Syndromes (293-4) 171

Healthy

Number of Participants 2904 / Percent of All Participants 9.0%

• Feared Complaint, No Diagnosis (V65.5) 2586
• Routine General Medical Examination (V70) 318

Headaches

Number of Participants 2757 / Percent of All Participants 8.5%

• Tension headache (307.81) 1016
• Migraine (346) 950
• Headache (784.0) 791

Respiratory Conditions

Number of Participants 1681 / Percent of All Participants 5.2%

• Asthma (493) 719
• Allergic Rhinitis (477) 501
• Chronic Upper Respiratory Inflammation (472-476) 461

Skin Disorders

Number of Participants 1387 / Percent of All Participants 4.3%

• Alopecia, hirsutism, and other diseases of hair and hair follicles (704) 407
• Fungus Infections (110-111) 406
• Contact dermatitis and other Eczema (692) 399
• Urticaria, various types (708) 175

Gastrointestinal Disorders

Number of Participants 1262 / Percent of All Participants 3.9%

• Irritable Colon (564.1) 496
• Esophageal Reflux (530.81) 429
• Enteritis and Colitis (558) 214
• Gastritis and Duodenitis (535) 123

Hypertension

Essential(401), Number of Participants 393 / Percent of All Participants 1.2%

Endocrine and Metabolic Disorders

Number of Participants 292 / Percent of All Participants 0.9%

• Lipoid Metabolism Disord. (272) 168
• Hypothyroidism (243-244) 124

Hearing Loss 

(388.02-388.2, 389), Number of Participants 130 / Percent of All Participants 0.4%

A few veterans' illnesses are known to be contagious, but there is little reason to believe that most veterans' illnesses can be spread to other persons. Of all the veterans (33,542) who have completed the detailed medical evaluations at the DoD clinics and hospitals, about 3% were found to have an infection as their main diagnosis. A small number of these veterans had infections well known to medical science which could be passed on to other persons (viral hepatitis, herpes simplex infections, HIV infection, and tuberculosis). Otherwise, the vast majority of the infections were either brief, one-time illnesses, easily treated and cured illnesses, or infections that are not contagious from person to person. Other than the specific infections of malaria and leishmaniasis (which are not spread from person to person), none of the veterans' infections can be specifically linked to service in the Persian Gulf. The infectious diseases among veterans resemble the range of illnesses common in the population at large. Despite the above, however, DoD and the VA continue to pursue research studies of the questions of contagion and of previously unrecognized causes of infection.

Mycroplasmas are the smallest, free-living infectious agents. They are distinct from viruses because of their ability to grow in cell-free media and from bacteria because they lack a cell wall and the ability to synthesize cell wall precursors. A variety of plant and animal diseases are caused by the mycoplasmas. However, only certain types have been clearly shown to cause disease in humans.

The Environmental and Occupational Exposures Division is looking at experiences in the 1990-1991 Gulf War from a more universal approach than previous investigations in general. An Environmental Exposures Report looks to describe any of a variety of exposure opportunities in the 1990-1991 Gulf War that would have occurred more universally, and that may have had an impact on the health of 1990-1991 Gulf War participants.

While previous case narratives mostly focused on discrete events or specifically identifiable occurrences, the Environmental Exposures Reports address events or exposures that had the potential to be experienced by anyone participating in the 1990-1991 Gulf War. The approach comes from a more universal perspective and includes personnel who share, or may share, common exposure potentials as relates to their environment.

Consistent with one of the charters of OSAGWI to “leave no stone unturned,” Environmental Exposure Reports will further describe events experienced by personnel in the 1990-1991 Gulf War that may have had a long-term effect on their health. These reports will add to the completeness of the story and better enable veterans, politicians, medical personnel, media, and other interested parties to understand the significance of 1990-1991 Gulf War events as they relate to illnesses experienced by the veterans.

We have adopted an assessment methodology patterned on that used by the U.S. Environmental Protection Agency. This process estimates the health risk from contaminant concentrations, site exposure, and contaminant toxicity characteristics. It consists of four steps: Hazard Identification, Toxicity Assessment, Dose Assessment, and Risk Characterization, defined below:

• Hazard Identification - who was exposed, and how? Which incidents warrant a full investigation?
• Toxicity Assessment - what are the known medical effects of human exposure? At what levels of exposure do these effects occur? How can the effects be mitigated?
• Dose Assessment - how much of the contaminant were the troops exposed to? What chemical or radiological doses do these intakes represent?
• Risk Characterization - using validated toxicity and dose information, what medical effects can be anticipated? How serious are those effects? How can the effects be communicated to those affected?

The former Office of the Special Assistant for Gulf War Illnesses (now Force Health Protection & Readiness Policy & Programs) has focused its investigation on determining what happened, what exposures may have occurred, and who may have been exposed. Exposures have been subdivided into levels and scenarios so they can be related to toxicity and dose information.

As of May 1998, approximately 5,425 veterans (0.78%) out of 697,000 participants in the 1990-1991 Gulf War had died. The Defense Manpower Data Center (DMDC) obtained this number by comparing lists of all 1990-1991 Gulf War veterans with files of deaths recorded by the Social Security Administration. A similar comparison disclosed that, of the 2,372,327 members of the active duty force and the selective reserve who did not deploy to the Gulf, 19,475 (0.82%) had died. No information on cause of death was available from this data search.

Previous studies by the Department of Veterans Affairs had compared deaths among GW veterans to those among a random sample (about half) of all other veterans. The overall death rates were about the same in the two comparison groups. GW veterans had higher rates of death due to external causes, particularly due to motor vehicle accidents. GW veterans had lower rates of death from natural causes.

During Operation Desert Storm, the threat of use of nerve agents by Iraq was very high. After careful deliberation by a specially constituted human-use review committee of the Food and Drug Administration, it was determined that the pretreatment could help save the lives of many Service members if nerve agents were used. Approval for the use of pyridostigmine bromide was based on extensive scientific information that supported the safety and effectiveness of pyridostigmine bromide as a preventive treatment.

Pyridostigmine bromide is not an exotic or experimental drug. The Food and Drug Administration approved it in 1955 for use in treating myasthenia gravis, a neuromuscular disease that causes muscle weakness and fatigue. However, when approved for use in the Gulf, the approval was as an investigational new drug. This classification means that pyridostigmine bromide had not been formally approved for general commercial marketing as a nerve gas antidote.

There was no effort to withhold information from the troops or the public. In fact, pyridostigmine bromide use was widely reported by the news media at the time. The Department of Defense believes that most individuals knew they were taking an oral drug to counter the effects of a possible attack with nerve agents. However, troops did not receive enough information about the possible side effects of pyridostigmine bromide. Information was prepared for distribution in the field, but it did not arrive before hostilities began.

The Defense Department estimates that approximately 250,000 personnel took at least some pyridostigmine bromide during the 1990-1991 Gulf War. During the 1990-1991 Gulf War, all U.S. troops were to have received packets containing pyridostigmine bromide pills.

Actual administration of the pre-treatment was decentralized in nuclear, biological chemical (NBC) and not medical channels. It was intended to be self-administered upon a unit commander's order. We know that in some units, pyridostigmine bromide administration was carefully monitored, while in others, it was not. However, accurate assessments of actual pyridostigmine bromide use are difficult because no specific records were kept of self-administered medications.

To date, the Food and Drug Administration has recalled none of the drugs or vaccines administered by the military. If you would like more information on pyridostigmine bromide you may contact the Defense Personnel Support Center at (215) 737-5768.