Wednesday, June 9, 2010

VA Announces New Task Force to Address IOM Report Recommendations

Written by Anthony Hardie

( - VA has formed a task force to address an April 9, 2010 Institute of Medicine (IOM) report on Gulf War Veterans’ illnesses that found associations between deployment to the 1990 - 1991 Gulf War and specific health problems. .  The new VA task force is reviewing the Institute of Medicine Report on Gulf War and Health and will make recommendations for VA action to VA Secretary Eric Shinseki.

The Persian Gulf War Veterans Act of 1998, enacted through the work of Gulf War veteran activists, directs VA to contract with IOM for the study of exposures and ailments potentially linked to service in 1991 Gulf War. 

VA’s review of IOM reports of new associations with wartime service generally result in expanded presumptions for service connected disability benefits and can result in new focuses in VA health care. 

In 2008, IOM began to review, evaluate, and summarize the literature on health outcomes noted in its 2006 report that seemed to appear at higher occurrence in Gulf War-deployed Veterans than non-deployed Gulf War Veterans. Also, IOM reviewed studies on cause-specific mortality in Gulf War Veterans and examined the literature to identify any emerging health outcomes.

In the April 2010 report, IOM found the following associations between deployment to the 1991 Gulf War and specific health outcomes:

  • Sufficient evidence of a causal relationship: PTSD, as might be expected from any combat experiences.  Rates of PTSD are much lower for veterans of the 1991 Gulf War than for other wars, and IOM found the percentage of Gulf War veterans with PTSD to be far lower than that with chronic multisymptom illness.
  • Sufficient evidence of an association:
    • Chronic Multisymptom illness (CMI).  IOM noted that this affects 250,000 veterans of the 1991 Gulf War and could not be attributed to any known psychiatric condition.  CMI is more popularly known as Gulf War Illness (GWI) or Gulf War Syndrome. 
    • Gastrointestinal symptoms consistent with functional gastrointestinal disorders such as irritable bowel disease (IBS)
    • Anxiety disorders and other psychiatric disorders. These disorders persist for at least 10 years.   It is well established that depression and anxiety are common in people with chronic illness.  A recent article showed that depression is often diagnosed before diagnosis of the real underlying disease.
    • Substance abuse, particularly alcohol abuse.
  • Limited/suggestive evidence of an association:
    • Fibromyalgia and chronic widespread pain
    • Amyotrophic lateral sclerosis (ALS).  ALS has been termed by involved scientists as a true “outbreak”, which peaked in 1995.  Scientists are monitoring whether there may be other future peaks.
    • Sexual difficulties
    • Death due to causes such as car accidents in the early years after deployment

Of the conditions found by IOM to be associated with 1991 Gulf War service, currently only fibromyalgia (FM) and irritable bowel syndrome (IBS) are presumptive for service-connected disability claims for veterans of the 1991 Gulf War.  While claims for chronic multi-symptom illness, called “undiagnosed or ill-defined illness” by VA, are also presumptive, VA has come under severe criticism for its high claims denial rates in this area. 

Another task force, chaired by VA Chief of Staff John Gingrich, is currently reviewing this and other related matters.

The report calls for a substantial commitment to improve identification and treatment of multisymptom illness in Gulf War veterans.

According to IOM, the path forward should include continued monitoring of Gulf War veterans and development of better medical care for those with persistent, unexplained symptoms.  IOM said that researchers should undertake studies comparing genetic variations and other differences in veterans experiencing multisymptom illness and asymptomatic veterans. 

According to IOM, it is likely that multisymptom illness results from the interactions between environmental exposures and genes, and genetics may predispose some individuals to illness, the committee noted.  IOM noted that there are sufficient numbers of veterans to conduct meaningful comparisons given that nearly 700,000 U.S. personnel were deployed to the region and more than 250,000 of them suffer from persistant, unexplained symptoms. 

IOM stated that a consortium involving the U.S. Department of Veterans Affairs, U.S. Department of Defense, and National Institutes of Health could coordinate this effort and contribute the necessary resources.

From the IOM:  About Us

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.

Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

The Institute of Medicine serves as adviser to the nation to improve health.

The IOM asks and answers the nation’s most pressing questions about health and health care. Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely. Each year, more than 2,000 individuals, members, and nonmembers volunteer their time, knowledge, and expertise to advance the nation’s health through the work of the IOM.

Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations. While our expert, consensus committees are vital to our advisory role, the IOM also convenes a series of forums, roundtables, and standing committees, as well as other activities, to facilitate discussion, discovery, and critical, cross-disciplinary thinking.


The U.S. Department of Veterans Affairs and the Institute of Medicine contributed to this story.

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