Gulf War Veterans:

Incidence of Tumors Cannot Be Reliably Determined From Available Data

NSIAD-98-89: Published: Mar 3, 1998. Publicly Released: Apr 9, 1998.

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Pursuant to a congressional request, GAO reviewed data on the incidence of tumors among Gulf War veterans, focusing on: (1) the reliability of data sources available for determining the incidence of tumors among Gulf War veterans; and (2) the Department of Veterans Affairs' (VA) and the Department of Defense's (DOD) use of data sources to monitor tumors and other illnesses among Gulf War veterans.

GAO noted that: (1) none of the data sources that provide information on the health characteristics of Gulf War veterans can be used to reliably estimate the incidence of tumors; (2) VA's benefits information system can track the vital status and causes of deaths among Gulf War veterans; (3) however, not all cancers result in death and those that do may take several years to show up; (4) as a result, the system will underreport overall incidence; (5) DOD and VA maintain large hospitalization reporting systems; (6) however, a large majority of Gulf War veterans do not use DOD and VA hospitals and there has been little effort to determine whether this hidden population has health conditions similar to those of the population captured by the reporting systems; (7) DOD's reporting system also does not account for outpatient medical care; (8) VA has recently begun to fill this gap for its outpatient facilities, but it may take several years before consistent and reliable reporting is available; (9) a national cancer registry reports aggregate population rates and trends but cannot be used to track the Gulf War population; (10) DOD and VA health registries report information on the type of health problems Gulf War veterans have experienced at the time of their examination; (11) however, because not all veterans are examined, the information collected cannot be used to estimate the frequency of illnesses among all Gulf War veterans; (12) VA is conducting a national survey to study the general health status of Gulf War veterans; (13) the study uses representative samples of deployed and nondeployed veterans; (14) however, the response rate to the survey has been low and the study's sample size may be too small to assess any elevated incidence of most cancers; (15) DOD and VA have initiated efforts to improve the utility of these data systems but have not developed the capability to specifically address questions about tumors or other illnesses among Gulf War veterans; (16) as a result, it is not known how many Gulf War veterans have tumors or whether they have a higher incidence of them than other veterans; and (17) according to agency officials, no other plans aside from periodic assessments of mortality have been made to monitor tumor cases within this population.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD and VA have indicated they are working to improve health information, including the transfer of data between the departments and the development of a joint computerized patient record system. However, DOD and VA have not developed a formal plan for making these changes and have not set any concrete timeline.

    Recommendation: In order to evaluate more effectively the incidence of tumors and other Gulf War illnesses over time, the Secretaries of Defense and Veterans Affairs should continue to strengthen existing monitoring capabilities. Attention should be directed toward improving the utility of existing data systems and particularly in developing cost-effective ways to make data systems more compatible with one another so that information from different sources can be linked. In addition, steps should be taken to address the data quality concerns identified in this report.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD and VA have indicated they are working to improve health information, including the transfer of data between the departments and the development of a joint computerized patient record system. However, DOD and VA have not developed a formal plan for making these changes and have not set any concrete timeline.

    Recommendation: In order to evaluate more effectively the incidence of tumors and other Gulf War illnesses over time, the Secretaries of Defense and Veterans Affairs should continue to strengthen existing monitoring capabilities. Attention should be directed toward improving the utility of existing data systems and particularly in developing cost-effective ways to make data systems more compatible with one another so that information from different sources can be linked. In addition, steps should be taken to address the data quality concerns identified in this report.

    Agency Affected: Department of Veterans Affairs

 

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