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Highlights

Pursuant to a legislative requirement, GAO analyzed the effectiveness of the government's clinical care and medical research programs relating to illnesses that members of the armed forces might have contracted as a result of their service in the Persian Gulf War, focusing on the: (1) Department of Defense's (DOD) and the Department of Veterans Affairs' (VA) efforts to assess the quality of treatment and diagnostic services provided to Gulf War veterans and their provisions for follow-up of initial examinations; (2) government's research strategy to study the veterans' illnesses and the methodological problems posed in its studies; and (3) consistency of key official conclusions with available data on the causes of veterans' illnesses.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense Because of the numbers of Gulf War veterans who continue to experience illnesses that may be related to their service during the Gulf War, the Secretary of Defense, in conjunction with the Secretary of Veterans Affairs, should develop and implement a plan to monitor the clinical progress of Gulf War veterans in order to help promote appropriate and effective treatment and provide direction to the research agenda.
Closed - Implemented
DOD noted in comments on the report that it had requested a draft feasibility proposal to evaluate the current health status of Comprehensive Clinical Evaluation Program participants. However, it asserted that its utilization management practices provided adequate oversight for the care provided. An Institute of Medicine study commissioned by VA and issued on September 14, 1999, identified a methodology for longitudinal assessment of changes in war veterans' health status. In comments on ongoing GAO work, DOD cited the need for such a methodological study in order to devise a means of assessing veterans' progress. On July 17, 2000, a VA official stated that longitudinal components had been added to federally sponsored research projects in Iowa, Louisiana, New Jersey, and Boston to develop information on the ongoing welfare of Gulf War veterans.
Department of Veterans Affairs Because of the numbers of Gulf War veterans who continue to experience illnesses that may be related to their service during the Gulf War, the Secretary of Defense, in conjunction with the Secretary of Veterans Affairs, should develop and implement a plan to monitor the clinical progress of Gulf War veterans in order to help promote appropriate and effective treatment and provide direction to the research agenda.
Closed - Implemented
VA has contracted with the National Academy of Sciences to conduct a review of methodologies for monitoring the health of Gulf War veterans. The report from this review was issued on September 14, 1999. On July 17, 2000, a VA official stated that longitudinal components had been added to federally sponsored research projects in Iowa, Louisiana, New Jersey, and Boston to provide information on changes in the welfare of Gulf War veterans.
Department of Defense Because of the numbers of Gulf War veterans who continue to experience illnesses that may be related to their service during the Gulf War, the Secretary of Defense, in conjunction with the Secretary of Veterans Affairs, should give greater priority to research on treatment for ill veterans and on low-level exposures to chemicals and their interactive effects and less priority to further epidemiological studies.
Closed - Implemented
DOD has contributed funds to a VA-administered randomized clinical trials for treatments of conditions that afflict Gulf War veterans. Patient recruitment for these trials began in 1999 and they are ongoing. DOD continues to pursue a variety of large, epidemiological studies in which data are analyzed without respect to veterans' specific exposures. Research continues to be impeded by poor information regarding the nature and intensity of veterans' exposures. In October 2000, DOD reassessed exposure to sarin from demolition conducted at Khamisiyah, Iraq and reclassified the exposure status of 60,000 veterans, half from not exposed to exposed and half in the reverse direction.
Department of Veterans Affairs Because of the numbers of Gulf War veterans who continue to experience illnesses that may be related to their service during the Gulf War, the Secretary of Defense, in conjunction with the Secretary of Veterans Affairs, should give greater priority to research on treatment for ill veterans and on low-level exposures to chemicals and their interactive effects and less priority to further epidemiological studies.
Closed - Implemented
Persian Gulf Veterans Coordinating Board officials from VA have stated that they see no need for additional, large epidemiological studies. In 1999, with combined VA and DOD financing, VA initiated patient recruitment for large randomized clinical trials of treatments for conditions that afflict Gulf War veterans.
Department of Defense The Secretaries of Defense and Veterans Affairs should refine the current approaches of the clinical and research programs for diagnosing posttraumatic stress disorder consistent with suggestions recently made by the Institute of Medicine, which noted the need for improved documentation of screening procedures and patient histories (including occupational and environmental exposures) and the importance of ruling out alternative causes of impairment.
Closed - Not Implemented
No action is intended.
Department of Veterans Affairs The Secretaries of Defense and Veterans Affairs should refine the current approaches of the clinical and research programs for diagnosing posttraumatic stress disorder consistent with suggestions recently made by the Institute of Medicine, which noted the need for improved documentation of screening procedures and patient histories (including occupational and environmental exposures) and the importance of ruling out alternative causes of impairment.
Closed - Not Implemented
No action is intended.

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