New IOM Panel Finds Nine Conditions Caused by or Associated with 1991 Gulf War Service

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) - A myriad of physical and mental health conditions are associated with the 1991 Gulf War, says a new report released April 9, 2010 by the Institute of Medicine (IOM), which also found that Gulf War Illness is real.  

The report, entitled, “Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War, found five broad types of physical and mental health outcomes caused by the 1991 Gulf War and four more for which their is limited but suggestive evidence of causation.

Among the physical ailments the IOM found to have "sufficient evidence of a causal relationship" are "multisymptom illness" (commonly referred to as Gulf War Illness), functional gastrointestinal disorders such as irritable bowel syndrome (IBS) and dyspepsia (upset stomach), and chronic fatigue syndrome.  

The IOM panel also found sufficient evidence of a causal relationship between Gulf War service and PTSD,  and other psychiatric disorders that persist at least 10 years after deployment.

The panel also found "limited/suggestive evidence of a causal relationship" between 1991 Gulf War service and  ALS, fibromyalgia and chronic widespread pain, "self-reported" sexual difficulties, and mortality "from external causes, primarily motor-vehicle accidents" in the early years following Gulf War deployment.  

The panel noted a long list of conditions for which inadequate research currently exists to determine whether or not there is a clear association with Gulf War service, as well as a shorter list of conditions for which current research suggests are not associated with Gulf War service.

Generally, the U.S. Department of Veterans Affairs (VA) follows IOM panel recommendations as a basis for new "presumptive" conditions for the purposes of VA service-connected disability claims.  Conditions for which there is "sufficient evidence of a causal relationship" are the most likely for new VA presumptions.  Conditions for which there is "limited/suggestive evidence of a causal relationship" may or may not be made presumptive by VA.

The verbatim list from the new IOM panel is posted below.

The panel also noted that 

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Summary of Findings Regarding Associations Between Deployment to the Gulf War and Specific Health Outcomes

Sufficient Evidence of a Causal Relationship

·      PTSD.
  Sufficient Evidence of an Association

·      Other psychiatric disorders, including generalized anxiety disorder, depression, and substance abuse, particularly alcohol abuse. These psychiatric disorders persist for at least 10 years after deployment.

·      Gastrointestinal symptoms consistent with functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia.

·      Multisymptom illness.

·      Chronic fatigue syndrome. 


Limited/Suggestive Evidence of an Association

·      ALS.

·      Fibromyalgia and chronic widespread pain.

·      Self-reported sexual difficulties.

·      Mortality from external causes, primarily motor-vehicle accidents, in the early years after deployment. 


Inadequate/Insufficient Evidence to Determine Whether an Association Exists

·      Any cancer.

·      Diseases of the blood and blood-forming organs.

·      Endocrine, nutritional, and metabolic diseases.

·      Neurocognitive and neurobehavioral performance.

·      Multiple sclerosis.

·      Other neurologic outcomes, such as Parkinson’s disease, dementia, and Alzheimer’s disease.

·      Incidence of cardiovascular diseases.

·      Respiratory diseases.

·      Structural gastrointestinal diseases.

·      Skin diseases.

·      Musculoskeletal system diseases.

·      Specific conditions of the genitourinary system.

·      Specific birth defects.

·      Adverse pregnancy outcomes such as miscarriage, stillbirth, preterm birth, and low birth weight.

·      Fertility problems. 


Limited/Suggestive Evidence of No Association

·      Peripheral neuropathy.

·      Mortality from cardiovascular disease in the first 10 years after the war.

·      Decreased lung function in the first 10 years after the war.

·      Hospitalization for genitourinary diseases.

*SOURCE:  National Academy of Sciences, Institute of Medicine, “Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War,” April 2010, p. 8 (Box S-1). 

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IOM criteria for evidence of relationship to the 1991 Gulf War

Sufficient Evidence of a Causal Relationship

Evidence is sufficient to conclude that a causal relationship exists between being deployed to the Gulf War and a health outcome. The evidence fulfills the criteria for sufficient evidence of a causal association in which chance, bias, and confounding can be ruled out with reasonable confidence. The association is supported by several of the other considerations used to assess causality: strength of association, dose-response relationship, consistency of association, temporal relationship, specificity of association, and biologic plausibility.

Sufficient Evidence of an Association

Evidence suggests an association, in that a positive association has been observed between deployment to the Gulf War and a health outcome in humans; however, there is some doubt as to the influence of chance, bias, and confounding.

Limited/Suggestive Evidence of an Association

Some evidence of an association between deployment to the Gulf War and a health outcome in humans exists, but this is limited by the presence of substantial doubt regarding chance, bias, and confounding.

Inadequate/Insufficient Evidence to Determine Whether an Association Exists

The available studies are of insufficient quality, validity, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association between deployment to the Gulf War and a health outcome in humans.

Limited/Suggestive Evidence of No Association

There are several adequate studies, covering the full range of levels of exposure that humans are known to encounter, that are consistent in not showing an association between exposure to a specific agent and a health outcome at any level of exposure. A conclusion of no association is inevitably limited to the conditions, levels of exposure, and length of observation covered by the available studies. In addition, the possibility of a very small increase in risk at the levels of exposure studied can never be excluded. 

*SOURCE:  National Academy of Sciences, Institute of Medicine, “Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War,” April 2010, pp. 5-6.