There

is sucient evidence of an associa3on between exposure to herbicides and the following outcomes: So= 3ssue sarcoma, Non- Hodgkins lymphoma, Hodgkins disease - Veterans and Agent Orange, 1994

Veterans Benets Act of 1998

For each agent and illness iden3ed [t]he Na3onal Academy of Sciences shall determine (A) whether a sta3s3cal associa3on exists between exposure to the agent and the illness (B) the increased risk of the illness among human or animal popula3ons exposed to the agent

Veterans Benets Act of 1998

a presump3on of service connec3ons is warranted [if the Secretary makes a] determina3on that a posi3ve associa3on exists between (i) the exposure of humans or animals to a toxic agent and (ii) the occurrence of a diagnosed or undiagnosed illness in humans or animals

Gulf War and Health, Vol. 1, 2000

For its evalua3on and categoriza3on of the degree of associa3on between each exposure and a human health eect, however, the [IOM] commiUee only used evidence from human studies. (p.72)

The commiUee concludes that there is inadequate/insucient evidence of an associa3on between low levels of sarin, pyridos3gmine bromide, anthrax vaccina3on and long term health eects.

U.S. Department of Defense

Conclusions: During the Gulf War:

The military did a very good job protecOng servicemembers from infecOon by pest-borne diseases It is likely that at least 41,000 servicemembers may have been overexposed to pesOcides Overexposures to pesOcides, parOcularly organophosphates and carbamates, may have contributed to the unexplained illnesses reported by some Gulf War veterans

Gulf War and Health, Vol. 4, 2006

[R]ecently, the Department of Defense published a report documen3ng a large amount of pes3cide use in the war theater. For most of those exposures, it is dicult or impossible to reconstruct doses because of lack of exposure measurements on either the individual or group level.

The situaOon is compounded by the stress experienced by many veterans during deployment and in some cases aUer deployment. Stress is known to have serious acute and chronic health eects, but at the Ome of the Gulf War relaOvely liYle aYenOon was given to reducOon of stress and its consequences.

[T]here is not a unique symptom complex (or syndrome) in deployed Gulf War Veterans.

Gulf War and Health, Vol. 8, 2010

mul3symptom illness is a diagnos3c en3ty, (p. 204)

sucient evidence of associa3on with service in the war, (p. 210)

aects an es3mated more than 250,000 veterans, (p. 262)

 cannot be reliably ascribed to any known psychiatric disorder, (p. 109) likely results from the interplay of geneOc and environmental factors, (p. 261)

 [T]o speed the development of eec3ve treatments, cures and, it is hoped preven3ons, [t]he commiUee suggests a path forward and we believe through rigorous scien3c input, answers can likely be found. - Stephen Hauser, M.D., Chair

Gulf War and Health, Vol. 9. Treatments, 2013

[C]linicians should approach CMI with a person-centered model of care that helps pa3ents understand that the word psychosoma3c is not pejora3ve. (p. 17)

The focus on toxicants may be aUributed, at least in part, to a general fear of toxins spread as a result of modern industrial life. (p. 13)

Working case deniOon

The presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories fa3gue, mood and cogni3on, musculoskeletal, gastrointes3nal, respiratory, and neurologic that may overlap with but are not fully captured by known syndromes (such as IBS, CFS, and bromyalgia) or other diagnoses. (p. 23)

VA Charge

Review all published peer-reviewed literature concerning treatment of populaOons with a similar constellaOon of symptoms.

VA Charge to Case DeniOon CommiYee

Review all published peer-reviewed literature concerning case deniOons for other populaOons with a similar constellaOon of symptoms.

USA T oday, M arch 1 3, 2 013

Department of Veterans Aairs ocials purposely manipulate or hide data that would support the claims of veterans from Iraq and Afghanistan to prevent paying costly benets, a former VA researcher told a House subcommiUee Wednesday. If the studies produce results that do not support the oce of public healths unwriUen policy, they do not release them, said Steven Coughlin, a former epidemiologist in the VAs public health department.

This applies to data regarding adverse health consequences of environmental exposures, such as burn pits in Iraq and Afghanistan, and toxic exposures in the Gulf War, Coughlin said. On rare occasions when embarrassing study results are released, data are manipulated to make them unintelligible.

New York Times, June 14, 2013

Navy Times, June 18, 2013

A Senate sta member said the Senate Veterans Aairs CommiUee, chaired by Sen. Bernie Sanders, I-Vt, is considering holding a hearing to inves3gate the issue.

Forbes, June 21, 2013

Rep. Mike Coman, R-Colo, Chair of the House Veterans Aairs CommiYee on Oversight and InvesOgaOons and a Gulf War veteran is skepOcal of the changes Coman said he and other legislators are considering a bill that would address VAs changes. I think that theres just a history of well-founded distrust by Gulf war veterans of the ac3ons of VA in addressing this issue.

The Ins3tute of Medicine (IOM) is an independent, nonprot organiza3on that works outside of government to provide unbiased and authorita3ve advice to decision makers and the public