SYMPTOMS IN 18,495 PERSIAN-GULF-WAR VETERANS - LATENCY OF ONSET AND LACK OF ASSOCIATION WITH SELF-REPORTED EXPOSURES

Toxic or environmental exposures have been suggested as a possible cau se of symptoms reported by Gulf War veterans. To further explore this hypothesis, we analyzed findings in 18,495 military personnel evaluate d in the Department of Defense Comprehensive Clinical Evaluation Progr am. The program was established in 1994 to evaluate Persian Gulf veter ans eligible for Department of Defense medical care who had health con cerns after service in the Persian Gulf during Operation Desert Shield /Desert Storm. The evaluation included a structured clinical assessmen t, a physician-administered symptom checklist, and a patient questionn aire addressing self-reported exposures, combat experiences, and work loss. Among 18,495 patients examined, the most common symptoms were jo int pain, fatigue, headache, memory or concentration difficulties, sle ep disturbances, and rash. Symptom onset was often delayed, with two-t hirds of symptoms not developing until after individuals returned from the Gulf War and 40% of symptoms having a latency period exceeding on e year. There was no association between individual symptoms and patie nt demographics, specific self-reported exposures, or types of combat experience. Increased symptom counts were associated with work loss, t he number of self-reported exposures, the number of types of combat ex perience, and certain ICD-9 diagnostic categories, particularly psycho logical disorders. Prolonged latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.