The United States Congress mandated the U.S. Department of Veterans Affairs' contract with the National Academy of Sciences (NAS) to provide reports on<unk> <unk>  illnesses. Since 1998, the NAS's Institute of Medicine (IOM) has authored ten such reports. In addition to the many physical and psychological issues involved in any<unk>  zone deployment,<unk> <unk>  veterans were exposed to a unique mix of hazards not previously experienced during<unk> time. These included pyridostigmine bromide pills (given to protect troops from the effects of nerve agents), depleted uranium munitions, and multiple simultaneous vaccinations including anthrax and botulinum toxin vaccines. The oil and smoke that spewed for months from hundreds of burning oil wells presented another exposure hazard not previously encountered in a<unk>  zone. Military personnel also had to cope with swarms of insects, requiring the widespread use of pesticides. High-powered microwaves were used to disrupt Iraqi communications, and though it is unknown whether this might have contributed to the syndrome, research has suggested that safety limits for electromagnetic radiation are too lenient. The Research Advisory Committee on<unk> <unk>  Veterans' Illnesses (RAC), a VA federal advisory committee mandated by Congress in legislation enacted in 1998, found that pre-2005 studies suggested the veterans' illnesses are neurological and apparently are linked to exposure to neurotoxins, such as the nerve gas sarin, the anti-nerve gas drug pyridostigmine bromide, and pesticides that affect the nervous system. The RAC concluded in 2004 that, "research studies conducted since the<unk>  have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain<unk> <unk>  veterans illnesses in the large majority of ill veterans." The RAC concluded that "exposure to pesticides and/or to PB pyridostigmine bromide nerve agent protective pills are causally associated with GWI and the neurological dysfunction in GW veterans. Exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as GWI is less clear. Gene-environment interactions are likely to have contributed to development of GWI in deployed veterans. The health consequences of chemical exposures in the GW and other conflicts have been called “toxic wounds” by veterans. This type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses." Earlier considered potential causes Depleted uranium Major<unk> <unk>  engagements in which DU rounds were used Depleted uranium (DU) was widely used in tank kinetic energy penetrator and autocannon rounds for the first time ever during the<unk> <unk>  and has been suggested as a possible cause of<unk> . A 2008 review by the U.S. Department of Veterans Affairs found no association between DU exposure and multisymptom illness, concluding that "exposure to DU munitions is not likely a primary cause of<unk> <unk>  illness". However, there are suggestions that long-term exposure to high doses of DU may cause other health problems unrelated to GWI. More recent medical literature reviews disagree, stating for example that, "the number of<unk> <unk>  veterans who developed the<unk>  following exposure to high quantities of DU has risen to about one-third of the 800,000 U.S. forces deployed," with 25,000 of those having suffered premature death. Since 2011, US combat veterans may claim disability compensation for health problems related to exposure to depleted uranium. The Veterans Administration decides these claims on a case-by-case basis. A team at the University of Portsmouth lead by Professor Randall Parrish tested urine samples of 154 US veterans in 2021, reporting that no soldiers with the syndrome were exposed to significant amounts of depleted uranium and that it "is not and never was in the bodies of those who are ill at sufficient quantities to cause disease". Pyridostigmine bromide nerve gas antidote The US military issued pyridostigmine bromide (PB) pills to protect against exposure to nerve gas agents such as sarin and soman. PB was used as a prophylactic against nerve agents; it is not a vaccine. Taken before exposure to nerve agents, PB was thought to increase the efficiency of nerve agent antidotes. PB had been used since 1955 for patients suffering from myasthenia gravis with doses up to 1,500 mg a day, far in excess of the 90 mg given to soldiers, and was considered safe by the FDA at either level for indefinite use and its use to pre-treat nerve agent exposure had recently been approved. Given both the large body of epidemiological data on myasthenia gravis patients and follow-up studies done on veterans it was concluded that while it was unlikely that health effects reported today by<unk> <unk>  veterans are the result of exposure solely to PB, use of PB was causally associated with illness. However, a later review by the Institute of Medicine concluded that the evidence was not strong enough to establish a causal relationship. Organophosphates Organophosphate-induced delayed neuropathy (OPIDN, aka organophosphate-induced delayed polyneuropathy) may contribute to the unexplained illnesses of the<unk> <unk>  veterans. Organophosphate pesticides The use of organophosphate pesticides and insect repellents during the first<unk> <unk>  is credited with keeping rates of pest-borne diseases low. Pesticide use is one of only two exposures consistently identified by<unk> <unk>  epidemiologic studies to be significantly associated with<unk> <unk>  illness. Multisymptom illness profiles similar to<unk> <unk>  illness have been associated with low-level pesticide exposures in other human populations. In addition,<unk> <unk>  studies have identified dose-response effects, indicating that greater pesticide use is more strongly associated with<unk> <unk>  illness than more limited use. Pesticide use during the<unk> <unk>  has also been associated with neurocognitive deficits and neuroendocrine alterations in<unk> <unk>  veterans in clinical studies conducted following the end of the<unk> . The 2008 report concluded that "all available sources of evidence combine to support a consistent and compelling case that pesticide use during the<unk> <unk>  is causally associated with<unk> <unk>  illness." Sarin nerve agent right Many of the symptoms of<unk> <unk>  illness are similar to the symptoms of organophosphate, mustard gas, and nerve gas poisoning.<unk> <unk>  veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides. Chemical detection units from Czechoslovakia, France, and Britain confirmed chemical agents. French detection units detected chemical agents. Both Czech and French forces reported detections immediately to U.S. forces. U.S. forces detected, confirmed, and reported chemical agents; and U.S. soldiers were awarded medals for detecting chemical agents. The Riegle Report said that chemical alarms went off 18,000 times during the<unk> <unk> . After the air<unk>  started on January 16, 1991, coalition forces were chronically exposed to low but nonlethal levels of chemical and biological agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft munitions and by fallout from allied bombings of Iraqi chemical<unk> fare munitions facilities. In 1997, the US Government released an unclassified report that stated: : "The US Intelligence Community (IC) has assessed that Iraq did not use chemical weapons during the<unk> <unk> . However, based on a comprehensive review of intelligence information and relevant information made available by the United Nations Special Commission (UNSCOM), we conclude that chemical<unk> fare (CW) agent was released as a result of US postwar demolition of rockets with chemical<unk> heads in a bunker (called Bunker 73 by Iraq) and a pit in an area known as Khamisiyah." Over 125,000 U.S. troops and 9,000 U.K. troops were exposed to nerve gas and mustard gas when the Iraqi depot in Khamisiyah was destroyed. Recent studies have confirmed earlier suspicions that exposure to sarin, in combination with other contaminants such as pesticides and PB were related to reports of veteran illness. Estimates range from 100,000 to 300,000 individuals exposed to nerve agents. While low-level exposure to nerve agents has been suggested as the cause of GWI, the 2008 report by the U.S. Department of Veterans Affairs (VA) Research Advisory Committee on<unk> <unk>  illnesses (RAC) stated that "evidence is inconsistent or limited in important ways." The VA's 2014 RAC report concluded that, "exposure to the nerve gas agents sarin/cyclosarin has been linked in two more studies to changes in structural magnetic resonance imaging findings that are associated with cognitive decrements, further supporting the conclusion from evidence reviewed in the 2008 report that exposure to these agents is etiologically important to the central nervous system dysfunction that occurs in some subsets of<unk> <unk>  veterans." Less likely causes According to the VA's 2008 RAC report, "For several<unk> <unk>  exposures, an association with<unk> <unk>  illness cannot be ruled out. These include low-level exposure to nerve agents, close proximity to oil well fires, receipt of multiple vaccines, and effects of combinations of<unk> <unk>  exposures." However, several potential causes of GWI were deemed, "not likely to have caused<unk> <unk>  illness for the majority of ill veterans," including "depleted uranium, anthrax vaccine, fuels, solvents, sand and particulates, infectious diseases, and chemical agent resistant coating (CARC)," for which "there is little evidence supporting an
Gulf War syndrome
SAHA syndrome
Toxic shock syndrome
Primrose syndrome
Proteus syndrome
Systemic inflammatory response syndrome
SUNCT syndrome
Severe fever with thrombocytopenia syndrome