WASHINGTON, DC—This year marks the 20th anniversary of the start of deployment for Operations Desert Shield and Desert Storm—the defining combat operations of the Gulf War. According to a report released last month by a VA task force, veterans of that war—of which there are nearly 700,000—are being underserved by VA, and the agency needs to readjust its outreach and treatment strategies to in order to address their needs.

The report, commissioned by VA in August, was prepared by the Gulf War Veterans’ Illness Task Force. It outlines an action plan that addresses issues in key areas of VA that affect Gulf War veterans, including outreach, research, treatment, clinical education, and benefits.

According to the report’s authors, VA has treated nearly 150,000 Gulf War combat veterans over the last 20 years. But Gulf War veterans as a whole feel both disenfranchised in these efforts and underserved by VA. The task force was formed to address these criticisms.

Hazardous Exposures

The experience of veterans in VA is profoundly influenced by how well DoD and VA share information, the report concluded. Much of the discussion of the illnesses of Gulf War veterans has revolved around their exposure to hazardous materials on the battlefield. Currently, an overarching memorandum of understanding exists between the two departments. In the future, the report states, VA and DoD must partner to find ways to store and transfer information on individuals’ potential exposure to toxic substances from DoD to VA, so that patients can be accurately diagnosed.

This issue was discussed at a DoD/VA working group meeting in January and, according to the report, remains a topic for discussion for both agencies on how to comprehensively share environmental exposure data.

The report also found that clinicians need to be educated on how to manage Gulf War veterans’ health needs, and their concerns over potential hazardous exposure. VA has historically used a series of clinician training programs, titled Veterans Health Initiative, to prepare staff to treat veterans. The task force found the program ’unwieldy,” the information contained within it “out of date,” and the format “unfriendly.”

“The process for updating these training programs lacks agility,” the report states. “VA needs a new approach to revise clinician training programs so they are relevant, timely, easy to use, and capture clinician’s respect and attention.”

There are also few exposure-related disease experts within the VA system, and providers may not be trained to recognize or diagnose such conditions, the report states.

Surveillance

Veteran-specific population-based longitudinal surveillance is currently not conducted as part of any nationwide surveillance plan, which limits the amount of data that researchers have available to them on the widespread health conditions of any particular veteran population. The report suggests that all aspects of VA care can be enhanced with knowledge gained from such a study, including deployment and other environmental exposures on long-term health.

The task force also noted that no process exists for periodic monitoring of the health status of veterans who belonged to units that may have been exposed to environmental hazards during their military service. According to VA, a program is being developed for veterans who may have been exposed to sodium dichromate while stationed at a water treatment plant at Qarmat Ali, Iraq, in April 2003. This model will be used to develop other medical surveillance programs for other exposure events.

Qarmat Ali is being used as a test case because of the relatively small number of veterans involved, the well-defined nature of the event, and the fact that there is only one offending chemical.

Research and Development

It is research that must be the central focus for improving the health of Gulf War veterans, the report’s authors concluded. There continues to be a lack of diagnostic tests for many Gulf War illnesses. And while there has been significant research into epidemiological questions and examination of potential biological indicators of illness, effective treatments continue to evade scientists.

VA needs to embrace a multi-pronged approach that balances the urgency of understanding and finding new diagnostic tests and treatments for ill Gulf War veterans in the short-term, and the need to do new studies on veterans as a whole in the long-term, the task force stated.

The report notes that VA’s Office of Research and Development issued three new RFAs in November aimed at potential new treatments for ill Gulf War veterans. A total of 13 applications were received for the three RFAs by December, and are in the process of being reviewed.

The ORD also has plans to design and implement a national study of veterans under the auspices of the VA Cooperative Studies Program and will include a genome-wide association study. The target for completion of the study design is September 2010.

VA published the draft version of the report at the end of March and solicited comments on it through the end of April. John Gingrich, chief of staff at VA, and chair of the task force, has high hopes that the report will do more than just sit on a shelf. “Reaching out to Gulf War veterans is not only essential to our transformation of VA, for many of us it is also personal,” said Gingrich, a retired Army officer who served during the Gulf War, in a statement. “Having commanded troops in the Gulf War, and then knowing that some of these brave men and women have fallen to mysterious illnesses has been both a frustrating and saddening experience. We now have an opportunity to do something about this situation and with this task force, I know that we will improve the care and services these veterans have earned.”

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