Department of Veterans Affairs:

Federal Gulf War Illnesses Research Strategy Needs Reassessment

GAO-04-767: Published: Jun 1, 2004. Publicly Released: Jun 1, 2004.

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More than a decade after the 1991 Persian Gulf War, there is continued interest in the federal response to the health concerns of Gulf War veterans. Gulf War veterans' reports of unexplained illnesses and possible exposures to various health hazards have prompted numerous federal research projects on Gulf War illnesses. This research has been funded primarily by the Department of Veterans Affairs (VA), the Department of Defense (DOD), and the Department of Health and Human Services. GAO is reporting on (1) the status of research and investigations on Gulf War illnesses, (2) the efforts that have been made by VA and DOD to monitor cancer incidence among Gulf War veterans, and (3) VA's communication and collaboration with the Research Advisory Committee on Gulf War Veterans' Illnesses (RAC).

Most federally funded Gulf War illnesses research projects and investigations are complete, but VA--the agency with lead responsibility for coordination of Gulf War illnesses issues--has not yet analyzed the latest research findings to identify whether there are gaps in current research or to identify promising areas for future research. As of September 2003, about 80 percent of the 240 federally funded medical research projects for Gulf War illnesses had been completed. In recent years, VA and DOD funding for this research has decreased, federal research priorities have changed, and interagency coordination of Gulf War illnesses research has waned. In addition, VA has not reassessed the extent to which the collective findings of completed Gulf War illnesses research projects have addressed key research questions. The only assessment of progress in answering these research questions was published in 2001, when findings from only about half of all federally funded Gulf War illnesses research were available. Moreover, it did not identify whether there were gaps in existing Gulf War illnesses research or promising areas for future research. This lack of comprehensive analysis leaves VA at greater risk of failing to answer unresolved questions about causes, course of development, and treatments for Gulf War illnesses. In a separate effort, DOD has conducted 50 investigations since 1996 on potential hazardous exposures during the Gulf War. Generally, these investigations concluded that there were limited exposures by troops to some hazards and, at most, limited short- or long-term adverse effects expected from these exposures. As of April 2003, all investigations were complete. Federal agencies have funded seven research projects related to cancer incidence among Gulf War veterans. However, several limitations exist that affect research related to cancer incidence. For example, some cancers may take many years to develop and be detected. In addition, some research projects studying cancer incidence have not studied enough Gulf War veterans to reliably assess cancer incidence. Research may also be impeded by incomplete federal data on the health characteristics of Gulf War veterans. RAC's efforts to provide advice and make recommendations on Gulf War illnesses research to the Secretary of VA may have been hampered by VA senior administrators' incomplete or unclear information sharing and limited collaboration on research initiatives and program planning. VA and RAC are exploring ways to improve collaboration, including VA's hiring of a senior scientist who would both guide VA's Gulf War illnesses research and serve as the agency's liaison for routine updates to the advisory committee. However, most of these changes had not been finalized at the time of our review.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: The Department of Veterans Affairs took initial steps to reevaluate the 21 key Gulf War illness research questions, but its efforts to fully reassess all of the questions have not continued. The 21 research questions were converted to 21 broad based research topic areas in 2004 and 2005. A review of these topic areas was initiated in the 2006 Annual Report to Congress and began with infectious diseases. Based on a review of scientific literature described in the 2006 report, VA concluded that there was no rationale to continue inclusion of infectious diseases as an area of Gulf War illness research. This resulted in the removal of 2 of the 21 research topic areas and the modification of one research topic area. In VA's 2007 update for us, reviews of the Gulf War illness research topic areas were intended to continue until all of the topic areas have been evaluated. However, there was no evidence in the 2007 Annual Report that this review has continued nor was there mention of this review in VA's 2008 update for us.

    Recommendation: With respect to the federal Gulf War illnesses research efforts, the Secretary of Veterans Affairs should conduct a reassessment of the Gulf War illnesses research strategy to determine whether the 21 key research questions have been answered, whether they remain relevant, and whether there are promising areas for future research.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: In June 2005, VA appointed a Ph.D. scientist to both oversee VA's Gulf War research program and to act as liaison to involve RAC in development of the research program. In addition, VA's Office of Research and Development has collaborated with RAC in several activities that facilitate RAC's ability to provide advice on Gulf War illnesses research, including development of a Gulf War illnesses research Request for Proposal (RFP) in March 2005 and generation of a proposed Gulf War Treatment Research Center RFP, resulting from RAC's recommendations for a dedicated treatment research center for illnesses affecting Gulf War veterans.

    Recommendation: To facilitate RAC's ability to provide advice on Gulf War illnesses research, the Secretary of Veterans Affairs should ensure that a liaison who is knowledgeable about Gulf War illnesses research is appointed to routinely share information with RAC.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: In June 2005, VA appointed a Ph.D. scientist to both oversee VA's Gulf War research program and to act as liaison to involve RAC in development of the research program. In addition, VA's Office of Research and Development has collaborated with RAC in several activities that facilitate RAC's ability to provide advice on Gulf War illnesses research, including development of a Gulf War illnesses research Request for Proposal (RFP) in March 2005 and generation of a proposed Gulf War Treatment Research Center RFP, resulting from RAC's recommendations for a dedicated treatment research center for illnesses affecting Gulf War veterans.

    Recommendation: To facilitate RAC's ability to provide advice on Gulf War illnesses research, the Secretary of Veterans Affairs should ensure that VA's research offices collaborate with RAC on Gulf War illnesses research program development activities.

    Agency Affected: Department of Veterans Affairs

 

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