Introduction
Operation Desert Shield and Desert Storm saw nearly 700,000 brave men and women deployed to the Persian Gulf in the early 1990s. These soldiers who served in Desert Storm faced unique environmental and operational challenges. Today, the Department of Veterans Affairs (VA) is dedicated to understanding and treating the health issues that some of these veterans are experiencing years after their service. VA researchers are at the forefront of this effort, conducting vital studies to improve the lives of those who served.
One of the most significant health concerns affecting soldiers who served in Desert Storm is Gulf War Illness (GWI), also known as chronic multisymptom illness or medically unexplained illnesses. This condition is characterized by a cluster of persistent, unexplained symptoms, including debilitating fatigue, chronic headaches, joint pain, digestive problems, insomnia, dizziness, respiratory issues, skin conditions, and memory problems.
A 2020 Department of Defense report estimated that GWI affects between 175,000 and 250,000 veterans out of the nearly 700,000 soldiers who served in Desert Storm from 1990 to 1991. The prevalence of GWI varies among different groups of veterans. Army and Marine Corps personnel are diagnosed more frequently than those in the Navy and Air Force. Enlisted personnel also experience higher rates of GWI compared to officers. Furthermore, the location of deployment during the Gulf War impacts GWI rates, with those stationed closer to combat zones reporting higher incidence.
A 2016 VA study, analyzing data collected two decades post-war, revealed that soldiers who served in Desert Storm continue to report poorer overall health compared to veterans who served during the same period but were not deployed to the Gulf. This highlights the enduring nature of health challenges for Desert Storm veterans.
Beyond GWI, the VA recognizes nine infectious diseases as related to military service in Southwest Asia during the Gulf War and Afghanistan. These include malaria, brucellosis, campylobacter jejuni, Q fever (coxiella burnetii), mycobacterium tuberculosis, nontyphoid salmonella, shigella, visceral leishmaniasis, and West Nile virus.
The VA also presumes certain chronic, unexplained symptoms lasting six months or more to be related to Gulf War service, regardless of the cause. These presumptive illnesses, which must have emerged during active duty in the Southwest Asia theater by December 31, 2021, and be at least 10% disabling, include chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders, and other undiagnosed conditions.
To gain deeper insights and improve treatment for health problems in soldiers who served in Desert Storm, the VA has established several registries and research initiatives:
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Gulf War Registry Health Exam: This program informs veterans about potential long-term health problems linked to environmental exposures during their service. The registry data is crucial for the VA to understand and effectively address these health issues. All veterans who served in the Gulf during Operations Desert Shield, Desert Storm, Iraqi Freedom, or New Dawn are eligible for this exam, separate from disability compensation processes, and VA health care enrollment is not required.
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Airborne Hazards and Open Burn Pit Registry: Veterans can register and report exposures to airborne hazards such as burn pit smoke, oil-well fires, or pollution during deployment, along with any health concerns.
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VA Gulf War Era Cohort and Biorepository: Established to further understand health conditions affecting veterans serving between 1990 and 1991, this cohort includes 1,275 men and women who served during the Gulf War era. Participants complete health surveys and provide blood samples for DNA analysis, regardless of whether they receive VA health care.
For more comprehensive information on VA initiatives for soldiers who served in Desert Storm, particularly in epidemiology and surveillance, the VA Office of Public Health website offers a dedicated section on Gulf War Veterans’ Illnesses.
Current Funded Studies
The VA Office of Research and Development (ORD) funds numerous projects focused on Gulf War health issues. A selection of these projects is listed below, and a complete list can be found on the ORD Funded Projects page by searching “Gulf War.”
| Project | Title ↓ | PI | Service |
|---|---|---|---|
| I01CX001480-01 | A Randomized, Double-blind Placebo-controlled Phase III Trial of Coenzyme Q10 in Gulf War Illness | Klimas, Nancy | Clinical Science R&D |
| IK2CX001679-01A1 | Acute exercise tolerance among Veterans with Gulf War Illness | Lindheimer III, Jacob | Clinical Science R&D |
| I01BX004740-01A1 | Advancing Non-Invasive Diagnostics and Treatments of Deployment-Related Chronic Lung Disease in Gulf War Veterans | Osterholzer, John | Biomedical Laboratory R&D |
| I01CX000798-05 | An investigation of the relationship between toxicant exposures during Gulf War deployment and prodromal Parkinson’s disease. | Chao, Linda | Clinical Science R&D |
| I01CX001569-01A1 | Biomarker Candidates in Gulf War Veterans: A 10-year Follow-up Investigation | Marx, Christine | Clinical Science R&D |
Research Advisory Committee on Gulf War Veterans’ Illnesses
The Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI) provides recommendations to the Secretary of Veterans Affairs regarding research and strategies to understand and treat the health consequences faced by soldiers who served in Desert Storm. The committee focuses on service in the Southwest Asia theater during the 1990-1991 Gulf War. More information about RAC reports and activities is available via the provided link.
Selected Major Accomplishments
VA research has made significant strides in understanding the health challenges of soldiers who served in Desert Storm. These accomplishments are guiding the development of better diagnostic tools and treatments for conditions like GWI.
New, Ongoing, and Published Research
VA researchers are continuously working to expand our knowledge of conditions affecting soldiers who served in Desert Storm and to identify the most effective diagnostic and treatment approaches. Their work is guided by a strategic plan for Gulf War research, developed in 2012 and updated in 2015 with input from leading scientists, researchers, physicians, and veterans themselves. This plan addresses a wide range of issues and emphasizes the critical need for effective treatments for veterans.
Current research areas include pain management, autoimmune diseases, neurodegenerative diseases, sleep disorders, gastrointestinal disorders, respiratory problems, and other chronic conditions prevalent among soldiers who served in Desert Storm.
➤ Longitudinal Study of Gulf War Veterans
The VA’s Longitudinal Health Study of Gulf War Era Veterans stands as one of the most extensive investigations into the long-term health of soldiers who served in Desert Storm. This study compares health changes over time between veterans deployed to the Gulf and those who were not deployed during the same era. The initial study involved approximately 30,000 veterans.
The first report, published in 2000, revealed that soldiers who served in Desert Storm experienced a higher prevalence of functional impairment, healthcare utilization, symptoms, and medical conditions compared to non-deployed veterans. They also rated their overall health, including mental, physical, and social well-being, lower.
Follow-up studies published in 2011 and 2016 confirmed that nearly 20 years later, soldiers who served in Desert Storm continued to report poorer health outcomes, both physical and mental, than their non-deployed counterparts. Researchers noted that veterans from this era, as a group, tend to have multiple health conditions and a higher body mass index, factors that could contribute to poorer health.
A third follow-up in 2021, involving over 6,300 veterans who participated in all three surveys, further indicated that soldiers who served in Desert Storm continued to report an increase in chronic diseases. These veterans were not only more likely to report health problems than their non-deployed peers, but they also reported these problems at an earlier age.
➤ Reported GWI Symptoms
Symptoms Persist 25 Years Later: A 2021 study from the Durham VA Medical Center reinforced the findings of the Longitudinal Health Study, demonstrating that multisymptom illnesses persist decades after deployment to the Persian Gulf. A survey of over 1,000 members of the Gulf War Era Cohort and Biorepository found that 84% met the CDC criteria for GWI, and 40% met the Kansas Gulf War criteria.
Deployed Women Veterans Report Multiple GWI Symptoms: A 2020 study involving VA, DOD, and other institutions revealed that 40% of women soldiers who served in Desert Storm reported more than 20 GWI symptoms—nearly double the rate of Gulf War-era women veterans who were not deployed. Deployed women were more likely to report cognitive, neurological, mood, and respiratory symptoms. A significant portion reported difficulty with memory and concentration, and respiratory issues. Researchers emphasized the need for further research into biological markers of GWI and gender-specific treatments.
Post-Exertional Malaise (PEM) Inconsistent in Veterans with GWI: A 2020 VA study found that while GWI veterans with PEM perceived exercise as more painful and fatiguing, not all GWI participants reported PEM after exercise. This suggests that PEM, a debilitating symptom where exertion worsens pain and fatigue, requires further investigation to understand its relationship with GWI and exercise.
Increased Rates of Respiratory Illnesses: A 2020 study by VA’s Health Outcomes Military Exposures (HOME) examined 10-year outcomes for over 360,000 soldiers who served in Desert Storm and over 320,000 non-deployed veterans. Deployed veterans showed a small but significant higher prevalence of chronic bronchitis, emphysema, chronic airway obstruction, and COPD. This highlights the importance of long-term respiratory health monitoring for Desert Storm veterans due to potential airborne hazard exposures.
Health Symptom Frequency for GWI: A 2018 study analyzing 21 peer-reviewed studies from 1990 to 2017 found that soldiers who served in Desert Storm had higher odds of experiencing all 56 reported symptoms compared to non-deployed veterans. Symptoms like irritability, detachment, muscle weakness, diarrhea, and rashes were significantly more prevalent. Researchers emphasize the importance of considering these symptoms when assessing the health of Gulf War veterans.
➤ Biomarkers of GWI
Inflammation: In 2016, researchers developed a blood marker panel that could diagnose GWI with 90% accuracy. The study identified four types of blood cells present in higher numbers in GWI veterans and found significant differences in inflammatory serum proteins. This suggests chronic inflammation as a potential component of GWI. A clinical trial testing an anti-inflammatory drug for GWI was completed in 2020, with results pending.
Human Leukocyte Antigen (HLA): Research in 2015 and follow-up studies revealed differences in HLA composition and brain function between veterans with and without GWI. Veterans with GWI showed reduced HLA protection and brain function differences in areas controlling movement and higher mental processes. HLA also affects neural synchrony, crucial for cognitive functions, and a 2017 study identified an HLA allele potentially protective against brain atrophy in GWI.
Genetic Study and Biorepository: The VA is conducting a genetic study of soldiers who served in Desert Storm, collecting survey data and blood samples in a biorepository to understand genetic influences on GWI and treatment response. Participants are followed long-term and agree to tissue donation post-mortem, providing invaluable data for understanding the health challenges faced by veterans of the Gulf War and future conflicts.
➤ Pain in Gulf War Veterans
Chronic Pain Affects Thinking: A 2021 study using MRI analyzed neural processing in soldiers who served in Desert Storm with chronic musculoskeletal pain. Results showed that veterans with chronic pain required more neural resources to maintain cognitive performance when exposed to pain stimuli, suggesting abnormal pain processing.
Structural Damage Linked to Musculoskeletal Pain: A 2017 MRI study found that veterans with chronic musculoskeletal pain had widespread disruptions in brain white matter structure, which correlated with greater pain, fatigue, and, to a lesser extent, depression.
Veterans with GWI and GI Complaints are Hypersensitive to Pain: A 2018 study found that soldiers who served in Desert Storm with both GWI and gastrointestinal symptoms exhibited a lower pain threshold compared to those without GI symptoms, indicating heightened somatic pain sensitivity. This understanding can inform the development of more targeted pain therapies.
➤ Toxic Exposures During Gulf War Service
Toxic Exposures Change Hippocampus: A 2021 animal model study simulating Gulf War toxic exposures found altered gene expression in the hippocampus, leading to memory problems. Exposure to insecticides and anti-sarin prophylactic caused inflammation and acute changes, suggesting a link between toxic substances and chronic brain degeneration in GWI.
Exposure to Sarin and Cyclosarin: Research using MRI scans on soldiers who served in Desert Storm exposed to low levels of sarin and cyclosarin from the Khamisiyah depot demolition in 1991 revealed reduced gray and white matter in the brains of exposed veterans. These veterans also showed more errors and slower responses in cognitive testing, confirming central nervous system pathology two decades post-exposure. Follow-up studies further identified hippocampal differences and potential brain white matter reorganization linked to sarin and cyclosarin exposure, impacting verbal learning and memory even 25 years later.
Toxic Exposure Increases Likelihood of GWI in Women: A study of women soldiers who served in Desert Storm found that exposure to pesticides, oil well fires, and pyridostigmine bromide pills significantly increased the likelihood of meeting GWI criteria. This suggests targeted treatment strategies based on specific toxic exposures may be beneficial for women veterans.
Chemical Exposure Could Cause Muscle Weakness in GWI: A study exposing rats to chemicals used during the Gulf War found that these chemicals led to muscle atrophy and loss of function, potentially explaining muscle weakness symptoms in GWI.
Effects of Depleted Uranium (DU): A 2017 study evaluating veterans with known DU exposure from embedded bullet fragments found no uranium-related health effects 25 years post-exposure. While veterans with embedded fragments showed elevated urine uranium levels, a 2018 study found no difference in lung function between veterans with high and low uranium concentrations. However, ongoing health surveillance for veterans with embedded DU fragments is recommended due to continuous radiation exposure.
➤ Treatments for GWI
Psychotherapy for Insomnia Improves GWI Symptoms: A 2021 study demonstrated that telephone-administered cognitive behavioral therapy for insomnia (CBT-I) improved insomnia symptoms and overall GWI symptom severity in soldiers who served in Desert Storm with GWI and insomnia. CBT-I shows promise as an effective, accessible treatment.
Existing Drugs May Help GWI: A 2019 study indicated that ribavirin, an antiviral drug, may be an effective treatment for GWI by restoring microbial balance in the gut, which is implicated in GWI and inflammatory diseases. Another 2021 study found that andrographolide, an herbal medicine, may also restore gut microbial balance and reduce inflammation in a GWI mouse model.
Curcumin May Improve Memory and Mood in GWI: A 2018 study found that curcumin, an antioxidant in turmeric, improved cognitive and mood function in a GWI model, potentially through improved neurogenesis and reduced inflammation.
Treatment for Brain Inflammation: Researchers are studying fingolimod, an anti-inflammatory drug used for multiple sclerosis, as a potential treatment for brain inflammation and neurological symptoms in GWI.
Grape Juice May Improve Cognitive Performance: A 2021 study suggested that Concord grape juice, rich in polyphenols, may improve cognitive function in soldiers who served in Desert Storm with GWI. Polyphenols in grape juice showed links to improved cognitive function, warranting further clinical studies to explore their therapeutic potential.
More on Our Website
For further information and resources related to Gulf War Veterans’ health, please explore other sections of our website.
Selected Scientific Articles by Our Researchers
- Acute gene expression changes in the mouse hippocampus following a combined Gulf War toxicant exposure. Murray KE, Delic V, Ratliff WA, Beck KD, Citron BA. Exposure to toxic substances that simulate Gulf War toxic exposure can cause chronic neurodegeneration. Life Sci. 2021 2021 Nov 1;284;119845.
- Nociceptive stress interferes with neural processing of cognitive stimuli in Gulf War Veterans with chronic musculoskeletal pain. Lindheimer JB, Stegner AJ, Van Riper SM, Ninneman JV, Ellingson LD, Cook DB. Gulf War Veterans with chronic musculoskeletal pain require a greater amount of neural resources to sustain cognitive performance when they are stressed by pain. Life Sci. 2021 Aug 15;279:119653.
- Cognitive behavioral therapy for insomnia in Veterans with Gulf War illness; results from a randomized controlled trial. Chao LL, Kanady JC, Crocker N, Straus LD, Hlavin J, Metzler TJ, Maguen S, Neylan TC. Cognitive behavioral therapy for insomnia delivered by telephone improves sleep and non-sleep symptoms of GWI. Life Sci. 2021 Aug. 15;279:119147.
- Gulf War illness in the Gulf War Era Cohort and Biorepository: the Kansas and Centers for Disease Control definitions. Gifford, EJ, Vahey J, Hauser ER, Simms KJ, Efird JT, Dursa EK, Steele L, Helmer DA, Provenzale D. Veterans who deployed to the Gulf War show evidence of sustained, multi-symptom illness compared to non-deployed Gulf War era Veterans nearly 25 years later. Life Sci. 2021 Aug 1;278:119454.
- Andrographolide attenuates gut-brain-axis associated pathology in Gulf War illness by modulating bacteriome-virome associated inflammation and microglia-neuron proinflammatory crosstalk. Saha P, Skidmore PT, Holland LA, Mondal A, Bose D, Seth RK, Sullivan K et al. Andrographolide may be able to restore gut microbiomes and viromes that have been altered by chronic multi-symptom illnesses like GWI. Brain Sci. 2021 Jul 9;11(7):905.
- Prevalence and patterns of symptoms among female Veterans of the 1991 Gulf War Era; 25 years later. Sullivan K, Krengel M, Heboyan V, Schildroth S, Wilson C Iobst S, Klimas N, Coughlin SS. Twenty-five years after the Gulf War, female combat Veterans continue to report a wide variety of symptoms at a significantly higher excess frequency prevalence than other Gulf War-era women Veterans. J Womens Health (Larchmt). 2020 Jun;29(6):819-826.
- Gut DNA virome diversity and its association with host bacteria regulate inflammatory phenotype and neuronal immunitoxicity in experimental Gulf War Illness. Seth RK, Maqsood R, Mondal A, Bose D, Kimono D, Holland LA, Lloyd PJ et al. Adjusting GI tracked viruses by repurposing existing FDA-approved antiviral drugs may be an effective treatment for GWI and its symptoms. Viruses. 2019 Oct 21;11(10):968.
- Evidence for somatic hypersensitivity in Veterans with Gulf War illness and gastrointestinal symptoms. Zhou Q, Verne ML, Zhang B, Verne GN. Somatic hypersensitivity is found in Veterans with GWI and diarrhea and abdominal pain. It is positively correlated with abdominal pain ratings. Clin J Pain. 2018 Oct;34(10):944-949.
- Motor unit number estimate and isometric hand grip strength in military Veterans with or without muscular complaints: reference values for longitudinal follow-up. Li M, Yao W, Sundahl C. This study established baselines for a longitudinal follow-up study of motor neuron function of troops deployed in the Gulf War. Mil Med. 2018 Sep 1;183(9-10):e399-e404.
- Detecting chromosome condensation defects in Gulf War illness patients. Liu G, Ye CJ, Chowdhury SK, Abdallah BY, Horne SD, Nichols D, Heng HH. Some patients with GWI exhibited a high level of chromosomal condensation defects. Curr Genomics. 2018 Apr;19(3):200-206.
- Impulse oscillometry measurement of distal airways obstruction in depleted uranium-exposed Gulf War Veterans. Hines SE, Barnes AH, Brown C, Gucer P, Oliver MS, Gaitens JM, Condon M, McDiarmid M. Veterans with high level exposure to depleted uranium have no higher levels of distal airways obstruction than those with low levels of exposure. Am J Ind Med. 2018 Apr;61(4):308-316
- Curcumin treatment leads to better cognitive and mood function in a model of Gulf War illness with enhanced neurogenesis, and alleviation of inflammation and mitochondrial dysfunction in the hippocampus. Kodali M, Hattiangady B, Shetty GA, Bates A, Shuai B, Shetty AK. Curcumin may lead to better cognitive function and mood for those with GWI. Brain Behav Immun. 2018 Mar;69:499-514.
- Meta-analysis of self-reported health symptoms in 1990-1991 Gulf War and Gulf War-era Veterans. Maule AL, Janulewicz PA, Sullivan KA, Krengel MH, Yee MK, McClean M, White RF. Higher odds of reporting mood-cognition, fatigue, musculoskeletal, gastrointestinal, and dermatological symptoms among Gulf War-deployed Veterans compared with Gulf War-era controls indicates those symptoms are important when assessing Gulf War Veteran health status. BMJ Open. 2018 Feb 13;8(2):e016086
