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The Gulf War Story

Environmental and Occupational Exposures: The Potential for Causing Gulf War Illnesses

Helicopter dispersing particulate matterWe are all exposed to chemicals in the air we breathe and in the food and water we consume every day. Some of these chemicals are man-made while others occur in nature.

Summary

Many Gulf War veterans have experienced a variety of physical symptoms, collectively called Gulf War illnesses. In response to veterans’ concerns, the Department of Defense established a task force in June 1995 to investigate those incidents and circumstances related to possible causes of these unexplained illnesses. The Office of the Special Assistant assumed responsibility for these investigations on November 12, 1996, and continues to gather information on environmental and occupational exposures during the Gulf War and their possible effects on the health of the troops who served there.

To inform the public about the progress of this office, the Department of Defense publishes (on the Internet and elsewhere) accounts related to the possible causes of illnesses among Gulf War veterans, along with documentary evidence or personal testimony used in compiling the accounts. The following is a summary of the reports we have published concerning our investigations into environmental and occupational exposures.

We are all exposed to chemicals in the air we breathe and in the food and water we consume every day. Some of these chemicals are man-made while others occur in nature. Someone living in a rural area will be exposed to different chemicals than someone who lives in a large city. Proximity to farms and industries, prevailing winds, and sources of food and water are some of the variables that affect the types and levels of chemicals in our environment. Furthermore, all environmental media can be affected; that is, air, water and soil can become repositories for chemicals released on a daily basis from human activities and natural actions. As a result, we are exposed to chemical contaminants on a continuous basis in our everyday lives.

Our occupations often expose us to chemicals, too. A factory worker may be exposed to all the chemicals used in the factory, more so to those specific chemicals he or she works with every day. Occupational exposures can potentially be more severe than other types of environmental exposures because the concentrations of chemicals encountered in an occupational environment tend to be much higher than in the ambient environment, and individual workers are exposed to these higher levels of chemicals over longer periods.

Several factors combine to determine an exposure’s potential for causing illness: the toxicity of the chemical, the concentration of the chemical, and the duration of exposure are important factors for the potential for causing illness. An individual’s susceptibility to the chemical adds another variable.

Occupational exposures are usually calculated for a 40-hour workweek, 50 weeks a year, over a 40-year working life. Human health effects from chemical exposures are determined from actual incidents experienced by people in occupations where they are routinely exposed to toxic chemicals, or are estimated based on studies involving animals in controlled laboratory environments.

U.S. military personnel who served in the Gulf War were not only exposed to chemicals in the ambient environment; they were also exposed to chemicals associated with their occupational activities. For example, pesticides were widely used to control insects, rodents, and other disease-carrying pests. These pesticides were applied where veterans worked, ate, and slept. Some subgroups of the general military population, that is, applicators who were involved in the day-to-day handling and use of pesticides, and who did not wear personal protective equipment, may have been exposed to certain pesticides above levels considered safe for human health. This is a concern because if improperly used, pesticides have the potential to cause adverse health effects. That is, pesticides that were used improperly may have created exposures above recommended limits – for example, the use of some pesticides formulated for use only in an outdoor environment were sometimes used indoors. Such use could have resulted in overexposures.

The Office of the Special Assistant has investigated the potential for human health effects arising as a result of exposure to pesticides and a number of other environmentally and occupationally related factors experienced by some US military personnel during the Gulf War. These investigations have resulted in the preparation of environmental exposure reports that discuss the issues and facts surrounding specific exposures. Some of these reports also estimate the likelihood that long-term adverse health effects could result. The reports are divided between environmentally and occupationally related exposures. Environmentally related issues included oil well fire smoke, particulate matter, and contaminated water. Occupationally related issues included pesticides, chemical agent resistant coating (CARC) paint, retrograde contaminated equipment, and depleted uranium.

All of the environmental and occupational related reports prepared by the Office of the Special Assistant have been published on the Department of Defense’s GulfLINK Web site and are briefly discussed in the following paragraphs.

Oil Well Fires

In response to the Iraqi’s occupation of Kuwait, nearly 700,000 US troops were deployed during the Gulf War in 1990 and 1991. In addition to the risk of sustaining combat casualties, many of these troops were exposed to a number of toxic substances from a variety of sources. The most visible source was the smoke from hundreds of oil well fires that burned out of control over a period of about nine months. Depending on their proximity to the burning oil wells, veterans were exposed to varying levels of petroleum combustion pollutants for hours to months in duration. Non-documented reports by some veterans of various short-term, adverse health symptoms occurred during the war. Some of these may have been related to exposures to oil fire smoke. Air monitoring studies and a review of records of reported adverse health effects did not reveal a widespread short-term problem, but the possibility remained that smoke exposures could cause diseases to develop in the future. The results of the investigation into the potential health effects of exposure to the smoke from the oil well fires in Kuwait is documented in our Oil Well Fires Environmental Exposure Report. Our report includes a summary of the facts associated with this issue as well as the results and findings of research conducted by other organizations.

Particulate Matter

The Oil Well Fires Environmental Exposure Report identified several issues that required additional investigation by us and further research by other organizations to resolve whether exposure to contaminants from natural and man-made sources could lead to long-term illness or explain any of the undiagnosed symptoms reported by some Gulf War veterans. One area identified for further investigation was the health effects associated with exposure to particulate matter. The Particulate Matter Environmental Exposure Report presents the results of our investigation and discusses what we currently know about US personnel exposures to particulate matter during the Gulf War.

Water Use

The rapid influx of Coalition forces into the Persian Gulf region during the early stages of Operation Desert Shield taxed the region's available potable water resources. Host nation and commercial outlets were unable to provide sufficient supplies of potable water to incoming troops. Water purification systems were brought in by the United States to supply US forces with chlorinated drinking water and water use policies were implemented in theater with respect to non-potable water.

After the Gulf War, some veterans became concerned about a possible relationship between water use during the Gulf War and their illnesses. Anecdotal reports suggested that some short-duration illnesses such as diarrhea and similar gastrointestinal illnesses may have been triggered by contaminated, over-chlorinated, or improperly stored drinking water, or by contaminated water used to grow the local produce eaten by veterans. The Office of the Special Assistant initiated the Water Use investigation to determine if these individual episodes could be linked to post-war illnesses reported by some veterans.

Pesticides

Troops used pesticides during the Gulf War for a number of purposes: on their skin and uniform to repel insects; in area sprays and fogs to kill flying insects; in pest strips and fly baits to attract and kill flying insects; and as delousing agents applied to enemy prisoners of war to control body lice. Pesticides used according to label directions (and with the use of appropriate personal protective equipment) pose a minimal health threat to most adults, but there are numerous reports of health problems, in occupational settings, resulting from overexposure—either through accident or misuse—to pesticides. The photo to the right illustrates misuse of a pesticide product. In this case the individual experienced a dermal reaction from wearing pet flea and tick collars. The potential for health problems from pesticide overexposure led some veterans and members of the medical and scientific communities to express concern over the long-term health consequences of pesticide use during the Gulf War. In response to these concerns, the Office of the Special Assistant investigated pesticide use during the Gulf War, and in March 2001, published the Pesticides Environmental Exposure Report. Our report describes how pesticides were used in the Gulf and describes what is known in the general literature about health effects associated with exposures to pesticides. In addition, the report presents what is known regarding the health effects that may have been experienced by those who were exposed to pesticides during their deployment to the Gulf.

Chemical Agent Resistant Coating

As part of the Operations Desert Shield and Desert Storm deployment, the US shipped thousands of vehicles and other equipment to the Persian Gulf. Much of the equipment had the three-color woodland camouflage scheme designed for the European theater, which would make it easy to spot in the barren desert environment. Consequently, there was an operational requirement to repaint incoming equipment with tan-colored urethane-based paint called chemical agent resistant coating, or CARC, to provide desert camouflage protection.

The military established a hand full of painting operations in Saudi Arabia to paint the vehicles. Some of these sites lacked the appropriate personal protective equipment to assure safe spray painting operations. Due to the lack of adequate personal protection, and a failure to adhere to applicable safety and occupational health policies and procedures, a number of soldiers directly involved in CARC painting may have suffered adverse health effects, primarily respiratory effects from exposures to hexamethylene diisocyanate (HDI) and solvents. Several spray painters at these sites reported short-term symptoms, including coughing, eye and throat irritation, skin rashes, headaches, and nausea. The Office of the Special Assistant investigated CARC to document its use, estimate to potential for exposure, and identify the potential health issues associated with these exposures.

Retrograde Equipment

At the end of the Gulf War, US military units began preparing equipment for redeployment back to their respective peacetime installations. These retrograde operations saw large numbers of vehicles and equipment assembled at sites where they were cleaned and processed in accordance with strict protocols for materials about to enter US air and sea ports. These protocols are meant to prevent the spread of disease and protect US agricultural resources from plant and animal pests and diseases that may be brought into the country by contaminated equipment.

Some military and civilian personnel who participated in processing the retrograde equipment are concerned that they may have been exposed to battlefield or general environmental contaminants that may have resulted in adverse health effects. In response to these concerns, the Office of the Special Assistant conducted the Retrograde Equipment investigation to determine whether there were any documented incidences of adverse health effects resulting from exposures to this equipment.

Depleted Uranium

The Gulf War was the arena for the first battlefield use of armor-piercing munitions and reinforced tank armor incorporating depleted uranium. This very dense metal is a byproduct of the process by which natural uranium is enriched to produce reactor fuel and nuclear weapons components. The leftover uranium, 40% less radioactive than natural uranium, is called depleted uranium, or DU. DU played a key role in US forces’ overwhelming success during the Gulf War. The extreme density of the metal and its self-sharpening properties make DU a formidable weapon. DU projectiles slice through thicker, tougher armor at greater ranges than do other high-velocity rounds. US forces also used DU to enhance their tanks’ armor protection. While DU’s combat debut showed the metal’s clear superiority for both armor penetration and protection, its chemical toxicity—common to all forms of uranium and similar to other heavy metals such as lead and tungsten—and its low-level radioactivity raised concerns about possible combat and non-combat health risks of DU. An investigation into the use of DU in the Gulf was conducted to determine whether DU posed an unacceptable health risk to American forces and whether personnel had been adequately trained to deal with this risk.

Focus on Current and Future Deployments

Collectively the investigations to-date into environmentally and occupationally related factors have further demonstrated the Office of the Special Assistant’s intention to leave no stone unturned in attempting to answer the question of what is causing the unexplained illnesses reported by some Gulf War veterans. While we have found no evidence of any environmental factor that can be directly and solely attributed to any of the illnesses reported by some veterans, we continue to pursue issues that may have a bearing on this question. Currently our efforts continue to focus on the health-related environmental issues not only of the Gulf War but also on current and future deployments. The ultimate goal is to insure that the concerns of veterans are consistently answered for them by the Department of Defense through consistent implementation of force health protection activities.

Additional Information Resources

The following web links provide additional scientific and technical information related to the environmental and occupational exposures that may have been experienced by our troops during Operations Desert Shield and Desert Storm.

"Preventing Asthma and Death from Diisocyanate Exposure," Department of Health and Human Services (NIOSH) publication no. 96-111, 1996
RAND Corporation, A Review of the Scientific Literature as it Pertains to Gulf War Illnesses, Vol. 6 – Oil Well Fires
RAND Corporation, A Review of the Scientific Literature as it Pertains to Gulf War Illnesses, Vol. 7 – Depleted Uranium
RAND Corporation, A Review of the Scientific Literature as it Pertains to Gulf War Illnesses, Vol. 8 – Pesticides
U.S. Environmental Protection Agency, Office of Pesticides Programs
U.S. Environmental Protection Agency, Technology Transfer Network, Hexamethylene-1-6-Diisocyanate

Scud Missile Attacks and Inhibited Red Fuming Nitric Acid

Scud MissleIraq began launching Scud missiles at Israel and Coalition forces soon after the Coalition's Gulf War air campaign began on January 17, 1991. An unexpected hazard in the Kuwait theater of operations was exposure to a highly corrosive oxidizer called inhibited red fuming nitric acid that was used in a rocket propellant for Iraq's Scud missiles.

Summary

An unexpected hazard in the Kuwait theater of operations was exposure to a highly corrosive oxidizer called inhibited red fuming nitric acid that was used in a rocket propellant for Iraq's Scud missiles.

Iraq began launching Scud missiles at Israel and Coalition forces soon after the Coalition's Gulf War air campaign began on January 17, 1991. Many Gulf War veterans observed or were aware of incoming or overflying Scud missiles, Patriot missiles fired in defense, and Scud missile or debris impacts. American and other Coalition forces in the Kuwait theater of operations (KTO) knew Iraq had the capability to use chemical weapons, so Scud missile attacks represented a significant cause for concern for anyone within their range. The fear of a chemical attack was reinforced by the chemical warfare agent alarms that coincided with some Scud attacks. Though the alarms subsequently proved to be false, their occurrence fed the general anxiety.

When Scuds broke up on re-entry or were destroyed by Patriot missile intercepts, they often released unexpended inhibited red fuming nitric acid (IRFNA) into the air. Many times this phenomenon was observed as a yellowish-brown or orange mist. Veterans related incidents of nausea, dizziness, tingling or burning skin and other symptoms consistent with IRFNA exposure. Lacking an explanation for these observations at the time of their occurrence, some veterans assumed that the cloud's presence or mist and the accompanying symptoms meant they had been subjected to a chemical weapons attack.

During investigations of many of these reported detections, we reviewed records, interviewed witnesses, and coordinated results with subject matter experts. In no case could we determine that Iraq's Scud missiles contained chemical warfare agents. Our analyses can be found in the following reports.

Scud Missles

Our information paper on Iraq's Scud ballistic missiles describes the missile's characteristics and targets, and assesses each Scud attack on the KTO. Iraq's Scud attacks involved 88 missiles, of which 46 reached Coalition countries in the KTO. Our paper discusses the possible IRFNA incidents caused by missile break-up during reentry and the effect of these break-ups on chemical agent detectors. The paper also briefly reviews topics related to counter-Scud operations, including Patriot missile defenses. Iraq filled both chemical and biological warheads for their Scud missiles before the Gulf War, but probably feared retaliation if they used them. In-depth research for this paper uncovered no evidence that Iraq fired Scuds with chemical or biological warheads during the Gulf War. All Scud debris indicated use of conventional warheads.

Inhibited Red Fuming Nitric Acid

Our information paper, Inhibited Red Fuming Nitric Acid, is designed to provide a basic understanding of IRFNA and identify where and how Gulf War veterans may have been exposed to this oxidizer. IRFNA contains mostly nitric acid, nitrogen oxides, a small percentage of water, and an inhibitor (an additive which prevents the acid from eating through its metal storage tank). This inhibitor is a halogen substance, such as hydrogen fluoride or iodine. When IRFNA combines with rocket fuel, the resulting combustion creates the thrust needed to launch a rocket or a missile. During the Gulf War, Iraq's military used IRFNA as the oxidizer in several weapon systems, including the Scud, Guideline, Silkworm/Seersucker, and Kyle missiles. These weapon systems were used throughout the Kuwait theater of operations. When a Scud missile broke up, impacted, or was intercepted by Coalition weapons, the missile fuel and IRFNA combination could have exposed some troops to nitric acid and nitric dioxide.

Al Jubayl, Saudi Arabia

Three significant events occurred in and around the greater Al Jubayl area during Operation Desert Shield and Desert Storm. One of these events is known as the "Scud impact" event.

On February 16, 1991, Iraq launched its 66th Scud missile of the war. The missile impacted in the waters of Al Jubayl harbor at approximately 2:00 AM. The Scud did not detonate and caused no equipment damage or injury to Coalition personnel. Eyewitnesses reported seeing an explosion that looked as if a Patriot missile had intercepted the Scud. Although there was a Patriot missile battery near the harbor, it was not operational at the time. The Scud missile's warhead was recovered and examined by explosive ordnance disposal personnel, who found no evidence of chemical warfare agents, but did confirm that the missile's warhead contained high explosives.

Our investigation into the Al Jubayl Scud impact event is detailed in our Al Jubayl, Saudi Arabia, case narrative. The narrative also includes a short history of Al Jubayl, a discussion of the environment military personnel lived and worked in, the results of our investigations into two other significant events—the "loud noise event" and "the purple T-shirt event"—and a synopsis of medical studies involving Seabees from Naval Mobile Construction Battalion 24, who reported experiencing post-war medical problems.

Kuwaiti Girls' School

Following the expulsion of Iraq's forces from Kuwait, the government of Kuwait began reconstructing the infrastructure damaged during Iraq's occupation. The schools in Kuwait, which had been closed for nearly a year, were a main focus of civil infrastructure repair. Their reopening was considered an important indicator of a return to normality within the country.

In early August 1991, a British explosive ordnance disposal firm, Passive Barriers, subcontracted by Brown & Root, an American firm carrying out reconstruction tasks on schools in Kuwait, discovered a suspicious metal storage tank alongside the perimeter wall of the Kuwaiti Girls' School. Rust-colored vapors were puffing from two bullet holes in the tank.

Initial indications that the tank contained mustard agent led to investigations by several US and British agencies. For some of the individuals involved there were unanswered questions about the nature of the tank's contents. Consequently, in 1997, we looked into the incident and determined the tank did not contain a chemical warfare agent, but did contain nitric acid, probably red fuming nitric acid. IRFNA was used in the anti-ship missiles that Iraq stored and repaired in the school's facilities. The story of our investigation is chronicled in the Kuwaiti Girls' School case narrative.

Possible Chemical Agent on a Scud Missile Sample

On September 18, 1995, during a meeting in Charlotte, N. C., a veteran provided a small piece of metal to the Presidential Advisory Committee on Gulf War Veterans' Illnesses. The veteran said the soldier who found it related it was a piece from a Scud missile that a Patriot missile had intercepted near King Fahd Military Airport in January 1991. The veteran said he experienced watering eyes, tingling skin, and blisters when handling the piece of metal. Analysis of the sample by the US Army Edgewood Research and Development Engineering Center revealed no evidence of chemical warfare agents. In July 2000, we published the final report on our investigation into the possibility that this Scud missile piece was contaminated with chemical warfare agent.

Medical Issues Relating to Symptoms Among Gulf War Veterans

soldiers getting immunizedMany Gulf War veterans have experienced a variety of physical symptoms and illnesses in the years since the Gulf War. Since June 1995 the Department of Defense has been investigating incidents and circumstances during the war that might be related to veterans’ symptoms.

Summary

Many Gulf War veterans have experienced a variety of physical symptoms and illnesses in the years since the Gulf War. In response to veterans' concerns, the Department of Defense established a task force in June 1995 to investigate incidents and circumstances during the war that might be related to veterans' symptoms. The Office of the Special Assistant - now known as the Deployment Health Support Directorate - assumed responsibility for these investigations on November 12, 1996, and continues to gather information on medical questions and issues related to the troops who served there.

To inform the public about the progress of this office, the Department of Defense (DoD) publishes on the Internet and elsewhere accounts related to the possible causes of medically undiagnosed physical symptoms among Gulf War veterans, along with documentary evidence or personal testimony used in compiling the accounts. The following is a summary of the reports we have published concerning our investigations into medical issues and providing information related to illnesses of Gulf War veterans.

Vaccinations

Since their return from Southwest Asia for Operations Desert Shield and Desert Storm, some US military personnel have developed medically undiagnosed physical symptoms that may relate to their service during their deployment. A number of veterans and others have expressed concern that the use of vaccines may have contributed to these symptoms. The Special Assistant examined this issue, and in December 2000, published the Vaccine Use During the Gulf War information paper, which addresses military vaccination policies and practices during and after the Gulf War, as well as plans for future deployments.

Vaccines are commonly-used health interventions that broadly benefit populations, as well as individuals. Because of its unique and diverse mission, the military employs vaccines as critical countermeasures against infectious diseases and biological warfare agents. Differences in vaccination policies among the military services reflect variations in their respective training cycles, missions, and expected levels of exposure. Military vaccine programs are also constantly updated to incorporate advances in preventive medicine, as well as in response to changing health threats.

During the Gulf War, anthrax and botulinum toxoid vaccines were used to protect US forces against the threat of Iraq's biological agents. Administration of these vaccines during Operations Desert Shield and Desert Storm was characterized by several difficult issues: lacking sufficient quantities of the vaccines; prioritizing military units for vaccination; using the investigational botulinum toxoid vaccine; obtaining informed consent; providing Service members with information about the vaccines dealing with operational security considerations; and documenting vaccines in health records.

Military personnel today are facing increasingly routine deployments overseas, exposures to environmentally hazardous battlefields, and risks associated with biological warfare agents. The Gulf War experience has brought shortfalls in vaccine administration to light and generated improvements in force health protection. Ensuring adequate production sources and maintaining sufficient stockpiles of safe and effective vaccines - especially vaccines in investigational status - remain daunting challenges, as does the communication of associated health risks to Service members. Importantly, progress has been demonstrated in vaccine tracking and documentation for deployments, and robust research on military vaccine development is ongoing. The Department of Defense should continue to build upon lessons learned from the Gulf War to ensure that advances in vaccine development and administration keep pace with changing health threats to military personnel.

Medical Recordkeeping During the Gulf War

Following the return of American Service members deployed to Southwest Asia during Operations Desert Shield and Desert Storm, veterans reported physical symptoms that believed may have been related to their service in the Gulf War, yet defied medical diagnoses. Medical records from this deployment did not provide substantial support in explaining these symptoms. The Special Assistant examined this issue and in August 1999, published the Military Medical Recordkeeping During and After the Gulf War information paper. This paper addresses recordkeeping policies and practices before, during, and after the Gulf War.

Military medical recordkeeping policies at the time of the Gulf War tended to be service-specific and published by the respective military Surgeons General. Prior to Operations Desert Shield and Desert Storm, these policies focused almost exclusively on the care of deployed forces during peacetime and less with recordkeeping under deployment conditions. During the Gulf War, some services deployed with abbreviated health records, while others typically deployed with their full, original records. The Department of Defense issued supplemental guidance on the documentation of immunizations (anthrax and botulinum toxoid) that were investigational or required some measures of operational security. Analysts with the Special Assistant found documentation of deployment medical information in individual health records to be problematic, mainly due to post-service disposition policies.

Post-Gulf-War medical recordkeeping policy continues to be made for each military service and the military health system as a whole. The Department of Defense (Health Affairs), the Joint Staff, and the military medical services are increasingly focusing on force health protection and the documentation of medical surveillance activities in support of continuing operational deployments in Bosnia, Kosovo, and Southwest Asia. Cooperation has also increased among the Department of Defense, the Department of Veterans Affairs, and the National Archives and Records Administration on issues involving the transfer and storage of medical records.

Groundwork continues for the development of an automated deployment health information device (e.g., a personal information carrier or "medical dog tag"), as well as a computer-based patient record system for all military beneficiaries. The Department of Defense views these as technological solutions to both the medical recordkeeping deficiencies associated with the Gulf War and a presidential mandate to create a force health protection program incorporating a comprehensive medical record for each military Service member.

While DoD has progressed in the addressing of medical recordkeeping shortfalls associated with the Gulf War, work continues on the significant challenges of documenting health care and other health-related matters associated with military deployments.

Information Capture of Data from Gulf War Hospital Inpatient Records

Responding to concerns raised by veterans, the Department of Defense, the Department of Veterans Affairs, and other organizations both inside and outside of government have conducted investigations into possible causes of medically undiagnosed physical symptoms in Gulf War veterans. All of these investigations have one thing in common: they examined illnesses that have been identified and diagnosed, and reported symptoms during the post-Gulf-War period. However, a large grouping of records and documentation for illnesses and injuries unequivocally attributed to service during the Gulf War had not been studied. These were the surviving hospital inpatient treatment records from the Gulf War archived at the National Personnel Records Center (NPRC) in St. Louis, Missouri. In June 1998, the Special Assistant began an effort to establish an Inpatient Treatment Records Database inventory of all Gulf War inpatient hospital treatment records archived at the NPRC. Efforts to locate, document, and inventory these records concluded in October 1999, with approximately 28,000 records identified and inventoried. With this new database, veteran contact managers within the Special Assistant assisted Gulf War veterans in obtaining copies of an existing inpatient record for the purpose of assisting to establish eligibility for VA benefits.

In January 2000, the Special Assistant directed a theater-wide review of inpatient treatment records be conducted archived at the Records Center. The data capture operation was conducted at the NPRC's research facility in St. Louis, from November 2000 through May 2001. At the conclusion of the operation, the Gulf War Inpatient Record Database contained 28,007 records of admissions to US military hospitals in the Kuwait theater of operations (KTO) and evacuee admissions to hospitals in Germany. For this study, KTO unit location data was linked to each US military patient. Unit location data is maintained and provided by the US Armed Services Center for Unit Records Research (CURR). By linking the patient diagnosis with the date of admission with the unit location data, the analysts at Special Assistant were able to produce an "epidemiological snapshot" of US troops deployed for Operations Desert Shield and Desert Storm.

Deployment Health Surveillance

The goal of deployment health surveillance is to ensure a fit and healthy force and to prevent illness, disease,adverse stress responses, and injuries from degrading mission effectiveness. As defined by the Centers for Disease Control and Prevention, health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to planning, implementation, and evaluation of public health practice. Medical surveillance of all Service members before, during, and after military deployments is mandated by Public Law 105-85, Section 765. The Deployment Health Support Directorate seeks to facilitate the operational awareness of Deployment Health Surveillance in today's military medical system.

Several new memorandums and directives provide procedures for conducting health surveillance in support of deployments. These include Department of Defense Directive 6490.2 and the Department of Defense Instruction 6490.3.

The Assistant Secretary of Defense (Health Affairs) issued a policy memorandum requiring both pre- and post-deployment health questionnaires in order to assess a Service member's state of health before and after deployment. The Pre-Deployment Health Assessment (DD 2795) should be administered at the Service member's home station or at the mobilization processing station before deployment. The Post-Deployment Health Assessment (DD 2796) should be administered before exiting the theater of operations. Copies of the health assessments are to be placed in the Service member's permanent medical record.

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