As of December 31, 2000, 56,845 1990-1991 Gulf War veterans were enrolled by self-referral into the program. Of this number, 16,129 declined evaluation.

We have no evidence that biological weapons were used during the 1990-1991 Gulf War. In addition we have not found any reports of verified biological agent detections nor are we aware of anyone, soldier or civilian, who has reported experiencing symptoms consistent with exposure to a biological agent.

To date, there is also no evidence that any warfare agents were released as a result of coalition bombings during the air war campaign, January 17, 1991 through February 23, 1991.

A case narrative is a report of what we know today about specific events that took place during the Gulf War of 1990 and 1991. A case narrative focuses on a particular incident and can include personnel interviews, reviews of official documents from various commands and agencies, collection of scientific data, and original research. From a broader perspective, a case narrative is part of our overall effort to inform the public about the progress being made to solve the many mysteries of 1990-1991 Gulf War illnesses.

These announcements are another step in the investigative process. The case narratives are not final reports. These narratives are intended to generate additional dialogue with 1990-1991 Gulf War veterans who may have more information that will help us accurately understand what occurred with respect to each case under investigation. We encourage veterans with additional information to call the Gulf War Incident Hotline at 1-800-472-6719 or DSN 878-3261.

To investigate these incidents and to determine if chemical weapons were used, the DoD developed a methodology for investigation and validation based on work done by the United Nations and the international community where the criteria include:

1. A detailed written record of the conditions at the site;
2. Physical evidence from the site, such as weapons fragments, soil, water, vegetation or human/animal tissue samples;
3. A record of the chain of custody during the transportation of the evidence;
4. Testimony of eyewitnesses;
5. Multiple analyses; and
6. Review of the evidence by experts.

Our method is designed to provide a thorough, investigative process to define the circumstances of each incident and determine what happened. Alarms alone are not considered to be certain evidence of chemical agent presence, nor is a single individual's observation sufficient to validate a chemical agent presence, without corroboration. By following our methodology, gathering evidence, interviewing eyewitnesses and key personnel, and analyzing the results, the investigator assesses the validity of the presence of chemical warfare agents on the battlefield. Because information from various sources may be contradictory, we have developed the following assessment scale, ranging from "Definitely" to "Definitely Not." This assessment is tentative, based on facts available as of the date of the report publication; each case is reassessed over based on new information and feedback.

The standard for making the assessment is based on the following: do the available facts lead a reasonable person to conclude that chemical warfare agents were or were not present? When insufficient information is available, the assessment is "Indeterminate" until more evidence can be found.

• DOD Incident Reporting Line: 1-800-497-6261
• DOD Gulf War Medical Registry (CCEP): 1-800-796-9699
• Veterans’ Affairs Registry: 1-800-749-8387 (PGW-VETS)

Mycroplasmas are the smallest, free-living infectious agents. They are distinct from viruses because of their ability to grow in cell-free media and from bacteria because they lack a cell wall and the ability to synthesize cell wall precursors. A variety of plant and animal diseases are caused by the mycoplasmas. However, only certain types have been clearly shown to cause disease in humans.

The Environmental and Occupational Exposures Division is looking at experiences in the 1990-1991 Gulf War from a more universal approach than previous investigations in general. An Environmental Exposures Report looks to describe any of a variety of exposure opportunities in the 1990-1991 Gulf War that would have occurred more universally, and that may have had an impact on the health of 1990-1991 Gulf War participants.

While previous case narratives mostly focused on discrete events or specifically identifiable occurrences, the Environmental Exposures Reports address events or exposures that had the potential to be experienced by anyone participating in the 1990-1991 Gulf War. The approach comes from a more universal perspective and includes personnel who share, or may share, common exposure potentials as relates to their environment.

Consistent with one of the charters of OSAGWI to “leave no stone unturned,” Environmental Exposure Reports will further describe events experienced by personnel in the 1990-1991 Gulf War that may have had a long-term effect on their health. These reports will add to the completeness of the story and better enable veterans, politicians, medical personnel, media, and other interested parties to understand the significance of 1990-1991 Gulf War events as they relate to illnesses experienced by the veterans.

We have adopted an assessment methodology patterned on that used by the U.S. Environmental Protection Agency. This process estimates the health risk from contaminant concentrations, site exposure, and contaminant toxicity characteristics. It consists of four steps: Hazard Identification, Toxicity Assessment, Dose Assessment, and Risk Characterization, defined below:

• Hazard Identification - who was exposed, and how? Which incidents warrant a full investigation?
• Toxicity Assessment - what are the known medical effects of human exposure? At what levels of exposure do these effects occur? How can the effects be mitigated?
• Dose Assessment - how much of the contaminant were the troops exposed to? What chemical or radiological doses do these intakes represent?
• Risk Characterization - using validated toxicity and dose information, what medical effects can be anticipated? How serious are those effects? How can the effects be communicated to those affected?

The former Office of the Special Assistant for Gulf War Illnesses (now Force Health Protection & Readiness Policy & Programs) has focused its investigation on determining what happened, what exposures may have occurred, and who may have been exposed. Exposures have been subdivided into levels and scenarios so they can be related to toxicity and dose information.

During Operation Desert Storm, the threat of use of nerve agents by Iraq was very high. After careful deliberation by a specially constituted human-use review committee of the Food and Drug Administration, it was determined that the pretreatment could help save the lives of many Service members if nerve agents were used. Approval for the use of pyridostigmine bromide was based on extensive scientific information that supported the safety and effectiveness of pyridostigmine bromide as a preventive treatment.

Pyridostigmine bromide is not an exotic or experimental drug. The Food and Drug Administration approved it in 1955 for use in treating myasthenia gravis, a neuromuscular disease that causes muscle weakness and fatigue. However, when approved for use in the Gulf, the approval was as an investigational new drug. This classification means that pyridostigmine bromide had not been formally approved for general commercial marketing as a nerve gas antidote.

There was no effort to withhold information from the troops or the public. In fact, pyridostigmine bromide use was widely reported by the news media at the time. The Department of Defense believes that most individuals knew they were taking an oral drug to counter the effects of a possible attack with nerve agents. However, troops did not receive enough information about the possible side effects of pyridostigmine bromide. Information was prepared for distribution in the field, but it did not arrive before hostilities began.

The Defense Department estimates that approximately 250,000 personnel took at least some pyridostigmine bromide during the 1990-1991 Gulf War. During the 1990-1991 Gulf War, all U.S. troops were to have received packets containing pyridostigmine bromide pills.

Actual administration of the pre-treatment was decentralized in nuclear, biological chemical (NBC) and not medical channels. It was intended to be self-administered upon a unit commander's order. We know that in some units, pyridostigmine bromide administration was carefully monitored, while in others, it was not. However, accurate assessments of actual pyridostigmine bromide use are difficult because no specific records were kept of self-administered medications.

To date, the Food and Drug Administration has recalled none of the drugs or vaccines administered by the military. If you would like more information on pyridostigmine bromide you may contact the Defense Personnel Support Center at (215) 737-5768.