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Thirty-Five Years Later, Gulf War Veterans Remain Sicker Than Counterparts
Gulf War veterans continue to report significantly higher rates of chronic physical and mental health conditions than their counterparts who did not deploy, according to a new analysis of data from an ongoing cohort study.
Veterans had higher rates in 22 of 47 (47%) self-reported medical conditions compared with nondeployed veterans of the same era, reported US Department of Veterans Affairs (VA) Director of Surveillance Military Environment Exposures for Health Outcomes Military Exposures Erin K. Dursa, PhD, MPH, et al in the Journal of Occupational and Environmental Medicine.
The conditions include chronic fatigue syndrome (13.7% vs 6.2%, respectively; adjusted odds ratio [aOR], 2.44), fibromyalgia (7.5% vs 4.2%, respectively; aOR, 2.05), and irritable bowel syndrome (20.8% vs 13.1%, respectively; aOR, 1.73), all of which are considered key components of Gulf War Illness (GWI), or Gulf War Syndrome. The differences were statistically significant.
“This is still happening. They're still sick with the very same things they’ve had for 34 to 35 years,” Robert Haley, MD, professor of medicine at the University of Texas Southwestern Medical Center in Dallas, told Federal Practitioner in an interview. Haley, who has studied GWI for decades, was familiar with the findings but not involved in the new research.
The US deployed nearly 700,000 troops during the Gulf War. Many troops began reporting chronic illness following deployment, during which some were exposed to oil well fires, nerve agents, pesticides, depleted uranium, and other hazards. An estimated 150,000 troops became sick, Haley said.
“Our group and a couple others started very quickly finding evidence that it was a real illness,” he said. “It was physical, not psychological.”
According to the VA, GWI encompasses chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders, and undiagnosed illnesses with symptoms such as abnormal weight loss, fatigue, cardiovascular signs, and muscle and joint pain.
Seeking an Explanation
Research links GWI to exposure to toxic sarin gas, a nerve agent used by Iraq, according to Haley. “It’s analogous to pesticide poisoning,” he said.
Other exposures may play a role, Haley said, but he believes sarin gas is the “major cause.” Sarin gas damages mitochondria within cells, causing them to produce less energy. The actual mechanism, however, remains unknown.
“We're getting real[ly] close to the answer, but we’re not there yet,” Haley said.
A 2000 study reported survey results from 15,000 Gulf War veterans and 15,000 nondeployed counterparts. The deployed veterans had a “higher prevalence of medical conditions, symptoms, functional impairment, and healthcare utilization than Gulf Era veterans.”
The new data, compiled between 2024 and 2025, represent the Gulf War Era cohort study’s fourth follow-up. Researchers surveyed 6888 Gulf War veterans and 5489 nondeployed veterans from the same era (response rate, 46.8%). The Gulf War veterans were 79.9% male; 73.1% White, 20.0% Black, 4.4% Hispanic, and 2.6% identified as another race or ethnicity. Most served in the Army (64.3%), and most were aged 17-25 (37.5%) or 26-32 (29.5%) years at deployment.
The nondeployed veteran group had similar demographics, although the cohort was older. In addition to chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, conditions that were significantly more common in Gulf War veterans than in nondeployed veterans included chronic obstructive pulmonary disease (aOR, 1.62), gastritis (aOR, 1.54), dermatitis (aOR, 1.45), bipolar or manic depression (aOR, 1.45), traumatic brain injury (aOR, 1.43), depression (aOR, 1.38), and alcohol or drug dependence (aOR, 1.36). The differences were statistically significant.
Multiple sclerosis (aOR, 0.42) was significantly less likely to be reported among Gulf War veterans.
The most common conditions reported overall by Gulf War veterans were hypertension (59.9%), sleep apnea (50.8%), arthritis not specified (41.9%), and depression (40.6%).
Affirming Reality
In an interview with Federal Practitioner, Beatrice Golomb, MD, PhD, a professor of medicine at the University of California San Diego and former VA staff physician who studies GWI, noted that researchers adjusted their analyses for body mass index (BMI), although “multiple studies show that weight gain is a metabolic feature of Gulf War Illness.”
This matters, Golomb said, because “if veterans develop increased BMI, and if that increase in BMI then contributes to things like diabetes, heart disease, and other outcomes, then adjusting for BMI will reduce the ability to see the causally-induced problems. For that reason, some problems are likely understated in this article.”
However, Golomb, who was not involved in the study, said the new research “supports findings from earlier studies to a considerable extent.” She added: “It affirms that Gulf War veterans, and those with Gulf War Illness, have elevations in many different health problems. These problems are real and often disabling.”
Lessons for the Clinic
Moving forward, “clinicians should be reminded that these veterans have real health problems, are legitimately affected, often in multiple ways, and deserve to be treated with the honor, respect, compassion, and seriousness they deserve," Golomb said.
In an interview with Federal Practitioner, Kimberly Sullivan, PhD, a research associate professor at Boston University School of Public Health who studies GWI, highlighted a new tool within the VA electronic health record that clinicians can use to screen eligible veterans for it. “This is a big improvement from the past when there was no easy way to track veterans with Gulf War Illness in the medical record, even for care providers trying to identify veterans for treatment studies,” said Sullivan, who was not involved in the new study.
Sullivan added that Gulf War veterans should be screened specifically for chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome.
The VA’s Health Outcomes Military Exposures program funded the study. The study authors have no disclosures. Haley discloses relationships with the Department of Defense and the VA. Golomb and Sullivan have no disclosures.
Gulf War veterans continue to report significantly higher rates of chronic physical and mental health conditions than their counterparts who did not deploy, according to a new analysis of data from an ongoing cohort study.
Veterans had higher rates in 22 of 47 (47%) self-reported medical conditions compared with nondeployed veterans of the same era, reported US Department of Veterans Affairs (VA) Director of Surveillance Military Environment Exposures for Health Outcomes Military Exposures Erin K. Dursa, PhD, MPH, et al in the Journal of Occupational and Environmental Medicine.
The conditions include chronic fatigue syndrome (13.7% vs 6.2%, respectively; adjusted odds ratio [aOR], 2.44), fibromyalgia (7.5% vs 4.2%, respectively; aOR, 2.05), and irritable bowel syndrome (20.8% vs 13.1%, respectively; aOR, 1.73), all of which are considered key components of Gulf War Illness (GWI), or Gulf War Syndrome. The differences were statistically significant.
“This is still happening. They're still sick with the very same things they’ve had for 34 to 35 years,” Robert Haley, MD, professor of medicine at the University of Texas Southwestern Medical Center in Dallas, told Federal Practitioner in an interview. Haley, who has studied GWI for decades, was familiar with the findings but not involved in the new research.
The US deployed nearly 700,000 troops during the Gulf War. Many troops began reporting chronic illness following deployment, during which some were exposed to oil well fires, nerve agents, pesticides, depleted uranium, and other hazards. An estimated 150,000 troops became sick, Haley said.
“Our group and a couple others started very quickly finding evidence that it was a real illness,” he said. “It was physical, not psychological.”
According to the VA, GWI encompasses chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders, and undiagnosed illnesses with symptoms such as abnormal weight loss, fatigue, cardiovascular signs, and muscle and joint pain.
Seeking an Explanation
Research links GWI to exposure to toxic sarin gas, a nerve agent used by Iraq, according to Haley. “It’s analogous to pesticide poisoning,” he said.
Other exposures may play a role, Haley said, but he believes sarin gas is the “major cause.” Sarin gas damages mitochondria within cells, causing them to produce less energy. The actual mechanism, however, remains unknown.
“We're getting real[ly] close to the answer, but we’re not there yet,” Haley said.
A 2000 study reported survey results from 15,000 Gulf War veterans and 15,000 nondeployed counterparts. The deployed veterans had a “higher prevalence of medical conditions, symptoms, functional impairment, and healthcare utilization than Gulf Era veterans.”
The new data, compiled between 2024 and 2025, represent the Gulf War Era cohort study’s fourth follow-up. Researchers surveyed 6888 Gulf War veterans and 5489 nondeployed veterans from the same era (response rate, 46.8%). The Gulf War veterans were 79.9% male; 73.1% White, 20.0% Black, 4.4% Hispanic, and 2.6% identified as another race or ethnicity. Most served in the Army (64.3%), and most were aged 17-25 (37.5%) or 26-32 (29.5%) years at deployment.
The nondeployed veteran group had similar demographics, although the cohort was older. In addition to chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, conditions that were significantly more common in Gulf War veterans than in nondeployed veterans included chronic obstructive pulmonary disease (aOR, 1.62), gastritis (aOR, 1.54), dermatitis (aOR, 1.45), bipolar or manic depression (aOR, 1.45), traumatic brain injury (aOR, 1.43), depression (aOR, 1.38), and alcohol or drug dependence (aOR, 1.36). The differences were statistically significant.
Multiple sclerosis (aOR, 0.42) was significantly less likely to be reported among Gulf War veterans.
The most common conditions reported overall by Gulf War veterans were hypertension (59.9%), sleep apnea (50.8%), arthritis not specified (41.9%), and depression (40.6%).
Affirming Reality
In an interview with Federal Practitioner, Beatrice Golomb, MD, PhD, a professor of medicine at the University of California San Diego and former VA staff physician who studies GWI, noted that researchers adjusted their analyses for body mass index (BMI), although “multiple studies show that weight gain is a metabolic feature of Gulf War Illness.”
This matters, Golomb said, because “if veterans develop increased BMI, and if that increase in BMI then contributes to things like diabetes, heart disease, and other outcomes, then adjusting for BMI will reduce the ability to see the causally-induced problems. For that reason, some problems are likely understated in this article.”
However, Golomb, who was not involved in the study, said the new research “supports findings from earlier studies to a considerable extent.” She added: “It affirms that Gulf War veterans, and those with Gulf War Illness, have elevations in many different health problems. These problems are real and often disabling.”
Lessons for the Clinic
Moving forward, “clinicians should be reminded that these veterans have real health problems, are legitimately affected, often in multiple ways, and deserve to be treated with the honor, respect, compassion, and seriousness they deserve," Golomb said.
In an interview with Federal Practitioner, Kimberly Sullivan, PhD, a research associate professor at Boston University School of Public Health who studies GWI, highlighted a new tool within the VA electronic health record that clinicians can use to screen eligible veterans for it. “This is a big improvement from the past when there was no easy way to track veterans with Gulf War Illness in the medical record, even for care providers trying to identify veterans for treatment studies,” said Sullivan, who was not involved in the new study.
Sullivan added that Gulf War veterans should be screened specifically for chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome.
The VA’s Health Outcomes Military Exposures program funded the study. The study authors have no disclosures. Haley discloses relationships with the Department of Defense and the VA. Golomb and Sullivan have no disclosures.
Gulf War veterans continue to report significantly higher rates of chronic physical and mental health conditions than their counterparts who did not deploy, according to a new analysis of data from an ongoing cohort study.
Veterans had higher rates in 22 of 47 (47%) self-reported medical conditions compared with nondeployed veterans of the same era, reported US Department of Veterans Affairs (VA) Director of Surveillance Military Environment Exposures for Health Outcomes Military Exposures Erin K. Dursa, PhD, MPH, et al in the Journal of Occupational and Environmental Medicine.
The conditions include chronic fatigue syndrome (13.7% vs 6.2%, respectively; adjusted odds ratio [aOR], 2.44), fibromyalgia (7.5% vs 4.2%, respectively; aOR, 2.05), and irritable bowel syndrome (20.8% vs 13.1%, respectively; aOR, 1.73), all of which are considered key components of Gulf War Illness (GWI), or Gulf War Syndrome. The differences were statistically significant.
“This is still happening. They're still sick with the very same things they’ve had for 34 to 35 years,” Robert Haley, MD, professor of medicine at the University of Texas Southwestern Medical Center in Dallas, told Federal Practitioner in an interview. Haley, who has studied GWI for decades, was familiar with the findings but not involved in the new research.
The US deployed nearly 700,000 troops during the Gulf War. Many troops began reporting chronic illness following deployment, during which some were exposed to oil well fires, nerve agents, pesticides, depleted uranium, and other hazards. An estimated 150,000 troops became sick, Haley said.
“Our group and a couple others started very quickly finding evidence that it was a real illness,” he said. “It was physical, not psychological.”
According to the VA, GWI encompasses chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders, and undiagnosed illnesses with symptoms such as abnormal weight loss, fatigue, cardiovascular signs, and muscle and joint pain.
Seeking an Explanation
Research links GWI to exposure to toxic sarin gas, a nerve agent used by Iraq, according to Haley. “It’s analogous to pesticide poisoning,” he said.
Other exposures may play a role, Haley said, but he believes sarin gas is the “major cause.” Sarin gas damages mitochondria within cells, causing them to produce less energy. The actual mechanism, however, remains unknown.
“We're getting real[ly] close to the answer, but we’re not there yet,” Haley said.
A 2000 study reported survey results from 15,000 Gulf War veterans and 15,000 nondeployed counterparts. The deployed veterans had a “higher prevalence of medical conditions, symptoms, functional impairment, and healthcare utilization than Gulf Era veterans.”
The new data, compiled between 2024 and 2025, represent the Gulf War Era cohort study’s fourth follow-up. Researchers surveyed 6888 Gulf War veterans and 5489 nondeployed veterans from the same era (response rate, 46.8%). The Gulf War veterans were 79.9% male; 73.1% White, 20.0% Black, 4.4% Hispanic, and 2.6% identified as another race or ethnicity. Most served in the Army (64.3%), and most were aged 17-25 (37.5%) or 26-32 (29.5%) years at deployment.
The nondeployed veteran group had similar demographics, although the cohort was older. In addition to chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, conditions that were significantly more common in Gulf War veterans than in nondeployed veterans included chronic obstructive pulmonary disease (aOR, 1.62), gastritis (aOR, 1.54), dermatitis (aOR, 1.45), bipolar or manic depression (aOR, 1.45), traumatic brain injury (aOR, 1.43), depression (aOR, 1.38), and alcohol or drug dependence (aOR, 1.36). The differences were statistically significant.
Multiple sclerosis (aOR, 0.42) was significantly less likely to be reported among Gulf War veterans.
The most common conditions reported overall by Gulf War veterans were hypertension (59.9%), sleep apnea (50.8%), arthritis not specified (41.9%), and depression (40.6%).
Affirming Reality
In an interview with Federal Practitioner, Beatrice Golomb, MD, PhD, a professor of medicine at the University of California San Diego and former VA staff physician who studies GWI, noted that researchers adjusted their analyses for body mass index (BMI), although “multiple studies show that weight gain is a metabolic feature of Gulf War Illness.”
This matters, Golomb said, because “if veterans develop increased BMI, and if that increase in BMI then contributes to things like diabetes, heart disease, and other outcomes, then adjusting for BMI will reduce the ability to see the causally-induced problems. For that reason, some problems are likely understated in this article.”
However, Golomb, who was not involved in the study, said the new research “supports findings from earlier studies to a considerable extent.” She added: “It affirms that Gulf War veterans, and those with Gulf War Illness, have elevations in many different health problems. These problems are real and often disabling.”
Lessons for the Clinic
Moving forward, “clinicians should be reminded that these veterans have real health problems, are legitimately affected, often in multiple ways, and deserve to be treated with the honor, respect, compassion, and seriousness they deserve," Golomb said.
In an interview with Federal Practitioner, Kimberly Sullivan, PhD, a research associate professor at Boston University School of Public Health who studies GWI, highlighted a new tool within the VA electronic health record that clinicians can use to screen eligible veterans for it. “This is a big improvement from the past when there was no easy way to track veterans with Gulf War Illness in the medical record, even for care providers trying to identify veterans for treatment studies,” said Sullivan, who was not involved in the new study.
Sullivan added that Gulf War veterans should be screened specifically for chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome.
The VA’s Health Outcomes Military Exposures program funded the study. The study authors have no disclosures. Haley discloses relationships with the Department of Defense and the VA. Golomb and Sullivan have no disclosures.
Thirty-Five Years Later, Gulf War Veterans Remain Sicker Than Counterparts
Thirty-Five Years Later, Gulf War Veterans Remain Sicker Than Counterparts