VA Policies on Gulf War Syndrome - Research Paper Example

VA Policies on Gulf War Syndrome American soldiers who served in the Gulf War. The common symptoms experienced by the soldiers are not only mysterious but are quite diverse as well. The commonly reported symptoms include fatigue, diarrhea, hair loss, and cancer. (Patarca-Montero 2000). However, the complete list of ailments also includes certain mysterious symptoms such as vomit that glows in the dark and burning semen. The acute and chronic symptoms associated with Gulf War Syndrome were reported in approximately 250,000 formerly strong soldiers out of a total of 697,000 veterans. The news of the malaise soon engulfed the UK like wildfire as more and more veterans came forward to report their unique symptoms. (Augerson 2000). Since the very beginning, the new and unique syndrome was attributed to prolong exposure to chemical warfare agents, vaccinations, toxic fumes from burning oil wells, NAPS tablets, depleted uranium utilized in tanks and projectiles, and organophosphate insecticides. (Brown 2002).World media became crazy over the fact that healthy soldiers dispatched to defend Kuwait from the deadly clutches of Saddam Hussein were returning home infected with a mysterious chronic multi symptom illness. World media were focused on extensively covering the story of ill fated soldiers who were suffering from an inexplicable illness. The story of GWS became even more compelling when the issue of children with serious birth defects being born to affected veterans surfaced. (Kilshaw 2010). During the Gulf War, the troops faced relatively different topographic characteristics than they had ever experienced before. The troops had different demographic characteristics and most men were from the National Guard and Reserve Units. Moreover, 7% of the total military troops were women. During the Gulf War, the numbers of US casualties were quite low. During the War in Kuwait, the American troops were exposed to a range of different toxic chemical substances. The toxic substances included oil smoke, diesel and jet fuel, petrochemicals and other chemical substances. (Brooks 2007). The troops were also exposed to chemical agent resistant coating paint, extreme heat, primitive living conditions, depleted uranium, sand, and endemic infections. At the end of war, a large number of veterans returned to United States of America. (Marrs et al 2007). Once in their homeland, they resumed their normal activities. Some active duty medical personnel and veterans began to report various health problems soon after their return. Most of the Gulf veterans considered their mysterious health problems to be a direct result of service related exposures in the Persian Gulf. The debilitating health of the Gulf War Veterans led to the surfacing of a number of investigations and reports in an effort to determine the underlying cause of the mysterious disease. A number of these investigations and reports were focused on providing recommendations about improving currently available diagnostic and therapeutic techniques. The diagnostic programs of DVA and DOD were time consuming and given the large number of veterans being admitted to the health facilities, therefore, it was inevitable that new diagnostic techniques, as outlined by the investigations needed to implemented. (Measuring the Health of Persian Gulf Veterans 1998). The polarization of the debate over Gulf War Syndrome led to the surfacing of differing views from different parties on the existence of the mysterious syndrome. The authenticity of GWS as a unique, physical condition occupied the heart of the debate across various medical centers around the world. Unfortunately, extensive medical investigations were unable to produce authentic evidence of a physical syndrome despite the fact that the victims and the supporting media were convinced of the organic nature of the illness. (Kick 2002). In accordance with various initial studies, the veterans did not have a specific syndrome and this finding was supported by various underlying reasons including the fact that veterans did not have an increased rate of mortality and there was no single cause of the ailments. In the very beginning, the consensus of international scientific and medical community states that the ill health of the veterans cannot be classified as a unique disease or a syndrome due to the presence of insufficient evidence available to support the claims of the victims. Therefore, initially the medical institutions and the government do not classify or recognize the “Gulf War Syndrome” as a medical condition because of the reasons mentioned above. (Kilshaw 2010). Defining service connected disability in the VA: The mysterious medical problem afflicting a number of veterans who served in the Persian Gulf through 1990 to 1991 has forced the VA to expand its definition of “Service Connected” disabilities. The US military extensively used the defoliant Agent Orange during the Vietnam War which resulted in diverse medical problems in veterans exposed to the substance. A similar scenario emerged in case of veterans who fought in the Persian Gulf to defend Kuwait. On returning to their homeland, Former strong soldiers complained to be suffering from various ailments including chronic fatigue, headache, skin rashes, memory loss, sleep disorders, chronic diarrhea, joint and muscular pain, and depression. (Henderson 2001). At the request of Congress, the Institutes of Medicine were entrusted with the task of assembling an 18 member committee to review the problem and issue its final report in the second half of 1996. The committee was unable to establish a correlation between the symptoms experienced by the veterans and their exposure to chemical or biological nerve agents during their stay in the Gulf region. Health Consequences of (Service During the Persian Gulf War 1995). The researchers from Southwestern Medical Center of the University of Texas found evidence that suffering veterans have an increased risk of developing Parkinson’s disease and other neurological diseases. Due to the unsatisfactory findings of the 18 member committee, the Congress ordered an extensive study in an effort a correlation between the exposure to 33 specific chemical agents and the development of problems of the Gulf War veterans. The DOD issued its final report in the year 1993, reporting that over exposure to certain pesticides have a correlation with the development of mysterious illness having multiple symptoms similar to that reported by Gulf War veterans. (Henderson 2001). Initial Response of the Government: The lack of governmental response over health concerns Vietnam veterans had generated tremendous media coverage. Therefore, the government was well aware of public reaction which would have been generated if the health concerns of Gulf War veterans were mishandled. The government took prompt response and some of the initial policies implemented included the following: i. Medical programs were established by the VA and DOD in order to promptly identify the illness in Gulf War veterans and to provide palliative as well as therapeutic symptomatic treatments. ii. The Executive Branch and the Congress established a joint venture with the VA with the aim of providing disability compensation for certain veterans who had served in the Persian Gulf and their illnesses were undiagnosed. iii. Extensive research was initiated by the VA, DOD and the Department of Health and Human Services to determine the authenticity of GWS related issues such as prevalence, nature, and possible causes of the development of the syndrome. (Lashof 1996). Initial Actions Undertaken by the VA: The Interim Report of the Advisory Committee organized to research GWS issues issued recommendations to the VA in order to establish policies in an effort to effectively tackle the problems faced by the veterans returning from the Persian Gulf. VA initially responded to the problem by taking the following actions: i. VA together with the DOD initiated the utilization of refined performance measures. Such performance measures were to be used in the determination of how well outreach services are functioning for the implementation of effective treatment strategies. ii. The use of the term “priority care” was abandoned by the VA. Instead, the VA clearly stated that all Gulf War veterans would receive free Persian Gulf Health Registry examination. iii. The broadcast public service announcements (PSAs) about VA’s toll free helpline were made explicit. The announcements also outlined the purpose of the helpline and the referral process for the affected veterans to follow. (Lashof 1996). Gulf War Registry Program: The Department of Veterans Affairs together with the Department of Defense established a Registry in August1992 with the purpose of clinically evaluate the health of veterans returning from the Gulf War. The Gulf War Registry provides free of charge clinical programs to every veteran who has served in the Persian Gulf. The CCEP was established in the year 1994 by DOD for the purpose of serving Gulf War veterans who are on active duty. (Rosof 2001). The sole purpose of CCEP and the Gulf War Registry Program is not to conduct research but only to provide treatment to the affected veterans. However, the data collected through these programs has been extensively used in the formulation of several hypotheses. An up to date databases are maintained for the clinical programs by both the VA and DOD. The Databases are used for the generation of information for diagnostic purposes and for the determination of risk communication. (Lashof 1996). VA’s Persian Gulf Registry program provides free of charge physical clinical examination to every Gulf veteran. In order to keep a record, VA manual requires the Registry to keep a centralized record of the participants who have received physical examinations. The centralized registry has enabled physicians and other health care personnel to recognize the most prominent symptoms. (Department of Veterans Affairs 2004). In accordance with the policy of Veterans Affairs, each medical center is supervised by a physician named by the VA. In the year 1994, the basic examination protocol system was expanded in an effort to increase the overall efficiency of the Registry. In the evaluation of unexplained illnesses, VA utilizes expanded assessment protocol on collaboration with the DOD. Apart from the Registry, VA is also involved in the provision of therapeutic care to Gulf veterans who are suffering from illnesses developed as a result of over exposure to toxic chemical agents in the Persian Gulf. In case it is determined that the veteran is suffering from a particular disease due to exposure to toxic substance then the individuals becomes eligible to receive special hospital and outpatient care. (Shays 1998). Establishment of Registry: The Secretary of Veterans Affairs was instructed by the Advisory Committee to establish and maintain a special record of the health concerns faced by veterans returning from the Persian Gulf. The Registry was initially known as the Persian Gulf War Veterans Health Registry which was later short titled as Registry. (United States Code, 2004). The Registry was composed of the following: i. An extensive list providing information about every veteran who served in the Persian Gulf theater of operations as a member of the Armed Forces, and also anybody who classifies in any of the following categories: a. Any veteran who utilizes care and services from the Department of Veterans Affairs under Chapter 17. The Chapter 17 referred to here is of title 38, United States Code; b. A dead veteran who has left a spouse, child or a parent behind who requests or claims for dependency and indemnity compensation under chapter 13. The chapter 13 referred to here is titled on the basis of such service; c. A veteran who is referred by the Depart of health examination under section 703; d. A veteran who is entitled to receive a health examination from the Department of Defense is also eligible to receive the services of the Persian Gulf War Veterans Health Registry. (United States Code, 2004). Other aspects taken into consideration during the establishment of Registry are as follows: a. The Registry would include all relevant medical data related to the health of a veteran who has returned from the Persian Gulf, provided the secretary considers that the information is relevant to be added in the Registry. All information up dated in Registry would be done under full consent of concerned veteran. b. In certain cases such as those in which the individuals submit their claims or requests before the date of enactment then the Secretary will include the information in Registry depending upon its feasibility. c. The Department of Defense Information- If the Secretary of Veterans Affairs considers certain information to be necessary for the establishment and maintenance of the Registry then the Secretary of Defense will furnish such information to the Secretary of VA. d. Relation to Department of Defense Registry- the Secretary of Veterans Affairs together with consultation with Secretary of Defense will undertake the task of ensuring appropriate ways to be followed in the collection of information. The information must be collected in such a way that it should allow effective cross reference between the Registry and the registry established under National Defense Authorization Act for Fiscal Years 1992 and 1993. (United States Code, 2004). e. Ongoing Outreach to Individuals Listed in the Registry- from time to time, the Secretary of Veterans Affairs is required to provide information to the individuals listed in the Registry regarding the developments in research conducted on the health consequences of veterans suffering from Gulf War Syndrome. Awareness about the inexplicable plethora of illness was ensured through the provision of information regarding developments in GWS to military service in Persian Gulf Theater of operations. (United States Code, 2004) Quality of Care provided by the Gulf War Registry Program: In the beginning, the VA registry worked by keeping a medical history, a thorough physical examination, and certain laboratory tests. In certain cases Phase II clinical evaluation was implemented by the provision of specialty consultations to patients requiring them. Both Phase I and Phase II clinical evaluation programs involve the same procedures as those involved in a good internal medicine evaluation, however, in the beginning no uniform assessment protocol existed within the Registry. During further development of the Registry, VA introduced specialty examination requirements for all veterans. Moreover, a standard questionnaire was also formulated in order to determine the extent the veterans were exposed to chemical agents while serving in the Persian Gulf. By the year 1994, a uniform assessment protocol was established system wide and is still in use today. (Lashof 1996). In accordance with the Registry records, 62,000 veterans had received complete physical examinations till the end of October, 1996. VA Registry medical history reveals that the most commonly cited symptoms experienced by the Gulf veterans were fatigue, headache, skin rash, joint pains and memory loss. VA Registry provided free of charge symptomatic treatment to every veteran returning from the Gulf. The VA databases reveal that 20% of the veterans received by the Registry were undiagnosed while all the others received diagnosis. The VA medical centers at Washington, Houston, LA, CA, and Birmingham function as Referral centers which are involved in the provision of clinical evaluation and treatments to Gulf veterans who are suffering from undiagnosed medical conditions. (Lashof 1996). Appointment Policy: At every VA medical facility Phase I examination is offered. The secondary and tertiary care facilities offer Phase II clinical examinations. In 1992, when VA Registry was established, scheduling appointments posed significant problems for the veterans. The problems were posed chiefly due to the tremendous number of veterans arriving each for clinical examinations. Furthermore, the Registry program was new and was not well adapted to handling such a large number of veterans with unexplainable illness. The need to reassign space and personnel within the facilities were some of the additional problems which complicated the process of scheduling an appointment. As time passed, the VA facilities became experienced in handling the health concerns of the veterans. The development of streamlined procedures increased the efficiency of the Registry by many folds. However, the major delays in scheduling appointments were minimized as the number of veterans requesting physical examination decreased. Administration delays were entailed at four of the VA’s Referral centers due to the time consumed in the preparation of medical records and consultations with referring physicians. (Lashof 1996). VA Referral Centers: VA policy has enforced rigorous protocols over the Referral Centers in order to ensure that they function at a high efficiency. The VA policy requires the Referral centers to ensure greater commitment of time and efficient utilization of specialty resources. The efficient usage of time limits the number of patients being examined and treated at a time which inevitably increases the overall efficiency of the Referral Center. (Lashof 1996). In accordance with VA policies, the Referral Centers are required to hire professional personnel with clinical and academic expertise. The VA eligibility criteria includes that the medical personnel must possess multiple expertise in multispecialty areas such as pulmonary and infectious disease, neurology, neuropsychology, toxicology and immunology. Upon completion of the treatment in the Referral Center, the veterans are sent for follow up treatments at the veteran’s home VA Medical Center. It is the responsibility of the VA medical center to provide follow up treatment to Gulf veterans once they have completed Phase I clinical evaluation examination. (National Academy Press, 1998). Adequacy of Medical Records: VA has a strict policy about the safe keeping of medical records. The medical records of the Registry and CCEP participants are stored and maintained separately from other records of the veterans. A common pathway if followed in the completion of the records. Once completed, the records are signed by the physician or the health practitioner. The completed and signed records are sent to the VA Central Office or the DOD Health Affairs office. (Lashof 1996). Follow-Up Treatments: In most instances, after completion of the Registry or CCEP clinical evaluation examination the veterans receive follow up care at their local medical facility. Follow up treatment in certain cases involving mental health issues are quite complicated despite the general medical adequacy of the follow up programs. Due to the tremendous number of veterans having mental health issues, VA Centers continue to face the problem of overloaded appointments and limited availability of psychiatric staffing. VA policy ensures that most veterans are able to receive follow up treatment and palliative care from both federal and private sector physicians and other personnel of the health care profession. VA is currently working to increase the efficiency of its Registry by minimizing the issue of command resistance to granting the necessary time off for the assurance of an effective and adequate treatment program. (Lashof 1996). VA Policy regarding the provision of Reproductive Health Services: A horrifying aspect of Gulf War Syndrome is the birth of disabled, disfigured babies to Gulf veterans. VA provides a range of primary and tertiary health care facilities to Gulf War veterans with disabled and disfigured babies. (Gaytan 2011). A child with disability and incapability of self support automatically becomes eligible for receiving treatment and palliative care in the Military’s Medical Services system. However, these services are only provided to the children of active duty service members. Similar services are not provided to disabled children of veterans who are no longer on active duty. The VA’s health care services and treatment programs are not available to disabled children born to parents who are no longer serving in service even if the cause of disability is the parents’ service experience. The exception is only in the case of children suffering from spina bifida being born to parents who are no longer in active service. Limited evaluation and treatment programs are available for veterans who have been rendered infertile due to their service experience in the Persian Gulf. However, certain specialty cases receive treatment from the VA medical centers and such cases include infertility problems caused by spinal cord injury during service and diabetes induced infertility in Gulf veterans. The VA Medical System does not offer obstetrical services to female veterans. However limited obstetrical services are offered to female veterans undergoing a complicated pregnancy due to service related experiences of the Persian Gulf. For systematically addressing the reproductive health concerns of Gulf War veterans, VA has not formulated or enforced any effective and significant policies. Persian Gulf Registry: The VA clinical program was revised in the year 1994 and was renamed the Persian Gulf Registry. The Persian Gulf Registry was empowered with revised policies which were better able to diagnose and effectively treat the health problems of Persian Gulf veterans. The Revised program is composed of two phases, the Registry examination and the UCAP. The Registry examination is also referred to as Phase I and the UCAP is also known as Phase II. Phase I Registry examination involves the preparation of a complete medical history, and family history. Other issues taken into consideration during Phase I Registry examination are the preparation of occupational history, social history, drug abuse history, civilian history of possible exposure to toxic chemical and biological agents. Phase I is completed with the preparation of psychological history and review of symptoms. VA policy is strictly enforced in each of its medical centers and requires the physician or other health care personnel to record the tome of onset of symptoms or condition, and their intensity. Furthermore, the physician is also expected to determine and record the degree of physical incapacitation and details of all previous treatments. In accordance with revised instructions, VA requires each veteran to receive a Complete Blood Count, and electrolyte glucose, or equivalent blood chemistries and a urinalysis. (National Academy Press, 1998). Uniform Case Assessment Protocol (Phase II): The specifications provided in the VA manual are as follows: “Individuals who after completing Phase I or Registry evaluations, have a disability and do not have a clearly defined diagnosis which explains their symptoms, must receive certain supplemental baseline laboratory tests and consultations”. (National Academy Press, 1998). The provision of such supplementary tests is known as Uniform Case Assessment Protocol (Phase II). The supplementary baseline laboratory tests include a CBC, Erythrocyte Sedimentation Rate (ESR), C - reactive protein, Rheumatoid Factor, Anti-Nuclear Antibody, Liver Function tests, Creatine Phosphokinase, Hepatitis serology, Human Immunodeficiency, VDRL, B-12 and Folate, Thyroid Function Test, Urinalysis, and Tuberculosis skin test purified protein derivative. In addition to the above listed supplemental baseline laboratory tests, the VA requires the patient to receive certain consultations which are listed below: i. Dental consultation ii. Infectious disease iii. Psychiatric counseling involving the use of physician administered instruments iv. Neuropsychological testing v. Symptom specific tests are also ordered in certain specialty cases In most cases, Gulf veterans complain of persistent headache. In such cases, the patient is entitled to receive an MRI and a lumbar puncture in an effort to determine the cause of headache. Similarly, the physician is required to order other tests depending upon the presence of symptoms. (National Academy Press, 1998). Data Collection and Reporting Policy: The basic information of all Gulf veterans is collected from the Persian Gulf Registry, UCAP and Referral Center on the Persian Gulf registry code sheet. The completion of Part I of the code sheet requires the cooperation of the veterans in order to receive basic demographic information, exposure history, veteran’s health status, and information about reproductive health. The completion of Part II of the code sheet involves the examination of the veteran by the physician. Moreover, Part II is considered incomplete without gathering information about symptoms, consultations needed, diagnostic issues, and patient disposition. The remaining three parts of the code sheet is completed if the veteran has significant symptoms but no identifiable diagnosis. VA orders that a copy of the completed code sheet is to be forwarded to the Austin Automation Center for the purpose of up loading the information on computerized databases. (National Academy Press, 1998). Bimonthly Report: In accordance with revised VA policy, a bimonthly report is to be submitted consisting information about the total number of initial and follow up examinations, and appointment dates. Moreover, the bimonthly report also requires that all VA facilities must keep a record of missed opportunities. (National Academy Press, 1998). In accordance with VA’s specifications, each health facility has to have a Veterans’ Registry Physician. The physician is responsible for serving as a primary health care provider to Veterans returning from the Persian Gulf. In accordance with the specifications listed the VA manual, the Physician has the following responsibilities: i. Offering information to veterans regarding the purpose of clinical evaluation examinations ii. the determination of the initial focus of the examination and the provision of symptomatic treatment to the veteran iii. The conduction and documentation of physical clinical evaluation examination. (National Academy Press, 1998). Furthermore, VA manual requires each VA medical center or health facility to have a registered Veterans’ Registry Coordinator, who is entrusted with the task of administrative management of the program. The responsibilities of a Veterans’ Registry Coordinator are to schedule appointments, monitor time frame compliance, review records for the purposes of accuracy and data completion to accomplish efficient report keeping. (National Academy Press, 1998). Policy regarding Performance Monitoring: In order to assess and monitor the appropriateness of medical care being provided by the Registry the VA has developed an instrument. VA manual clearly specifies that each VA medical center and heath care facility is required to utilize the instrument for the assessment of at least 10% of its physical clinical evaluation examination programs. (National Academy Press, 1998). Environmental Agents Service: Within the VA, the focal point is occupied by the Environmental Agents Service as far as the clinical issues regarding the Persian Gulf veterans are concerned. Many outreach programs are organized and enforced from the office of Environmental Agents Service. The Veterans are informed about health care services provided by the VA through extensive outreach efforts. For disseminating updated information on Persian Gulf War syndrome the primary vehicle is the Persian Gulf Review newsletter. (National Academy Press, 1998). Evaluation of Department of VA Uniform Case Assessment Protocol: Evaluating the adequacy of UCAP has always been a focal point in increasing efficiency of the Registry and which is precisely the reason why VA charged IOM with task of evaluating UCAP and its providers. A committee was assembled by IOM in response to the demand of VA. The committee was composed of members having diverse expertise including neurology, implementation, VA efforts at outreach at veterans, internal medicine and infectious diseases. The committee was entrusted with the task of reviewing published materials and performed site visits of VA health facilities. A total of three meetings were conducted by the committee and numerous presentations were reviewed as well. Another task undertaken by the committee was the solicitation of written testimony from VA health care providers in an effort to gather information about general views on the adequacy of the protocol. (National Academy Press, 1998). Agreement with the National Academy of Sciences for Review of Health Consequences of Service during the Persian Gulf War: An agreement was signed between the Secretary of Defense and Secretary of Veterans Affairs in an effort for seeking joint venture with the National Academy of Sciences. The agreement was signed for reviewing the existing scientific, medical and other information on GWS by the Medical Follow up Agency of the Institute of Medicine of the Academy. In accordance with the terms and conditions of the agreement, the Medical Follow up Agency will provide an opportunity for the members of veterans’ organizations and members of the scientific community to evaluate and analyze the methods used by the MFUA in the propagation of extensive review. The agreement specified that the examination and evaluation of medical records of individuals will be done by the MFUA. The Secretary of Veterans Affairs and the Secretary of Defense will be given 180 days after the enactment of this Act to enter into an agreement. (Patriotic and National Observances 2009). Recent Developments: In the year 1994, Clinton Administration supported the legislation regarding the provision of compensation benefits to chronically disabled Gulf veterans because they had realized the fact that it would take a long time to determine the cause of disability. A final regulation was published on 3rd February 1995, this policy was implemented and VA began to pay compensation to its chronically injured and disabled Gulf veterans. President Clinton approved the request of VA and extended the eligibility criteria for compensation for undiagnosed illnesses on 7th March, 1997. The eligibility criteria were extended on 21st December 2001 in order to allow a window for the manifestation of symptoms of undiagnosed illnesses. In accordance with the record of Veterans Affairs, a total of 27,383 Gulf veterans are receiving compensation for chronic illnesses mediated due to exposure to toxic substances during the Gulf War. In accodance with another record, approximately 660 Gulf veterans are receiving compensation for undiagnosed illnesses. (Measuring the Health of Persian Gulf Veterans 1998). Conclusion: The Gulf War Syndrome is a mysterious disease occurring in former strong veterans who served in the Persian Gulf during the Gulf War of 1991. The disease presents a plethora of mysterious symptoms such glowing vomiting and burning semen. Furthermore, fatigue, diarrhea, hair loss, and cancer are some of the most common symptoms reported in Gulf Veterans. (Knight 2003). Realizing the seriousness of the syndrome and the large number of emerging cases, the Congress authorized $2 million for utilization in the provision of free of charge physical evaluation examinations. The amount authorized by the Congress enabled the delivery of free physical examinations to more than 4500 Gulf veterans. VA has formulated follow up policies and treatment benefits but they are not provided by the Persian Gulf Registry. The Toll Free information hotline (800-749-8387) has been established by the VA for the provision of information about disease symptoms and therapeutic strategies to be followed in the treatment of Gulf War Syndrome. (Shays 1998). Annotated Bibliography: Kilshaw, Susie. Impotent Warriors: Gulf War Syndrome, Vulnerability and Masculinity. New York: Berghahn, 2010. Print. The author outlines the dangers and risks to which the veterans are exposed and their ramifications in their lives. The book extensively describes the mysterious illness known as Gulf War Syndrome and also provides information on the vulnerability of the veterans to this mysterious chronic illness. Henderson, James W. Health Economics and Policy. Australia: South-Western/Thomson Learning, 2001. Print. Health Economics and Policy provides extensive information on various service related diseases and the actions taken by the government to curb these illnesses such as those reported by veterans who served in the Vietnam War and the Persian Gulf. The author provides detailed information about modern day issues in medical care delivery. Lashof, Joyce C. Presidential Advisory Committee on Gulf War Veterans' Illnesses: Final Report. Washington, D.C.: The Committee, 1996. Print. The book provides detailed information about the initial response of the government to the issue of GWS. The author briefly outlines the effectiveness of the response and provides an in depth analysis on the working of the Presidential Advisory Committee on Gulf War veterans illness. The author has also provided detail information on the working of VA’s Gulf War Registry. Adequacy of the Va Persian Gulf Registry and Uniform Case Assessment Protocol. Washington, D.C: National Academy Press, 1998. Print. The book provides information about the VA Registry program and addresses issues relating to the effectiveness of the Registry. The author provides an in depth analysis on the Uniform Case Assessment Protocol which is also referred to as the Phase II. United States Code, 2000 Edition: Containing the General and Permanent Laws of the United States, Enacted During the 107th Congress, Second Session, January 2, 2001 to January 6, 2003. Washington: U.S. G.P.O, 2004. Print. The publication provides an in depth analysis on the laws enacted for the benefits of veterans in the United States of America. The publication provides information on the establishment of the Registry and its contents. United States Code 2006: Title 36, Patriotic and National Observances, Ceremonies, and Organizations, to Title 38, Veterans' Benefits. United States Govt Printing Office, 2009. Print. The publication provides information on the laws enacted to provide health protection and services to veterans who have served in the Persian Gulf. The book provides information on the actual policies implemented in an effort to provide diagnostic and therapeutic services to Gulf War Veterans. Shays, Christopher. Status of the Dept. of Veterans Affairs to Identify Gulf War Syndrome. DIANE Pub, 1998. Print. The book generally provides information on the symptoms specific to Gulf War Syndrome and also provides a list of mysterious symptoms including glowing vomit and burning semen. The book is an excellent source of information regarding the efficiency and tasks of the VA. Measuring the Health of Persian Gulf Veterans: Workshop Summary. Washington, D.C. (2101 Constitution Ave., N.W., Washington, D.C. 20418: National Academy Press, 1998. Internet resource. This summary provides information on various investigations and reports which were undertaken soon after the veterans started to report the symptoms of GWS. Marrs, Timothy C, Robert L. Maynard, Frederick R. Sidell, and Timothy C. Marrs. Chemical Warfare Agents: Toxicology and Treatment. Chichester, England: Wiley, 2007. Print. The book is based on the toxicology of the different chemical substances the Veterans were exposed to during there stay in the Persian Gulf. It outlines some of the predicted causes of the GWS. Patarca-Montero, Roberto. Concise Encyclopedia of Chronic Fatigue Syndrome. New York: Haworth Medical Press, 2000. Print. The book provides detail information on the symptoms specific to the Gulf War Syndrome. Knight, Peter. Conspiracy Theories in American History: An Encyclopedia. Santa Barbara, Calif: ABC-CLIO, 2003. Internet resource. The book provides information on GWS and the conditions the veterans were exposed to in the Persian Gulf such as primitive living conditions, toxic substances and infectious diseases. Brown, James S. Environmental and Chemical Toxins and Psychiatric Illness. Washington, DC: American Psychiatric Pub, 2002. Print. The book provides information on the hazardous conditions the veterans were exposed to such the smoke from the oil fields to which the Iraqis had set fire to before retreating. Rosof, Bernard M, and Lyla M. Hernandez. Gulf War Veterans: Treating Symptoms and Syndromes. Washington, D.C: National Academy Press, 2001. Internet resource. The book provides information on the Gulf Registry Program and its initial response to the plethora of mysterious illnesses referred to as the Gulf War Syndrome. Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action. Washington, D.C: National Academy Press, 1995. Internet resource. The book provides information about the advisory committee established by the Congress and outlines its role in handling the issue of GWS. Augerson, William S. Chemical and Biological Warfare Agents. Santa Monica, CA: RAND, 2000. Print. The book provides information on the symptoms of GWS. Department of Veterans Affairs: Federal Gulf War Illnesses Research Strategy Needs Reassessment : Report to the Chairman, Subcommittee on National Security, Emerging Threats, and International Relations, Committee on Government Reform, House of Representatives. Washington, D.C.: U.S. General Accounting Office, 2004. Internet resource. Outlines the policies utilized in the formation of Gulf War Registry. Brooks, Matthew S. "the Vietnam Veteran Experience: A Life Course and Aging Perspective". , 2007. Print. The publication outlines the different combat and other military condition faced by the veterans in the Persian Gulf and attempts to correlate the issue of GWS to these military conditions. Kick, Russell. Everything You Know Is Wrong: The Disinformation Guide to Secrets and Lies. New York, NY: The Disinformation Co, 2002. Print. The book provides information on different aspects of GWS and the health problems faced by the GWV. Gaytan, Peter S, and Marian E. Borden. For Service to Your Country: The Essential Guide to Getting the Veterans' Benefits You've Earned. New York: Citadel Press, 2011. Print. The publication provides information on the benefits provided by the Gulf War Registry to the Gulf Veterans. References: Kilshaw, Susie. Impotent Warriors: Gulf War Syndrome, Vulnerability and Masculinity. New York: Berghahn, 2010. Print. Henderson, James W. Health Economics and Policy. Australia: South-Western/Thomson Learning, 2001. Print. Lashof, Joyce C. Presidential Advisory Committee on Gulf War Veterans' Illnesses: Final Report. Washington, D.C.: The Committee, 1996. Print. Adequacy of the Va Persian Gulf Registry and Uniform Case Assessment Protocol. Washington, D.C: National Academy Press, 1998. Print. United States Code, 2000 Edition: Containing the General and Permanent Laws of the United States, Enacted During the 107th Congress, Second Session, January 2, 2001 to January 6, 2003. Washington: U.S. G.P.O, 2004. Print. United States Code 2006: Title 36, Patriotic and National Observances, Ceremonies, and Organizations, to Title 38, Veterans' Benefits. United States Govt Printing Office, 2009. Print. Shays, Christopher. Status of the Dept. of Veterans Affairs to Identify Gulf War Syndrome. DIANE Pub, 1998. Print. Measuring the Health of Persian Gulf Veterans: Workshop Summary. Washington, D.C. (2101 Constitution Ave., N.W., Washington, D.C. 20418: National Academy Press, 1998. Internet resource. Marrs, Timothy C, Robert L. Maynard, Frederick R. Sidell, and Timothy C. Marrs. Chemical Warfare Agents: Toxicology and Treatment. Chichester, England: Wiley, 2007. Print. Patarca-Montero, Roberto. Concise Encyclopedia of Chronic Fatigue Syndrome. New York: Haworth Medical Press, 2000. Print. Knight, Peter. Conspiracy Theories in American History: An Encyclopedia. Santa Barbara, Calif: ABC-CLIO, 2003. Internet resource. Brown, James S. Environmental and Chemical Toxins and Psychiatric Illness. Washington, DC: American Psychiatric Pub, 2002. Print. Rosof, Bernard M, and Lyla M. Hernandez. Gulf War Veterans: Treating Symptoms and Syndromes. Washington, D.C: National Academy Press, 2001. Internet resource. Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action. Washington, D.C: National Academy Press, 1995. Internet resource. Augerson, William S. Chemical and Biological Warfare Agents. Santa Monica, CA: RAND, 2000. Print. Department of Veterans Affairs: Federal Gulf War Illnesses Research Strategy Needs Reassessment : Report to the Chairman, Subcommittee on National Security, Emerging Threats, and International Relations, Committee on Government Reform, House of Representatives. Washington, D.C.: U.S. General Accounting Office, 2004. Internet resource. Brooks, Matthew S. "the Vietnam Veteran Experience: A Life Course and Aging Perspective". , 2007. Print. Kick, Russell. Everything You Know Is Wrong: The Disinformation Guide to Secrets and Lies. New York, NY: The Disinformation Co, 2002. Print. Gaytan, Peter S, and Marian E. Borden. For Service to Your Country: The Essential Guide to Getting the Veterans' Benefits You've Earned. New York: Citadel Press, 2011. Print. Read More