Neurological Disease Among 1990-1991 Gulf War and Era Veterans in a Large National Cohort: Onset, Patterns of Occurrence and Association with Deployment Characteristics

The United States deployed more than 690,000 military service personnel to serve as part of a large multinational military coalition responding to Iraq’s invasion of Kuwait for the 1990-1991 Gulf War. This conflict was relatively brief and highly successful. Yet, since shortly after it ended, Gulf War veterans (GWVs) and their advocates have continuously expressed substantial concerns about potentially having increased risk for developing major debilitating neurological diseases like amyotrophic lateral sclerosis (ALS), brain cancer, and Parkinson’s disease, or developing them at younger ages because of their PG deployment. Deployed GWVs are in fact recognized as broadly exposed to numerous potential hazards during deployment that could potentially influence neurological disease risk ranging from long-burning oil well fires, depleted uranium munitions, and known neurotoxicants including military grade pesticides, exposure to chemical weapon nerve agent sarin/cyclosarin in association with destruction of a weapons facility in Iraq, to use of the anti-nerve agent prophylactic medicine pyridostigmine bromide. We propose to perform the largest and most comprehensive cohort-based evaluation of GWVs risk of developing major neurological diseases in adults including ALS, Parkinson’s disease, Multiple Sclerosis, Migraines, Epilepsy, Brain Cancer/Brain tumors, and Dementia. We propose to leverage and greatly expand on our previously identified nationwide cohort of ~140,000 GWVs (~1/3rd deployed). All are in the VA’s Million Veteran Program (MVP) study, and were identified for an earlier limited GWAS study on Gulf War Illness or GWI (~30% deployed GWI+ per self- reported symptoms based on recommended Kansas and CDC diagnostic criteria). We will use multiple sources of data including linked time-updating VA medical records and databases dating back to 1999, veteran surveys on medical and risk factor data, Department of Defense data on military service, linked external healthcare databases like Medicare, language guided narrative medical note searches and electronic medical review. An expert advisory panel will use clinical guideline criteria to validate all cases. We will employ longitudinal multivariable modeling to assess if deployment (including specific aspects of deployment like time or branch/location) or comorbid GWI influence neurological disease risk in GWVs. Our timely study will help address long-standing veteran concerns, and is responsive to the National Academy of Sciences’ continuing guidance to the VA to perform critically needed rigorous large-sample cohort studies to address these concerns.