Gulf War I Registry Gulf War I Registry ExaminationsExaminations

The Atlanta VAMC ExperienceThe Atlanta VAMC ExperienceSuzanne Cullins, M.D.Suzanne Cullins, M.D.

Gulf War Registry ExamsGulf War Registry Exams

•• Compensation and Pension/Special Compensation and Pension/Special Exams Unit SectionExams Unit Section

•• C & P examsC & P exams•• Agent Orange Registry examsAgent Orange Registry exams•• Gulf War Registry examsGulf War Registry exams•• Military Separation examsMilitary Separation exams•• Other examsOther exams

Gulf War Registry ExamsGulf War Registry Exams

•• Section ChiefSection Chief•• ExaminersExaminers——MDMD’’s, NPs, NP’’s, Fellows, s, Fellows,

ResidentsResidents•• Administrative staffAdministrative staff

Gulf War I EraGulf War I Era

•• Desert Shield and Desert StormDesert Shield and Desert Storm•• U.S. deployed 697,000 military U.S. deployed 697,000 military

personnelpersonnel•• Kuwait TheaterKuwait Theater•• Public Law 102Public Law 102--585585——Gulf War RegistryGulf War Registry

Gulf War I VeteranGulf War I Veteran’’s Demographicss DemographicsMaleMaleFemaleFemale

939377

Age (mean) in 1991 (years)Age (mean) in 1991 (years) 2727

CaucasianCaucasianAfrican AmericanAfrican AmericanHispanicHispanicOtherOther

707023235522

EnlistedEnlistedOfficerOfficer

90901010

ArmyArmyNavyNavyMarinesMarinesAir ForceAir Force

5050232315151212

Active dutyActive dutyReserves or National GuardReserves or National Guard

83831717

Gulf War I Registry ExamsGulf War I Registry Exams

•• Per EAS registry, 3272 unique registry Per EAS registry, 3272 unique registry exams completed in Atlanta VAMC from exams completed in Atlanta VAMC from 01/01/1990 to 12/31/200801/01/1990 to 12/31/2008

•• Represents 3098 unique veteransRepresents 3098 unique veterans——2692 males and 406 females2692 males and 406 females

•• For 2009, 19 exams for Gulf War I For 2009, 19 exams for Gulf War I veterans completed to dateveterans completed to date

Gulf War I Registry Exams 1990-2008

0

20000

40000

60000

80000

100000

120000

140000

Atlanta VA Wide

Atlanta Gulf War I Registry Exams 1990-1999

0

100

200

300

400

500

600

700

800

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Atlanta Gulf War I Registry Exams 2000-2008

0

50

100

150

200

250

300

350

400

2000 2001 2002 2003 2004 2005 2006 2007 2008

0

200

400

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1200

1400

1600

1800

2000

Decade 1 Decade 2

Atlanta Gulf War I Registry Exams for Two Decades

0

500

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3000

3500

One Exam Two Exams Three Exams

Atlanta Gulf War I Registry Exams 1990-2008

Two Gulf War I Registry Exams

0

20

40

60

80

100

120

1990-1995 1996-2001 2002-2005 2006-2008

Three Gulf War I Registry Exams

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1990-1995 1996-2001 2002-2005 2006-2008

Gulf War I Registry Exams Gulf War I Registry Exams ExposuresExposures•• Smoke from oil firesSmoke from oil fires•• Diesel fumesDiesel fumes•• Exposure to burning Exposure to burning

trash/fecestrash/feces•• Drank or consumed Drank or consumed

food contaminated food contaminated with smoke, oil or with smoke, oil or other chemicalsother chemicals

•• Unknown chemicalsUnknown chemicals•• Bathed in Bathed in

contaminated watercontaminated water•• Drank contaminated Drank contaminated

waterwater

PTSD

Rash

Arthralgia

Fatigue

Headache

HTN

Migraines

Back pain

Sleep dist

Dyspepsia

Diarrhea

Hair loss

Dyspnea

Tremor

Depression

Common Symptoms/Complaints in Male Veterans

Migraines

Back pain

HTN

Fatigue

Rash

Headaches

Arthralgia

Tremor

FMS

Hair loss

Bloating

Common Symptoms/Complaints in Female Veterans

Gulf War I Registry ExamsGulf War I Registry Exams

•• PTSDPTSD•• Panic disorderPanic disorder•• DiverticulitisDiverticulitis•• Migraine headachesMigraine headaches•• Diabetes mellitusDiabetes mellitus•• Sleep apneaSleep apnea

Gulf War I Registry ExamsGulf War I Registry Exams

•• Coronary atherosclerotic heart diseaseCoronary atherosclerotic heart disease•• Depressive disorderDepressive disorder•• Benign prostate hypertrophyBenign prostate hypertrophy•• Hiatal herniaHiatal hernia•• Bipolar disorderBipolar disorder•• DJD of multiple jointsDJD of multiple joints

Gulf War I Registry ExamsGulf War I Registry Exams

•• Complete Compensation and Pension Complete Compensation and Pension claim if not already doneclaim if not already done

•• Primary care follow up at the VAMC or Primary care follow up at the VAMC or with private providerwith private provider

•• As health condition changes, followAs health condition changes, follow--up up with another registry examinationwith another registry examination

Gulf War I Veterans and C & P Gulf War I Veterans and C & P examinationsexaminations

•• Exam specific requests seen in veteran Exam specific requests seen in veteran who served in Gulf Warwho served in Gulf War

•• Gulf War exam requests with symptom Gulf War exam requests with symptom related complaintsrelated complaints

Gulf War I Veterans and C & P Gulf War I Veterans and C & P ExaminationsExaminations•• CoughCough•• DyspneaDyspnea•• FatigueFatigue•• ArthralgiasArthralgias•• RashRash•• Chest painChest pain•• GastroenteritisGastroenteritis•• MSMS

•• HeadachesHeadaches•• Rhinitis/SinusitisRhinitis/Sinusitis•• Back painBack pain•• Sleep disorderSleep disorder•• FMSFMS•• CFSCFS•• Memory LossMemory Loss•• DepressionDepression

Gulf War I Veterans and C & P Gulf War I Veterans and C & P ExaminationsExaminations•• Greater outreach and encouragement to Greater outreach and encouragement to

complete Gulf War registry complete Gulf War registry examinationsexaminations

•• Encouragement to complete C & P Encouragement to complete C & P claimsclaims

•• Awareness that the VAMC is available Awareness that the VAMC is available and ready to assist with healthcare and ready to assist with healthcare needsneeds

ReferencesReferences

•• EAS Registry reports and data, EAS Registry reports and data, retrieved 02/09/2009retrieved 02/09/2009

•• Atlanta VAMC Gulf War Registry exam Atlanta VAMC Gulf War Registry exam data, retrieved 02/09/2009data, retrieved 02/09/2009

•• IOM, Gulf War and Health, Volume IIOM, Gulf War and Health, Volume I•• IOM, Gulf War and Health, Volume IVIOM, Gulf War and Health, Volume IV•• www.va.govwww.va.gov