Although the 1990-1991 Persian Gulf War was considered a brief and successful military operation with few injuries and deaths among coalition forces, many returning veterans soon began reporting numerous health problems that they believed to be associated with their service in the Persian Gulf.

In 1998, in response to the growing concerns of the ill Gulf War veterans, Congress passed two laws: PL 105-277, the Persian Gulf War Veterans Act, and PL 105-368, the Veterans Programs Enhancement Act. Those laws directed the secretary of veterans affairs to enter into a contract with the National Academy of Sciences to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines associated with Gulf War service and to consider the NAS conclusions when making decisions about compensation. Those studies were assigned to the Institute of Medicine (IOM).

Gulf War and Health: Volume 4. Health Effects of Serving in the Gulf War differs from the previous work of IOM in that it summarizes in one place the current status of health effects in veterans deployed to the Persian Gulf irrespective of exposure information.  The charge to this IOM committee was to review, evaluate, and summarize peer-reviewed scientific and medical literature addressing the health status of Gulf War veterans.

The committee found that although veterans of the first Gulf War report significantly more symptoms of illness than soldiers of the same period who were not deployed, studies have found no cluster of symptoms that constitute a syndrome unique to Gulf War veterans.

The committee did find evidence that suggests there may be an elevated rate of the rare disorder amyotrophic lateral sclerosis (ALS) among Gulf War veterans. However, there does not appear to be an increase in mortality and hospitalizations among Gulf War veterans. Evidence regarding rates of testicular cancer, brain cancer, and certain birth defects among Gulf War veterans is inconsistent and the committee recommended further surveillance for those health outcomes.