Specialist Medical Review Council Declaration and Reasons for Decisions Section 196W Veterans’ Entitlements Act 1986 Re: Statements of Principles Nos. 55 and 56 of 2014 in respect of Chronic Multisymptom Illness Request for Review Declaration No. 33 In relation to the Repatriation Medical Authority (the RMA) Statements of Principles Nos. 55 and 56 of 2014 concerning chronic multisymptom illness made under subsections 196B of the Veterans' Entitlements Act 1986 (the VEA), the Council under subsection 196W(5) of the VEA: DECLARES that there is insufficient sound medical-scientific evidence on which the RMA could have relied to amend the Statements of Principles to include the following factor(s): depleted uranium; oil well smoke; medical countermeasures (such as pyridostigmine bromide, and vaccinations for anthrax, plague, pertussis); contaminated food and water; chemical and biological weapons; and pesticide exposure (including N,N-diethyl-m-toluamide (DEET)).
this study was in direct contrast to the work of Asa et al discussed previously, and noted the inconclusive nature of a suggested link between squalene antibodies and unexplained illness. In a case-control by Steele et al52 discussed at [116], found no significant associations between veterans who reported receiving vaccines in theatre and ‘Gulf War Illness’ when other exposures were taken into account. In a cohort group by Smith et al84 where results of self-reported anthrax vaccine exposure were compared to electronic documentation of vaccination, there were no differences between vaccinated and unvaccinated participants in overall measures of health (using the Medical Outcomes Study 36-Item SF Health Survey for Veterans Only the subset of participants who self-reported they had received the anthrax vaccination, but had no electronic documentation, had consistently lower measures of health, suggesting reporting bias.84 The Council felt that the large sample size in this study was a strength of the study, but the sample used may not be representative of the military population in general (a point identified by the authors themselves). The Council felt that the self-reported nature of the ill-health in those with no vaccination record indicated a potential degree of recall bias. The Council has previously noted this as a methodological issue with studies relying on self-reported data. In a cohort to determine whether anthrax vaccine resulted in adverse health effects in Canadian Forces members eight months after vaccination, Hunter et al85 found no significant increase in adverse health effects, using the International Classification of Diseases 10th revision (ICD-10). The Council noted that this study relied on objective medical records rather than self-reported health data. However, the timeframe of the study was relatively short, which limits the ability to extrapolate the findings of this study more generally. Murphy et al86 conducted a cohort study of UK armed forces to assess the relationship between health and self-reported vaccinations received, and health and medical records of vaccinations received. A total of 4882 randomly selected military personnel deployed to Iraq since 2003 and a subset of 378 whose vaccination records were accessed were studied. Military personnel who reported receiving two or more vaccinations on a single day were more likely to report symptoms of fatigue and had multiple physical symptoms.