Responses to occupational and environmental exposures in the U.S. military--World War II to the present.

Since the Civil War, a proportion of U.S. service members continues to return from war with new health problems and continues to reference battlefield exposures as the cause. Hence, one of the most pressing public health debates in military policy, the determination of causality and linking of battlefield exposures to health outcomes in veterans, continues. The advances in military environmental and occupational epidemiologic research and Department of Defense policy concerning battlefield exposures are summarized and examples from World War II through the first Gulf War are provided. The limitations associated with the unique battlefield environment, multiple environmental exposures, and the inherent stresses of war, beget challenges for researchers responsible for determining causality. In light of these difficulties, six strategies for addressing environmental exposures and their possible impact on veterans were recommended by the Institute of Medicine post Operation Desert Storm. These strategies, along with their respective progress and remaining gaps, are addressed.