From the activities conducted to-date on this investigation, the following findings are presented:

• Military personnel conducted major retrograde equipment and vehicle washing operations at primary and secondary airports and seaports of debarkation.^[7] The two initial primary airports of debarkation were located at Dhahran and Riyadh, Saudi Arabia. Eventually, the US expanded the airlift operation to other Saudi airports, principally King Fahd and King Khalid. The two principal seaports were Al Jubayl and Ad Dammam, Saudi Arabia. Bahrain, Oman, and the United Arab Emirates provided ports for other in-theater operations—moving pre-positioned stocks and providing storage. Before final processing at the primary ports of debarkation, military personnel sometimes performed preliminary equipment and vehicle-cleaning activities at various tactical assembly areas located in-theater.
• There were as many as 50 wash stations (racks) at each of the primary airports and seaports of debarkation. One estimate put the total number of wash points in Saudi Arabia at 782.^[8] Personnel performing the washing operations typically allowed runoff and waste containing discharges to percolate into the soil or flow down storm drains which discharged into the Persian Gulf.^[9]
• There were reports that personnel used non-potable well water and recycled water or industrial, non-potable (gray) water at some washing stations at King Khalid Military City (KKMC), Al Jubayl, Hafar Al Batin, and Dhahran.^[10] Toxic or hazardous contaminants, if present, could have accumulated over time at these wash stations and nearby US personnel could have been exposed to them. No evidence of environmental monitoring and sampling at these or other locations exists. Interviews with military personnel knowledgeable in this subject suggest that environmental monitoring and sampling was, in general, not conducted.^{[11,12,13,14]} Consequently, a full assessment of the exposure and resulting risk to human health cannot be made. Similarly, sampling data on contaminant levels on retrograded equipment and vehicles at locations within the United States are either not available or were negative for the parameters analyzed.^[15]
• Each unit was responsible for cleaning its own vehicles and equipment before redeployment. Each vehicle required two to three individuals (or about 24-man hours) to complete the cleaning.^[16,17]The Army alone washed more than 2,000 vehicles per day. In the first 120 days of redeployment, military personnel cleaned more than 117,000 wheeled vehicles, 12,000 tracked vehicles, and 2,000 helicopters, and also packed 41,000 containers of supplies.^[18] Assuming the average soldier spent about 30 days^[19] cleaning vehicles and equipment, the data suggests that more than 20,000 soldiers may have been involved in the washing and packaging operations conducted in-theater.^[20]
• Despite the large numbers of troops involved in retrograde operations, a relatively small proportion attribute their symptoms to their retrograde activities. For example, of the 225 veterans interviewed,^[21] the vast majority believes that their current medical condition is not related to their retrograde activities. For those who reported an adverse health effect, the occurrence of rashes was the most commonly reported symptom. This occurred in about 20% of the self-reports. Fatigue, joint pain, headaches, and memory loss each accounted for about 10%. The remainder (~40%) was roughly equally divided between all other reported symptoms.
• While US forces generally complied with the rigid US Military Pest Management Board and US Department of Agriculture protocols governing the cleanliness of returning equipment and vehicles, information collected during this investigation suggests that on occasion, retrograded items were not cleaned to standards.^[22] This information suggests that personnel processing these materials at locations outside of the KTO would have been exposed to the same contaminants (if present) as those involved in cleaning operations in the KTO. There have been, however, no reports by military personnel of any adverse health effects attributable to contact with retrograde materials at any of the major equipment and vehicle processing installations visited by investigators.
• Based on veteran interviews regarding exposure incidents and activities at retrograde processing sites in the Kuwait theater of operations investigators have determined that a clustering of symptoms,^[23] events, and/or exposure scenarios is not apparent. In addition, the symptoms that have been reported by the veterans have not been verified through medical evaluations. Furthermore, very little documentation or data exists that would either support or refute any of the exposure claims at these locations. Therefore, it is impossible to verify that contamination was present and that the contamination resulted in exposure and the onset of adverse health effects.
• Some veterans speculated that the application of fumigants, preservatives, or other forms of pesticides to shipping containers might have lead to inadvertent exposure to toxic or hazardous chemicals contained in these compounds. Investigators have found no evidence of this practice. Guidance on operational washdowns and cleaning procedures for all branches of the military service are contained in the Armed Forces Pest Management Board Technical Information Memorandum No. 31.^[24] This guidance does not include provisions for applying fumigants and pesticides to shipping containers. Interviews with personnel at the USMC Blount Island Command indicate that the application of pesticides to shipping containers is not standard practice within the USMC Maritime Prepositioned Ships program.^[25]
• Washing operations typically involved the use of high-pressure water and in some instances cleaning agents (e.g., there were anecdotal reports of cleaning agents being used during aircraft washing operations) such as PD680, Decontaminating Solution No. 2 (DS2, an ammonia-based detergent) and super tropical bleach (STB).^[26] By some accounts, cleaning personnel also used commercially available solvents and cleaning agents.^[27] Short-term symptoms associated with the inhalation of DS2 include nausea, vomiting, and respiratory tract irritation.^[28] Dermal contact may result in burns. STB is a bleaching agent containing calcium hypochlorite (a powerful oxidizer) and calcium oxide (a corrosive material). STB is corrosive to the skin and eyes and extremely destructive to tissues of the mucous membranes and upper respiratory tract.^[29]
• Anniston Army Depot was one of two locations where civilian workers reported similar symptoms after coming in contact with retrograde equipment. This incident involved shop workers who worked on chemical-biological-radiological filters from retrograded M1A1 tanks.^[30] Workers developed a number of symptoms, primarily rashes, after coming in contact with the filters. The filters were tested for radiological and chemical parameters and found to be negative. A high chromium content was detected, however, as chromium is used in the filter media. In sensitive individuals, chromium has been known to cause contact dermatitis and therefore may explain the rashes reported by some individuals. ^[31]
• The second incident involving similar reported symptoms occurred at Camp Robinson. As many as 13 shop workers reported similar short-term symptoms that included headaches, nausea, nose bleeds, joint pain, and some eye irritations. The symptoms were physician diagnosed as arising from workplace conditions and not related to contact with retrograde equipment.^[32] None of the shop workers who were interviewed as part of this investigation reported that they are currently experiencing any symptoms.^[33] Samples of sand were taken from potentially contaminated vehicles and were analyzed for chemical and biological agents. The analytical results were negative for all parameters tested. ^[34]
• Evidence collected to date indicates that there have been no diagnoses of any chronic illnesses associated with exposures to retrograded equipment, both in the KTO and locations within the US. The short-term symptoms most commonly reported by military and civilian personnel were joint pain and skin rashes.
• Materials and information obtained to date from equipment manufacturers provide no evidence to support a connection between reported symptoms and chemicals contained in tenting, netting, and sleeping bags.^[35] However, some chemicals contained in these items can, in sufficient dosages, cause health effects. For example, chromium, commonly used in tent pigments before 1993, may cause contact dermatitis in sensitive individuals.^[36]
• The results to date into exposure incidents at sites within the United States (Table 4) are thus far incomplete. With the exception of the Camp Robinson case, the health symptoms reported across and within each of the sites varied. In general, however, clustering of symptoms, events, and/or exposure scenarios is not apparent.
• Environmental samples of various media (e.g., sand, filters, and surfaces) have been taken at four site-specific locations where potential exposures had been reported; these included: USMC Logistics Base - Albany, Alameda Naval Air Station, Anniston Army Depot, and Camp Robinson. Analyses of the samples for radiological contaminants, chemical agents, and biological agents proved negative.^[37,38,39]

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