FORT STEWART, Ga. – Col. Paula K. Underwood, an Army doctor, had just returned to her post in Germany from the 1991 Gulf War when she saw a patient whose condition baffled other doctors.
The patient was a soldier, also just back from the war, who complained of memory loss. He could no longer find his way from home to work. He had trouble remembering how to make his morning coffee.
He was the first of 72 patients with unexplained illnesses Underwood would see before leaving Germany in 1993. Some complained of aches and pains. Others said they got sick more often than normal.
"There were a variety of concerns they had, none of which fit into a neat category," said Underwood, now chief of the medical staff at Fort Stewart's Winn Army Community Hospital. "These were the days before anybody talked about the so-called Gulf War Syndrome."
Twelve years later, Underwood and her staff are preparing to screen 16,500 soldiers of the Army's 3rd Infantry Division returning from Iraq for any symptoms that might point to a new wave of illnesses.
It is part of a military-wide effort to avoid the delays and denials sick soldiers faced after the first Gulf War, as well as the lack of early data that stymied scientists trying to solve the mystery.
"We're prepared this time, whereas in the first Gulf War we really weren't," Underwood said. "We're doing it across the board and we're not waiting for them to come to us. When I stop and think about it, this is unprecedented, really, in military medicine."
The Pentagon has ordered health screenings for every U.S. service member deployed for the Iraq war — from Army infantrymen and Marines who fought on the ground to Air Force fighter pilots and Navy crews serving aboard aircraft carriers.
Within 30 days of their homecoming, everyone will fill out a health questionnaire, review it with a health provider and give a blood sample that will be kept in case the person develops symptoms later.
An estimated 250,000 troops — including National Guardsmen and reservists — were sent to the Persian Gulf region during the war.
Army doctors have prepared a clinic on Fort Stewart, the biggest post east of the Mississippi River, to screen up to 400 soldiers per day once they get home, probably later this summer. A gymnasium has also been set up to screen thousands of returning reservists.
The five-page questionnaire will ask troops if they developed any symptoms while deployed such as chronic cough, rashes or diarrhea. They will be asked to list possible exposures to such things as pesticides, oil fires, or biological and chemical weapons. The form also asks whether they have had problems with depression or stress.
In addition, soldiers will have sit-down interviews with doctors and mental health counselors.
Capt. Paul Jacobson, an Army physician's assistant overseeing the screenings, said he will have a staff of 30 ready by mid-June.
"We know this onslaught's coming," Jacobson said. "We're prepared for a flood, and hopefully we can handle it."
Military bases with troops returning by sea anticipate less of a crush. Most of the 2,200 Marines from Camp Lejeune, N.C., who arrived on Memorial Day had their health screenings done on ship during their monthlong voyage from the Persian Gulf.
An estimated 100,000 veterans with Gulf War illnesses have been reported since the war 13 years ago, including some 2,000 at Fort Stewart.
Research has shown that veterans of Operation Desert Storm are more likely to suffer from a range of chronic symptoms such as memory loss, fatigue, joint pain, depression, anxiety, insomnia, headaches and rashes.
But after 12 years and hundreds of studies looking at possible causes including stress, low-level nerve gas exposure, pesticides and depleted uranium from armor-piercing ammunition, researchers have yet to determine conclusively what made the soldiers sick.
"It sounds to me as if we're in a better position to understand the cause of unexplained illnesses than we were after the Gulf War, but just how much better is really impossible to tell," said Dr. Harold Sox, former chairman of an Institute of Medicine committee on Gulf War illness. He is now editor of the Annals of Internal Medicine.
Steve Robinson, executive director of the National Gulf War Resource Center, said soldiers were better equipped this time to protect themselves from toxins.
Also, a number of threats seem never to have materialized. Only a few Iraqi oil wells were set ablaze during this war, compared with hundreds of oil fires in Kuwait 12 years ago.
And there have been no reports of troops being exposed to chemical weapons. The Pentagon says about 130,000 soldiers in the 1991 war were exposed to sarin nerve gas when U.S. troops destroyed an Iraqi weapons depot.
"I don't believe we're going to see hundreds of thousands of mystery illnesses coming out of this war, because it was a different kind of war," said Robinson, a former Army Ranger. "And the things that happened in the first Gulf War that were mysteries then aren't mysteries now."
Dr. Robert W. Haley, chief of epidemiology at the University of Texas Southwestern Medical Center at Dallas, has published almost two dozen studies suggesting a link between Gulf War illnesses and nerve gas.
"My own view is you probably won't see anything on the order of what we saw after Gulf War One because it appears there was no exposure to nerve gas during Gulf War II," said Haley, who serves on the Department of Veterans Affairs advisory committee on Gulf War illness.