INTRODUCTION, FACILITIES, AND METHODS: Decompression sickness (DCS) occurring in hypobaric environments related to aviation or spaceflight was a major focus of research at Brooks AFB/City-Base, TX, throughout the period 1960-2010. Multiple hypobaric chambers and extensive support facilities were built for research on altitude DCS using both human subjects and animal models. Areas of study included symptomatology, incidence, prediction, and prevention of DCS. High-altitude aviation, spacecraft atmospheres, and pressure suits were evaluated with various decompression and prebreathing schedules to reduce DCS risk. FACTORS AFFECTING DCS INCIDENCE: The results from these efforts were recorded in an extensive Altitude DCS Research Database which served as a resource for developing reports and exploring relationships of various parameters such as altitude, time at altitude, prebreathe time, and mode of activity while decompressed. PREVENTION AND PREDICTION OF DCS: Individual susceptibility to DCS was also evaluated in an effort to tailor preventive measures and predict susceptibility. Completion of the 26 human-use protocols provided information which was incorporated into NASA and USAF operational practices to reduce DCS risk. DCS researchers working at Brooks throughout this period produced 177 papers documenting results of thousands of subject-exposures and other experiments. An Altitude DCS Risk Assessment Computer Model was fielded in 2005. This review centers on the results of research at Brooks and notes questions about operational DCS risk that have not yet been answered.