PRESIDENTIAL SPECIAL OVERSIGHT BOARD
FOR DEPARTMENT OF DEFENSE INVESTIGATIONS
OF GULF WAR CHEMICAL AND BIOLOGICAL INCIDENTS
Friday, November 20, 1998
Senate Hart Building
Hon. Warren B. Rudman (biography)
Hon. Jesse Brown (biography)
Dr. Vinh Cam (biography)
LTG (Ret.) Marc A. Cisneros (biography)
CSM (Ret.) David W. Moore (biography)
RADM (Ret.) Alan M. Steinman (biography)
ADM (Ret.) Elmo R. Zumwalt, Jr. (biography)
COL (Ret.) Michael E. Naylon (biography)
CALL TO ORDER
Hon. Warren B. Rudman
DEPARTMENT OF DEFENSE RESPONSES TO THE PAC
Dr. John Mazzuchi
MG Robert Claypoole
Dr. David McLean
COL Eric Daxson
CAPT David Trump
BOARD QUESTIONS TO OSD HEALTH AFFAIRS
OSD/JCS RESPONSE TO SENATE COMMITTEE ON VETERANS AFFAIRS REPORT
Dr. Bernard Rostker
Ms. Dee Morris
LTC Michael Abreu
RADM Michael Cowan
Ms. Norma St. Clair
BOARD QUESTIONS TO OSD PANEL ON SENATE REPORT AND ANSWERS
Dr. Vinh Cam
LTG (Ret.) Marc A. Cisneros
Ms. Dorothy Brooks, Esq., Veterans Advocate
COL David E. Root, USAFR (Ret.), Physician
VETERANS SERVICE ORGANIZATION COMMENTS
AMVETS, Mr. Dave Woodberry Director of Veterans Affairs
Veterans of Foreign Wars, Mr. Bill Frasure
Legislative Special Assistant
Mr. Paul Sullivan, Executive Director, National Gulf War Resource Center
American Legion, Mr. Matt Puglisi
Assistant Director for Veterans Affairs and Rehabilitation
BOARD QUESTIONS TO VETERANS SERVICE ORGANIZATION REPRESENTATIVES
Hon. Warren B. Rudman
Mr. Jon Jennings
SENATOR RUDMAN: Good morning. Sorry for the delay. I will resist all temptations to pun about this this morning, other than to say that if that had continued, this hearing would have been murkier than I expected.
Welcome to the panel. And I believe what we're going to do set up this morning, in the interest of conserving time, is I note that some of you on the panel would be on the second panel, as well, and I believe that what you would like to do is to cover that aspect of it while you're here.
So why don't you do that, and we'll try to get back on schedule.
It is my hope to have this hearing conclude a little earlier than the schedule shows, because I would like to allow some of my commissioners to get to their far-flung homes on the West Coast and the Southwest, and if they don't get out of here in mid-afternoon, they're probably going to have to spend the night in Washington, which there are better things to do with a Friday night.
So go ahead.
DR. MAZZUCHI: Thank you, Senator. Mr. Chairman and distinguished members of the Presidential Oversight Board, it is an honor for me to have the opportunity to appear before your committee to speak about the Department of Defense's clinical and research programs supporting veterans of the Gulf War.
I am John Mazzuchi. I am the deputy assistant secretary of defense for clinical and program policy. I have been asked this morning to characterize the improvements we have made to our comprehensive clinical evaluation program, the CCEP, and to discuss the status of our research program.
In addition, I have been asked to comment on some of the SIU recommendations as the second panel, and I will do those after I've done this.
I have submitted a full, detailed statement for both committee questions, and I would like to highlight, in the interest of time, some of the portions of that statement, if you don't mind.
Refinements to enhance the CCEP have been made based on recommendations of the Institute of Medicine. The assistant secretary of defense for health affairs asked the IOM to evaluate the CCEP regarding the assessment of health problems of Gulf War veterans with a specific emphasis on psychological conditions and ill-defined conditions.
The committee concluded that, overall, the CCEP provides an appropriate screening approach for the diagnosis of a wide spectrum of neurological diseases and conditions.
Standard documentation of the screening and evaluation are prescribed in the CCEP program guide. Recent updates to the CCEP have implemented the recommendations of and IOM, and these recommendations concern the following issues:
Number one, to ensure documentation of the screening used during Phase 1 for patients with psychological conditions, such as depression and post-traumatic stress disorder;
Ensuring documentation of the neurologic screening used during Phase 1 and 2;
To ensure that physicians evaluating patients during Phase 1 had ready access to a referral neurologist and a referral psychiatrist;
To ensure that documentation of complete histories, including personal and family histories, onset of health problems, and occupational environmental exposures;
And finally, to ensure that the evaluation of all organ systems is fully documented for each patient.
The Institute of Medicine recommendations will be very helpful to us in enhancing the clinical practices within the DoD for evaluating veterans for potential health effects of nerve agent exposures, medically unexplained symptoms, and stress-related and psychological conditions.
The department, in collaboration with the Department of Veterans' Affairs, has recently asked the Institute of Medicine to assist us in designing an assessment of the current health status of veterans who are previously participating in the DoD and VA registry evaluation programs.
We have contracted with the IOM to provide advice on the optimal methods to assess the health status of those veterans and the effectiveness of treatments being offered by the Department of Defense.
We have additional efforts underway to attempt to answer questions on the current health status of veterans who have chosen to participate in the CCEP.
Walter Reed Army Medical Center has initiated a prospective study of a subset of the veterans who have been evaluated by their Gulf War Health Center. This study will establish baseline health status and compare that with health status during the after subsequent evaluation, care, and treatment.
Each participant is individually contacted three months and again six months upon completion of the specialized care program. These followup contacts establish current health status and, if necessary, provide information for additional evaluations.
The Federal research effort addressing this problem involves scientists in the Federal, academic, and private institutions, both in the United States and abroad. It involves research sponsored by the VA, the Department of Defense, the Department of Health and Human Services.
The coordination and management of this extensive international research effort on Gulf War veterans' illnesses has required the establishment of an overall research policy framework linking each department's research management hierarchy.
This essential linkage is provided through the Research Working Group of the Persian Gulf Veterans Coordinating Board. Over half of the research projects have involved non-Government scientists who received Federal funding for their research, through rigorous, competitive, peer review processes.
In their final report of the extensive review of the research programs managed by the Research Working Group, the Institute of Medicine, and the President's Advisory Committee on Gulf War Illnesses endorsed the research directions of the working group.
The DoD expenditure for Gulf War veterans' illnesses specific research, from 1994 through 1998 -- and I'm speaking of fiscal years -- totalled more than $62 million.
The annual investment has increased by approximately $14 million since 19 94, and from 1998 through fiscal '02, the department estimates investing approximately $20 million a year in Gulf-related- illness specific research, thereby bringing the total since 1994, through fiscal 1992, to more than $142 million.
We appreciate the interest of this committee and others who share in the concern for the health of our men and women who have served in the military. The military health system wants to achieve its goal to take care of those men and women and their families and protect their health.
We recognize that our commitment in keeping our veterans healthy does not end when they leave service. We will continue to work with you and the VA to ensure the Government meets this commitment to our veterans.
Before General Claypoole discusses another aspect of the program dealing with force surveillance, I'd like to then address some of the recommendations of the special investigative unit which primarily concerned themselves with birth registry and with a health center.
Let me explain that we have now more than envisioned, we actually have drafted a policy to establish a deployment health center, and we envision that the center is a virtual one under the executive authority of the Department of Army, which would build on its existing clinical programs at Walter Reed.
This is the center I referred to previously, the Special Treatment Center at Walter Reed, building on that center and on the surveillance programs at the Army Center for Health Promotion and Prevention, the USACHPPM, as it's known, and the research programs of the Naval Health Research Center in San Diego.
The Center for Deployment Health will build upon Army, Navy, and Air Force experience, current clinical and research programs, and past and present initiatives in epidemiological, clinical, and risk communication research.
Programs will include:
Management of services, such as the comprehensive clinical evaluation program and the specialized care program, with related quality improvements and continuing medical education efforts.
Clinical research efforts evaluation risk factors, etiologies, new treatment, prevention strategies targeted to deployment health concerns, risk communication interventions and evaluation, surveillance for patterns of risk factors for illnesses and injuries, planning, coordination of epidemiologic analyses of medical surveillance data relevant to specific deployments.
Epidemiological studies investigating longitudinal health experiences of previously deployed military personnel, and development and evaluation of appropriate health surveillance strategies, and finally, longitudinal studies of symptoms, studies of hospitalizations, and studies of reproductive outcomes.
These studies will involve investigations of personnel who remain on active duty, as well as those who have left the military service.
We also envision that this center will work in very close cooperation, and perhaps even with shared personnel with the VA Center for Deployment Health. The goal of the center will be to ensure the identification of trends and diseases, illnesses or injuries among such members as the result of specific operations.
Another initiative of the department is the establishment of a birth defects registry for military service members.
The Department of Defense military health system is dedicated to providing the best possible health care of military personnel and their families. Key to meeting this commitment is our ability to detect and understand health-related problems as soon as possible, so that appropriate preventive measures and strategies may be initiated.
Last year, we requested the Naval Health Research Center in San Diego to conduct a pilot study to determine the best methods of collecting health information for reproductive outcomes, including birth defects.
This effort will lead to a mechanism for accurate collection of health data regarding birth defects among the offspring of military service members.
We envision a robust surveillance system with both active and passive surveillance components that will identify birth defects among DoD beneficiaries, infants born in both military hospitals and civilian medical facilities, and provide incidence rates of newly diagnosed cases for births and fetal demises.
This will be accomplished by establishing surveillance for birth defects among DoD health care beneficiaries through a scientifically sound cost-effective hybrid birth defects registry.
We continue to work cooperatively with the Department of Veterans Affairs to ensure that our respective programs are both coordinated and compatible. We have a memorandum of understanding with the VA agreeing, to the extent feasible, to create a database combining the data from each department's medical registry and evaluation programs.
This memorandum of understanding outlines the agreement between the departments to combine their respective data to conduct analyses of these combined data and to report the findings of these analyses.
A report of the combined analysis was published in March of 1998. Data exchanges with the VA occur on a monthly basis.
And we vision that this would be a hypothesis generating activity with studies that would peer reviewed by an outside agent.
Additionally, the department is currently collaborating with the VA on the optimal execution of two multisite cooperative DoD and VA treatment trials, including a trial designed to assess the efficacy of protocols for treating Gulf War veterans who suffer from chronic fatigue syndrome and fibromyalgia.
I believe that these answer the spirit of the recommendations of the Senate investigating committee, both in terms of a birth defect registry that we are very excited about, and about the deployment health center, which I think will go a long way to helping us understand deployment health problems, not only of the Persian Gulf War, but of wars in the future.
I will be happy to answer any questions. MG Claypoole is ready to make a statement on our force protection.
SENATOR RUDMAN: General, go ahead.
MG CLAYPOOLE: Thank you. Senator Rudman, Secretary Brown, members of the board, it is an honor for me to have this opportunity to appear before the board to speak about the Department of Defense's policies for deployment-related health assessments and epidemiology, policies on informed consent, and studies on depleted uranium.
The Secretary of Defense, the Joint Chiefs of Staff, the theater commanders in chief, and the military services have aggressively developed policies and pursued implementation of unified force health protection strategies.
We published DoD Directive 6490.2, Joint Medical Surveillance, and an accompanying implementing instruction in August 1997.
The policies require more intense evaluation of the health of deployed military members, both active and reserve component, before, during, and following major deployments.
The requirements include identification of the deployed troop populations, assessment of the health threat, identification of preventive countermeasures, and individual and population health assessments.
Before the directive was published, many of its requirements had been already put in place for the forces that had deployed to Operation Joint Endeavor in Bosnia, Croatia, and Hungary, and other deployments as well.
Since publication of the directive, the services and the combatant commanders have issued policy messages that establish health assessment and other medical surveillance requirements for recent deployments to the Balkans and to Southwest Asia.
At present, the joint staff and the services continue to implement the requirements for current operations and to incorporate them in planning and training.
All of these efforts are responsive to the requirements for a medical tracking system for members deployed overseas in the National Defense Authorization Act for fiscal year 1998.
While DoD is identifying all of the information management and technology requirements to collect, analyze, report, and retain both deployment-related health data and total force health data, our ongoing efforts are already giving us much more robust ability to conduct epidemiologic surveillance and research among military personnel during and after deployments.
The Army medical surveillance activity at the U.S. Army Center for Health Promotion and Preventive Medicine, the CHPPM, as Dr. Mazzuchi mentioned, has been designated to provide deployment medical surveillance analysis for DoD.
The medical surveillance activity maintains the defense medical surveillance system, known as the DMSS, and the DoD serum repository. Using the DMSS, the staff of the medical surveillance activity has been able to evaluate the pre, during, and post-deployment hospitalization experience of military members who deployed to Operation Joint Endeavor and compare their experience to those who had not deployed.
CHPPM also supports the deployment environmental surveillance program, which is addressing environmental sampling and assessments related to the deployments.
Regarding informed consent and the use of investigational new drugs and vaccines, the United States will need, for the foreseeable future, to rely on investigational new drugs for the medical defense in both military contingencies and civilian terrorist contexts.
For most chemical and biological threat agents, there are not yet available effective Food and Drug Administration approved prevention or treatment products.
In the future, the best medical judgments available will demand the use of some products classified by the FDA as investigational. In general, FDA rules are designed to regulate investigational products in well-controlled clinical studies which are not feasible in the context of a chemical or biological battlefield or domestic mass casualty terrorism incident.
DoD believes that the President must be given a range of options, including the feasible use of investigational products for providing credible medical protection against chemical and biological weapons. The lives of individual members, the safety of their comrades who rely on them, and the success of the military mission require uniform use of investigational products for medical protection.
The consequences of an action which leads to foregoing availability of a needed investigational drug will lead to an unacceptable military operational setting in which the lives of personnel and the accomplishment of mission are jeopardized.
The authority to direct usage of medical countermeasures and waive informed consent is limited to cases in which, based upon the nature of the threat, the evidence of safety and efficacy, and the absence of an available satisfactory alternative therapy, the use of an investigational product is clearly in the best interest of the individual service member.
The 1999 National Defense Authorization Act, which was signed into law on October 17th, includes the provision sponsored by Senator Byrd which establishes the controlling policy. The Byrd amendment provides that the President, and only the President, can waive informed consent for military operations.
To do so, the President must determine in writing, in relation to a particular military operation, that obtaining consent is not feasible or is contrary to the best interest of the military personnel involved, or is not in the interest of national security.
If the President's determination is based on the not feasible ground, or the best interest ground, which are the grounds currently in FDA law and regulation, the President shall apply the standards and criteria that are set forth in the relevant FDA regulations for a waiver.
If the President's determination is based on the national security ground, it is independent of FDA regulations.
FDA and DoD will best assist the President in carrying out these responsibilities by working together to establish standards and criteria for determining that informed consent is not feasible, or contrary to the best interests of military personnel.
Secretary Cohen's anthrax vaccination immunization program, or AVIP, provides a foundation for managing future medical defense initiatives, including those requiring the use of investigation into drugs.
The military member receives information on the benefits and risks of anthrax vaccine and can ask questions before receiving the vaccine. Accurate computerized records are maintained in a centralized database.
While DoD and FDA would agree in advance to additional requirements pertaining to DoD's use of investigational drugs and vaccines, DoD has established a foundation for effective implementation of a force health protection initiative requiring the use of an investigational product.
You have asked for an explanation on studies regarding the effect of depleted uranium induced on surrounding cells. The Armed Forces Radio Biology Research Institute, or AFRA, has conducted laboratory research into looking at DU's effect on cellular transformation and generation of tumors to see whether or not a link can be established to any long-term cancer-causing potential.
The problem with these and other studies, as they relate to the board's question, is that no one has figure out how to differentiate between the effects induced by heavy metal toxicity and ionizing radiation induced effects.
Given the extremely low level of radioactivity associated with depleted uranium, some feel that any effect resulting from DU exposure will be a consequence of its heavy metal toxicity, which in turn needs to be considered in the context of other heavy metals, such as tungsten, nickel, and lead.
COL Eric Daxson and Dr. Mclean from AFRI are available to address specific questions on DU and the ongoing DoD-supported research,
Again, I appreciate the opportunity to testify to the board, and look forward to answering your questions. SENATOR RUDMAN: Secretary Brown, do you have any questions for the panel?
SECRETARY BROWN: Yes, Mr. Chairman, I just have a couple.
First of all, I would like to thank all of you for being here today. I found your remarks very rewarding and informative. There are two questions that I would like to ask.
Have we learned anything that is beneficial to any of our troops if they were to return to the Persian Gulf?
And the background on that question is that many of them returned home sick and disabled. And we have spent a lot of money and a lot of time and effort trying to find out why.
And there is a very real possibility that we may be back in the Persian Gulf, and I want to know if we can minimize any of them that return from getting sick, as a result of lessons learned.
MG CLAYPOOLE: I believe that we -- of course the environment which they would be subjected to, if they are interjected back into a combat situation, would be different vis-a-vis if there are oil fires or smoke or chemical weapons or biologic weapons.
Based on the deployments at the present time, although we've analyzed data, I don't think we've come across any significant kinds of findings that would allow us to mitigate, but we do have the ability to track medical information while people are over there, as well as to look at some of the environmental epidemiology issues.
DR. MAZZUCHI: But I do think we would do things differently. And this is probably not the specific answer to your question that I know you would like to have.
We would do things differently. I think when MG Claypoole talked about the anthrax program, that gives you some insight into at least a change of how we would operate that I think is important.
In the past, when the military was faced with a situation where it needed to use an investigational drug, we went through the process of getting permission to do that and so forth, and did it and kept records.
I think we are much more aware today of the need to inform our troops, give our troops some dialogue about the reason for the DoD decision, what are the medical risks, what are the medical benefits, and to have an opportunity for the troops to discuss those prior.
I think we have also learned lessons of the necessity to have forward labs, to do a better screening job of people before they go, to begin to recognize problems, some of which are command problems that can mitigate, particularly in the area of stress, that would be different, that would, I think, give us a different outcome next time.
And I also think the department would be in a much better position -- I know it would be in a much better position -- to address health concerns of people.
Because one of the major lessons learned in the Persian Gulf is -- and that's why I put that in my statement, because I personally mean it and I know the Secretary means it very deeply -- that the commitment to our troops doesn't end when they come back from a deployment.
We have to be on guard against any possible trends of illnesses or diseases. We have to understand them and study them. We have to do better risk communication.
And I believe the department is in a position to do those things in a far better way than it was in the past.
I think the answer that will be probably a little bit more in the future, but I do think it's again in an area of strong improvement, is in both the creation of a DoD as well as a VA deployment health center, where we will begin to tie in all of the knowledge that we have with both research and clinical experience, risk communication experience, and treatment, in terms of dealing with people who have come back from any deployment.
Because I think there's been a number of pieces of research that show that there are significant health risks for people who have deployed, wherever they have deployed, and then there are specific health risks to specific deployments. And we need to understand those better; and that's why I think that research center is such a phenomenally good idea.
The other area where we have been able to do -- and I recognize the frustration of the veterans in the slowness of science; unfortunately, science is slow -- and that is in the creation of the Veterans Coordinating Board.
When you presided, sir, at a farewell for the first DOD members of the Persian Gulf Coordinating Board, and I joined you in that ceremony, we discussed afterwards what a good idea the Persian Gulf Coordinating Board was.
It was one of the things that brought the VA and the DoD together to think about deployment and deployment health and deployment research in a way that we had not done before, through the PRD and the establishment of the Veterans Coordinating Board. It's not merely just for the Persian Gulf, although that will remain.
I think that the departments work much more closely in what do we need to have in terms of records, medical records, medical information, so that we can help them, whether they're in our DoD system or in the VA system. The thought is much more in a continuum of care.
So I don't have, and I regret I don't have a more specific, easy answer for your question, but I do think the Department of Defense as well as the Department of Veterans Affairs are much more prepared to address deployment health-related issues than we were in the past.
SECRETARY BROWN: Okay. Let me do a 1-A on my original question.
You have kind of broadly and generally outlined some of the things that you feel that we as a nation should do differently, if our best and brightest were redeployed to the Persian Gulf.
Are you satisfied that we have communicated those changes to DoD personnel that are responsible for returning out troops there and are responsible for their wellbeing once they are there?
MG CLAYPOOLE: I think everybody can always do things better and things can get better.
But to answer your question, I really believe that, as part of the product of the experiences from the Operation Desert Storm, and as part of the benefit from the anthrax immunization program, line commanders and troops and soldiers realize how important all of this that fits into the force health and protection package is. And it really serves as a force multiplier.
So I think that, you know, both the line commanders, as well as the soldiers, sailors, and airmen and Marines who deploy, realize how important this type of a program is.
SECRETARY BROWN: General, I'm not so sure that this is -- I don't know too much about this military structure, but it just seems like, to me, that we should be talking about policy, not talking about the implementation at the line command level.
And I want to know if all of the things, or all of the lessons that have been learned thus far have been communicated to the Department of Defense in a way that it can become policy to mitigate against the risk of deploying our young folks back in that area.
ADM ZUMWALT: I know that there have been -- I think the answer to that question is yes.
I know that the Secretary and the under secretary have held numerous meetings, open discussions with the Chairman of the Joint Chiefs of Staff, with members of the joint staff, with the service surgeons general, with the service line staff, on the importance of force medical protection and of our deployment surveillance program.
That is critical. That is a critical piece to the defense mission that we be able to monitor the health status of our people prior to their deployment, while they're on deployment, and when they return.
The level of interest in the department has been very, very high.
And I think the anthrax vaccination program is the beginning of seeing what that is, in the sense that, prior to our initiating that program, there were many, many discussions in the tank, at very high levels, of the need for the department, (a) to do the program, but also to do it right, to communicate the risks and the benefits to our troops, to make sure that records were appropriately kept, that they were kept in a central place so that we could track the shots that were given, because it's a series of shots, and that we had to get it right.
I think that has permeated the department, that we really need to do a better job of communicating, both within ourselves, to s policy is clearly understood, the importance of that policy is clearly understood, and that, in fact prior to launching a program, we've got to have an action plan that shows we're going to get it right.
SECRETARY BROWN: Mr. Chairman, I have just one more question, if I may.
Doctor, do you concur with the conclusion of OSAGWI, that exposures to DU toxicity or low-level radiation are not a cause of the undiagnosed illnesses affecting some Persian Gulf veterans?
And I want you to answer the question just like I asked it, that that made a specific conclusion that there was no relationship between the problems that our young folks are having and DU and low-level radiation exposure.
I would like to have your opinion on that conclusion.
MG CLAYPOOLE: May I ask Col Daxson and Dr. McLean, who are really intimately involved with this program?
SECRETARY BROWN: Yes, sir. You're the general. I was a corporal.
SENATOR RUDMAN: I would say to the vice chairman that yesterday, Admiral Steinman pursued that point with some vigor, and I'm interested to hear the other response this morning.
But I think to fairly state what the answer was yesterday, and I'm sure if I'm stating it incorrectly somebody will correct me, that some of the statements were probably regrettable, in that they were based on, really, data that was insufficient, and the conclusion right now is that a great deal more research has to be done.
And those statements that you are referring to and which Admiral Steinman referred to were, at the very least, much too declarative, and at worst, probably should not have been made. I think that's what came out of that? Okay.
DR. McLEAN: My name is David McLean. I'm with the Armed Forces Radio Biology Research Institute in Bethesda. I'm a team leader for a program to investigate some aspects of the health effects of depleted uranium.
We're using -- it's a laboratory project. We're using research animals and also cultured cells and materials like that.
To date, we have not noticed any remarkable toxicity of depleted uranium in any experiments that we've done. Our experiments have been with embedded uranium fragments. We're not looking at other aspects of uranium exposure, such as inhalation.
But it's remarkable in our experimental animals that the animals appear -- that we have embedded uranium fragments in these animals, and we've looked at some of the toxic effects. And it appears that the animals adapt, actually adapt to the presence of these metals in their bodies.
So, to date, you know, looking only at the data that we have, you know, I would say that there's no remarkable toxicity, that is that we've demonstrated, associated with depleted uranium.
SECRETARY BROWN: Okay. Now, did you say all of that to say that you agree or you disagree with the conclusion that there is no relationship between the undiagnosed illnesses of some Persian Gulf veterans and their exposure to heavy metals or low-level radiation?
DR. McLEAN: Well, I can only speak from my position as a researcher. I'm not really qualified to make any judgment about the actual, the veterans' exposures.
I can only tell you what our research has shown, and our research has shown that there is no remarkable toxicity associated with at least embedded fragments of depleted uranium.
SECRETARY BROWN: But you admit that that does not take into consideration veterans who ingested or who inhaled particles?
DR. McLEAN: Yes, those are different routes of exposure. You know, our research had been limited to that one aspect only, embedded uranium. I wouldn't be qualified to really talk too much else out of that realm.
SECRETARY BROWN: Thank you.
COL DAXSON: Secretary Brown?
SECRETARY BROWN: Yes, sir.
COL DAXSON: I have a couple of comments on the inhaled route. My name is COL Eric Daxson. I was at AFRI when the DU program was started, and I've been involved with it since about 1986.
I was the person that initially made the decision not to look into inhaled and stick with the fragments.
The primary reason for that is there's a lot of research already out there on inhaled particles. This is something we've been studying since the early '40s, since the inception of the Manhattan project. So we focused on fragments, because that was the hole in the available literature.
Once the particles are inhaled in the body, they basically distribute to the body the same way the uranium in the embedded fragments distributes once it makes it into the bloodstream.
So the only difference between an inhalation, really, and an embedded fragment is the site at which the uranium first starts going into the body. And, based upon what we've seen, uranium is something, again, that we've studied in human populations from uranium mine workers, and a lot of other people have studied this thing.
I was present in the NIH panel in 1994 that also addressed this issue. Their conclusion was that it was unlikely.
My personal view on the OSAGWI report is it basically confirms the NIH panel conclusion, that it is unlikely. And that would be my personal view on that, Mr. Secretary.
SECRETARY BROWN: Okay. It sounds like your conclusion is a little bit different from the OSAGWI conclusion. I mean, you're using terms like "unlikely," and the conclusion was much more definitive than that.
Is that a difference, or is it just me misreading what you have said?
COL DAXSON: Sir, I believe the OSAGWI statement -- and I don't have it in front of me -- had words to the effect that it was at this time.
SECRETARY BROWN: I don't recall that. I really that -- but what did it say?
COL DAXSON: I'm talking from the narrative, sir.
SECRETARY BROWN: "The report's bottom line conclusion, based upon a comprehensive review of available data and its scientific-based methodology is that exposure to DU, chemical toxicity, or low-level radiation are not a cause of undiagnosed illnesses affecting some Gulf veterans."
COL DAXSON: Sir, my personal statement would be unlikely.
SECRETARY BROWN: Okay. So there is a difference?
COL DAXSON: Yes, sir. I'd have to say very unlikely.
SECRETARY BROWN: Okay.
COL DAXSON: But I can't get any more definitive than that, because it's very hard for --
SECRETARY BROWN: But you would not come right out and say that it is -- there is no relationship? You are not ready, based upon the science that's available at this point, to say that there is no relationship between --
COL DAXSON: No, sir. I would say it's very unlikely.
SECRETARY BROWN: Okay. Thank you.
SENATOR RUDMAN: And I think, in fairness to OSAGWI, that yesterday, that they essentially backed off that very declarative statement, essentially would agree with what the colonel said.
The other thing that was interesting yesterday, though, and since we're on the subject, my recollection is that, so far, those people who we know have embedded uranium fragments have not reported cases of illness. Or have there been some, with the embedded fragments? Who can answer that question? Dr. Rostker?
DR. ROSTKER: The fragments that were embedded in friendly fire --
SENATOR RUDMAN: Yes.
DR. ROSTKER: -- were as a result of a traumatic event.
SENATOR RUDMAN: Right.
DR. ROSTKER: Many of those soldiers are suffering from war wounds.
SENATOR RUDMAN: Yes.
DR. ROSTKER: When you differentiate for war wounds, as I understand it, and look for basically kidney function, the entire population is functioning normal, births have been recorded with members of that population without any indication.
I might add, Secretary Brown, part of the statement you read was in terms of the undiagnosed illnesses. We continue to support and sponsor research in terms of both radiation and heavy metal toxicity.
What we were trying to get at, quite poorly, I would have to admit, is that many of the symptoms that are associated with undiagnosed illnesses -- for example, memory loss -- there is no connection in the medical literature that would relate memory loss to depleted uranium, and we were trying to clarify it in those terms.
Future research will, of course, provide even more information in terms of radiological effects or heavy metal effects. There is no literature, medical literature, that deals with memory loss or joint pain or rashes, which are some of the common symptoms of undiagnosed illness.
COL DAXSON: Sir, this gets back to all of the things that you have to do to say something is likely.
You need to take a look at the exposures. And from what I understand, the undiagnosed illnesses are pretty well pandemic throughout the theater.
In the chart that was shown yesterday, high concentrations of DU are not throughout the theater. They are only in certain specific locations.
So if you try to find a correlation between DU exposure and these things, you don't find that correlation.
SENATOR RUDMAN: But there is ongoing research?
COL DAXSON: Yes, sir.
SENATOR RUDMAN: Which is what our concern is, of course. We as you know, are not positioned either tactically or by authorization to make determinations. We are only concerned that those who are in a position to make determinations are doing it thoroughly.
And I expect that so far -- what I think we've heard, Secretary Brown, is that even though they have reached the conclusion of unlikely, there is still enough question out there to continue research, to be sure that we finally get an answer, if we can get an answer.
DR. ROSTKER: Mr. Chairman, let me even stress that we in Department of Defense, in concert with Department of Veterans Affairs, have reached out to several hundred veterans who were exposed to depleted uranium oxides and we have a program to bring them in to test. And we have opened this up, on a voluntary basis, to anyone in the Gulf.
So we're looking to see if those conclusions -- I'd have to say again, the misguided statement was in terms of those symptoms relating to undiagnosed illnesses. It might provide, frankly, some level of assurance to veterans who have those symptoms, that this might not be the cause.
But we still are quite interested, and press forward, in terms of understanding any radiological aspects or heavy metal toxicity, which is, we believe, the primary concern for not only depleted uranium, but lead and tungsten and nickel, as well.
SECRETARY BROWN: I have no further questions, Mr. Chairman.
SENATOR RUDMAN: Thank you very much, Mr. Secretary. General.
LTG CISNEROS: MG Claypool, yesterday I had some questions regarding peer review. And the issue I guess we confronted here was the difference in terminology that you just used, and now some of the clarifications.
Let me ask you, were you involved in the peer review of the OSAGWI report? What is your assessment of the peer, or the tie-in with you with OSAGWI or the reports they were going to publish -- you or the community here, whoever can best handle it.
MG CLAYPOOLE: We did review those, and yes, we -- in terms of being tied in, we were part of the staffing process, and did have an opportunity to comment.
LTG CISNEROS: And the conclusion they drew, you were tied in with that, about the wording we just went through here, where you just said that you would have used a different word?
COL DAXSON: Yes, sir. I also caveated that, in the narrative, I think the way it was worded in the narrative, it was "at this time." It was a report that was an interim report.
LTG CISNEROS: Yes, that was clarified yesterday. But the dilemma is that it became a dilemma, and it is a dilemma.
And so what I'm trying to get to is your assessment -- your assessment -- about your interface with OSAGWI on the case reviews and the conclusions, and the process which they indicate peer review was used.
Are you personally aware of the peer review, and were you satisfied that, even in hindsight now, was that a good process, from your perspective?
MG CLAYPOOLE: I believe so, yes, sir. I believe it was a good process and it did have a lot of people with different expertise looking at it from different angles.
COL DAXSON: Sir, there were a lot of outside, non-DoD agencies that reviewed that report, also. I personally know the EPA did and Health and Human Services did. And I had a chance to review the report, also.
LTG CISNEROS: Outside from where?
COL DAXSON: Outside of DoD.
LTG CISNEROS: But still governmental?
COL DAXSON: Yes, sir.
LTG CISNEROS: Okay. That's all the questions I have, Mr. Chairman.
SENATOR RUDMAN: Dr. Cam.
DR. CAM: I have a couple questions for MG Claypoole.
The first one is, is there any current effort now to seek waiver to administer any investigational new drug to deploy U.S. troops?
My second question is, I understand that Rand has recently submitted a paper indicating that myasthenia gravis patients who took PB did show some side effects, so I would like to know whether there is any change in DoD current thinking policy in using PB as a prophylactic agent against chemical weapons exposure, and does the FDA support the OSD position?
MG CLAYPOOLE: We currently do not enforce any protocol of looking at a waiver of informed consent. So ho answer to your firs question is no.
In terms of the Rand study, we are familiar with it and have looked at it, and I don't -- you know, I think it is -- I mean, i think the report raises issues that I don't think everybody totally agrees are necessarily scientifically valid.
And so I think we are aware of it, but I don't know if it's -- you know, it is just another point on a curve. But I don't think that the scientific community necessarily concurs with it.
ADM ZUMWALT: One follow-on point, though, I think is important to understand, is that the Department of Defense has continued to work with the Food and Drug Administration on looking at pyridostigmine and providing data on safety and efficacy of the drug.
This is an ongoing effort. So, in other words, we are not simply relying on the data that we had during the Gulf War.
There is continued both communications as well as review of studies being conducted by the Army Research Command on pyridostigmine, and there's a whole section that deals with this drug, and those people have been working closely with the FDA.
MG CLAYPOOLE: We totally agree that a waiver is a default position that we really would not like to get ourselves into. We would like to be able to use a fully approved, licensed drug for whatever kind of conditions we want.
So we're looking at pursuing, with the FDA, means to go ahead and obtain licensure for other agents using different models. So we're continue to try to work towards a solution.
DR. CAM: I'm trying to find out if you're going to be less aggressive in using PB, or you just continue the way you have used PB before?
MG CLAYPOOLE: Less aggressive. I think the current plan is that unless there is a bona fide threat, and unless there is a commander's perceived need to use that to protect the health of his troops, he would not request the use of an agent such as PB. And right now, we do not have such a waiver in force.
We would prefer to find other ways, other kind of countermeasures, other than PB, to use, and we are looking, as I say, for ways to go ahead and use a surrogate model, perhaps, to go ahead and license the drug for that.
But we are not pursuing that might now, we are not pursuing a waiver right now.
DR. CAM: Thank you.
CSM MOORE: I have one question for Dr. McLean, Mr. Chairman.
Dr. McLean, in your studies, were you able to determine any changes or change with the litter situation with DU, with embedded DU in the lab rats?
DR. McLEAN: With regard to what kind of change?
CSM MOORE: Litter.
DR. McLEAN: Oh, yes. We have some preliminary studies that have been funded, you know, through competitive grant, with the Medical Research and Materiel Command that are looking at reproductive effects of embedded DU in female rats.
And we have some preliminary data that indicates that there may be some -- an indication that further research is required in that regard.
It appears that this has never been done with uranium, or looked at with uranium before, so all of this information is really sort of pioneering work.
But it does seem to parallel the kind of work that has been done with other heavy metals, like lead and cadmium and other heavy metals that do tend to affect parameters such as litter size and the health of the pups that are born in the animals.
CSM MOORE: So there is a possibility --
DR. McLEAN: Well, there's a possibility. I'm saying that we have seen some preliminary data that indicates that definitely further study would be warranted. We would want to look at it further, yes.
CSM MOORE: Thank you, Doctor.
SECRETARY BROWN: May I follow up, Mr. Chairman, on that question?
SENATOR RUDMAN: Sure. Go right ahead.
SECRETARY BROWN: Can you tell me, a followup to his question, what are the laboratory values of the female rats that had DU embedded? Is the urine output normal, all of the -- just the baseline lab values?
MG CLAYPOOLE: Well, the general toxicity of the female rats that have had depleted uranium pellets implanted in them, again, there's no real difference between the female and the male rat studies that we've done. We haven't found any kind of demonstrable toxicity in the female rat.
In other words, they are -- when you do implant pellets in these animals, you do, after a period of time, you start to see uranium appearing in the urine. You see uranium accumulating in certain target organs, such as the kidney and the bone.
But the physiological tests that we've looked at to try to assess whether the presence of that uranium is actually affecting those target tissues, all of the tests that we've done so far have indicated that no there is no effect.
Sos, despite there being a fairly large buildup, for example, of uranium in the kidney, for example, when you look that the -- when you look at the physiological tests that indicate whether the kidney is functioning properly, all of these tests are within normal ranges.
SECRETARY BROWN: To me, I'm not a doctor, but that's kind of strange.
If you have the female and the male rats that have embedded uranium, all their lab values are basically normal, which is to be expected, yet and still, in the female, there are pathological processes taking place that manifest themselves in the offsprings, at least preliminarily. I mean, that's what you said. It requires additional study.
MG CLAYPOOLE: Oh, yes, definitely. Well, the pathological process, the only thing that we've noticed that's abnormal was there was a decrease in some litter sizes. And we're about one quarter away through that experiment.
There have been decreases in the litter sizes in some of the rats. Some of the rats are normal litters, and some are not.
But it's not unusual to expect that the parameters -- just because of the parameters we were looking at, let's say with kidney function, that were indicating normal kidney function in these animals, it's not necessarily a contradiction to say that, well, we've observed a potential effect and reproductive effect in these things.
You know, you just have to -- we don't know exactly where to look for the kind of changes that are occurring in these animals. This is a pilot study that we're doing here.
And so we do believe and I think everybody believe here that further research is warranted so we can try to, you know, find the answer to questions like that. What is the connection? Right now, we don't know.
SECRETARY BROWN: Thank you, Doctor.
COL DAXSON: The point I'd like to make, just for clarification here, is that the dose levels that we're talking about in these females is relatively high. There are a lot of pellets in these females. So the amount of uranium that's coming out in the urine is very high. And we can provide that data, if you would like to see it.
DR. McLEAN: Yes. We purposely have very large amounts of uranium in these animals, to try to exert an effect.
Initial pilot studies that were done with these animals, what we thought would be something that would demonstrate an effect didn't show anything. And so these animals are carrying very large loads of uranium in order to try to generate an effect.
RADM STEINMAN: Touching on the issue of pre and post-deployment screening of personnel deployed, can you, in some detail, walk us through how that process would work for the typical soldier, sailor, airman, Marine, Coastie that gets deployed?
MG CLAYPOOLE: An individual who is going to be deployed has a survey or a form that is filled out that looks at his current state of health, or assessment of health, and any kind of medical events that need to be annotated. The form is collected, and he is deployed.
I'm sorry, you asked before, and then --
RADM STEINMAN: I'm just trying to get an idea how this is going to work from a -- at the deck plate level.
CAPT TRUMP: First of all, there is a requirement, for example, using the troops who are deploying to Southwest Asia, and at least for the last year or longer, the Central Command has the requirement that for those deploying individuals, that a lot of things be accomplished.
That's certain immunizations, evidence of DNA testing be on record, providing information about what the health threats are during this deployment, and then also a requirement for a pre-deployment health assessment.
Some of this is almost more documenting things that normally take place, and it varies with the service, as far as how these deployments are being handled.
Air crews can be going in small numbers. And the Air Force is looking at how they deal with a crew that's going in and out of country most efficiently, you know, to do what we need to do for health assessment, but then also not be pulling them into medical every other day to fill out a form.
Army, though, for example, will go through a mobilization processing, where the whole unit is going through a line, getting a lot of things taken care of -- wills and powers of attorney on the legal side; medical issues, such as immunizations, and asked to fill out deployment health assessments.
Trying to keep that relatively simple at this point, as asking the questions about their health, about whether there's been a change in their health status, something that they're concerned about with this deployment, that is more of a flag for the medical folks to say, "Well, tell me about what the issue is so we can look at it before you get on the plane or before you deploy."
This has to --
RADM STEINMAN: Let me stop you right there. Is this something different from SF-93? Is that basically what they fill out, or is there a different form and set of questions?
CAPT TRUMP: The SF-93 is the standard history form.
RADM STEINMAN: Right.
CAPT TRUMP: Which is used primarily for the periodic physical examinations, occurring anywhere from every once a year to every five years, depending on the age and service policy.
What we're using right now is a very short form, about eight questions, that really try to assess, you know, are you having any health problems, have you -- or any concerns that you have.
And again it's a flag. Because this is usually being done in a short window, from the time they're told that they're mobilizing until they're on the plane and going into a theater of operation.
So it really has to minimize its impact on, you know, letting them get their mission done.
For the long term, some of the things we are looking at is whether we can actually get a better assessment of the health of individuals and the total force by going through an annual evaluation, such as health assessment or health enrollment assessment review.
ADM ZUMWALT: Let me make a few comments about that, because actually our shops are working very closely on this issue.
When we put together, and the program started under me and we slightly reorganized, General Claypoole picked them up, the vision originally of the pre, during, and post-deployment surveillance was very much as Captain Trump has laid it out to you, a short form question that would flag people who needed further assessment prior to deployment.
During deployment, forward labs, better centralized kept hospital and outpatient data.
Following deployment, again, health screening, which sometimes might generate full physical examination, central repository for those data.
This really came right out of the Persian Gulf War. I mean, people said, "Well, what was the health status of this veteran prior to going over to the Gulf?" The answer was, "Well, we don't know." That's not a good answer. We need to know what's the baseline data.
But when we looked at this, we also recognized that it's very important to have baseline data and a continuum of health data centrally kept and looked at for our troops, from the time they're assessed into the military until they retire.
We need to know about people who had conditions that were waived before they came into active duty, and how they did with those conditions. We need to know about a service person's medical history when we're evaluating that person for disability retirement in our retirement system.
So, although deployment surveillance, pre, during and post-deployment surveillance became an entity unto itself because of our concerns about Persian Gulf veterans, overarching that was that we need better medical surveillance, period.
One of the ways that we are expecting to accomplish that is through the health enrollment assessment review here, which is an annual survey. It's an interactive survey with our personnel, not only military, but family members, that asks a lot more detailed questions on health status. That will eventually become our pre-deployment stuff.
You don't want to rely on data that you've asked as you're getting ready to deploy and you got to hurry up and get this questionnaire done. That's not a very good way of getting data.
So what we really want is to look at -- the pre-deployment data is going to become the data that we capture on that person through the year, over many years.
Then we will use the during deployment data as those hospitalizations and outpatient visits that are centrally recorded and kept and analyzed, and then following deployment, the questionnaire which could lead to a physical examination, so we can put all that together and lay out a person's health history, hospital seeking or medical care seeking activities prior to and following the war, to determine how much the deployment experience is contributing to that person's health status now.
SENATOR RUDMAN: I'm going to try to keep more or less to some sort of a schedule. I think we've had a good discussion here. Appreciate your incorporating your comments for the next panel.
At this time, unless someone on this commission has any other questions, I'm going to move to the next panel. Are we all set? Thank you.
ADM ZUMWALT: Thank you, Mr. Chairman.
SENATOR RUDMAN: We're going to hear from Dr. Rostker and others on the response to the Senate Committee on Veterans Affairs report.
I believe that we can probably do this and stay on schedule.
DR. ROSTKER: While we're changing name tags, I'd like to add just one point on depleted uranium.
When we published our paper on depleted uranium we hoped to release, at the same time, a review of the medical literature that Rand was doing. Both papers went through the peer review process, and many of the people up here were part of that process.
It was determined from peer comments that the Rand paper was not ready to be released. Rand took those comments and they tell me they're about ready to release that paper.
Now, as compared to our papers, we are not a release authority for Rand. Those comments were made available to Rand. They're responsible for their own peer review and for their own quality control.
But this was an example where the peer review process of comments stopped one of the two papers and that paper will come forward, and I think is quite germane to many of the questions that you asked today about the state of medical research, and will help inform you about the statements that are in the paper.
Mr. Chairman and members of the oversight board, thank you for the opportunity to appear before you today to discuss the activities and the recommendations of the Senate Veterans Affairs special investigative unit.
I'll play master of ceremonies, and we'll have specific presentations by members of my staff and others.
Before I turn the microphone over to Mrs. Morris, who will talk about depleted uranium training for DU, I would like to comment that the working relationship between the special investigative unit and my office I think is a model for the way the executive and legislative branch should operate.
It was highly professional. It was quite interactive, but independent. It was efficient, in the sense that we made an offer that was accepted by the committee, that their investigators were welcome to travel with us overseas. And we had one or two investigators with us in all of our overseas visits.
If you know their report, it didn't prevent them from being critical where it was justified. But I think we both came away with a high regard for the professionalism, we certainly of their staff, and greatly appreciated the working relationship and comments. I want to make that formally, for the record.
SENATOR RUDMAN: Could you give me some idea, Dr. Rostker, of the length of each presentation? I'm just trying to do some scheduling here.
DR. ROSTKER: I think most of the presentations will be about five minutes. The longest presentation is about the Khamisyah plume, which was fairly technical, and a lot of interactions between, or suggestions from the special oversight team -- I'm sorry, the Senate investigative team.
Many of these recommendations we are not taking, and I think we need to explain to you why.
SENATOR RUDMAN: So you've got five presenters here?
DR. ROSTKER: We have five, and it's about five minutes each except for --
SENATOR RUDMAN: So we're looking at about a half an hour of presentations?
DR. ROSTKER: Well, except for Colonel Abreu, who will be a little longer than that.
SENATOR RUDMAN: He can talk more rapidly, anyway.
DR. ROSTKER: Yes, sir. He's only a lieutenant colonel.
SENATOR RUDMAN: Fine.
MS. MORRIS: As Dr. Case mentioned yesterday, this morning I will address the department's depleted uranium awareness training program.
The Senate Veterans Affairs Committee special investigative unit report recommended that, "The Secretary of Defense establish troop training and safety programs to minimize possible health hazards from contact with depleted uranium."
In fact, the department has had a safety and training program since depleted uranium was introduced into our arsenal. However, this program emphasized handling of depleted uranium as a low-level radiation emitter in peacetime.
This program was also limited to those service members, such as tank crewman and aircraft armament specialists, who had the greatest likelihood of being in contact with depleted uranium munitions or armor.
As a result of a 1993 General Accounting Office report on how the Army handled depleted uranium training, and which highlighted the issue of equipment contaminated by depleted uranium oxides, all services were directed to ensure that they were providing training on depleted uranium hazards commensurate with their personnel's potential for handling depleted uranium contaminated equipment.
The Army developed a training package, but provided little emphasis to conduct training down to the individual soldier level. The remaining services adapted the Army training package to train selected personnel.
During the course of our investigation into Gulf War activities involving depleted uranium, we repeatedly heard from veterans that training on the hazards of depleted uranium contamination was not being conducted as directed.
Our subsequent investigation confirmed this and prompted the deputy secretary of defense to issue stronger guidance in January of 1988.
Since that guidance was issued, the Office of the Special Assistant has assessed the services' programs and is in the process of reporting back to the deputy secretary.
The Army and Marine Corps are emphasizing training down to the individual soldier and Marine. The Air Force and Navy are still more selective.
Of particular concern to us, however, is that the current training programs do not accurately convey what we now know about the hazards of depleted uranium contamination and the appropriate precautions.
In addition, we have found that the hazards of depleted uranium munitions, armor, and contamination are inconsistently portrayed in various doctrinal publications we have reviewed, and this confusion may be contributing to the lack of emphasis.
Since we have determined that a significant amount of work remains to be done, we have assumed responsibility for facilitating the services' coordinated efforts to develop consistent implementation programs.
Our plan includes agreeing on the appropriate messages to convey to our service members about depleted uranium and recommending appropriate policies. This will allow us to assign specific responsibilities within the Joint Staff, Office of the Secretary of Defense, and the services, to include handling of depleted uranium in planning guidance, make necessary doctrinal changes, and implement more appropriate training programs.
All of this will support the necessary cultural changes within our military concerning managing exposure to depleted uranium and other occupational hazards of the battlespace. The Office of the Special Assistant will facilitate the services' efforts and continue to monitor their implementation.
LTC ABREU: Mr. Chairman, members of the board, thank you for allowing me the opportunity to appear this morning.
You requested that the Office of the Special Assistant for Gulf War Illnesses report on their chemical hazard modeling and also report on the Senate Veterans Affairs Committee's Special Investigation Unit, or SIU, report.
Consequently, this morning I will describe the joint DOD-CIA modeling process, compare that effort to the Air Force Technical Applications Center, the AFTAC modeling effort commissioned by the SIU, and conclude by addressing some of the criticisms and misconceptions of the SIU regarding the DOD-CIA effort.
With the discovery that U.S. troops inadvertently destroyed unmarked chemical weapons in an open pit at Khamisyah, Iraq on March 10, 1991, it was imperative to determine if a significant chemical release hazard had been generated by that event.
Since no instruments were present to measure atmospheric conditions or concentrations of agent released, the extent of this hazard had to be simulated through computer modeling and applicable field testing.
In November 1996, a panel from the Institute for Defense Analyses, or IDA, was commissioned by the deputy secretary of defense to review earlier Khamisyah pit modeling and recommended measures to enhance that effort.
They advised on model selection and methodology and recommended that the weather modeling be directly coupled to the agent dispersion modeling.
Additionally, in order to reduce model bias, they recommended that the results of several DoD and non-Dod models be integrated in the analysis.
Lacking empirical data on the release caused by the open air destruction of 122-millimeter rockets, the department and the CIA jointly conducted field tests at Dugway Proving Grounds.
These tests were to determine the agent mass balance. That is, how much agent was released instantaneously and how much over time through evaporation? This data is often called in the literature source terms, or source characterization.
Data from these field tests, combined with data from the intelligence community, led to the simulation-developed estimate that approximately 18 percent, or 342 gallons, of nerve agent was released from the destruction of the rockets in the Khamisyah pit.
With the source terms determined, the next step was the meteorological and dispersion modeling.
The purpose of the meteorological modeling was to simulate the weather conditions in the vicinity of Khamisyah on the 10th of March 1991, and succeeding days. Results from three global weather models, three high-resolution, or mesoscale weather models, and three dispersion models in five different combinations were used.
Course scale -- that is, 80 to 250 kilometer horizontal resolution -- weather fields produced by the three global models combined with operational weather observations at 300 to 400 kilometer resolution, and further enhanced by declassified observations from the Saudis, the U.S. Navy, and U.S. special operations forces were used to initialize the high-resolution models.
These models simulated the weather in the vicinity of Khamisyah to a resolution of 1 to 5 kilometers. The simulated weather and the source terms were input into the three dispersion models to replicate how the agent was dispersed and transported.
Due to the uncertainty of modeling and the consistency of the simulations, the result of each of the five combinations could be considered equally likely, a hypothesis endorsed by the IDA panel.
Consequently, in order to err on the side of the veteran and identify areas of potential exposure, a union of the five simulation results was used to describe the potential hazard area.
The National Oceanic and Atmospheric Administration, NOAA, endorsed this methodology prior to publication. Upon publication, the Office of the Special Assistant commissioned the technical review of the effort.
This review, by a panel of widely recognized experts in meteorology and atmospheric modeling, from NOAA, academia, and the University Corporation for Atmospheric Research, or UCAR, endorsed the methodology but recommended changes to the models and model applications. These changes have been incorporated, and the simulation is being redone.
The affect modeling, commissioned by the SIU and described in AFTAC's December 1997 report, consisted of three separate simulations. Each used the same source terms and full complement of observed data as the DoD-CIA effort.
In addition, AFTAC used a global weather data set for each of its simulations, which was also used in several of the DoD-CIA runs.
The first simulation consisted of combining observed and global weather data to drive a dispersion model with no high resolution modeling.
The second simulation used the same synthesis of global and observed weather data to initialize a high resolution model. This high resolution model was then used to drive the dispersion model. Although only using two models, this simulation was the most similar in process to the DoD and CIA effort.
The last simulation applied an agent decay model, still under research and development, to the results of the first simulation.
The AFTAC effort was reviewed internally by AFTAC and the Air Force Weather Directorate.
Although based on a different methodology -- that is, dispersion model driven directly by global weather with no high-resolution modeling -- the result of the first AFTAC simulation was generally consistent with the DoD-CIA union results.
However, these results did show a pocket of low-level exposure to the east and to the Persian Gulf, which departs from the DoD-CIA ensemble result.
The cumulative impact of the differences between both the DoD-CIA and AFTAC simulations would have been the additional notification of one unit of 321 individuals.
The second simulation, although most similar in process, was inconsistent with all five of the DoD-CIA simulations and with the previous AFTAC simulation, in that the surface winds was far weaker by a factor of 2 or more.
The AFTAC report states that the result of this simulation was inconsistent with their previous simulation, and even inconsistent with declassified observed weather from the area. But this was not considered a "significant" discrepancy.
With the diminished wind effects, the hazard area of this simulation remains centered around Khamisyah. The cumulative impact of the simulations would have been the additional notification of 21 units and 1,844 individuals, the increase primarily caused by the inconsistent wind effects.
The last simulation, modeling agent decay, will be discussed as part of the criticisms of the SIU.
The SIU report states several criticisms and misconceptions regarding the DoD-CIA modeling effort. These are:
That the Dugway experiments did not replicate Khamisyah;
That AFTAC's work was peer reviewed and DoD-CIA's effort was not;
That the DoD modeling effort should have used Air Force weather;
That DoD-CIA modeling should have included agent decay;
And that the DoD-CIA modeling effort should have used an intersection of model results versus the union, thus identifying a smaller population of potential exposure.
As a result of these criticisms, the SIU report called the DoD-CIA effort flawed, and expresses a high degree of confidence in the AFTAC methodology. I would like to address each of these points in turn.
First, regarding the Dugway field experiments.:
The Dugway rests were never designed nor intended to replicate the Khamisyah event. Indeed, even if we could have acquired sufficient 122-millimeter rockets and exactly replicated and reconstructed the Khamisyah pit, we could have never duplicated the surface and weather conditions.
The purpose of the Dugway experiments was to answer certain fundamental questions regarding the effect of placing charges directly on or adjacent to 122-millimeter chemical rockets, or in the case of the test, chemical simulant filled rockets.
Specifically, which rockets in the demolished stack actually released agents, and the mechanism for how the agents were released, whether as a vapor or as droplets or as liquid spilled onto the soil and the wooden packing material of the rockets.
This information, along with rocket damage modeling, allowed us to simulate the agent mass balance of the Khamisyah release. During the testing, interviews and participation of soldiers who conducted the Khamisyah pit destruction were used to replicate demolition and charge placement and rocket disposition and configuration.
These experiments and subsequent simulations resulted in establishing that 18 percent of the agent was released, 2 percent instantaneously, 1 percent as droplets, 1 percent as a vapor, 6 percent from evaporation from the soil, and 10 percent in evaporation from the wood and crates housing the rockets.
Without the Dugway tests, these data would never have been discovered. Indeed the Dugway tests were never attempting to exactly replicate the Khamisyah release.
Regarding peer review:
AFTAC's work was reviewed internally by AFTAC and the Air Force Weather Directorate. The DoD-CIA effort was reviewed by a panel of non-Dod experts from within and outside of Government prior to and after publication.
The comment that we should have used Air Force weather is perplexing. The World Meteorology Organization collects global weather observations for multinational use. These observations are used to drive weather models to simulate weather around the globe.
Indeed, the historical observations available in the Air Force Combat Climatological Center referenced by the SIU is the same as a large portion of the global weather data set used in the DoD-CIA analysis.
Moreover, the DoD-CIA modeling team provided AFTAC the same comprehensive set of declassified observation data and source terms used in their effort. So the comment is unfounded.
It is true that the DoD-CIA analysis did not model agent decay. There are several reasons why this was not included.
Very little is known on how the combination of environmental factors, such as hydrolysis, temperature, hydroxyl molecules, photochemistry, and ultraviolet light degrade nerve agents. Simulating the precise effects of the combination of these factors without well-established empirically based data was deemed speculative.
Indeed, the AFTAC report clearly states that the results of their model to replicate decay was provided for information only and needed to be tested further and evaluated.
Throughout the entire process of trying to simulate the potential exposure hazard resulting from the events at Khamisyah, the Office of the Special Assistant has followed one underlying philosophy: If we are to err, we will err in favor of the veteran.
To diminish the potential hazard area in an unproven manner would have been considered haphazard under scientific scrutiny and would violate this philosophy of erring on the side of the vet.
We agree that environmental effects would decrease the potential hazard area, but at this time, we are not in a position to state, in an accepted, scientifically credible fashion, what the results of those environmental effects are.
To include such an immature process when trying to identify those individuals potentially exposed would have been a disservice to those veterans.
Similarly, comments that the DoD-CIA effort should have used an intersection of model results further illustrate this differing philosophy.
In the absence of any empirical data, we used a suite of atmospheric and contaminant dispersion models to simulate the potential hazard area resulting from the Khamisyah pit destruction.
Because of our philosophy of erring on behalf of our veterans, and the recommendations of expert reviewers, we used the union of the simulation results. These decisions are consistent with both expert opinion and a policy of making sure that every veteran who may have been exposed was given the benefit of the doubt.
Applying a less conservative philosophy, the intersection of the model results and including decay, would have resulted in notifying fewer veterans, but would have been inconsistent with our policy and the accepted practices of risk communications.
Rhetorically, should we not notify an individual whose unit was identified as potentially exposed, using a scientifically credible and technically reviewed simulation merely because it was not identified by all the reviewed simulations?
We could not say with certainty that any one of the five consistent simulation results was more realistic than the others were. In such a case, using the intersection of the hazard areas as a basis for notification of potential exposure would be inappropriate.
The union of results led us to the identification and notification of nearly 100,000 potentially exposed to very low levels of nerve agent. However, potential exposure does not necessarily imply illness.
The standard used in our simulations is the general population level established by the Centers for Disease Control. This level is over 300,000 times lower than the level that causes the first noticeable symptoms of chemical agent exposure.
There is very limited epidemiological research on the effects of exposure to such low levels of chemical agent. Our simulations identified a population potentially exposed to low-level chemicals that can facilitate that research.
That research continues. However, to date, emerging results have been unable to link potential exposure to low levels of chemical agent to Gulf War illnesses. As such, our work to date is consistent with the Senate SUI report.
Regarding comments that the DoD-CIA effort was flawed, a panel of widely recognized non-DoD experts in meteorology and atmospheric modeling from inside and outside of Government did not agree. The results of the five simulations were consistent and the panel deemed the results scientifically credible. I defer to their judgment.
In conclusion, I would like to leave the board with three thoughts:
First: Modeling isn't reality. Model differences are expected and no model can assure absolute certainty. The question to ask is are the results of the simulations scientifically credible based on the data available?
The technical review panel stated that the ensemble created by the union of DoD-CIA simulations produced "credible predicted concentrations for use in determining the area where service personnel might have been exposed."
Second: We had to make policy choices, and those can always be second guessed. Differing philosophies -- the union versus intersection, decay versus no decay -- all impact the potential exposure hazard.
Given the uncertainty of simulating the events of Khamisyah seven years after the fact, we selected a policy with the best welfare of the veteran in mind. If there was a chance of potential exposure, the veteran was included.
Third: The models used, whether it's the DoD-CIA suite or AFTAC's or others, are subject to challenge. Indeed, any institution with the ability to conduct atmospheric modeling can claim their model is better.
I go back to my first thought: are the models and their results scientifically credible?
We used a process recommended by IDA and blessed by a review of experts. Their assessment is that our work is credible. If so, we should focus on the underpinning assumptions of the work done, not the sequential inclusion of new or different models and their results.
Consequently, we continue to hone our assumptions and refine our modeling procedures to better serve our Gulf War veterans. Thank you.
SENATOR RUDMAN: Thank you very much, Colonel. It was an excellent presentation. We thank you, Colonel.
RADM COWAN: Good morning, Senator and members of the board. And to introduce myself to Secretary Brown, I'm Dr. Mike Cowan. I'm the director for medical readiness on the Joint Staff. As such, I'm the chief medical advisor to General Shelton and the Joint Staff.
I am here this morning to report briefly on four special investigative unit recommendations. I've submitted more complete point papers. I'll hit the tops of these and summarize the issues.
The first is the Recommendation 1.1, that the Secretary of Defense create a single focal point in each unified command to gather, analyze, and report on all intelligence information in support of any military operation to avoid information sharing and communication failures that occurred during the Gulf War.
It goes on to state that the director of central intelligence must fully coordinate and cooperate in ensuring the unified approach.
This is essentially the job description of the J-2 at each of the unified commands. And today, in each of the unified commands, he is assisted by senior representatives from Defense Intelligence Agency, National Security Agency, National Imagery and Mapping Agency, and Central Intelligence Agency, and those people are assigned at all those locations.
That is, mirrored at the Joint Staff, or the Joint Staff J-2, providing operational control, oversight, and support, provides a flow of crisis intelligence for operation.
When a crisis occurs, the Joint Staff takes the additional step of forming a national intelligence support team. These NISts regularly deploy to an area of crisis where they are chopped -- that is, shifted command control over to the unified command.
In addition, we not routinely use secure video teleconferences to share intelligence information back and forth between Washington and the area.
There is a great sensitivity at the national level and the commands to identify battlefield hazards. I know that from the Joint Staff, because General Shelton has included force protection, to include force health protection, as one of the six major tenets of his time as chairman, and when he is interested in something the rest of us in uniform become fascinated with it.
I have also information that the director of central intelligence works very closely with the Joint Staff to ensure that these goals are accomplished.
The second recommendation is Number 1.2, that states that the training of and instructions to intelligence analysts at the Central Intelligence Agency, Defense Intelligence Agency, and Department of Defense should ensure awareness of historical and collateral facts and situations that may affect how they interpret and handle intelligence data.
Specific to the issues here are lessons learned from the Gulf War. There are two particular Capstone products that are being used and are on the web sites, the DoD's Gulf Link web site.
The first is entitled, "Highlights of Intelligence and Warnings about Chemical Weapons at Khamisyah."
The second is, "Khamisyah, a Historical Perspective on Related Intelligence."
These documents are multi-sourced. They have come from CIA, DIA, DoD sources and, as I said are sort of considered Capstone documents summarizing all those lessons.
To bring those lessons home to the community, to the intelligence community, the Joint Military Intelligence College has incorporated them into three of their semester-long graduate courses.
These are courses that lead to the Master of Science in Strategic Intelligence. The course are Weapons of Mass Destruction, Counter-proliferation, and Analysis Bias.
Additionally, five different undergraduate courses are having these lessons incorporated into their academic structure, and the courses are open to all branches of the intelligence community.
The third recommendation is Number 3.1, which states:
"The Secretary of Defense should reinforce compliance with current statutory and regulatory requirements that all records, logs, and other documents related to wartime and other military operations that are permanent records under law are retained, and require that all unified commanders demonstrate this duty is being implemented and understood as a priority at every level in that command."
I believe a great deal of progress has been made in this arena in streamlining the way we handle those records and data.
Three separate DoD documents will be completed in spring of '99 that will articulate policy and provide guidance and implementation directives for the CINC.
The first is DoD Instruction 1515.2, titled "DoD Records Management Program." The important thing about this is that it shifts responsibility from the services to the Joint Staff.
The second is a policy on records management policy for the combatant commands. It's a policy document for the CINCs' record management program outlining those records that must be kept, how they are to be, what forms, and so on.
And, finally, there's a manual being put out by the Chairman of the Joint Staff.
This is 5760.01, which is the CINCs' and Joint Staff's manual identifying the CINCs as having the responsibility for the record management for any operation down to the task force level; and to ensure compliance and final record disposition, it makes the Joint Staff responsible.
The final one is SIU Recommendation 4.4, which states:
"The Department of Defense, in consultation with the EPE and the Centers for Disease Control and Prevention, should make available to military commanders environmental intelligence about factors that could adversely affect troop health and thereby impede the successful achievement of military missions."
The agency responsible for this is a branch of the Defendant Intelligence Agency called the Armed Forces Medical Intelligence Command. They acquire information from multiple sources, to include CDC, Environmental Protection Agency, and the services' preventive medicine units that are deployed worldwide, collecting medical intelligence information.
AFMIC routinely provides finished medical intelligence products to commanders performing operations in humanitarian, peacekeeping, and wartime environments. These products focus on epidemiological and environmental health concerns and are available to commanders and joint task force surgeons in a variety of hard copy, CD ROM, and the interlink network.
I can personally attest to the fact that this works. I was the joint task force commander for Operation Restore Hope in Somalia, and the information that they gave us in regard to disease threats, infrastructure, availability of additional health assets in surrounding countries, and et cetera, were spot on the mark in every case. So this is an excellent organization, and is functioning very well.
Sir, subject to your questions, that concludes my portion.
SENATOR RUDMAN: Thank you very much. Ms. St. Clair.
MS. ST. CLAIR: Hello. I'm Ms. Norma St. Clair from the Office of the Under Secretary of Defense, Personnel and Readiness.
I am talking to you today about Recommendation 3.2: "The Secretary of Defense should implement a personnel tracking system such as that now being deployed by the U.S. Army Center for Health Promotion and Preventive Medicine, in order to track and identify where individual service members were located during military operations."
Since yesterday, I talked to you in general about tracking. I won't repeat all of that. I went home last night. Nothing has changed. So there is nothing new to report on where we are.
The approach that they are using at the U.S. Army Center for Health Promotion and Preventive Medicine is basically using the available data to try and fit things together.
They have, for instance, information from the Persian Gulf Registry, where the service members self-reported the units they were in.
They have some information from the Center for the Research of Unit Records, where they have some information about troop movements, unit movements.
And then they have records from the Defense Manpower Data Center that have some unit assignment information.
And what they are trying to do is piece together the information that would have been in the morning reports.
As I mentioned yesterday, our goal is that, in future deployments, we will not have to do this kind of an exercise. It's not the most efficient way to get the information. And our goal is to have the information that they are trying to piece together as a natural outcome of the capabilities that we put in place.
SENATOR RUDMAN: Thank you very much. I want to just start out just with a comment, and then we'll open it for questions. And we appreciate your brevity and keeping us on schedule without delay this morning.
Colonel Abreu, do I pronounce your name correctly? I think it's kind of interesting, and everybody ought not to lose the fact of this, because this is something I had watched very closely during the year before this board was established, and that was the whole issue of modeling in Khamisyah, and so forth.
So that no one misunderstands what came out of this, the congressional investigating committee essentially said to you folks, "You've covered too many veterans." Now, based on my experience, that's the world turned upside down. Normally, you would expect to hear, "You covered too few."
But the point I'm making to you and the question I have for Dr. Rostker, which is a very fundamental question, we have spent a huge amount of time, a huge amount of money. We've got the best experts the country has to offer, and I think I can say that unequivocally.
And we've now reached the point where we have produced the best modeling we can on the most extraordinary incident that we know about, and I guess we're still doing some modeling on several more that we've just finishing up.
When that's done, what's left to do in terms of modeling that makes any sense at all? I mean, you know, this war ended nine years ago. We've got a lot of sick people out there. And, at some point, we do the best we can with modeling, and then we ought to, in my view, say, "There's nothing else we can do."
Is that a fair statement?
DR. ROSTKER: Absolutely. We had made a commitment to the President's Advisory Committee that we would apply this regimen of models to the bombing campaign, and that's in process.
I wish we had been able to report the results to you at this time, but it turns out that we are still gaining intelligence as to exactly what happened in the bombing campaign, and in this regard, there's a lot of interactions with UNSCOM because of UNSCOM's access to areas deep inside Iraq.
Once we have done that and then we publish the Khamisyah, the modeling efforts are complete as far as the known exposures.
As we discussed at the end of my remarks yesterday, the question then becomes, are there other exposures in the theater of operation? And that's where we're still looking at individual cases.
SENATOR RUDMAN: When you say the bombing campaign, the bombing campaign as it related to the dropping of explosives on suspected chemical munition sites, biological sites; is that what you're talking about?
DR. ROSTKER: There's a number of theories that that could have penetrated the battlefield, bathed the battlefield with chemicals for weeks. The CIA has modeled in a much more rudimentary way all of those sites and, worse case, found that was not true.
But the PAC was unwilling to accept that without a fresh look with the Khamisyah type models, and that's why we're engaged in that.
SENATOR RUDMAN: Dr. Rostker, you come from a discipline of being a research scientist, really, most of your life, and I come from a background of having prosecuted a lot of cases in my life.
Can you rely on nine-year-old evidence, I don't care how good you are?
DR. ROSTKER: Well, the evidence isn't nine years old. The evidence is the weather at the time as best we understand it. But those are contemporary readings.
The issues that are most difficult are what was released at Al Muthana, for example, how many bombs were there? That's the biggest hangup.
SENATOR RUDMAN: At best, your answers are problematic.
DR. ROSTKER: At best. And first cut through it showed that none of the chemicals that were released, as best the CIA could tell two years ago, made their way to any U.S. troop concentration.
SENATOR RUDMAN: I guess the bottom line that I'm getting to -- and I speak only for myself, obviously; this board is going to have to do a lot of deliberation. One of the things that we've been asked to do, and you even repeated yourself, is give some guidance as to where this whole thing is going.
I mean, we've hit a lot of resources in a fairly resource-scarce environment. And I just wonder whether we're putting them in the right place.
Now, I understand that the PAC report -- and I must say publicly for the first time, I just disagree enormously from a lot of that report. That's my own personal view. I've told that to people who ought to hear it.
But you obviously paid attention to it. You did what you had to do. But I mean, there is a point here where the continued pouring of resources towards these kind of issues, the resources would be much better served in doing research on illnesses, rather than how many containers of VX were at such and such a coordinate on such and such a day where, if the wind velocity is misjudged, the density and altitude is misjudged, then all of your modeling goes into a cocked hat.
DR. ROSTKER: Absolutely no question about it.
SENATOR RUDMAN: Well, I just want to kind of tell you thinking. And we're going to have a talk about this, and I'm going to have to talk to the board about this, because we are in a resource-scarce environment, and I'm just wondering how long it's going to -- I can just see this hearing room here in 2012.
There will be another board talking about modeling --
DR. ROSTKER: As I said yesterday, the department is in the poorest position to say it's time --
SENATOR RUDMAN: In no position to say that, but others may be.
You know, this whole modeling things reminds me of, Colonel, of economic models, which I'm very familiar with. There are 20 economic models, all of which disagree with each other.
Based on what happened to the hedge fund up in New York last month, they were all wrong.
SENATOR RUDMAN: So I just make the observation that we ought not to get too taken away with modeling, as if it's some exact science, because, of course, it isn't.
Doctor, do you have a question?
DR. CAM: Yes.
SENATOR RUDMAN: Go ahead.
DR. CAM: On modeling. In your testimony, you conclude that modeling is not reality. Why, on that basis alone, did it make sense to send the letters to over 100,000 veterans?
And I understand that you are in the process of revising that number. Whether it's up or down, it would cause more confusion in the public and it would add a credibility problem to your program.
What I'm trying to grasp is, how many people are really exposed and get sick? Because I'm concerned about the gap. Here you report 100,000 exposed, and a very small amount of people report illnesses.
So even if we were going out to outreach to all the people who are really sick, we never reach the target. And there's a perception that we are not doing our best to reach all the people who are exposed. That's my main concern.
DR. ROSTKER: There is a philosophy, an ethos which is generally referred to under the term "risk communication."
And that ethos requires us to notify anyone who may have been exposed, even if we -- there's no treatment. I's simply a notification. It's under the theory that a person has a right to know what he or she had been exposed to.
Moreover, we're required to make that notification to some levels that are called the general population level, which, as someone mentioned this morning, was 300,000 less of a dose than you would get for first effects, which are not even medical effects.
The whole issue of low-level exposure to chemical weapons is now a subject of a forthcoming Rand report and of ongoing medical research.
I have great sympathy to what you propose, but we were very much responding to what the current state of discussion is, and that requires us to be forthcoming in identifying who may have been exposed.
DR. CAM: Let me stop you right there. When you send out these notifications, do you also explain to people what it means?
DR. ROSTKER: Yes, we did. We worked closely with the Department of Veterans Affairs to craft a letter to indicate that it was a likely exposure, there wasn't even certainty, that these were the results of simulation models.
We explained that there were -- may not be health effects, but that we were meeting our obligation to keep them fully informed.
And, in that regard, we strongly believe that the union of models is the appropriate fashion.
DR. CAM: Thank you.
SENATOR RUDMAN: General, any questions?
LTG CISNEROS: Yes, sir, I have one, if I could, to Admiral Cowan.
One of the things that we received when we first came on in a briefing from OSAGWI was the pesticide issue and the quantities that were used. And some of those, as I understood, were pesticides that probably were prohibited in the United States, and Deet was one of them. Is that --
RADM COWAN: Deet is a commonly used pesticide in the services today. We use it --
LTG CISNEROS: I don't remember. But I recall that there were some bought by the local contracting officers to go and buy from the local markets --
DR. ROSTKER: This was Snep, which is an organophosphate. It's a fly killer, fly bait and fly killer. LTG CISNEROS: That's the one that I meant. And you were trying to track the amount that might have been purchased; I think your organization was trying to find out from the vendors how much they shipped to Saudi Arabia for purchase by American forces?
DR. ROSTKER: That's correct.
LTG CISNEROS: The point here is that, what efforts have been implemented since then to try to make this awareness?
Because I'm very familiar when we deploy, your contracting officers go buy some pesticides and they'll buy whatever, without perhaps not being aware that some of it is banned in the United States, like DDT.
And I'm not a technical expert on it, but I know that there are some readily used chemicals in other countries that are prohibited in the United States.
Have we made any progress in making awareness of what the rules are for --
RADM COWAN: Sir, I'm not aware of any specific guidance that we've sent out from the Joint Staff. I would defer to Dr. Rostker.
DR. ROSTKER: No, we're still very much involved in the research around pesticide use. And when we are completed, then there will be lessons learned. But your point is well taken, and I think we can do certainly preliminary, in terms of working with the Joint Staff on warning.
We think the issue is much greater than just the pesticides that were purchased, but a general lack of appropriate use of pesticides. And we're trying to quantify that through surveys, and then that will lead to, I think, a whole set of lessons on the application of pesticides.
Some of these pesticides are very mean stuff, and we want to really understand what was good in its application and where we may have gone wrong.
LTG CISNEROS: I understood that there was something that had been put out by the joint chiefs about having environmental type officers or oversight in each one of the unified commands that were supposed to -- environmental implies to me that they're also looking at what the potential hazards are.
Let's say, if you're in Panama, you may be buying, or one of the other countries that may have wide use of pesticides, whatever it is, that might be outlawed in the United States, because our standards are high to protect our environment in that regard.
And yet the contracting officer, the local people or units may have no awareness at all about that.
RADM COWAN: Yes, sir. I think the problem -- well, we have standard operating procedures and we have approved things. But the ingenuity of people in the field who find local sources and local vendors is not to be underestimated.
The teams that go around and do the surveillance and do the preventive medicine and do the oversight do have that obligation.
I think it unlikely today, vanishingly unlikely, that a vendor would be able to buy a chemical agent unapproved, because we have good, tight control over those sorts of things.
But I would never say that someone would not be able to still go out in a local field and find something that we had never thought of and never heard of.
I think the suggestion brings the idea to me that we should product additional guidance to the best of our ability to anticipate those, so I think it was very useful for me to take that --
LTG CISNEROS: The impression I got, Dr. Rostker, when you briefed us on that first orientation meeting, was that there were very significant quantities of that.
And, to be honest with you, personally, that's the one that worries me more, from what I know of all the issues involved here, about what the impact, if the quantities were, in fact, used to the degree indicated there.
DR. ROSTKER: We followed through on that, because some of the use scenarios could have resulted in people putting it out in trays in mess tents.
The tray gets knocked over, they fill the tray again. The tray gets knocked over, they fill it again, and all of a sudden, in the soil you have excessive amounts of this material.
So we've been looking at how it would be aerosolized, how it would be incorporated into the body, and that's part of our whole view of this. But there are some alarming scenarios that we're not comfortable with.
We're not comfortable just with the anecdote. We want to be able to understand whether these anecdotes we have were widely observed or not widely observed. So that's the gist of our research on pesticides, sir.
LTG CISNEROS: Thank you.
SENATOR RUDMAN: Secretary?
SECRETARY BROWN: Dr. Rostker, just one observation, that I agree with your overall effort to provide notification to any veteran that was possibly exposed, not probably exposed.
I think it's always best to err on the side of the veteran, so that at least they are put on notice, in the event they begin to notice deterioration in their health.
So I think that's a good policy and you should stand by and continue to make sure that it's a part of the overall conclusion of your report.
DR. ROSTKER: We had a little problem this summer, which may come to your attention. And that was that some veterans, actually a group that was at a veterans hospital, believed they were under the plume. Our reassessment of location suggested they were under the plume.
They asked for letters, and unfortunately, the staff said, "Well, you'll get it when we republish." That was the wrong answer. And the right answer is if a person wants a letter on exposure, we will immediately give it to them.
If a person says to us, "I was there," we're not going to argue with them. Based upon his representation of where he was, we'll provide him the letter.
People need the feeling that we're not hiding anything.
SENATOR RUDMAN: It's 11:30. We have three witnesses who are five or six minutes each. We've been sitting here for quite a while.
I'm going to take about a quick -- and I mean quick -- five, six minute break. We'll reconvene and hear those witnesses, break for lunch, and start again at 1300. Thank you.
(A brief recess was taken.)
SENATOR RUDMAN: If we could all gather, and please be seated. Witnesses, Ms. Diane Dulka Gates, who is president of the Connecticut Chapter of Gulf War Veterans of New England; Mrs. Dorothy Brooks, who is a veterans advocate; and Colonel David E. Root, United States Air Force Reserve (Retired), who is a physician.
I believe that we have one person who is not here.
I'm sorry we have such limitations of time, but you know what the time limitations are, and your statements certainly will be incorporated in the record, and if you have anything you want to add later, you can certainly do it in writing and it would be incorporated in the record.
Thank you for being here.
MRS. BROOKS: Thank you.
SENATOR RUDMAN: Mrs. Brooks, go right ahead. MRS. BROOKS: Senator and members of the board, my name is Dorothy L. Brooks and I'm a license attorney and legal analyst. I'm also the wife of a disabled, service connected, but not Gulf War connected, Persian Gulf veteran.
In the proceedings yesterday, the members of this board detected and even responded to the distress from veterans in the medical community of Assistant Secretary Bernard Rostker and his staff. It appeared as though the board was not obtaining and the veterans were not clearly presenting the solid proof that has led to this distrust of Mr. Rostker and his staff.
Let me give you some examples, not from months ago, days ago, or even years ago, but yesterday and today.
Mr. Rostker and his staff testified that a complete depleted uranium protocol was in place, functioning, and had been used by numerous veterans.
Additionally, he stated that the research pertaining to DU was based on a combination of the studies done in the Baltimore control group and veterans from other areas.
Today, he states that this testing is open to anyone who served in the Gulf on a voluntary basis.
I'm not certain when any protocol was placed into service or where this testing is taking place at, but one thing I do know. I know that my husband has been waiting for a DU screening and assessment to be conducted by the VA since 1993.
Supposedly, he is the first person on the list at the VA Hospital in Fayetteville, North Carolina. As of November 4, 1998, 16 days ago, according to officials at the VA Hospital in Fayetteville, such protocol still was not perfected and distributed to the hospitals.
In statements made at the American Legion Hall earlier this year, Mr. Rostker stated that there was no research available on the use of DU prior to the Gulf War. This excuse was used to mitigate the lack of adequate training for troops exposed to the uranium battlefields in Southwest Asia.
Now, Mr. Rostker presents evidence of preliminary findings that DU is not a contributing factor to Gulf War illnesses, and he cites as a part of his conclusive research a review of testing done of depleted uranium prior to the war. Which time is accurate?
If the members of this board are paying close attention, you have by now noted that obvious, apparent, and verifiable deceptions and distortions of the truth have been perpetrated repeatedly by Mr. Rostker and his staff.
Mr. Rostker does not merit the use of my entire time. Therefore, let me address the real world effects of some of his actions. Let me address the concerns of my husband.
In June of 1991, less than 30 days after being discharged and 60 days after returning from the Gulf, my husband filed his initial claim for disability for an illness he apparently obtained in the Gulf. His symptoms mirrored the tens of dozens of other veterans that you all have heard from.
Like most of those other veterans, his claim was denied. His medical records could not be obtained. That is, they could not be obtained until we filed an action in mandamus.
It is ridiculous that my husband and I had to spend months away from our valuable legal education to file a suit against the Federal Government to obtain his medical records.
I see that my time is about to run out, so let me move on to the recommendations that I would like to make to the board.
My recommendations for redress are as follows:
One, appoint a special prosecutor to investigate the conduct of Assistant Secretary Rostker and his management of the information and funds available to OSAGWI.
Two, in your oversight capacity, take actions to compel that the adjudicators and other officials within the Department of Veterans Affairs comply with the laws that have been passed. Let this action take the form of swift and specific reprisal for those who failed to comply.
Three, considering that Mr. Rostker has lost all credibility as a result of his own actions, this board should strongly consider the benefits of recommending his replacement.
I just have two more recommendations, if I could, please.
SENATOR RUDMAN: Go right ahead.
MRS. BROOKS: Fourth, on May 24, 1998, and again in a town hall meeting at Camp LeJeune, North Carolina, on October 19, 1998, members of OSAGWI and staff agreed and endorsed a proposal by the Unified Veterans of America to have an oversight committee composed solely of veterans to review the progress and activities of OSAGWI. Similar recommendations have been made by various other governmental committees.
I suggest that this board use its power to compel OSAGWI to develop and implement that protocol within the next 30 days.
Finally, the conduction of the survey that has been mentioned regarding the use of pesticides should be done with the leadership of a neutral outside third party.
Let me conclude my comments by stating that, in my capacity both as an attorney and as a spouse, I do not expect that you all can tell me what made my husband sick. Only DoD has that power.
But I do expect that you can assure that the laws and rights that he fought to protect are enforced. I don't look to you all for a cure. I look to you all for justice.
Thank you for your service on this board, and letting me speak.
SENATOR RUDMAN: Ms. brooks, let me ask you a question.
MRS. BROOKS: Yes, sir.
SENATOR RUDMAN: You're a member of the bar of the State of North Carolina?
MRS. BROOKS: I sure am. Yes, sir.
SENATOR RUDMAN: All right. You said that you thought we should call for a special prosecutor to investigate Dr. Rostker?
MRS. BROOKS: Yes, sir.
SENATOR RUDMAN: For criminal conduct?
MRS. BROOKS: Yes, sir.
SENATOR RUDMAN: What would Dr. Rostker's motive be to commit crimes?
MRS. BROOKS: Sir, I believe --
SENATOR RUDMAN: I mean, I'd like your opinion as a lawyer, I mean, because as you know, you have to have motive to commit a crime.
MRS. BROOKS: I do not -- I think that many of the crimes that he is guilty of involve and center around perjury. Okay. I don't believe that he always tells the truth. I think that he intentionally misleads --
SENATOR RUDMAN: For what motive, Ms. Brooks?
MRS. BROOKS: I would like to believe that no member of DoD, that Mr. Rostker, or that no member of the OSAGWI staff has a personal motive. But he is pressured to act in reprehensible and criminally responsible ways.
SENATOR RUDMAN: You've told me the results, but you haven't answered my question. What would the motive be for any Federal employee, when it concerns sick veterans, what would the motive be to commit perjury? What would their motive be?
MRS. BROOKS: I think that the motive is largely an attempt to protect the system, for lack of a better rationale. I mean, I can't know what their motive is.
SENATOR RUDMAN: Well, no, but if you call for a special prosecutor --
MRS. BROOKS: You know, but that is my --
SENATOR RUDMAN: Okay. Thank you. You've answered my question.
SECRETARY BROWN: You said your husband filed a claim with the VA sometime in June, post-June of '91?
MRS. BROOKS: Uh-huh. That's correct. Yes, sir.
SECRETARY BROWN: And he has been waiting for a DU screening since and around that time?
MRS. BROOKS: Since approximately 1993. However, when we first -- I believe that on his initial claim, he documented exposure to depleted uranium.
SECRETARY BROWN: If you don't mind, I'm going to have the staff to talk to you, so we can get some details. I think we can get that worked out.
MRS. BROOKS: That would be wonderful. I'd appreciate that, Mr. Secretary.
SECRETARY BROWN: Thank you, ma'am.
DR. CAM: Ms. Brooks, I just want to know how your husband is doing now, and medically is he taken care of? Can you just tell us a little bit about that?
MRS. BROOKS: Actually, my husband is doing extremely well. We are very fortunate that we have access to other medical services and the financial resources to get him outside care and treatment.
He is on a series of antibiotic treatment that is prescribed, not by any physician that you all have heard from, but just by his specialty physicians that he is seeing. He sees all kinds of specialty doctors.
Does he still have problems? Absolutely. His gums still bleed. His sinuses still bleed. He has the gastrointestinal problems. But, through the treatment with the antibiotic therapies, his symptoms are at least alleviated.
DR. CAM: And he has to pay that out of his pocket?
MRS. BROOKS: Yes, we do pay for that out of our pocket. Yes, ma'am.
DR. CAM: I just want to assure you that we really, you know, understand what you go through. That's all.
MRS. BROOKS: Thank you very much.
SENATOR RUDMAN: Colonel Root.
COL ROOT: Yes, sir, Senator Rudman and members of the board. I'm very honored to be here this morning, and I thank General Sandler of the Reserve Officers Association for inviting me to participate in this hearing on the Gulf War chemical and biological incidents.
I was in active service in the U.S. Air Force for 20 years, retiring in October 1980 as a chief flight surgeon and senior pilot.
I'm board certified in occupational medicine and aerospace medicine. In addition to my medical training, I received a Master's Degree in public health from Johns Hopkins University.
After leaving the military, I started in occupational practice in Sacramento, California in 1981 and have been building the practice since that time.
The challenge for the occupational physician is to provide relief to the injured worker, to rehabilitate him, and return him to work.
Since 1982, I've been using a detoxification program to treat patients who have been exposed to fat-soluble chemicals, either at work or from environmental sources. This program, developed by L. Ron Hubbard in 1978, has, over the last 15 years, been evaluated and used by a growing number of professionals throughout the world who have examined it use in relieving the after-effects of chemical exposure and found it to be very effective.
To my knowledge, there is no other peer reviewed method for reducing the body burden of fat-soluble toxic chemicals. Papers documenting the efficacy of the Hubbard program have been published by such organizations as the World Health Organization, and Royal Swedish Academy of Science, the Society for Occupational and Environmental Health, and others.
I have included in the packet before you precis of several papers concerning the detox program, a short description of the program, and a reference list.
The Hubbard detoxification program has long been upheld as compensable under state and national workmen's compensation laws. Over the past 16-1/2 years, I have used it to treat approximately 2,500 patients with varying degrees of illness from exposure to toxic chemicals.
The program has enabled me to fully rehabilitate many workers with serious exposures, returning them to full employment with little or no residual disability.
Over the years since the Gulf War, I have followed the articles in the medical literature and the lay press regarding what has been called the Gulf War syndrome. I have also read many of the Government-sponsored reports regarding the Gulf War illnesses and noted a striking similarity between the symptoms voiced by the veterans and the symptoms of patients exposed to toxic chemicals whom I've treated.
These symptoms include marked fatigue, difficulty with concentration, short-term memory problems, emotional liability, skin rashes, vague muscle aches and pains, GI symptoms, and sensitivity to chemicals at very low concentrations.
Since the symptoms so closely resemble those that I had treated successfully in thousands of cases, I decided to accept two Gulf War veterans into my detoxification program.
Case number one was a 49-year-old Marine lieutenant colonel who served in the Gulf War theater from August 1990 to March '91 as a Marine offload coordinator for the Marine expeditionary force. He was in excellent health when he deployed to Saudi. He did use pyridostigmine bromide. He also used clothing and used Deet and permetherine, as well as being given the anthrax vaccine.
He complained of many of the same symptoms noted above: multiple aches and pains, shoulders, joints, feet, headaches, fatigue, memory problems, irritability, lack of energy, sleep problems.
He underwent the detoxification program in my office in June 1996, completing it in 16 days. Upon completion he felt that the above symptoms were at least, in his word, 95 percent improved.
Case Number 2 was a 20-year-old Marine Reserve lance corporal from Connecticut stationed near Kafji, Saudi Arabia and in Kuwait City, and was therefore in the middle of the oil fire area in Kuwait.
He also took the pyridostigmine bromide tablets twice a day, clothing impregnated with deet, permetherine, as well as being exposed to some Lindane for delousing prisoners.
He also had very similar symptoms, underwent the detoxification program in my office in March and April of '96, and did very well, completing in 27 days on the program. And his self-assessment was that he was at least 80 to 90 percent improved.
This detoxification program is not a cure for cancer. It cannot help patients who suffered structural or anatomic damage to their peripheral or central nervous systems.
However, to the extent that symptoms can be ameliorated by reducing the body burden of these fat-soluble toxic chemicals, the program can and does help exposed individuals.
I am not claiming to have discovered either the cause or the cure for the Gulf War syndrome, but I do know that veterans who have been exposed to combinations of chemicals and chemical byproducts, including pesticides, vaccinations, oil fires, and possibly chemical warfare agents, have suffered greatly. They deserve the best in evaluation and treatment that this great country of ours can manage.
While millions have been spent to study the problems that soldiers who served in the Gulf War are experiencing, little has been done to provide relief.
Based on nearly two decades of clinical experience, I believe that this detoxification program may be a means to provide some such relief.
I realize I've treated only a handful of cases, but the results have been extremely encouraging. Therefore, I would be willing to work with any appropriate agency to establish a pilot project which would evaluate and treat a larger group.
I have already received encouragement for such a pilot project from professionals in medicine and toxicology who would be willing to serve as advisors. I think this is a concrete and practical idea, and I would encourage the board to strongly consider it.
Thank you very much.
SENATOR RUDMAN: Thank you very much, Colonel. I would point out to you, on your last paragraph, the board is specifically barred from conducting any scientific research. That is not to say that others in the Government might not take you up on your offer.
Let me ask you if you could tell us in a couple of minutes or less, what is this program?
COL ROOT: The detoxification program that I used was arrived at by L. Ron Hubbard. It involves physical modalities to reduce the body burden of primarily fat-soluble chemicals.
These include using exercise, aerobic exercise with heat stress in a sauna. We will have the patient in and out of the sauna over a period of about four hours.
Also used is niacin in a mode not as a vitamin, but as a mobilizer of fat, as well as causing a flushing effect, which we utilize.
The patient comes into the office. He takes the niacin. He exercises for 20 or 30 minutes. And then we put him in the sauna. And he or she is in the sauna for 10, 20, 30 minutes, up to their ability to withstand it.
They come out, they replenish fluids, electrolytes, shower down, cool off, back into the sauna. So they're actually on the unit in my office for about five hours a day.
Little by little, over a period of days, the xenobiotic chemicals, some come out through the skin, through sebaceous sweat. Some come out through the GI tract.
And I will mention that those that go into the GI tract would be reabsorbed by the bile acids from the liver. However, we use an all-blend oil by mouth to block that reabsorption. They go out through the GI tract.
So 85 percent leaves through the GI tract, 15 percent, roughly, through the skin, some through the kidneys.
Over a period of time -- and it varies; it averages about 21 days, but it can take sometimes longer, sometimes shorter periods -- the patient achieves a clinical improvement, at which point we terminate the program.
We've been very successful in using it. It's been very, very helpful.
SENATOR RUDMAN: I know that in your statement that you say that the detox program is compensable under state law in many states?
COL ROOT: In California, we've been challenged by some of the work. comp. companies. Every challenge we've had that went to the California Work. Comp. Appeals Board, we have won.
SENATOR RUDMAN: Have you any idea whether or not this program is compensable in other states?
COL ROOT: I don't know whether it is or not. We've had, I believe, one Federal exposure case, which we were compensated for.
SENATOR RUDMAN: Okay. Well, thank you.
SECRETARY BROWN: Doctor, Colonel, has this detox program been duplicated by anyone else, other than yourself, in California or in any other state in the country, or another country?
COL ROOT: There are other programs around which purport to use this program. However, to my knowledge, most of them have modified the program significantly, such that it doesn't really qualify as being the Hubbard detox program.
The reason I say that is that this program has been looked at, scientifically validated, and any other changes would have to undergo human experimentation protocols.
So this one is -- my clinic, as far as I know right now, is the only one using this clinic in the United States. I will say that it's in use in Russia. I had a chance to go to Russia a couple of years ago. They are using this. There have been probably 70 physicians in Russia who have been trained. And it's in use around in other areas of the world.
SENATOR RUDMAN: Dr. Cam.
DR. CAM: I just wonder whether you have talked with the VA and DoD about doing something, some kind of collaboration project? Because I understand they have trial projects coming up.
COL ROOT: I have not. This is the first opportunity that I've had to discuss this at the Federal level.
DR. CAM: All right. Senator, do you mind? I have another question.
SENATOR RUDMAN: Go right ahead.
DR. CAM: Mrs. Brooks?
MRS. BROOKS: Yes, ma'am.
DR. CAM: I just wanted to know, what will it take for your husband to get reimbursed from the HMO he is joining now?
MRS. BROOKS: My husband's medical care is paid for because of my employment. So it is being handled that way.
Our medical -- you know, for a while, his antibiotics were costing us $150 a pop, you know, because they're intensive antibiotics. But we have changed medical plans, so that our, you know, our portion is not as expensive.
I don't know what it would take to be reimbursed. I'll tell you that, from my perspective, terrible as this is, it's not worth the hassle to me, you know.
DR. CAM: Did you go back to the HMO and ask what kind of requirements they would need?
MRS. BROOKS: Well, it is covered by my medical insurance.
DR. CAM: I understand. 100 percent covered?
MRS. BROOKS: No, ma'am, not 100 percent coverage. But because of it's only costing us at this point $10 for each time he gets it filled -- now, as of this year, it's only costing us $10, now.
And, to be honest, it's just not worth the hassle to me to worry with getting the Government to reimburse us or to pay for his prescriptions.
As a service-connected veteran, he could actually get all of his prescriptions through the VA. Let me state that. Some of the prescriptions, though, that his doctor recommends are not available through the VA.
And, therefore, we want to follow the exact protocol that his civilian doctor is obviously recommending, and we choose to just pay for those prescriptions, rather than accept what may be a different medication with different effects.
DR. CAM: Thank you.
CSM MOORE: I just have one question, Mr. Chairman. Mrs. Brooks --
MRS. BROOKS: Yes, sir.
CSM MOORE: -- what is your husband diagnosed with?
MRS. BROOKS: My husband is compensated for a vertebrae fracture that occurred in his back in the Gulf, for which he has a line of duty statement. He is also compensated for a sinus condition which he developed as a result of his service in the Gulf, for which he had documentation that he visited the medical facilities there in country while deployed.
So those are the two things that he is compensated for, if that answers your question, sir.
CSM MOORE: Thank you, ma'am. Yes. Thank you, Mr. Chairman.
RADM STEINMAN: I have a question for Dr. Root. In your treatment protocol, do you make any objective measurements on your patients, or is it simply subjective signs or symptoms that they relate that they feel better? Do you take any blood tests, urine tests, biopsies, whatnot?
COL ROOT: Each patient undergoes a thorough physical examination. We do a baseline CBC, chem panel, thyroid panel, urinalysis, electrocardiogram.
Early on, I was doing some fat biopsies to look for specific chemicals. Many times, we don't know specific chemicals to look for. It's very expensive. Most of the patients that come to me are paying either out of their pocket or trying to get their third party payers to pay for it.
It's very difficult to get anyone to pay for the very expensive special testing that we might do -- as an example, immunotoxociology studies. We have not done those, because they're very expensive and we haven't -- we haven't had any way of paying for those.
So generally speaking, the findings on physical are usually minimal. It's very much the same as what you'll find with most of the Gulf War vets, I would say. They may have some observable skin problems. But usually, the joint pains don't show up as objective swellings and that sort of a thing.
And that's exactly the same sort of pattern that I see in the other patients who are exposed as on the job or environmental exposures. They have very few physical findings. Their lab studies, baseline ones, are usually normal.
But what I'm doing is, I'm treating people. These people come to me and they're ill. They fee bad, and they have all of these same symptoms you've been hearing about. And when they finish the program, they're improved.
Now, I don't claim to cure any of them. But in terms of their self-assessment of how they feel when they finish the program, 80 to 90 percent is very common, in my experience.
RADM STEINMAN: Have you published results of the series of your patients?
COL ROOT: I haven't published much. I'm a very busy clinician. I'm not a researcher. I do have a couple of articles in there.
And you'll see I've had an opportunity to go to Yugoslavia in 1987 and participated in setting up a detox program there, and there are several articles which I participated in. So there are a few listed.
But I haven't published as much as I would like to. RADM STEINMAN: Okay. Thank you.
CSM MOORE: Mr. Chairman, I just have one more quick question.
Doctor, have you been able to establish a latent period for these illnesses?
COL ROOT: No. It is very difficult. Frequently, in my experience with most of the civilians that I've treated, they have a particular chemical exposure which might not be overwhelming, and not enough to send them to the emergency room or anything of that sort.
And then, over a period of time -- and that might be days, weeks, months, even sometimes several years -- they become -- they seem to react to very low levels of environmental chemicals, things like perfumes and hair spray and exhaust fumes and cigarette smoke, to the point that exposure to those types of environmental chemicals cause an immediate recrudescence of their symptoms. They flare up, they get worse very rapidly.
So we see that quite frequently. And they do quite well in this program.
CSM MOORE: Thank you, doctor. You answered my question. Thank you, Mr. Chairman.
SENATOR RUDMAN: Thank you very much, Mrs. Brooks, Colonel Root.
We are going to now adjourn. We're going to have a quick lunch. We will reconvene here, I think 15 minutes after 1:00, which will give everybody a chance to get out, have something to eat, and get back.
We will then hear from the veterans service organizations. There are a number of them that will appear, starting with the AMVETS, at a little after 1:00, and we would hope to then be able to conclude the entire hearing by around 3:30 this afternoon.
Thank you very much.
(Whereupon, at 12:07 p.m., a luncheon recess was taken.)
SENATOR RUDMAN: The Board will come to order. We will now hear, for the next hour, hour-and-a-quarter, representatives of the various veterans service organizations, and we welcome all of you.
I think the way it's set up, we would ask for Mr. Woodberry from the AMVETS; Mr. Quintero from the American GI Forum. Please be seated. Mr. Frasure from the VFW, thank you for being here.
MR. WOODBERRY: Senator Rudman, distinguished board members --
SENATOR RUDMAN: I think you'll find the closer you pull that, the better it will be for all of us.
MR. WOODBERRY: Okay.
SENATOR RUDMAN: Thank you.
MR. WOODBERRY: Is that better?
SENATOR RUDMAN: That's great.
MR. WOODBERRY: Okay. I'm Dave Woodberry, National Service Director for AMVETS. We appreciate the opportunity to appear before you this afternoon and to testify concerning the oversight responsibilities with which you have been tasked.
As background, AMVETS is a veterans service organization with a combined membership of approximately 250,000. Although we currently have no data concerning the number of our veterans who saw service in the Gulf War, by the end of the year, as our new membership tracking system matures, we will be able to develop and report this type of information.
Furthermore, of the nearly 51,000 veterans who have, to date, sought treatment for Gulf War-related illnesses, we have no mechanism in place to identify those who are AMVETS members.
From our perspective, a veteran is a veteran. We will assist any veteran, member or not, at no cost, in his or her efforts to receive health care of other benefits to which they are legally entitled.
You invited us here today to testify concerning how this oversight board can best conduct its responsibilities with regard to the ongoing Department of Defense investigation of Gulf War chemical and biological incidents.
In this regard, it seems to us there are three fundamental issues:
The first relates to the timeliness of DoD's current investigative efforts.
The second deals with DoD's credibility and its ability to present the facts in a straightforward manner, unfettered by bureaucratic spin.
The third is, how do we prevent reoccurrence of situations like this in the future?
None of us can change the current timeline, and the fact that Dr. Rostker's investigation on behalf of the Department of Defense is proceeding some years after the conclusion of the Gulf War hostilities. Clearly the reconstruction of key events and the development of a credible explanation of what occurred, how, when, and to whom, has been a formidable undertaking.
However, based on the information Dr. Rostker's team has released to date, we believe the search for answers concerning the cause or causes of illnesses among Gulf War veterans is headed in an appropriate direction.
Regrettably, due to the time delays in this investigative process, we may never fully achieve an accurate picture of how cause and effect combined to produce the phenomenon we now describe as Gulf War illness. For our part, however, we've been impressed with the thoroughness and recent openness of Dr. Rostker's efforts.
In the continuing effort to leave no stone unturned, however, we believe the notable professional credentials and detached objectivity you collectively bring to your current tasks will serve this process well.
Although no one can turn the calendar back, your oversight of the ongoing investigative process, the fact you bring a fresh perspective to the process, which is not clouded by any investigative preamble should serve both DoD, the American people, and the veterans we all seek to help quite well.
The issue of credibility is one in which we believe this special oversight board may play a critical role.
As you are certainly well aware, DoD's credibility has been challenged in the media, by the public at large, and by the Congress, to such a degree that one might wonder if there will ever come a time when the Department of Defense will regain the degree of public trust and confidence it deserves.
Dr. Rostker's group is now completing its second year, which, according to its annual report covering the period through November 1997, anticipated completing all major investigations into possible chemical and biological exposures this year, with the attendant likelihood that drawdown within the Office of the Special Assistant would then follow.
We believe that a drawdown may still be premature. As impressive as Dr. Rostker's group's investigative thoroughness may be, we still have not answered the fundamental question: why have over 50,000 veterans reported unexplained illnesses as a result of their participation in the Gulf War?
It seems to us that until a plausible explanation of this phenomenon is presented, the investigative process is incomplete. For this reason, we believe it would be prudent to retain DoD's team intact, at least for the foreseeable future, in order to achieve closure as expeditiously as possible.
As the circumstances surrounding the current investigation clearly illustrate, once the team is dismantled, it becomes increasingly difficult to regenerate momentum and reconstruct or revalidate events.
As issues dealing with your oversight responsibilities evolve, we think the preservation of DoD's current investigative team may serve you well.
Although, thanks to the efforts of Dr. Rostker's team, we may now be in a much stronger position to rule out certain phenomena, to achieve closure, we still need, to the best of our ability, to answer the fundamental question: if chemical and/or biological agents -- the environmental effect of dense smoke and particles from the oil fires, the use of pesticides, and/or the use of non-FDA approved inoculations -- cannot be conclusively linked to the reported incidence of illness, from where did these events evolve? Why are these veterans ill?
Only after these issues are resolved can we turn our full attention to the most critical element, which is, what must we do to expeditiously assist the return of these veterans to normal, healthy lives?
In this regard, the outreach initiatives, Gulf-Link and Gulf News, have established important communications paths for veterans.
There is, however, another avenue which we believe needs to be aggressively pursued. Considering the number of veterans who have reported illness, surely there are clinical and/or diagnostic trends which can be developed, which may help lead us to closure.
For example, the resident civilian and DoD physicians at VA hospitals and elsewhere, who have seen and treated these veterans, may be a fertile source of information concerning patient symptoms, treatment, and long-term prognosis. We believe we need to be as thorough in our examination of these sources of information as Dr. Rostker's group has been in other areas.
Specifically, who are the veterans concerned? What is the nature of their reported illnesses? What, if any, clinical diagnosis and treatment has occurred, and what outcomes have been observed?
Where were these veterans stationed during the war? Are there common symptoms within the population and, if so, can they be cross-referenced to locations, troop and theater deployments, et cetera?
In other areas involving outreach initiatives, Document 98-048, entitled Rostker Advises Vets, "Don't Tough it Out," documents a reported tendency on the part of some active duty Gulf War veterans not to report illness, for fear an ensuing medical evaluation might find grounds for medical separation prior to their retirement eligibility.
An important oversight responsibility we feel you may wish to exercise resides in ensuring active duty veterans who do come forward in response to Document 98-048 are not penalized for seeking medical assistance for Gulf War-related ailments.
Furthermore, we believe that until we extend our outreach efforts directly to those affected and the physicians who are treating them, we may be incapable of describing the events in a manner which produces a clear, comprehensive explanation of what happened.
Finally, we believe your oversight responsibilities should address actions you believe are required to prevent events such as these from reoccurring. In this regard, Dr. Rostker's 1997 annual report address several lessons learned. Perhaps his annual report for this year's effort will offer additional insights into this area.
The advantage of hindsight may serve us well in this area. DoD has already instituted procedures based on their lessons learned. Once again, however, the fresh perspective you bring to this process may help to define those procedures more thoroughly. We believe your advisory functions will provide an essential underpinning in a path leading to closure.
In summary, we believe that, as your oversight efforts proceed, your advisory role and recommendations need to address three broad areas:
First, in the investigative phase, have we, in fact, left no stone unturned in our efforts to investigate, describe, and explain the events which occurred during the Gulf War, and which now manifest themselves so dramatically within an ailing veterans' population.
Second, do the facts, as they have been reconstructed and presented, adequately explain events in a way which will help to re-establish DoD's credibility?
And, finally, have we appropriately applied the lessons learned in a way which will help us avoid situations like this in the future?
Senator, Rudman, that concludes my testimony.
SENATOR RUDMAN: Thank you, Mr. Woodberry. Appreciate your statement. And we'll save questions for the end here.
MR. FRASURE: Thank you, Mr. Chairman, and members of the Special Oversight Board. On behalf of the 2 million members of the Veterans of Foreign Wars, I am pleased to appear before you today to provide our views regarding the scope and mission of the Special Oversight Board.
The VFW has been vigorously involved in assisting Persian Gulf War veterans since their return home over seven years ago.
It has been, and continues to be, an absolute top priority of the VFW that those Gulf War veterans who are suffering from undiagnosed illnesses receive the best possible medical treatment. We believe that the Special Oversight Board has a significant role to play toward ensuring that this goal is realized.
The issue of Gulf War undiagnosed illnesses has been defined by a torpid history. The lack of an immediate response to veterans' ailments by the VA and DoD created much resentment and mistrust toward the Government by many Gulf War veterans. Indeed, the track record of both DoD and the VA regarding undiagnosed illnesses has been less than perfect.
With that said, however, I want to make it unequivocally clear that the VFW is not interested in dredging up past history. Again, our chief concern is that treatments are found for the host of symptoms stemming from undiagnosed illnesses, and that these treatments are made available to Gulf War veterans.
Furthermore, we want to ensure that these veterans are properly compensated for the illnesses they are suffering from because of their service in the Gulf War. Adjudicating Gulf War veterans' claims regarding undiagnosed illnesses has proved to be a complex task for the VA.
These claims mark the first time that a claim must be adjudicated based on symptoms and not on a diagnosis. Gulf War undiagnosed illness claims take roughly four times the length of time to adjudicate as all other claims do, and the accuracy of the rating decisions has been a problem.
We encourage the Board to meet with the Veterans Benefits Administration if possible, and to further address this issue, and get their perspective.
The VFW believes that the Special Oversight Board should focus on three specific medical areas relevant to Gulf War undiagnosed illnesses: the use of depleted uranium munitions on the battlefield; the potential hereditary generic effects of all battlefield toxic hazards; and the emergency of ALS, known as Lou Gehrig's Disease, in Gulf War veterans.
The use of DU munitions in the Gulf War proved to be a highly effective weapon that saved many American lives. The VFW believes that our armed forces should continue to use this potent weapon for the sake of tactical advantage over our enemies.
However, we do harbor some concerns regarding the health effects of DU on our troops. The VA recently has expanded their followup study on the effects of DU on Gulf War veterans from 35 veterans to 350.
Many Gulf War veterans do not accept DoD's recent report on the health effects of DU. In light of this, we strongly believe that the health effects of DU should continue to be thoroughly studied by both the VA and DoD in conjunction with the National Academy of Sciences.
We request the Board to closely monitor all developments concerning studies on DU and ensure that DoD fully implements a safety training program for all troops who will handle and/or be potentially exposed to DU during their service.
The VFW is also highly concerned about the potential of hereditary genetic birth defects in the offspring of our Gulf War veterans. It has yet to be finitely determined whether or not Gulf War undiagnosed illnesses have caused birth defects in the children of Gulf War veterans or if symptoms have been passed on to veterans' family members.
We suggest that the Board pay close attention to the results of examinations given to veterans' family members by the VA and to all studies addressing this issue.
Furthermore, the VA has claimed that there is no relationship between Lou Gehrig's Disease and service in the Gulf War. The VFW does not directly dispute this. Yet, we do believe that the VA ought to conduct a study on ALS in Gulf War veterans before coming out with such a definitive statement.
Currently, there are no statistics regarding Lou Gehrig's Disease in Gulf War veterans. Many scientists and doctors believe that low-level chemical exposure may potentially cause Lou Gehrig's Disease. The VFW believes that the Board ought to ensure that the VA and DoD address this issue as a high priority.
Your emphasis on the immediate need for medical, scientific research regarding a possible relationship between service in the Gulf War and Lou Gehrig's Disease will be very appreciated.
Our reasoning is empirical. Currently, we are involved with two Gulf War veterans who have suffered from very rapid progression of Lou Gehrig's Disease.
The Gulf War is a prelude to the battlefields of the 21st century. Soldiers today and in the near future will face a variety of dangers that our medical and scientific community is only beginning to understand.
It is essential that DoD implement a strong and substantial force health protection program to ensure that our troops will be adequately trained, educated, and protected against these dangers. Monitoring this program should be a top priority of the Board.
In sum, the VFW believes that the Special Oversight Board should ensure that the President's directives of November 1997 regarding Gulf War illnesses are fully carried out.
The VFW expects a cooperative and productive relationship between the National Academy of Sciences, VA, the Department of Defense, and all other agencies.
The National Academy of Sciences should be privy to any and all information held by all agencies pertinent to Gulf War illnesses, so that they can conduct a complete review of all studies.
Both the VA and the Department of Defense should continue to study the unsolved medical issues surrounding Gulf War illnesses. The Department of Defense must aggressively go ahead with their plans for a force health protection program.
The Special Oversight Board should guide the VA and the DoD towards closure of this matter. To the VFW, closure means that solutions and treatments are developed for the medical problems of Gulf War undiagnosed illnesses.
Closure means that treatment and just compensation are made available to every Gulf War veteran who is ill from these undiagnosed illnesses.
Finally, closure means that the Department of Defense and the VA take all necessary steps to avoid a repeat of this matter after future conflicts.
Thank you, Mr. Chairman, for inviting the VFW to this hearing. This concludes my statement. I welcome whatever questions you may have.
SENATOR RUDMAN: Thank you, Mr. Frasure. Mr. Woodberry, let me ask you one question, and then we'll see if the panel has additional questions.
I was interested in your remark that you thought it might be premature to shut down Dr. Rostker's organization, and that well may be.
It's occurred to me that if, in fact, at some point in the future, all of the scenario studying is done with, and to the extent that any evidence is available following the PAC's request, they come up with whatever scenarios that they deem predictable, logical, modeled under some model -- and we talked about models this morning. They're not terribly reliable sometimes.
Let's assume that's done. At that point, would the various organizations of our Government in place -- DoD, the health components of DoD, the VA, the Persian Gulf Coordinating Board, made up of three key departments -- would you think that it still has a function to carry out after that, or do you think it might be more cost-effective to let it go back to traditional places, if that part of its role was done?
MR. WOODBERRY: Senator, I was more worried about supporting you than any long-range plan to carry Dr. Rostker's group out in --
SENATOR RUDMAN: Okay.
MR. WOODBERRY: It seemed to me, when I read his annual report in '97, that the conclusion basically was, "We'll basically be done with our investigative processes in the next year and, at that moment in time, we'll start unwinding."
Given your oversight responsibilities, it occurred to me that it might be helpful to have them in place on hand and available for those kinds of questions that may come to you in the course of your oversight review. And that was really the only --
SENATOR RUDMAN: All right. Well, I agree with that.
Obviously, we will have to have, for some period of time in the future, even if all of the current tasking was completed, an administrative staff that could, in fact, interface not only with this board, but with other parts of the Government, for data that is uniquely in their archives.
But you're not suggesting that once those tasks are done, that we ought to continue the full organization in place?
MR. WOODBERRY: No, sir. Once we achieve closure to the oversight board's view, it would seem to me then that the responsibility ought to go back to the various departments who ought to have responsibility for these things.
SENATOR RUDMAN: Fine. And, Mr. Frasure, if I understood what you were saying, of what your VFW's objectives are, it seems to me you're essentially saying that, you know, we're getting to the point where we ought to not look too much at history, and we ought to start looking vigorously, if we can, to find the causes and to medical research, and treat the veterans, and be just. I mean, that was your message.
MR. FRASURE: Yes, that's correct, insofar as much of the history isn't relevant to the actual medical problems today and the actual treatment that they are receiving.
We're really not interested in playing any kind of detective game right now. Our emphasis is on medical treatment.
SENATOR RUDMAN: See, I have a sense that if you continue an organization like that too long, with all of the traditional Government agencies in place that are charged with these kinds of things, you could actually have a negative effect on what your bottom line was, to try to help veterans.
So I'm not in a hurry to shut the operation down, but I think one of the things this oversight board has to look at is what is the best way to deliver what has to be delivered, and we all can agree on what that is.
And so that's why I asked you both the question. Thank you. General.
LTG CISNEROS: Mr. Frasure and Mr. Woodberry, first of all, personally, thank you for your presentations. They were very succinct and very helpful to me, how you came across and you got to the point, and it was very helpful to me, in view of the last day-and-a-half of hearings here.
I do have a comment, though, Mr. Woodberry, I'd like to ask you, as I heard it a couple of times before, and it really concerns me. It has to do with active duty veterans not being concerned to be punished.
I've heard this a couple of times. I want to tell you that I retired two years ago. I was a commander and my son served in Desert Storm.
And my experience is -- and I know everybody will say, "Well, he was a general and he's trying to protect, you know, there's a plot there," and so forth. But I assure you that my concern for the soldiers, regardless, is paramount. I don't take a back seat to nobody in that regard.
And I'm concerned the perception is there that the leadership of the Army -- and I know the leadership of the Army. I mean, there are some people that are not on line. But I'm concerned that the implication is that we, the active Army leadership, is holding the active duty soldiers from coming out with their ailments because they're afraid.
Where is this coming from? Is this coming from the active duty soldiers? I know there's an issue there, and I'll stop talking and let you respond, that, well, the active Army isn't complaining, it's the Reserves that are complaining. And I don't buy that at all, either.
But it seems to be used as a justification there, and I'm concerned about where that is leading us to.
MR. WOODBERRY: Yes, sir. This was not a statement accusing the Army of anything. Are you familiar with D. Rostker's press release? This is the material I was referring to.
If, indeed for whatever reason, there are active duty military who are hesitant to come forward with illnesses they believe they received incident to the Gulf War, for fear of separation short of retirement, then I think it's something that folks ought to look at.
I'm certain the Army is. In fact, there are points in here where everybody has tried to get out the word, "Don't worry about that, come forward." And the thrust of Dr. Rostker's article was: "Don't tough it out. Get the treatment that you need."
LTG CISNEROS: No, and I understand that. I wasn't saying that you came up with that statement.
MR. WOODBERRY: Okay.
LTG CISNEROS: I think your presentation was very, very objective, and I appreciate it.
But I'm concerned about it. I guess I'm just reflecting back to you, because I've heard it so often, and then I hear people, "Well, the troops are telling it."
Well, I talked to soldiers every day, also, and like I said, I don't take a back seat to anybody when I was on active duty, of trying to do something that was going to be harmful for the soldiers.
The first duty of any good leader is to take care of his men, period, and we stress that, and that bond has to be there between the leadership and the soldier. If you lose that bond, you lose military efficiency.
And I'm just -- my question to you is that, in your talk to veterans who have just come out of active duty and those that you come in contact that are no longer on active duty supposedly can be outspoken, like I feel I can do now, which I couldn't when I was in uniform.
Are you getting this perception from recent veterans about --
MR. WOODBERRY: No, sir. I picked it up off of this release from Dr. Rostker's office. I'm retired Navy, and share your views on the bond between command and the troops.
And it concerned me, because if, indeed, this is going on, I'm sure that's not the Army's intent. It would certainly not be the Navy's intent. But if it's going on, then whatever steps we need to take to get rid of it so that people who need treatment get it, ought to proceed.
And to the extent this is part of your oversight, or may be part of your oversight responsibilities, I thought it was worthy of raising.
LTG CISNEROS: I appreciate it. Thank you, sir.
SENATOR RUDMAN: Dr. Cam.
DR. CAM: I have a couple questions. And these are for both Mr. Woodberry and Mr. Frasure.
The first one is, what is the percentage of your members who are registered in the CCEP or the VA Registry?
And the second question is, how many members of your organization suffer from Gulf War illnesses?
MR. WOODBERRY: I can't tell you that, Doctor. We don't track veterans that way within my organization. We will be able to tell you in about a year -- well, the end of this year -- how many of our members are Gulf War veterans. But we don't track people as a function of illness.
MR. FRASURE: Unfortunately, Dr. Cam, I can't give you an exact percentage, either. I can tell you that we have about approximately 30,000 Gulf War veterans in the VFW.
Our Action Corps Department, which is our grassroots legislation department, for about three years, they maintained a database. It was sort of our own registry of Gulf War veterans. On that registry, there is about 2,000 Gulf War veterans. Out of that 2,000 -- and again, I stress, this is just going off the top of my head here --
DR. CAM: Right. Yeah. That's fine.
MR. FRASURE: -- there is about, I would say, 1,500 who reported symptoms. That's the best answer I can give.
DR. CAM: But you don't know how many have been registered?
MR. FRASURE: No, I don't.
DR. CAM: Thank you.
SENATOR RUDMAN: I want to thank you both very much.
Mr. Rick Weidman, Director of Legislative Affairs, Vietnam Veterans of America; and Mr. Paul Sullivan, National Gulf War Resource Center, Executive Director, if you would like to come up.
I take it Mr. Quintero is not here, so we will proceed with the panel of Mr. Puglisi, also, of the American Legion.
Well, I guess we're down to the last two witnesses. Evidently, the other witnesses weren't able to make it here. So I will then proceed.
Mr. Sullivan, if you would like to go first; then Mr. Puglisi. And then we will proceed to some questions. Go right ahead.
MR. SULLIVAN: Good afternoon, Senator Rudman and distinguished members of the Presidential Special Oversight Board. Thank you for the opportunity to speak with you today.
I also wish to thank Dr. Vinh Cam, Colonel Naylon, and Lieutenant Colonel Kaplan for attending our Gulf War Resource Conference here in Washington in September.
I also thank you, Senator, for asking that veterans speak first.
The National Gulf War Resource Center is the only non-profit organization based in Washington, D.C. devoted solely to Gulf War veterans illnesses.
Formed in 1995, the Resource Center is a coalition of 54 grassroots groups in the United States and in the United Kingdom. The overwhelming majority of those are veterans who are organizing grassroots groups because they're ill.
Thank you for asking us for our suggestions on how your Special Oversight Board should review the past, current, and future work of OSAGWI and Dr. Rostker, the under secretary of the Army.
The public impression made by the creation of the Special Oversight Board represents and confirms our belief that the work of OSAGWI has been less than vigorous and less than candid.
In summary, we have three messages:
One, we do want to acknowledge OSAGWI has made some positive accomplishments, and these are in our written testimony that we have provided, and we ask that that be entered into the record.
SENATOR RUDMAN: The entire statements will be included in the record today.
MR. SULLIVAN: Thank you, Senator.
Second, OSAGWI has made some serious mistakes, and these are detailed in our prepared remarks.
And three, much work needs to be done by the SOB and OSAGWI. Veterans are ill, and have earned the right to know why we are ill in such large numbers, and to receive prompt and thorough medical care.
Our bottom line is this: please oversee that veterans receive answers and health care.
As detailed by Dan Fahey and James Tuite, both former members of the Resource Center Board of Directors, OSAGWI has made many serious mistakes. The Resource Center is familiar with and supports their testimony. We also support the testimony of the other veterans, many of whom are associated with the Resource Center, who spoke yesterday.
Of the mistakes listed in our prepared remarks, there's only one we wish to focus upon today: the OSAGWI failed to release some of their reports in a timely manner.
Specifically, several self-imposed deadlines given by OSAGWI for release of a depleted uranium report were missed by OSAGWI. This seriously undermined the credibility of OSAGWI and led many veterans to question the vigor of OSAGWI investigations.
Therefore, we ask, reports must be issued promptly and be accurate.
In light of the U.S. Air Force's outrageous delays in releasing and manipulating information from the ranch hand studies on Agent Orange exposures for two decades, such delays by DoD about Gulf War illnesses do not serve the best interest of those in need of accurate information, including veterans and health care providers.
This summer, OSAGWI released misleading and incomplete information about depleted uranium. The Department of Defense falsely claimed there was no link between undiagnosed illnesses and DU exposure The DoD's claim rings false, because the DoD confirms there are no studies on DU inhalation or DU ingestion. LIkewise, there are no studies on those with undiagnosed illnesses.
However, in contrast, there are studies showing DU in the semen of some Gulf War veterans. There are also studies that implicate DU with neurocognitive disorders in humans and testicular and ovary disorders among animals.
This information, compiled by Dr. Melissa McDiarmid, as well as documents turned over by Dr. Doug Rokke to OSAGWI in July 1997, implicate DU in many serious current health problems among veterans.
Yesterday, the OSAGWI released a very detailed map showing extensive areas of widespread radioactive toxic waste contamination all over Kuwait and Iraq, and some contamination in Saudi Arabia. All of this information was intentionally withheld from veterans.
You all had the opportunity to see this map. This is something we believe that could have been included in the report, but that was not done.
We believe this outrage must not be repeated. The Resource Center now restates our claim that the overwhelming majority of frontline troops, as clearly described in this overlay where the troops went through two distinct areas of DU contamination, may have been exposed. Many units remained in those areas for up to two months. These are not fleeting exposures.
Also, many units traveled down the Highway of Death from Iraq to Kuwait, and an area of extensive tank battles shown by the OSAGWI map to be heavily contaminated. Again, that's the pink area on the right side. That's basically the Highway of Death.
When DoD falsely claimed there was no relationship between DoD (sic) and Gulf War illnesses, the DoD severely damaged their credibility. Because the DoD advocates the expanded use of DU, the Pentagon cannot and should not be the lead or sole agency investigating the health effects of DU. The DoD has a clearcut conflict of interest.
OSAGWI's biased handling -- and the PAC acknowledged this in their report -- represents its most serious mistake. The Resource Center stands very firm in our position of OSAGWI's mishandling of an investigation into depleted uranium.
Recent legislation was passed that we hope may lower the debate on this issue. The Resource Center pushed through Public Law 105-277, the Persian Gulf Veterans Act of 1998. The legislation drew a strong bipartisan support, and it dramatically changed the landscape on this issue.
The law places the NAS, with a contract with the VA, in the lead role of determine what relationship, if any, exists between dozens of toxic exposures and the illnesses reported by more than 110,000 Gulf War veterans.
Essentially, the new law releases the DoD from a lead role investigating the illnesses and their causes. However, the new law does not release DoD from their role in determining toxic exposures reporting those exposures to veterans and the NAS, and learning lessons from their mistakes from Gulf War exposures.
The new law should benefit ill Gulf War veterans by providing expedited, independent, quality, credible answers to our reasonable questions.
The Resource Center has 10 suggestions, based on your request and the legislation, legislation that Under Secretary Rostker publicly supports.
We ask the SOB to consider 10 suggestions. We believe our suggestions will improve and enhance the Gulf War veterans' goals, providing answers as to why veterans are ill, advocating for the best health care of Gulf War veterans, and highlighting areas of concern for correction, so mistakes are not repeated.
One, our first suggestion: In 1994, Congress passed a law that the DoD determine a case definition for Gulf War illnesses. This has not yet happened, and DoD must complete this task ordered by Congress.
Developing a case definition may provide the start for desperately needed treatment programs and additional research for the 110,000 claiming illnesses.
In addition, the DoD and OSAGWI have not provided Gulf War veterans with a detailed explanation of why they have not completed what Congress ordered them to do.
Two, the Resource Center believes OSAGWI should be a full-time position with no other duties.
Three, we believe OSAGWI should complete ongoing reports. They should also share all their information with NAS.
The Resource Center believes that after many of the reports are completed, the overall OSAGWI operation should be scaled back. Notice we're not saying closed, scaled back, considerably.
Four, the Resource Center respectfully demands a more candid, vigorous, and rigorous report about depleted uranium. A radioactive toxic waste product uses anti-tank ammunition.
So long as the DoD fails to address this critical issue openly, quickly, and with vigor and rigor, veterans will have the evidence and the impression that the Pentagon is less than candid.
I just have a few more. Is that okay, sir?
SENATOR RUDMAN: Why don't you finish your statement, Mr. Sullivan?
MR. SULLIVAN: Thank you very much.
SENATOR RUDMAN: Continue to the end.
MR. SULLIVAN: In light of Dr. Rostker's comments yesterday that OSAGWI's DU report conclusions were "ill-advised," Rostker has further tarnished his already weak credibility among Gulf War veterans.
In a related manner, the Resource Center supports the recent VA expansion of research into veterans exposed to DU. We believe this should have happened in 1991, but we're very glad it's happening now.
The Resource Center supports the request for a General Accounting Office investigation into the DoD's handling of DU made by Senator Ross Feingold.
The World Health Organization has also launched a study to determine the effects of DU on civilians in war zones. The Resource Center, at the request of WHO, is now cooperating with their investigation.
Thus, as a result of the GAO and WHO probes, more information on this controversial toxic exposure may come to light soon. We believe the book on DU remains wide open.
Five, since NAS has now taken a lead role on this issue, we hope that OSAGWI cooperates with NAS and turns over all relevant data.
Six, the OSAGWI has held several meetings with veterans' organizations. This helps build credibility with the veterans community and the public. The Resource Center believes such meetings should continue.
The Resource Center believes, based on passage of the new legislation, that many of the contentious areas of acrimonious debate may subside. This is one of our goals. This may make it easier for the veterans, as those who are ill, and as the witnesses to key events, to have more faith in the efforts of OSAGWI and DoD.
As a note, so long as OSAGWI is not seen as credible, this issue may linger and fester. As for the Resource Center, we would prefer answers, health care, and closure.
Seven, the Resource Center understands that calls from veterans to the OSAGWI incident reporting line are declining. We hope that the line should stay open and that information about it be more widely publicized.
Eight, the Resource Center appreciates the publication of OSAGWI's first annual report, and we hope they issue a second and subsequent reports.
Nine, one of the most serious mistakes of the DoD since the start of Operation Desert Shield in 1990 was the failure to maintain adequate records. With so many types of toxic exposures and with so many types of illnesses reported, it is incumbent upon the DoD to more than perform CCEP exams.
The Resource Center strongly believes that the DoD should compile statistics about the health and exposures of Gulf War veterans as part of their process. Such statistics should, at a minimum, include cancers, birth defects, deaths of children, women veterans' health, and ALS -- Lou Gehrig's Disease -- among others.
We do note again, the DoD, in possible violation of regulations, failed during Desert Shield and Desert Storm, and to our understanding is continuing to fail today, to maintain records or perform required medical testing on those known or suspected to have been exposed to DU. I'm talking about the active duty folks.
Ten, the DoD has yet to improve their chemical and biological warfare agent protection, detection, and casualty doctrine. This was confirmed by a recent General Accounting Office report.
The Resource Center believes the SOB should monitor OSAGWI and DoD activities as they relate to improving the military's ability to deal with this clear and present threat.
Low-level chemical exposures remain a danger, especially in light of recent deployments and the likely possibility that the U.S. military may once again bombard chemical warfare agent manufacturing and storage facilities in Iraq.
This issue may be addressed as a result of the recent language the Resource Center supported, that was passed as part of the defense authorization bill.
Again, we thank you for the opportunity to speak today, and thank you for extending my remarks, in light of what Dr. Rostker said yesterday.
If you have any questions, I will be more than happy to answer them at this time. Thank you very much, Senator.
SENATOR RUDMAN: Thank you very much, Mr. Sullivan. Mat Puglisi from the American Legion is Assistant Director for Veterans Affairs and Rehabilitation. And thank you for being with us.
MR. PUGLISI: Thank you, Mr. Chairman. And good afternoon to you and the other distinguished members of the Special Oversight Board. The American Legion appreciates the opportunity to offer testimony at the Board's first public hearing.
The American Legion would like to take this opportunity to offer its recommendation as to what role the Board can play in resolving some of the controversy surrounding the Department of Defense's investigations of Gulf War chemical and biological incidents.
Mr. Chairman, the Special Oversight Board's membership is comprised of individuals with impressive careers in public service, including yourself. Two members in particular -- former Secretary of Veterans Affairs Jesse Brown and Admiral Elmo Zumwalt -- are well-known veterans' advocates. The Board, therefore, begins its work with a great deal of credibility.
The American Legion must note with disappointment, however, that over one year has passed since the Presidential Advisory Committee on Gulf War Veterans' Illnesses released its special report. That report recommended the creation of an oversight body such as the Special Oversight Board, and the White House was slow in acting on that recommendation.
Continuous and formal oversight of the Office of the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, or OSAGWI, has been absent since the PAC expired on October 31st of last year.
In the meantime, Congress has passed legislation presuming that Gulf War veterans were exposed to the very environmental hazards that OSAGWI is investigating.
Congress has therefore made OSAGWI's efforts practically irrelevant vis-a-vis service-connected disability compensation. OSAGWI's work is still important, but it will have little impact on whether or not Gulf War veterans are compensated for certain disabilities.
Compensating disabled veterans for their service-connected disabilities is a sacred duty of the Federal Government, and the American Legion continues to aggressively oversee how well or poorly this duty is performed. Our oversight has improved the compensation process, and that has resulted in thousands of Gulf War veterans securing the compensation they earned.
But specifically on the role that we foresee for the Special Oversight Board, we would hope it would become the Good Housekeeping seal on the work produced by OSAGWI. We challenge the Board to step up to the plate and either certify the work of OSAGWI or send it back to the drawing board to get it right.
Gulf War veterans are not looking for bureaucratic battles as occurred between the Presidential Advisory Committee and OSAGWI. They're looking for a thorough and credible investigation.
The Federal Government did not acknowledge that U.S. troops may have been exposed to chemical warfare agents until June of 1996. Until that date, the DoD and CIA insisted that there was no use, presence, or exposure of U.S. troops to CW agents in the Kuwaiti theater of operations.
Now, the announcement was not news to the American Legion nor to many Gulf War veterans. What was news was that DoD was ready to admit what many Gulf War veterans already knew: the CW agents were present and were released in the KTO.
The Presidential Advisory Committee, the Senate investigative unit, and investigative reporter Seymour Hearsh have since failed to find that a vast conspiracy or coverup occurred at DoD.
It doesn't appear that DoD knowingly lied about the presence of CW agents in the KTO prior to June '96. It is apparent, however, that there was a staggering level of incompetence within DoD prior to that June announcement.
Various congressional committees addressed Gulf War illnesses as far back as 1993, and the possible role of chemical warfare agents. DoD witnesses before hearings held at that time testified that there was no evidence of Iraqi use or presence of CW agents in Kuwait.
DoD also testified that there were no confirmed detections of CW agents or treatment of U.S. or coalition personnel as chemical casualties. That testimony was false, in light of evidence that has been disclosed prior to and since June '96.
This inaccurate testimony not only battered DoD's credibility. It delayed scientific research into the health effects of exposure to low-level chemical warfare agents. Gulf War veterans may now have to wait five years longer for medical answers.
These Gulf War veterans are people. They're constituents, former constituents of yours. They're folks who served under your command, or have gone to VA when Secretary Brown was there. These are real people, who don't understand. And you've heard from them since this hearing has taken place yesterday.
So what DoD has done has not only hurt itself. It has hurt thousands of Americans who now must wait longer to get some answers.
In 1994, a report by the Senate Banking, Housing, and Urban Affairs Committee studied documents regarding Iraqi chemical and biological capabilities, anecdotal evidence from Gulf War veterans, combat operation logs, and other information, and made the case that Iraqi chemical warfare agents had been deployed in the KTO.
In 1997, an investigation by the Senate Veterans Affairs Committee found some great flaws in the way that the Department of Defense has conducted its investigation.
But the American Legion still believes that the controversy surrounding Gulf War illnesses has overshadowed sick veterans' day-to-day struggle to get well.
Over at the Department of Defense, a number of initiatives have occurred since the end of the Gulf War, most of them ending in failure.
In 1994, DoD created the Persian Gulf Investigative Team, and its mission was to investigate all reports of exposure that may have led to poor health in Gulf War veterans. This 12-member operation was then under the guidance or the supervision of the Office of Health Affairs within the Office of the Secretary of Defense.
But it was the United Nations, not the Persian Gulf Investigative Team, that would break open the Khamisyah story to the American public and to the world.
In May '96, in a repeat inspection of the Khamisyah ammunition bunker in Iraq, the U.N. Special Commission concluded that there were rockets that had been filed with nerve agent, and they had been destroyed by U.S. troops sometime after the Gulf War. The story is well known to you and to many people.
What is important, from the American Legion's perspective, is that it was not Federal agencies that made this announcement until they were confronted with evidence presented by the U.N., evidence that they had in their files somewhere in the Pentagon and down at Langley.
As you can imagine, the Presidential Advisory Committee found that the Persian Gulf Investigative Team investigation lacked vigor, had fallen short on investigative grounds, and stretched credibility.
It's important to note, however, that the Presidential Advisory Committee was impressed with CIA's concurrent efforts with the Persian Gulf investigative team. But both investigations, CIA's and DoD's, were failures. The PAC itself failed to find that these investigations both were going down the wrong trail.
In anticipation of the PAC's final report in January '97, DoD revamped its investigation of chemical warfare agents and Gulf War illnesses. Dr. Bernard Rostker was appointed as special assistant to the deputy secretary of defense for Gulf War illnesses in November of '96, and his investigative staff grew from the original 12 to over 120; and Dr. Rostker admitted that DoD's earlier efforts had been inadequate.
Dr. Rostker has approached his duties with energy, and his outreach efforts have far outdistanced those of the Department of Veterans Affairs, in our judgment.
Dr. Rostker, however, vigorously battled the Presidential Advisory Committee over seemingly minor issues of investigative methods, to the point of distraction. Those very public battles led directly to the creation of this board.
Some of his public comments regarding particular environmental exposures have downplayed their potential risk to human health, the most notable being depleted uranium.
Past failures of the Department of Defense may have made the creation of the Special Oversight Board likely. OSAGWI's fights with the PAC and some public statements may have made the Board's creation inevitable.
The American Legion, in conclusion, encourages the Special Oversight Board to certify the work produced by OSAGWI. The American Legion expects that the case narrative process will be analyzed by the Board.
We expect any disagreements between OSAGWI and the Board to be settled quickly and professionally. Gulf War veterans are tired of controversy, fingerpointing, and bureaucratic bumbling. They want health care, compensation, and answers.
OSAGWI can provide some answers. The Board must ensure that the answers are credible.
Mr. Chairman, that concludes my statement. I'll be happy to answer any questions of you or the Board.
SENATOR RUDMAN: Thank you very much, Mr. Puglisi. Doctor?
DR. CAM: This is for both gentlemen.
Last time, when I was at your conference in August, I heard a lot. The common concern I heard was that there is a great deal of resistance and insensitivity at the regional and local level when Gulf War vets go for help, although there is much better sensitivity at the headquarters level.
Would you care to give us specific examples and just share your views on that, give us recommendations on how to overcome that? v MR. PUGLISI: The regional and local level at the Department of Veterans Affairs or --
DR. CAM: Well, when veterans go and ask for help, like -- you know, they're not really welcome. And I heard there is one instance, the person said, "We don't believe in Gulf War illnesses," and things like that.
RADM STEINMAN: I think you mean at the local clinics?
DR. CAM: Yeah, probably local clinic or local facility. I heard a lot of that in that meeting. So if you would care to elaborate on that?
MR. SULLIVAN: May I, Dr. Cam?
DR. CAM: Yes.
MR. SULLIVAN: You're right. I would say, based on the calls that we get -- and again, the Resource Center tends to be a focal point for the most serious cases of Gulf War veterans.
So that said, the veterans who contact us generally state that they visited someone at Hospital X, without naming places, and the doctor knew nothing about Gulf War illnesses, didn't know what DU was, didn't know that the Pentagon had admitted that some soldiers may have been exposed to chemical warfare agents.
Specifically, I know of cases, and many of these are older cases, where veterans went in claiming illnesses, and they said, "I think I'm sick because I was exposed to chemicals," and that generated a consult to the psychiatric department, for the veteran.
In light of Pentagon admissions, now, that some folks were possibly exposed, that veteran is now getting better health care.
So at the local level, there seems to be a little bit of a disconnect. Because I know I've had the opportunity to meet in person, and the Resource Center now participates, because our office has been open here for seven months, at various VA Central Office meetings, including the Veterans Health Administration, the Veterans Benefits Administration, Readjustment and Counseling Services.
And those folks seem to get it. Some of them still need a little bit more information, but when compared to the local level, I would say the Central Office is doing much better learning about the issue.
And I would say the solution to that would be for the VA and DoD to have some Gulf War veterans conduct outreach, because what's more credible than having Gulf War veterans go and meet with VA folks and other Gulf War veterans to bring them up to date on the latest legislation, the latest exposures, and the latest research?
So I think the solution is some outreach by VA and DoD working with veterans' organizations.
DR. CAM: Thank you.
MR. PUGLISI: Could I follow up to that?
DR. CAM: Yes.
MR. PUGLISI: Paul hits the nail on the head when he talks about experience with Gulf War veterans, and you've spoken with them.
What I'd like to do is not defend the way those physicians react to the veterans, but point out that it's a problem in medicine, I think, and not just necessarily VA.
I have a cousin who is a physician, and I've spoken with him about some of the conditions that Gulf War veterans have. And the first thing he did was, he rolled his eyes. He said, "Oh, not one of those patients."
And we have a medical consultant at the American Legion who is an occupational specialist. And he's found in his own practice and in looking at the literature and talking with other physicians, that patients who don't have clear diagnoses, patients who have symptoms like chronic fatigue and headaches and joint and muscle pain are very difficult to treat, and many physicians don't receive very good training on how to treat them, and frankly, there aren't really good accepted treatment protocols for those patients.
So what Gulf War veterans are finding at VA is what active duty folks have found at military hospitals and Gulf War veterans have found with private physicians, and that is, they really just don't know what to do all the time.
So that experience that they have been having is true. Those anecdotes you're hearing are adding up to a lot of people who aren't seeking health care or aren't going to VA. And the problem is not only at VA, but it's the medical system.
I think that the legislation that Paul referred to in his testimony, which is going to have the National Academy of Sciences work with VA on coming up with treatments is going to be slow, but I think within the next two or three years, those physicians are going to be armed with better tools and resources to make these people feel better.
DR. CAM: Thank you.
MR. SULLIVAN: And if I could, Dr. Cam, my answer wasn't complete.
The VA Central Office is trying to correct the problem. I recently attended a meeting with them, where they have come out with a card that's about yay big -- about what, three, three-and-a-half by five -- that they're giving to physicians so that physicians know the type of questions to ask different veterans of different eras. And on the Gulf War segment of that card, it does prompt some questions for the doctors. That's good.
The VA also came out with a VA medical training guide. Now, while the idea of the guide was good, we found some mistakes with some of the information in there. But the idea of the guide was good, to get the latest information out to the doctors.
So they are trying at some places at the Central Office.
RADM STEINMAN: Let me ask a question of Dr. Kilpatrick. If a veteran came to you directly with a complaint that Medical Treatment Facility X, let's say on active duty, failed to follow through on a Gulf War veteran's illness, are you in a position to be able to feed that back down the chain to the MTF and get that situation corrected?
In other words, can a veteran your hotline, call your 800 number, and say, "This is what happened to me, and you guys can fix it"?
DR. KILPATRICK (not at microphone): -- down to the hospital level. But for those that have been seen in a VA hospital, my direct line is to Dr. Susan -- or Dr. Fran Murphy saying that "There is an issue here that is within your scope," and they take those for action.
So we are encouraging veterans in our outreach -- and understand the issue or doesn't communicate with them --
RADM STEINMAN: My understanding now is that all the MTFs -- I can just speak for the DoD -- all the MTFs should have in place a mechanism, a protocol for handling Gulf War veterans' complaints.
And so if this is still happening now, I'm concerned, and your organization should be a way to feed that information back if the veterans contact you first, so that mechanism gets down to the MTF, to make sure that veteran gets taken care of.
MR. PUGLISI: I think the challenge, and we have been getting the word out, but the challenge -- and it came up in the question and answer period for the prior panel -- is just the nature of the military.
It's a lot like a football team. And, if you tell the coach that you're not well, well, then, you don't start, and maybe you're not going to be on the team anymore.
So folks who are on active duty and who are sick have an awful decision to make. We encourage them to get help and get better, but they're all very aware, especially now, with the amount of time that has happened since the Gulf War.
These are senior enlisted or field grade senior officers. These are people who are at the home stretch of their careers, and they don't want to jeopardize them.
So they may not even get to the point where they're going to call up Dr. Kilpatrick or someone like that. And there is -- we have come across veterans, Gulf War veterans on active duty, who will not report to the military hospital, for those reasons.
RADM STEINMAN: And I've talked to some of them, as well.
MR. SULLIVAN: Admiral, the prior panel mentioned the press release distributed by OSAGWI regarding, "Folks, don't tough it out, come forward."
In that press release, that the Resource Center also distributed out electronically to Gulf War veteran groups and Gulf War veterans, there was one part that was a little bit chilling, and it was -- and I don't have it in front of me.
But I believe the number was 1,100 or 1,700 -- and I don't have it in front of me -- active duty folks who have gone to CCEP have actually been boarded out.
And that line in there, however you want to phrase it or twist it or spin it, sent the message that, well, there are people who are coming forward who are being kicked out if they report that they're ill.
So, now, the intention of Dr. Rostker's office I believe was probably genuine. But when you read the text and you see that, they go, "Oh, wow, there really are people getting booted out," then that sends a chill.
I think I'm making sense. Am I, Admiral?
RADM STEINMAN: Yes, you are.
MR. SULLIVAN: Okay.
RADM STEINMAN: And that's a serious concern. It sounds like an inartful way of perhaps describing a beneficial program that has the opposite effect, of scaring the veterans, rather than encouraging them to come forward seeking help.
LTG CISNEROS: I'm concerned again. You know, I've been here for a day-and-a-half, and we hear accusations and insults and generalities. And all of us want to get to the issue, trust me.
You know, if one soldier, and I'm not saying only one, but if one soldier says, "I'm afraid to go to the medical facility because they would kick me out," and you all interpret that to mean that it's an institutional problem, do you feel we have an institutional problem based on the number of people, or -- that's -- we got to get to the Army, I got to get to the Army leadership and say, "We do have a problem." I don't want to over-address it, but I keep hearing it over and over again, but no empirical data.
I mean, we got 500,000 soldiers. And if you take two people that go and say something, and you're trying to make a case out of it, that's not valid. It's not right, either. That's the point I'm making.
But if it's right, then we need to correct it. And I want to assure you that the leadership, in my view, at least those that I know, would not want that perception to exist in the active Army.
I mean, those of us who have to deal with men realize the confidence that must exist between us and our men, and that's a threat to our national defense aspects if that is, in fact, the reality.
I want to tell you, I did not see that. And I'm not saying it's not valid. I want to check it. But I just can't accept that we have men coming and telling us this. Well, how many, out of how many?
MR. PUGLISI: General, I served on active duty from '89 to '93, and I've been in the Marine Reserves since, and was a commander of an artillery battery for a couple of years.
LTG CISNEROS: Good for you. Not all are privileged to be artillery men.
MR. PUGLISI: That's right. Absolutely. We have another red leg here in the crowd, too, sir.
And there were Gulf War veterans in my unit, not many, but there were some. And before I took command there was one who I was responsible for, who came to me, knowing what I did in the civilian world, my real job, and asked me what he should do.
He wasn't feeling well. He was a Reservist. He was an active duty at the time he was in the Gulf. And my advice to him was to go to VA and to seek care there.
I wasn't confident that -- and it went something like this. Nobody -- nobody within the chain of command or the Department of the Navy or DoD had said, "Okay, any Gulf War veteran who comes forward sick, kick him out."
But the fact of the matter is, if this individual had something that would preclude him from performing his duties, at some point down the road, the Department of Defense would have to separate this individual, unless he could get better.
As it turns out, he went to VA and got some treatment, got better, and continued --
LTG CISNEROS: Do you disagree with the policy that if you cannot perform a duty, you cannot, should not be put in to perform that duty? I mean, it's like saying if, you know, you lose a leg, you're going to need a crutch. Of course you are.
MR. PUGLISI: Right. And that's the dilemma that these individuals face. If they come forward, then they put their careers in jeopardy. If they don't come forward, then they're never going to get the kind of care that they rate.
LTG CISNEROS: But it's like saying somebody comes forward -- excuse me, Senator.
SENATOR RUDMAN: That's all right.
LTG CISNEROS: It's like somebody coming forward and saying, "I have cancer," and you diagnose he has cancer, and say, "I'm sorry, you can't be an infantryman anymore, because you have cancer." Is that wrong?
MR. PUGLISI: No, but --
LTG CISNEROS: You're saying they're careers are threatened because they're removed from that active duty.
MR. PUGLISI: Right. I think the losing the limb analogy was even better. If someone comes forward and says, "I've lost my legs," "Sorry, you can't be a grunt; you know, we're going to have to give you a backpack, you have to get from Point A to Point B, so you cannot do it."
So again, I don't think -- I don't want to speak for Paul. I'm not -- the American Legion isn't criticizing the military for separating people who aren't able to perform their duty.
However, there are Gulf War veterans on active duty who may very well get better, if they came forward, and they got treatment. But I have met them, and many of you probably have as well.
They will not come forward in the first place and seek care within the military health system, because they're afraid if they do not get better, if they go through that process and the outcome is that they're disabled, and they can't accomplish or perform their duties, then they're going to be separated.
Does that make sense, General? I'm --
LTG CISNEROS: It's just that my experience has been the opposite in the military. You can go there and tell them, "I have terminal cancer, I have this, this," and they say, "Here's an aspirin, go back to being an infantryman." It's completely opposite of what you're saying, that if I go and say that, they're going to take me out.
Usually, I've found it's the other way. It's get them to -- they usually say "You're fit, you're good to go. Go. Go. Go." I mean, that's been always my experience.
And now, the argument that it's the opposite, I just did not see that, in my experience.
SECRETARY BROWN: Let me just make one observation. I agree with the presenters. This is not a new problem, though. This problem has been around for a long time.
I think at one time DoD had a moratorium on discharging individuals until they had a chance to take a look at it. I think it has not been resolved.
We're not necessarily talking about catastrophic disabilities where an individual might lose an arm or lose a leg or something from cancer.
We're talking about people who are suffering from joint pain and headaches that really interfere with their ability, but it has not been determined that the conditions are so severe that they are not able to continue to perform the duties of their rank but, by coming forward, they have put themselves in jeopardy.
Let's say an individual may have, say 17 or 18 years in. He's taking a chance on getting kicked out with severance pay. And If he can just hold on for another two years, then he gets his 20-year retirement. That's a big decision.
And so a lot of people, rather than coming forward to get medical attention, they kind of avoid it until they get through that process, so they can protect their vested interest.
So we do need to look at it, as was pointed out, because I think that it has an impact. And even though this problem has been known for a number of years, I do not think that it has been satisfactorily resolved.
MR. SULLIVAN: General, if I may, there has been a study conducted by the Department of Defense National Guard Inspector General between '93 and '94, and I believe the gentleman that was in charge of it was a Major Bookmark or Bookman, if you need to track that down.
But what the National Guard Bureau Inspector General's Office found is that there were many Gulf War veterans who said that they were ill, who were, in the eyes of the IG report, improperly and prematurely discharged.
So there is some evidence to support the contention of what the American Legion and the Resource Center are saying.
LTG CISNEROS: discharged from the National Guard?
MR. SULLIVAN: Yes, sir.
LTG CISNEROS: Because I'm sure the National Guard
IG does not go and investigate the active Army. MR. SULLIVAN: Well, they did --
LTG CISNEROS: I don't know how they can be discharged, because the National Guard is not active duty full-time service.
MR. SULLIVAN: Well, sir, I do believe that, during the Gulf War, a considerable number of them were called up, and then they -- from National Guard status to active duty status, and then went back to National Guard status.
And I'm not going to pretend to be an expert on who's in charge of what, but that's how the National Guard Bureau got involved.
SENATOR RUDMAN: Anyone else?
SENATOR RUDMAN: Thank you very much. Appreciate your being here today.
Before we close this hearing, members of the Board felt that it was important that, in public, we lay out our investigative oversight procedure that this Board has adopted.
It is not available in any published form, and so we thought it would be good to have it in the record of this hearing. It will take me probably five or six minutes to go through it, and then I will ask for any comments or amplification by any members of the Special Oversight Board that wish, and after that, we will adjourn.
As you all know, who have followed this situation, this Special Oversight Board was created to provide the President, through the Secretary of Defense, advice and recommendation based on oversight of the remaining investigations being conducted by DoD into the possible detection of and exposure to chemical or biological warfare agents and environmental factors that may have contributed to Gulf War illness.
And, two, evaluation of DoD's plan for and progress toward or disagreement with the implementation of the Presidential Advisory Committee recommendations contained in its special report submitted to the President on October 31, 1997.
Now, this is a very public event. But most of our work will hardly be public, because it will be of an oversight nature.
So we thought it would be good for all interested parties to (a), know how we intend to go about it, and (b), to extend an invitation to anyone who is an interested party to contact us if you have any questions about what we are currently doing.
First, let me talk about general oversight. And it's interesting, Mr. Puglisi. This almost follows out of your closing remarks about what you thought we ought to do.
So either you have a crystal ball, we have a terrible leak --
SENATOR RUDMAN: -- or, more likely, you're just very smart.
SECRETARY BROWN: He's a Marine. He's a Marine.
SENATOR RUDMAN: is that it?
SECRETARY BROWN: Yeah.
SENATOR RUDMAN: There's always one on the panel.
SENATOR RUDMAN: Under general oversight, we are going to receive monthly updates from DoD about activities of OSAGWI's analysis groups and teams, case investigations, and information papers.
We're going to receive bimonthly updates from the Persian Gulf Veterans Coordinating Board about ongoing research efforts. We'll receive bimonthly updates from the Joint Staff on related issues.
We will prepare the Board for bimonthly meetings with DoD and other Government officials about oversight issues, and prepare the Board for regional sessions, the number of which is yet to be determined.
Secondly, on case narratives, we are going to and now we are already in the process of analyzing existing case narratives to determine if they reflect complete and accurate reporting of incidents, meet with DoD representatives to discuss issues of concern, make recommendations to Board members about case narratives that need to be finalized, and ensure that issues requiring followup action are timely and properly implemented.
Under current case investigations and information papers, we are going to continue to monitor efforts of the Office of the Special Assistant for Gulf War Illnesses in compiling information pertaining to current case investigations and information papers. We will analyze newly reported case narratives and information papers as they are published.
The criteria we will use include the following: Ensuring that the findings are responsive to the objective, and they are supported by evidence;
Ensuring that conclusions are clearly stated, logically formed from evidence in the findings and are based on evidence;
Rooting out inconsistencies between new and previously published products;
Ensuring that the methodology for determining likelihood of exposure is consistently applied;
Determining if products are thoroughly peer reviewed;
And determine whether lessons learned from the case narrative have been implemented.
We will report all those findings to the full Board on a regular basis.
On research, we will meet with all of the people from the various Government organizations and agencies on a regular basis to receive updates on the status of ongoing research.
Although we have a specific ban in our charter from conducting scientific research, I do not read that to mean that we cannot have very strict oversight over scientific research and we intend to do that.
We will evaluate how DoD is incorporating results from research into case narratives, information papers, and we will report findings and recommendations and so forth to the Board.
Incidentally, the Board, in small teams of two, sometimes one, will be making various trips to various places, carrying out various initiatives that the leadership of the Special Oversight Board believes are essential or, in some cases, in which members of the Board themselves, having read a great deal of information, wish to follow up.
We've already had what, two or three of those trips? One trip out of the area, a number of visits in the area. And we do that because getting the entire Board together at all times is just not necessarily the most efficient use of everyone's time, and so we set up in separate task forces to do that.
Let us talk about outreach. We will monitor and analyze OSAGWI's outreach efforts. We will plan regional meetings designed to elicit from veterans their organizations, their concerns about DoD's investigations of possible chemical and biological incidents and other factors that may have contributed to Gulf War illnesses.
We will meet with members of veterans and military service organizations on a regular basis to determine their concerns. And this, thus, is an open invitation to any veterans service organization, or any veteran, to contact our staff at any time about any of those concerns.
We will evaluate the integration of the PAC special report of October 31, 1997 recommendations into the OSAGWI investigations.
Finally, we will issue an interim report by June 1999, according to our mandate, based on our analysis and evaluation. We will publish, at that time or sooner, any recommendations or advice that we give to any Government agencies to ensure that there is an adequate record of what we have believed and what we have done.
By March 2000, we will issue a final report, as charged in our charter. We are not only looking at the past, but as many of you have mentioned in your testimony and your concerns, we are looking to the future, to ensure that U.S. forces, when deployed, can have, in some cases, better protection, better tracking than they have in the past.
That is our plan. Every member of this Board is committed to this, and I hope that we can continue to have all of your cooperation.
Members of the panel?
SENATOR RUDMAN: Now, under the Presidential Advisory Commission Act, although I have chaired literally hundreds of hearings, I am deemed incompetent to either open or close this one.
Under that Act, passed by Congress -- I probably voted for it, not knowing what was in it -- there's a requirement that a Federal officer from, in this case, the White House, since this is a Presidential Commission, open and close our hearings.
And so for that splendid task, I turn to Jon Jennings.
MR. JENNINGS: Thank you, Senator. I wish you were doing that, instead of me.
On behalf of the President of the United States, I would like to thank, again, this distinguished Board for their leadership on behalf of our veterans.
There is no higher calling in service to our country than to be a member of our armed forces. Your work over the past two days has given many people an opportunity to voice their concerns and beliefs, and the American people thank you for your commitment.
The President would also like to thank all of the individuals and organizations that have appeared before this Oversight Board.
We began this hearing yesterday with the appearance of five veterans, five heroes. Your country thanks you for your service and your courage.
As the designated Federal officer, it is now my responsibility to declare this special oversight hearing adjourned.
SENATOR RUDMAN: Thank you, Jon. Thank you all.
(Whereupon, at 2:35 p.m, the special oversight hearing was adjourned.)
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